Wednesday, December 1, 2021

The American Medical Association Only Promotes and Protects Doctors, Not Public Health


Dr. Gerald E. Harmon, president of the American Medical Association (AMA), authored a commentary November 19 claiming that the “FDA made the wrong choice in allowing Vuse marketing.”

Dr. Harmon said that the FDA’s decision “is wrong on many levels,” but I will show that his commentary better fits that description.

Harmon says that the FDA’s “gravest error is to frame its action as ‘appropriate for the protection of the public health.’”  Gravest error?  Harmon tells his readers in the next paragraph that the FDA had no choice: Congress dictated that precise standard in legislation giving FDA regulatory authority over tobacco in 2009 (here).

Next, Harmon claims that “the role that e-cigarettes may play in smoking cessation strategies is unclear.”  That may be true – for someone who has never looked at federal surveys (here, here and here), never read the scientific literature (here, here and here) and/or never met a former smoker (also called an “anecdote”) (here).    

Incredibly, Harmon cites a recent study from the University of California San Diego involving “smokers who turned to e-cigarettes as a cessation device.”  No.  They.  Didn’t.  As I recently explained in a critique on that study (here and here). 

Then he gets to the core of his commentary: “The AMA has specifically recognized the use of e-cigarettes and vaping as an urgent public health epidemic and has called for a total ban on all e-cigarette and vaping products that do not meet FDA approval standards as cessation tools.” (emphasis added)  In other words, the AMA wants prohibition if the FDA doesn’t regulate e-cigarettes as harshly as it regulates cancer chemotherapy.

Harmon comes up with a claim that will make ever smokers laugh out loud: “Data has shown that using FDA-approved cessation medicine can double a persons [sic] chance of quitting smoking successfully.” 

Double what?  Every year only 5% of smokers quit, so doubling that number makes 10%.  Does Harmon care about the other 90% of smokers who couldn’t quit the AMA way?  I don’t think so.

A lot of Harmon’s rant about Vuse was devoted to “fruit- and candy-flavored” products.  This is strange.  The only Vuse products the FDA authorized are tobacco-flavored.

Why does the AMA, one of the most influential organizations in American medicine, take such a prohibitionist position when 480,000 American smokers are dying prematurely every year?  Well, its influence derives not from its commitment to public health, but from its power as a trade organization.  And trade organizations’ first and foremost goals are to advance the interests of its members.  According to blogger Matthew Yglesias, the AMA actively makes the number of doctors in the U.S. scarce, by blocking increased scope of practice for nurses, making it hard for foreign-trained doctors to practice in the United States, and historically pushing to train too few doctors here at home.  This results in big salaries for doctors and dismal, expensive access to medical care for Americans compared to many other developed countries (see chart below). 

The AMA protects and promotes doctors, it doesn’t care about American smokers.