AMA: Why Does It Favor Pro-Tobacco Congressmen?
A study in this month's American Journal of Public Health examines why the American Medical Association, the "eighth largest political action committee in the United States," which has donated over $4.1 million in the 1996 election, consistently favors pro-tobacco legislators over anti-tobacco legislators despite its high-profile anti-tobacco campaign. The study was spurred by findings that in the 1990 and 1992 congressional elections, "the AMA's political action committee significantly favored supporters of tobacco export promotion over opponents by about $1,700 on average," a statistic seemingly inconsistent with the organization's public health mission. The AMA leadership defended its expenditures, saying its PAC existed not simply in the interest of public health, but to support "the practice concerns of physicians." However, since the 1990 and 1992 campaigns, the AMA has "called for politicians not to accept money from the tobacco industry, for investors to divest from tobacco stocks and for Congress to strengthen the control of the Food and Drug Administration over tobacco products in the proposed tobacco settlement." In reaction to these events, Dr. Joshua Sharfstein set out to examine the data from the 1995-96 election cycle -- a period when tobacco control became a much more significant policy issue -- to see if the trends did in fact hold.
Sharfstein classified candidates' position on tobacco with respect to their "position on efforts by the FDA to reduce teenagers' use of tobacco products in 1995-96." Pro-tobacco representatives were defined as such "if they signed a December 15, 1995, letter 'strenuously object[ing] to the FDA's effort to expand its jurisdiction and the federal bureaucracy' by regulating nicotine." Anti-tobacco candidates were identified by their signing of a commitment "to oppose efforts to enact legislation that would weaken or delay the president's proposal to decrease tobacco use by children." Overall, Sharfstein labeled 122 members as "pro-tobacco" and 112 as "anti-tobacco." Candidates who did not sign either statement, or who signed both statements, were not considered in the inquiry. Donation data was obtained by the Center For Responsive Politics (www.crp.org), which supplied information about the AMA, the tobacco industry, health businesses, public health groups and health services firms. Sharfstein found that the AMA contributed an average of $5,382 per pro-tobacco representative, while only giving $2,103 per anti-tobacco member. Sharfstein noted, "This marked preference was surpassed only by the tobacco industry itself."
Why The Discrepancy?
Sharfstein dismisses several factors that may account for the trend, such as influential membership on a health care committee, party affiliation, a larger campaign budget or an AMA member hailing from a tobacco-growing state. Thus, he is left with only one conclusion: "[T]he behavior of the AMA's committee is most likely explained by the priorities of the AMA." He notes that "votes on malpractice reform are a significant predictor of AMA contributions." Legislators who voted twice for a bill that would have capped noneconomic rewards in malpractice cases received an average of $6,885 from the AMA, those who did so once got $3,647 on average, while those who voted against the measure both times only received $553. According to Sharfstein, "the campaign to limit malpractice awards can fully explain why the AMA significantly favors pro-tobacco candidates," as those candidates who support malpractice reform tended to be pro-tobacco. While the AMA's efforts to cap malpractice damages failed, Sharfstein questions how the AMA's contributions will affect tobacco legislation in this Congress. He concludes: "If the donations are as influential as the AMA informs its members, then the millions of dollars spent by U.S. doctors in the 1995-96 congressional elections may represent lost opportunities in the fight against tobacco use" (Sharfstein, AJPH, 8/98 issue).