Correspondence

Contributions from the American Medical Political Action Committee to Members of Congress

N Engl J Med 1994; 330:1614-1615June 2, 1994

Article

To the Editor:

In regard to the article by Sharfstein and Sharfstein (Jan. 6 issue)1 on campaign contributions by the American Medical Political Action Committee (AMPAC): contributions from political action committees and public health funds are two entirely legitimate but dissimilar pools of money. To compare their use by the American Medical Association (AMA) and AMPAC is to compare not apples and oranges but apples and hippopotamuses.

Political action committees were approved by the Supreme Court in 1972 so that the process of supporting candidates could be clearly observed by the American people. Medical political action committees (such as AMPAC) exist to provide purely discretionary contributions to candidates of any party whose platforms are largely congruent with the practice concerns of physicians (e.g., confidentiality in the patient-doctor relationship, physicians' autonomy, the scope of practice, and tort reform). Furthermore, AMPAC is a grass-roots political action committee, taking its direction not from the AMA but from the state medical societies that determine the committee's priorities.

As for medical membership organizations like the AMA, one may belong to such groups without donating money to a political action committee. But in joining a medical organization, one must pay dues, and money from membership dues must be spent in conformity with the aims of the organization, among which are public health goals. Does the AMA support public health goals? Absolutely. We regularly fund campaigns promoting such goals as smoking cessation, women's health, handgun safety, and intervention in child, spouse, and elder abuse.

It is unfortunate that the authors have such a limited understanding of the difference between these two mechanisms for expressing the valid but not identical advocacy needs of physicians and patients. More unfortunate is the dissemination of such misinformation.

Lonnie R. Bristow, M.D.
American Medical Association, Chicago, IL 60610

1 References

1. 1

   Sharfstein JM, Sharfstein SS. Campaign contributions from the American Medical Political Action Committee to members of Congress -- for or against the public health? N Engl J Med 1994;330:32-37
   Full Text | Web of Science | Medline

To the Editor:

An extensive literature in political science and economics provides little support for the claim that contributions by political action committees, in any area of policy, influence legislators' roll-call votes1. Most political action committees (the primary exceptions are those associated with labor unions) make contributions for the purpose of gaining access to members of Congress rather than influencing their roll-call votes2. If AMPAC's primary goal were to sanction and reward members of Congress for their votes, as the authors suggest, would we not expect to see a marked difference in the rates of contributions to AMA supporters and opponents? In fact, marked differences are impossible to demonstrate, because there is almost no variation (see Table 4 in the article by Sharfstein and Sharfstein). Over 90 percent of the members of the House of Representatives received a contribution from AMPAC.

John D. Wilkerson, Ph.D.
University of Washington, Seattle, WA 98195

2 References

1. 1

   Wright JR. Contributions, lobbying, and committee voting in the U.S. House of Representatives. Am Polit Sci Rev 1990;84:417-438
   CrossRef | Web of Science

2. 2

   Jacobson GC. The politics of congressional elections. New York: HarperCollins, 1992.
   

To the Editor:

It is difficult to imagine that I have a better-than-average grasp of the obvious. Yet Sharfstein and Sharfstein, in discussing their study of AMPAC congressional contributions, never seem to recognize the clear implication of their data: AMPAC is not used to support public health.

Political action committees exist to support the interests of those who provide the money used for contributions; for other political action committees, this purpose is explicitly acknowledged. Yet for AMPAC, an amorphous altruistic quest for public health obscures the committee's obvious mission: to support physicians' incomes.

Sharfstein and Sharfstein have documented what AMPAC does not do; if they had examined the records and positions of supported candidates on matters such as taxes on high-income professionals, I suspect the data would have shown a significant positive correlation.

Wolffe Nadoolman, M.B.A.
Yale University School of Medicine, New Haven, CT 06504

To the Editor:

Common sense would suggest that the slightly larger contributions by AMPAC to opponents of tobacco-export restrictions, gun control, and gag-rule repeal can be attributed to an unintended and happenstance or random byproduct of AMPAC's effort to win support for its political and economic agenda rather than to a sinister or misguided effort to subvert AMA policy. That being the case, the contrived discussion by the authors seems naive and to some extent absurd. The authors explore various possible explanations for their findings, including the explanation that contributions to opponents of AMA positions were deliberately made to change their minds.

Harvey D. Rothberg, M.D.
419 N. Harrison St., Princeton, NJ 08540

To the Editor:

The AMA supported increased funding for the National Institutes of Health and research, supported and continues to work for the maintenance of funding for residency training, and worked laboriously for the mandatory installation of air bags in automobiles. These are all important health-related issues.

Malpractice reform is an important political and economic issue, and few other organizations have attacked that beast with as much effort as the AMA has. The AMA has not been perfect, but application of the standards of pseudoscience in the broad context of the legislative process in the United States reflects great naivete or the development of another editorial opinion or both. The article by Sharfstein and Sharfstein should have been in the editorial section of this prestigious medical journal.

Stewart B. Dunsker, M.D.
University of Cincinnati, Cincinnati, OH 45267

To the Editor:

In a democracy, representatives may choose to vote for one measure and against another for many reasons, following neither party nor ideological rules. Thus, a representative from a tobacco-producing state may support tobacco exports but also strongly support gun control and oppose the gag rule. In the end, it is the total number of votes, not their ideological consistency and purity, that gets legislation passed. AMPAC contributed substantially more often (and usually more total funds) to the campaigns of congressional representatives who supported the AMA's political position on each of the issues the authors examined (Table 1Table 1AMPAC Contributions to House Members, According to Their Stance on Three Issues.).

Using its contribution policy (assuming there is one), overall, AMPAC supported with more money almost twice as many successful candidates voting with the AMA on two or three of these issues as the number of successful candidates voting with the AMA on none or only one of the issues (200 vs. 105 candidates; $1.9 million vs. $1.2 million, respectively). If the aim is to get bills passed, the AMA strategy seems to work. By the way, I am not a member of the AMA.

William P. Peters, M.D., Ph.D.
Duke University Medical Center, Durham, NC 27710

Author/Editor Response

The authors reply:

To the Editor: We demonstrated that AMPAC, the AMA's political action committee, contributed more on average to representatives who opposed the AMA on the gag rule (which limited what physicians could say to patients), gun control, and tobacco-export promotion. Now, the AMA's Bristow writes that AMPAC exists to advance “the practice concerns of physicians.” This statement is not an argument against our findings, but it is a persuasive explanation for them. Presumably, AMPAC preferentially backed the AMA's opponents on public health issues because these same representatives tended to support its practice concerns. If Bristow is correct, AMPAC's activities reflect physicians' pursuit of other interests at the expense of support for the privacy of the doctor-patient relationship, worldwide resistance to American tobacco, and safety from violence caused by guns.

Bristow attempts to distance the AMA from AMPAC by noting differences between them. But the AMA is ultimately accountable for the actions of its official political action committee. We are not convinced by the implication that the AMA's advocacy of public health issues frees AMPAC to disregard them. Unlike Bristow, many medical students and physicians consider public health a practice concern.

Bristow's description of AMPAC's agenda undermines Wilkerson's claim that AMPAC has no agenda and Rothberg's insistence that our results are “random.” We showed statistically that AMPAC's preference for the AMA's opponents on public health issues was highly unlikely to be due to chance. Although not intentional, this preference makes sense as a direct byproduct of AMPAC's non-public health priorities. Apparently, Nadoolman knew this all along.

Dunsker accuses us of “great naivete.” Why is it naive to ask whether the AMA -- whose motto is “physicians dedicated to the health of America” -- supports the health of Americans through the contributions of its political action committee?

Considering total rather than average contributions, Peters calculates that AMPAC gave more to supporters on public health issues than to opponents. But total contributions have no importance in Congress; what matters is how much individual representatives receive for their campaigns. By comparing total rather than average sums of money, Peters ignores the denominator -- an approach that would also lead him to conclude that family practitioners earn more than neurosurgeons.

Finally, Peters's notion that “the AMA strategy seems to work” is wrong. Representatives backed by AMPAC blocked legislation against the gag rule and in favor of gun control until President Bill Clinton's election. Other close votes on issues related to public health are looming. Until subsequent analyses show a change in AMPAC's contribution patterns, physicians who contribute to AMPAC may be risking their patients' health.

Joshua M. Sharfstein, A.B.
Harvard Medical School, Boston, MA 02115

Steven S. Sharfstein, M.D.
Sheppard and Enoch Pratt Hospital, Baltimore, MD 21204

Citing Articles (1)

Citing Articles

1. 1

   J Sharfstein. (1998) 1996 congressional campaign priorities of the AMA: tackling tobacco or limiting malpractice awards?. American Journal of Public Health 88:8, 1233-1236
   CrossRef