Dec 2018

Naming and the Public Health Roles of Physicians

Kelsey Walsh, MA
AMA J Ethics. 2018;20(12):E1201-1211. doi: 10.1001/amajethics.2018.1201.

Abstract

Resources from the American Medical Association (AMA) Archives facilitate historical consideration of how physicians’ authority has been exercised in naming diseases, epidemics, and other health-related issues of national importance. Selected images emphasize physicians’ roles in motivating public health initiatives through public service posters, advertisements, and minutes of the AMA House of Delegates meetings.

 

Figure 1. Centennial Meeting

Figure 1 mhst2-1812

Courtesy of the American Medical Association Archives.1

American Medical Association (AMA) president Harrison H. Shoulders, MD addressed the assembled membership at the Centennial Annual Meeting in 1947:

The problems which face medical practitioners today are different in character from those which our predecessors encountered. Yet the fundamental principles they used still apply. It is important for us to remember that environments, technics [sic] and tools may change but that fundamental principles do not change. They are eternal.2

Fundamental principles include maintaining focus on patients, public health, and the art and science of medicine.3 Throughout the history of the profession, physicians have recognized the inexact nature of medicine and ways in which social and cultural trends can influence clinical and public health practice. The AMA Archives offers an abundance of resolutions presented to the House of Delegates that expressed the need for the profession of medicine to respond to social, cultural, and technological changes.

 

Figure 2. Sometimes Alcohol Takes Over

Figure 2 mhst2-1812

Courtesy of the American Medical Association Archives.4

This AMA public service poster, published in the 1970s, reframes the idea of alcoholism. Naming addiction—specifically alcoholism—as a disease enables recognition of alcoholism as an illness and facilitates development of resources to help physicians respond to affected patients and populations. At several points in AMA history, medically treating alcohol addiction has been reaffirmed as a way to help affected individuals, families, and their communities. The AMA also urged Congress to increase funding for alcoholism treatment and for clinical research into better understanding of physical, social, and cultural causes of alcoholism. Although the AMA passed a resolution urging equality in hospital admissions for patients with alcoholism in 1956,5 it had to urge Congress to fund treatment programs as late as the 1990s. This funding lag suggests how deeply entrenched was the notion of drinking as a moral failing. In naming alcoholism as an illness worthy of treatment, physicians have helped change public perceptions of alcoholism, which has generated not only economic structures of reimbursement for treatment but also social, cultural, and moral empathy for individuals, families, and communities who suffer alcohol-related harms.

 

Figure 3. Heroin PSA

Figure 3 mhst2-1812

Courtesy of the American Medical Association Archives.6

This poster—produced by the AMA in the 1970s—identifies death as a potential consequence of drug use. This image conveys the AMA’s message that responding to addiction is within medicine’s purview. At a time when the War on Drugs had gained momentum and harsh policies prioritized punishment over treatment, the AMA publicly emphasized addiction as an illness and treatment as a job of medicine. The AMA urged health professionals and the government to become more informed about drug dependency and to create responsive policy. In the cultural and political environment of the 1980s, physicians used their training and education to serve the public by facilitating a shift in focus from criminalizing “addicts” to treating patients suffering from the illness of addiction. Indeed, the AMA increased its outreach to remind the public of treatment options in response to the predominantly punitive government and police responses to illicit drug use.7

 

Figure 4. HIV Blood Test Counseling: AMA Physician Guidelines

Figure 4 mhst2-1812

Courtesy of the American Medical Association Archives.8

This 1988 booklet is one of several HIV- or AIDS-focused publications attempting to bridge gaps between a public without much knowledge about a sensitive topic and clinicians charged with talking to patients about a newly prevalent disease with no known cure. In naming the AIDS crisis of the 1980s an epidemic and a public health issue, the AMA advocated for nondiscrimination in workplaces, schools, and hospitals; public education; and more research. The AMA worked to help prepare physicians by offering conferences and training on how to care for patients with HIV or AIDS, the importance of confidentiality, and the critical public health role of testing. Developing policies and guidelines for HIV-infected health care personnel, confidential testing, maternal screening, contact tracing, and partner notification were also AMA priorities during this time. The AMA fought stigma against HIV, AIDS, and AIDS-related illnesses by educating the public on facts about virus transmission. The AMA also modeled expressions of empathy for those suffering from HIV, AIDS, and AIDS-related illnesses.

 

Figure 5. Where’s Your Seatbelt?

Figure5 mhst2-1812

Courtesy of the American Medical Association Archives.9

Posters like this one produced in the 1960s took aim at diseases and injuries resulting from a person’s choices rather than by chance. In 1954, the AMA passed a resolution recommending that all manufacturers equip automobiles with seatbelts and emphasize safety in their design. This commitment to car safety increased through the years, and, by 1977, AMA policy asserted that seatbelt use was an important expression of preventative medicine. Noting that injuries were the most frequent cause of death among Americans aged 1 to 44 and that motor vehicle accidents (MVA) were involved in half of all deaths due to injury, the AMA encouraged physicians to assume leadership roles in MVA-related injury prevention. This effort resulted in a public campaign on behalf of the AMA and America’s physicians to re-emphasize the need for all vehicle occupants to use seatbelts. By naming preventable motor vehicle injuries as a public health issue, the AMA extended the influence and social power of physicians from clinical encounters to public health.

 

Figure 6. The Best Time to Stop Smoking

Figure 6 mhst2-1812

Courtesy of the American Medical Association Archives.10

This public service poster was one of many the AMA produced in the 1970s targeting lifestyle choices that adversely affect public health. The AMA officially took a stand against cigarette smoking as early as 1964, encouraging physicians to lead by personal example and to advise patients about the health hazards of smoking. In 1972, the AMA launched a campaign to ban cigarette advertising from all public media, which marked the beginning of a major social, cultural, and political push to reduce—with the goal of eliminating—tobacco’s place in public life. Previous AMA efforts to combat tobacco use focused specifically on the harms of tobacco use from a clinical standpoint. Naming a “best time to stop smoking” was one strategy for focusing on tobacco advertising, especially advertising that might appeal to children. This strategy broadened the AMA’s approach to tobacco-related health risk from a clinical to a public health point of view.

 

Figure 7. If America Dies, Where Will We Bury It?

Figure 7 mhst2-1812

Courtesy of the American Medical Association Archives.11

The AMA’s Committee on Environmental Health focused on issues related to public health and environmental conditions, reviewing scientific evidence on topics such as climate change, pollution, fossil fuel combustion, and deforestation. This advertisement from the 1970s displays one of the AMA’s messages to the public and names environmental health as public health, stating, “A sick environment can make people sick. It can undo everything a doctor works for.” The AMA produced a free booklet discussing interactions between the environment and health. At the time, the AMA estimated that $38 billion was spent on environment-related health costs. According to the AMA, preserving a clean environment was a key preventative medicine strategy for curtailing the predicted skyrocketing costs of health care. AMA policy continues to support ongoing efforts to address environmental pollution and its corresponding health hazards.12

 

Figure 8. Are You a Candidate for Creeping Obesity?

Figure 8 mhst2-1812

Courtesy of the American Medical Association Archives.13

Communicable diseases were supplanted as the leading causes of death in the United States in the 1970s, when accidents, heart disease, cancer, cirrhosis of the liver, and other conditions due to lifestyle and environmental conditions became more prominent causes of death.14 Advertisements like this one illustrate physicians’ frustrations navigating a shifting health care environment. The AMA saw a lack of ingenuity in public health education and forcefully stepped into this role by publishing public service announcements and advertisements naming preventative care’s importance in medicine and illuminating obesity as one kind of health condition that is both environmentally influenced and a product of individual choice. A symposium titled “Obesity: The Cause and Management” was presented at the AMA’s 1974 Clinical Convention. The Department of Foods and Nutrition—then an arm of the AMA’s Scientific Activities Division—planned this symposium, which took place alongside presentations on alcohol toxicity and total parenteral nutrition within hospital settings.

 

Figure 9. Take Your Sun Time in Small Doses

Figure 9 mhst2-1812

Courtesy of the American Medical Association Archives.15

This public service poster from the 1960s is one product of the AMA Committee on Cosmetics’ charge to educate physicians and the public about the sun’s potential harm to skin. In 1961, the Committee displayed exhibits titled “Sunlight and the Skin” and “The Aging Skin” during AMA meetings and distributed comprehensive pamphlets on these topics. By naming “excessive exposure” of skin to sunlight as a health risk, the AMA illuminated the importance of prevention as a feature of public health. The AMA supports educating physicians and their patients about health risks of ultraviolet light from the sun and from commercial tanning.16

References

  1. American Medical Association. Centennial Meeting. 1947. Photograph Collection; Oversize Box 5, Series 1 (1506). Chicago, IL: American Medical Association Archives.
  2. American Medical Association. House of Delegates proceedings, annual session. Chicago, IL: American Medical Association; June 1947. http://ama.nmtvault.com/jsp/viewer.jsp?doc_id=ama_arch%2FHOD00001%2F00000041&page_name=23. Accessed September 19, 2018.

  3. American Medical Association. AMA Principles of Medical Ethics. Code of Medical Ethics. https://www.ama-assn.org/delivering-care/ama-principles-medical-ethics. Accessed September 12, 2018.

  4. American Medical Association. Sometimes alcohol takes over [poster]. 1960s. Photograph Collection; Oversize Box 6, Series 1 (1760). Chicago, IL: American Medical Association Archives.

  5. Mann K, Hermann D, Heinz A. One hundred years of alcoholism: the twentieth century. Alcohol Alcoholism. 2000;35(1):10-15.
  6. American Medical Association. Heroin PSA [poster]. 1970s. Photograph Collection; Oversize Box 6, Series 1 (1760). Chicago, IL: American Medical Association Archives.

  7. American Medical Association. House of Delegate proceedings, annual session. Chicago, IL: American Medical Association; November 1956. http://ama.nmtvault.com/jsp/viewer.jsp?doc_id=ama_arch%2FHOD00001%2F00000061&page_name=34. Accessed 24 July 2018.

  8. American Medical Association. HIV blood test counseling: AMA physician guidelines. Pre-1994. Council on Science and Public Health Collection; Box 23-6, Folder 9850. Chicago, IL: American Medical Association Archives.

  9. American Medical Association. Where’s your seat-belt [poster]? 1960s. Photograph Collection; Oversize Box 6, Series 1 (1760). Chicago, IL: American Medical Association Archives.

  10. American Medical Association. Best time to stop smoking is before you start [poster]. 1970s. Photograph Collection; Oversize Box 6, Series 1 (1760). Chicago, IL: American Medical Association Archives.

  11. American Medical Association. If America dies, where will we bury it [poster]? 1970s. Photograph Collection; Oversize Box 6, Series 1 (1760). Chicago, IL: American Medical Association Archives.

  12. American Medical Association Council on Science and Public Health. Pollution control and environmental health H-135.996. https://policysearch.ama-assn.org/policyfinder/detail/Environmental%20Health?uri=%2FAMADoc%2FHOD.xml-0-367.xml. Accessed September 19, 2018.

  13. American Medical Association. Are you a candidate for creeping obesity [poster]? 1950s. Photograph Collection; Oversize Box 6, Series 1 (1760). Chicago, IL: American Medical Association Archives.

  14. American Medical Association. House of Delegates proceedings, annual convention. Chicago, IL: American Medical Association; June 1977. http://ama.nmtvault.com/jsp/viewer.jsp?doc_id=ama_arch%2FHOD00001%2F00000104&page_name=10. Accessed July 24, 2018.

  15. American Medical Association. Take your suntime in small doses [poster]. 1960s. Photograph Collection; Oversize Box 6, Series 1 (1760). Chicago, IL: American Medical Association Archives.

  16. American Medical Association. Protecting the public from dangers of ultraviolet radiation H-440.839. https://policysearch.ama-assn.org/policyfinder/detail/UVA%20UVB?uri=%2FAMADoc%2FHOD.xml-0-3855.xml. Modified 2014. Accessed October 11, 2018.

Citation

AMA J Ethics. 2018;20(12):E1201-1211.

DOI

10.1001/amajethics.2018.1201.

Conflict of Interest Disclosure

The author(s) had no conflict of interest to disclose. 

The viewpoints expressed in this article are those of the author(s) and do not necessarily reflect the views and policies of the AMA.