Vocal Physicians Group Renews Health Law Fight
Barry Meier
New York Times
Published: January 18, 2011
The Association of American Physicians and Surgeons is pursuing the repeal of the health care law, but some medical groups say the association, with 3,000 dues-paying members, doesn't represent most of the nation's physicians.
A small professional group of doctors involved in the effort to repeal the new health care law has a history of opposing government involvement in medicine, including challenging President Bill Clinton's attempts to overhaul health care in the 1990s.
The group, the Association of American Physicians and Surgeons, has exerted vocal influence in the country's health care debate, despite having just 3,000 dues-paying members. Other medical groups assert that the association's positions are unrepresentative of most of the nation's 800,000 physicians and that its scientific views often fall outside medicine's mainstream.
As Republicans in the House of Representatives move forward Wednesday with an expected repeal vote, the group's executive director, Dr. Jane M. Orient, said it would start an effort to rally public support for the repeal, which faces stiff opposition in the Senate. Dr. Orient said that several congressmen who are members of the association, including Representatives Tom Price and Paul Broun, both of Georgia, and Ron Paul of Texas, are expected to be involved in the effort, which is expected to include a rally in Southern California with members of the Tea Party.
"We are going to tell Congress to repeal this monster because it really can't be fixed," said Dr. Orient, an internist in Tucson, where the association is based.
The group has been opposed to President Obama's health care efforts since the beginning. Last year, it filed a lawsuit asking a federal judge to declare the new law unconstitutional; it is still pending. This fall, yet another physician member of the group, Dr. Rand Paul, an ophthalmologist and son of Representative Ron Paul, made opposition to the health care law central to his successful Senate bid in Kentucky.
A spokesman for Senator Paul said he was unavailable for an interview. In an e-mail, a spokesman, Gary Paul, said that Dr. Paul supported the groups' stance against "government-run health care."
There is no question that doctors differ in their view toward the new health care law, and some groups opposed its passage. Still, most of the nation's professional medical organizations, including the American Medical Association, the country's biggest, have supported it, saying that fundamental changes to the nation's health care system are needed.
The heads of several medical groups supporting the health care overhaul, moreover, said they believed that the positions of the Association of American Physicians and Surgeons ignored the realities of medicine and patient needs.
"I respect their philosophical consistency," said Dr. Ronald Goertz, the president of the American Academy of Family Physicians, which counts about 63,000 practicing doctors among its members. "But with half of all Americans receiving some sort of assistance to help them get care, I think there is a responsibility to make sure that care is of the highest quality."
Founded in 1943, the Association of American Physicians and Surgeons opposed the creation of Medicaid and Medicare. A decade ago, it was among groups that unsuccessfully urged the United States Supreme Court to release post-mortem photographs of a former Clinton administration official, Vincent Foster. In its brief, the group argued that an independent inquiry was necessary to confirm that Mr. Foster, whose death was attributed to suicide, was not murdered.
A big moment for the organization came in the 1990s when it filed a lawsuit that helped force the Clinton administration to disclose the workings of an internal panel that drafted its health care reform proposal.
"Our organization was formed to fight socialized medicine and to fight the government takeover of medicine," Dr. Orient said.
The association has promoted some scientific views that other medical experts have characterized as curious.
Its internal periodical has published studies arguing that abortion increases breast cancer risks, a tie rejected by an expert panel of the National Cancer Institute, as well as reports linking child vaccinations to autism, a discredited theory. Another report, "Illegal Aliens and American Medicine," contended that illegal immigrants not only brought disease into this country but benefited if their babies were born with disabilities.
"Anchor babies are valuable," that 2005 report stated, using a negative term for children born in America to illegal immigrants. "A disabled anchor baby is more valuable than a healthy one."
The publication's longtime editor, Dr. Lawrence R. Huntoon, said its articles were "peer-reviewed" or checked for accuracy by experts, a standard that is used by major medical publications. When asked, he said he could not say that what percentage of those reviewers were members of his own organization.
The National Library of Medicine, a part of the National Institutes of Health, declined requests by the group in 2004 and again in 2008 to index its journal's articles in the national database of medical reports that the library operates.
Dr. Orient said the library did not index the publication's reports because the content was adequately covered elsewhere. However, the library's associate director for operations, Sheldon Kotzin, said that was only one of the reasons that a review panel turned down the group's request. Mr. Kotzin, citing library policy, declined to identify the other reasons.
Within the courtroom, the Association of American Physicians and Surgeons has taken a stance on a variety of issues related to health care or the practice of medicine. For one, it has argued for a ban on late-term abortion and also challenged the oversight procedures of state boards that license doctors, contending that such boards abuse their power to railroad doctors out of practice. The organization has also supported physicians accused of illegally prescribing narcotics, arguing that prosecutors are imposing their views of what constitutes adequate pain treatment. The group holds that health care is not a "right" but a professional service and that doctors should treat patients based on their medical judgment, a role in which government should not interfere.
Dr. Orient added that her group favored a "free market" approach to medicine and that some members did not accept payment from government programs or private insurers. The group says it believes that such third-party payers are at the root of many problems in medicine because they interfere with the doctor-patient relationship and drive up costs.
The president of another doctors' group, Dr. Valerie Arkoosh of the National Physicians Alliance, said the suggestion that medicine was better before government involvement was a myth.
"We have had a market-based system in this country for many years and I don't see that it has been a very successful strategy," said Dr. Arkoosh, who is an anesthesiologist in Philadelphia.
During the run-up to the health care law, Dr. David McKalip, a Florida neurosurgeon who is a member of the group, became the subject of controversy when it was publicly reported that he had forwarded an e-mail to Tea Party members that showed President Obama dressed as an African witch doctor with a bone through his nose. The physician subsequently apologized for doing so.
In a telephone interview, Dr. McKalip said he remained strongly opposed to the health care law, arguing that it would, among other things, provide financial incentives to doctors to take steps that would harm patients. He also said that President Obama had repeatedly been disrespectful of doctors by saying they profited by carrying out unnecessary procedures.
"Unlike President Obama, I apologized for those offensive images," Dr. McKalip said, referring to the witch doctor e-mail. "The president never apologized for implying that doctors performed tonsillectomies and amputations for money."
