The American Medical Association (AMA) is the main professional trade group representing American doctors. The AMA publishes a medical journal, the Journal of the American Medical Association (JAMA).

In the early half of the 20th century, petrochemical giants organized a coup on the medical research facilities, hospitals and universities. The Rockefeller family sponsored research and donated sums to universities and medical schools which had drug based research. They further extended this policy to foreign universities and medical schools where research was drug based through their “International Education Board”.

Establishments and research which were were not drug based were refused funding and soon dissolved in favor of the lucrative pharmaceutical industry. In 1939 a “Drug Trust” alliance was formed by the Rockefeller empire and the German chemical company I.G. Farben (Bayer).

In his 1994 book, The Assault on Medical Freedom, author P. Joseph Lisa gained access to secret files in the AMA's Chicago Department of investigation under the guise of collecting information to expose “mental health quackery.” In the process, he uncovered hundreds of AMA photocopies of memos, minutes and other documents. In a subsequent ten year investigation, he found little evidence of “quackery” and much evidence of an organized propaganda campaign to discredit alternative medicine and foreign drugs.

By 1964, the AMA's Committee on Quackery extended membership to become the Coordinating Conference on Health information (CCHI). Members included the American Cancer Society (ACS), the American Pharmaceutical Association, the Arthritis Foundation, the Council of Better Business Bureaus, the National Health Council, the Food and Drug Administration, the Federal Trade Commission, the U.S. Postal Service, the Office of Consumer Affairs, the U.S. and State Attorney Generals' Office and the Internal Revenue Service. *CCHI officials allegedly asked the FDA to prosecute drugless “quackery” targets* beginning to intrude on their markets. ¹⁾

by P. Joseph Lisa 1994Research shows that during the first one hundred years of the AMA's existence it formed councils and committees which sat in judgement of its economic competitors. These committees would “investigate” the various alternative health-care systems and would then report on their findings and make determinations and recommendations that the public should stay away from such “quackery.” The CCHI and the AMA's Committee on Quackery continued to serve this function from 1963 to 1975. However, when the writing was on the wall, Doyl Taylor saw that his propaganda department was “going down for the count.” He apparently took steps to see that his work continued even if he weren't around to supervise the AMA's campaigns against the “quacks.”

In his description of what the CCHI should be, he took steps to maintain its secrecy by dictating that no minutes of their meetings should be taken. This made finding the new CCHI (or “shadow” CCHI) a lot more difficult. However, even those most careful to cover their tracks often leave clues for determined investigators to find. In the case of the CCHI, Taylor left one big clue. In the OBJECTIVES and GOALS of the CCHI, he stated:

Protection of the public by gathering and disseminating by all means possible any and all information involving health quackery to each member [of the conference], particularly those agencies involved in law enforcement.

By itself it isn't much of a clue. But when one dissects this stated GOAL of the CCHI and looks closely, one can clearly see several good leads to follow in unearthing this “shadow CCHI.” To find such an organization, one needs to find a group who:

First, is pretentious and arrogant enough to espouse the principle that the public needs to be “protected” in the health-care marketplace. From what are we being “protected”? Health “quackery” of course. Exactly what is health “quackery”? Apparently it's simply anything that the medical and pharmaceutical industry cannot control. Interestingly, it is also the [italics] economic competition [end italics] to drugs and medical treatment.

Second, claims to be “protecting” the public by “gathering and disseminating any and all information involving health quackery.” One would have to find a group that has a large storage of information on “health quackery.”

Third, is connected to the government and whose members are “gathering and disseminating” information on “health quackery,” particularly to “those involved in law enforcement.”

Fourth, has a [italics] vested interest [end italics] or is doing the work of or for a vested interest. It was proven that the AMA had a vested interest in the original CCHI.

Fifth, consists of most of the same members of the CCHI, or at least is connected to the members of the CCHI.

Sixth, serves the same or similar function as did the CCHI in terms of spreading the propaganda through Congresses on Quackery or some similar type of “conference”on “quackery.”

With these leads in mind, I began the search for the link between the old AMA campaign and the current one. I began to build the bridge between the two with information I had come across over the years, as well as information I obtained during my current investigation, which began in earnest in 1984.

“Additionally, this campaign has targeted vitamins, homeopathy, naturopathy, and many others. The removal of these options would represent many billions of dollars in new drug sales.

The increase in drug sales is good reason in itself to conduct a campaign directed at one's economic competitors. The earlier campaign and the current one have [italics] dollars and profits [end italics] as one common denominator. The other common denominator is that both campaigns are in blatant violation of antitrust laws, as well as RICO conspiracy laws. There can be little doubt that the current crusade is just an extension of the earlier campaign.

The current campaign has several elements in it that were not seen as frequently in the old AMA campaign. These include such illegal acts as breaking and entry, unauthorized phone taps, the theft of files from practitioners offices, intimidation and harassment of patients, violations of search-and-seizure statutes, physical violence and threats of violence, and break-ins into attorneys' offices involving the theft of case records. ²⁾

Physician Financial Transparency Reports (Sunshine Act)

The Physician Payments Sunshine Act, which was part of the Affordable Care Act (ACA), requires manufacturers of drugs, medical devices, and biologicals that participate in U.S. federal health care programs to report certain payments and items of value given to physicians and teaching hospitals.

Manufacturers will submit the reports to the Centers for Medicare & Medicaid Services (CMS) on an annual basis. In addition, manufacturers and group purchasing organizations (GPOs) must report certain ownership interests held by physicians and their close family members. The majority of the information contained in the reports will be available on a public, searchable website. Physicians have the right to review their reports and to challenge those reports that are false, inaccurate, or misleading.

There are many interactions between physicians and manufacturers of drugs, medical devices, and medical supplies that benefit patients and advance the art and science of medicine. The reports provide patients and the public with information on the financial interactions of physicians and industry. These interactions often drive innovation, discovery, and changes in medical practice that may promote better patient outcomes. The congressional sponsors of the ACA reporting provisions have stated that this process is not designed to stop, chill, or call into question beneficial interactions between physicians and industry, but to ensure that they are transparent.

Summary of Key Provisions of the Sunshine Act

Financial Transfers: All manufacturers of a drug, device, biological, or medical supplies participating in federal health care programs will have to report to CMS any direct payments or transfers of value to physicians and/or teaching hospitals of $10 or more. However, there are 12 exceptions where a direct payment or transfer of value is not subject to reporting. These include product samples and educational materials that directly benefit patients.

There are a limited number of transfers, not made directly to physicians, that are subject to reporting (called indirect transfers). Transfers or payments that the physician specifies should be given or paid to another person or entity would be reportable, so too would any transfer or payments that another person indicates are being made on behalf of the physician.

Ownership: All manufacturers and GPOs participating in federal health care programs will have to report to CMS certain ownership interests held by physicians and their close family members. However, there are certain ownership interests, such as stock in a publicly traded manufacturer, which are not reportable ownership interests.

Pubic Reports: The majority of the information contained in the transparency reports will be available on a public, searchable website. By statute, physicians are provided, at a minimum, 45 days to review the transparency reports and make corrections before they are made public. Manufacturers and GPOs face civil monetary penalties for failing to report transfers and/or ownerships interests.

Frequently Asked Questions

What is being reported? Payments, transfers of items that have value, and ownership interests.

Payments and Transfers of Value: Manufacturers must report payments and “transfers of value” made directly to physicians and teaching hospitals. Manufacturers are required to describe how the recipient received the payment such as cash or cash equivalent, in-kind items or services, or stock, stock option(s), or any other ownership interest, dividend, profit, or other return on investment. In addition, manufacturers must specify the nature of the payment or transfer of value. There are 14 possible categories including, for example, consulting fees, grants, research, honoraria, and charitable contributions. In addition to direct payments, manufacturers must report certain payments and transfers of value that are made indirectly.

Ownership Interests: Manufactures as well as GPOs are required to report on ownership interests held by physicians and their immediate family members. The transparency report must include the dollar amount invested, the value, and terms of ownership or investment interest, and any payment provided to physician owner or investor. However, ownership or investment interests in publicly traded security and mutual funds are excluded.

Who has to report? Manufacturers must submit the reports to CMS on an annual basis. In addition, manufacturers and GPOs must report ownership interests held by physicians and their close family members.

What type of payments and transfers of items of value are reported? Manufacturers must report payments or “transfers of value” to physicians and teaching hospitals. Manufacturers are required to describe how the recipient received the payment (such as cash or cash equivalent, in-kind items or services, or stock, stock option(s), or any other ownership interest, dividend, profit, or other return on investment). In addition, manufacturers must provide a reason for the payment. There are 14 possible categories including, for example, consulting fees, grants, research, honoraria, and charitable contributions.

What type of ownership interests is reported? Manufacturers as well as GPOs are required to report on interests held by physicians and their immediate family members. The transparency report must include the dollar amount invested, the value, and terms of ownership or investment interest, and any payment provided to physician owner or investor. However, ownership or investment interests in publicly traded security and mutual funds are excluded.

Do the reports document unethical, fraudulent, or illegal interactions? Congress did not intend for the reports to reflect unethical, fraudulent, or illegal interactions. Instead, it was to create transparency. Just as there are rules that require public meetings for public officials, the transparency similarly shines a light on interactions to ensure that these interactions advance the best interest of patients and advance the art and science of medicine.

What is exempt from reporting? Certified and Accredited Continuing Medical Education? Probably will be exempt, but will be specified in the implementing regulation. It is not possible for manufacturers to make a direct payment or transfer of value to an individual physician for certified CME either as a speaker or as participant.

Samples? Yes, samples are exempt as long as these are provided to patients.

Educational materials benefiting patients? Yes, educational materials that benefit patients are exempt.

Medical Journal Re-Prints? Probably will be exempt, but this will be clarified in the implementing regulations.

Meals? No, meals are not exempt (unless under $10, but meals will count regardless if the total in a reporting year cumulatively is valued at $100 or more).

Educational Speaker Bureaus? No, any payment or transfers of value are subject to reporting.

When does reporting begin? The final implementing regulations will specify. It is not known, yet.

What form of payment or transfer is reportable?

  cash or a cash equivalent;
  in-kind items or services; and,
  stock, a stock option, or any other ownership interest, dividend, profit, or other return on investment.

Manufacturers are required to categorize the nature of payments or transfers of value in the following manner-

• consulting fees;
• compensation for services other than consulting;
• honoraria;
• gift;
• entertainment;
• food;
• travel;
• education;
• research;
• charitable contribution; or
• royalty or license;
• current or prospective ownership or investment interest;
• direct compensation for serving as faculty or as a speaker for a medical education program; or,
• grant.

When does the public disclosure of transparency reports begin? The final implementing regulations will specify. It is not known, yet.

How do I find out about what industry is reporting about me? CMS will have a website where you will be able to check a consolidated report at the end of the annual reporting period. However, you should check with any manufacturer from which you have received payment or any item of value to see what information they are tracking and intend to report.

What do I do if the information reported about me is wrong? Physicians will have at least 45 days after CMS provides to each physician a consolidated annual report to challenge the content of the reports. The final regulations will specify the process that physicians will need to follow.

What are the 12 direct payments or transfers of value that are exempt from reporting?

• A transfer of anything of value which is less than $10, unless the aggregate amount transferred to, requested by, or designated on behalf of a physician by a manufacturer during the calendar year exceeds $100.
• Product samples that are not intended to be sold and are intended for patient use.
• Educational materials that directly benefit patients or are intended for patient use.
• The loan of a covered device for a short-term trial period, not to exceed 90 days, to permit evaluation of the covered device by a physician.
• Items or services provided under a contractual warranty, including the replacement of a covered device, where the terms of the warranty are set forth in the purchase or lease agreement for the covered device.
• A transfer of anything of value to a physician when the physician is a patient and not acting in his or her professional capacity.
• Discounts (including rebates).
• In-kind items used for the provision of charity care.
• A dividend or other profit distribution from, or ownership or investment interest in, a publicly traded security and mutual fund.
• In the case of a manufacturer who offers a self-insured plan, payments for the provision of health care to employee physicians under the plan.
• In the case of a physician who is also licensed as a non-medical professional, a transfer of anything of value to the physician if the transfer is payment solely for the non-medical professional services.
• In the case of a physician, a transfer of anything of value to the physician if the transfer is payment solely for the services of the physician with respect to a civil or criminal action or an administrative proceeding.

links to full AMA member groups and registration banner at page bottom)

= Public Webpage – Transparency Reporting == *CMS is required to provide most of the information contained in the transparency report in a public Webpage. When the link is available, it will be posted here.*

The AMA along with 49 medical specialty societies and 43 state medical associations, submitted a sign-on comment letter on the proposed rule. In addition, the AMA joined a sign-on letter submitted by national organizations involved in Continuing Medical Education (CME) in the United States, including Accreditation of CME Providers, granting of CME Credit for CME activities, and fulfillment of the responsibility of the Profession of Medicine to self-regulate in the arena of CME.

October 10, 2012 AMA comments to CMS as follow-up to Senate Special Committee on Aging RoundtablePDF FIle

February 17, 2012 AMA sign-on comment letter to CMSPDF FIle

February 16, 2012 CME Provider sign-on comment letter to CMSPDF FIle

April 8, 2011, AMA Comments to CMSPDF FIle

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