Tobacco Firms, AMA Once Friends : Parting of Ways Not Without Its Embarrassing Moments

Imagine a tobacco company setting up shop at a convention of doctors to extol the virtues of its cigarettes. Today, it might outrage. Decades ago, it did not.

There were no surgeon general’s annual smoking reports. No dire warning labels on cigarette packs. No Great American Smoke-Outs.

In 1942, Camel cigarettes invited doctors at the American Medical Assn.’s convention to “see for the first time the dramatic visualization of nicotine absorption from cigarette smoke in the human respiratory tract.”

In fact, Camel ads once boasted they were the brand doctors smoked most.

Convention Chums

In 1940, Philip Morris invited doctors to drop by its cigarette booth at a New York medical convention. Fourteen years later, Viceroy thanked 65,000 doctors who visited its exhibits at medical conventions.

The AMA and its 260,000 members have since parted company with America’s tobacco producers. While 60% of physicians smoked in the late 1940s, today only 15% of doctors light up.

The AMA says it has a long record of opposing tobacco. The first issue of the Journal of the American Medical Assn., in 1883, carried a report on the “pernicious” effects of smoking on children.

And, in its boldest move against the health hazards of smoking, the association’s policy-making House of Delegates in December called for a ban on all cigarette advertising and promotion and a tobacco-free society by the turn of the century.

But the parting of the AMA and the tobacco industry has not been without embarrassing moments, and some critics call the AMA’s commitment to ending smoking half-hearted.

“It seems to me they have been foot-dragging on tobacco for 25 to 30 years,” said Dr. Elizabeth Whelan, director of the American Council on Science and Health. “They have not given it the priority it deserves.”

“For much of the last 17 years, they have . . . politely patted people on the head who were trying to raise the issue,” said Dr. Alan Blum, editor of the New York State Journal of Medicine and founder of Doctors Ought to Care, a health promotion group.

To assert now they are leaders “is a bitter irony that sticks in my craw,” added Blum, an AMA member whose journal has chronicled smoking advertising campaigns and the AMA’s record on the issue.

Critics’ Evidence

AMA critics cite evidence to support their contention that the nation’s largest organization of doctors has not been sufficiently aggressive in confronting one of the nation’s top public health questions:

--AMA President Harrison Rogers, who owned a part-interest in Georgia farmland, said he sold his interest this year. He said he had only seen the land once and was not aware that tobacco was grown on a small section of it.

--The AMA held tobacco stock as late as 1981. It sold its $1.4 million in stock, part of a $113-million pension fund in AMA members retirement plan, after the House of Delegates initially rejected a motion to divest.

--It was not until 1972, eight years after a landmark surgeon general’s report on the hazards of smoking, that smoking was discouraged at House of Delegate meetings. Cigarette machines were removed from the AMA’s headquarters in Chicago last year.

--The AMA initially told the Federal Trade Commission warning labels on cigarette packs would not do any good. It has since changed its stand and recommended that warnings be made even more explicit.

Today, smoking is blamed for 350,000 deaths each year. It is the leading cause of preventable death in America.

As much as 30% of all coronary heart disease deaths and 30% of all cancer deaths are linked to smoking, according to the federal Office on Smoking and Health.

Worse Than Toxics

The 17th annual Surgeon General’s report on smoking and health, released in December, said cigarette smoking causes more death and disability among American workers than exposure to hazardous substances in the workplace.

Some contend that real leaders in the anti-smoking movement have been groups like the American Heart Assn., the American Cancer Society and the American Lung Assn.

But, unlike those associations, the AMA has a broad agenda concerned with doctors’ fees, malpractice, research and accreditation of medical schools.

The AMA is a scientific, professional and “democratic organization,” said Dr. M. Roy Schwarz, AMA assistant executive vice president for medical education and science. “It takes a while for a consensus to emerge. . . . Often, we pay a price for it.”

Today, the AMA “probably has the most aggressive anti-smoking policies of any health organization,” Schwarz declared. AMA officials point to:

--A 32-year ban on advertising of tobacco in AMA publications.

--Congressional testimony opposing federal subsidies for tobacco growers and support of a 32-cent cigarette tax.

--A House of Delegates statement in 1964 recognizing “a significant relationship” between cigarette smoking and lung cancer and other diseases and a recognition that smoking is “a serious health hazard.”

--Calls for no-smoking sections on airlines and health education programs.

--JAMA and AMA specialty journals have published more than 600 references on the subject since the late 1950s. Each of the last two years, entire issues have been devoted to the subject.

In the mid-1960s, an AMA committee was authorized to seek funds for smoking research. Over 10 years, six major tobacco companies donated $15 million, which was distributed to hundreds of researchers, said Dr. Ron Davis, sole resident trustee on the AMA board.

Committee’s Conclusion

The committee in 1978 summarized the research in a 365-page report, “Tobacco and Health.” One major conclusion: “cigarette smoking plays an important role” in the development of chronic lung disease.

Both critics and AMA officials agree that a new anti-smoking push has emerged within the association in recent years, largely due to an infusion of young non-smokers.

Davis noted that many of the newer anti-smoking proposals presented at association meetings came from students and residents.

Blum says a ban is not enough: Counter-advertising is necessary. And, for now, he is reserving judgment.

“If the AMA is willing at long last to call a spade a spade and point the finger where it belongs,” he said, “then this movement will have some momentum.”