DOCTORS' DILEMMA

By Christine Gorman

It probably looked like a neatly packaged, over-the-counter cure for a financial headache. In need of cash for new public health campaigns on smoking and violence, the American Medical Association decided to turn to the Sunbeam Corp. While best known for its food mixers, blenders and toasters, the Delray Beach, Fla., company also makes medical equipment--thermometers, heating pads and blood-pressure monitors. Under an arrangement that could conceivably net the association millions of dollars a year in royalties, last week it gave Sunbeam exclusive rights to fix the A.M.A. seal on some of the firm's health-care products--and promptly set off a feverish debate.

"An appalling decision," huffed a New York Times editorial, saying the deal "casts suspicion on the A.M.A.'s credibility." Many physicians, including A.M.A. members, also weighed in with harsh diagnoses. "What stands out here is the stupidity, even more than the venality," snapped Dr. Quentin Young, head of an advocacy organization called the Health and Medicine Policy Research Group, adding, "The A.M.A. is cashing in its debilitated reputation as a guardian of American health and becoming straightforward feather merchants."

The flap comes at a time when the A.M.A. least needs it. Once it commanded virtually unchallenged respect. Today its power, despite a membership of 300,000, is greatly diminished from its heyday in the 1960s, when it had enough clout on Capitol Hill to dictate substantial changes in Medicare laws. Older physicians in particular are dismayed that it has been unable to slow down the managed-care revolution that has deprived them of income and decision-making power over patients. Many younger physicians find the organization simply irrelevant.

Perhaps indicative of how out of touch the A.M.A. is was its surprised reaction to the furor that the Sunbeam deal provoked. "People are too willing to think something sinister is going on here," complains Larry Jellen, the A.M.A.'s vice president of marketing. "Our intentions are exceptionally honorable." Maybe so, but the A.M.A. might have found it instructive to do a case history. Back in the 1950s the organization retreated from another health-product-endorsement program out of liability concerns.

Then there is the more recent experience of the American Heart Association. Seven years ago, it launched an ambitious nutritional-labeling program that would have netted as much as $600,000 per endorsement of commercial products, depending on market share. Like the A.M.A., the heart association had a public-spirited goal: it wanted the labeling to help consumers understand the nutritional content of the foods they bought. But the Food and Drug Administration objected, and the A.H.A. eventually dropped the program--though a few years later the FDA itself started requiring more explicit food labels. (The A.H.A. has since instituted a more modest "food certification" program.)

The American Cancer Society stirred less controversy last year when it entered an exclusive deal with the Florida Orange Growers Association. The society gets $1 million annually for cancer research in exchange for allowing the A.C.S. logo to appear on ads and juice cartons. "We do walk a fine line," acknowledges A.C.S. spokesperson Steven Dickinson. "But what we're doing is not a formal endorsement. We make it clear that orange juice is only an example of the kinds of foods in a healthy diet."

The model commercial arrangement for a health group may have been devised by the American Dental Association. For years it has put its seal of acceptance on products that it has tested--at its own expense. Two years ago, it started charging modest application fees that cover about a third of its $1.2 million testing budget. Says Kenneth Burrell of the A.D.A.'s Council on Scientific Affairs: "The A.D.A. seal is viewed very positively, and we didn't want to lose that."

The A.M.A. can make no such claim for its exclusive deal with Sunbeam. Says Dr. Robert Graham of the American Academy of Family Physicians: "I'd be more comfortable if they were assessing all comers."

Nonetheless, the A.M.A. seems reluctant to retreat. At first Dr. Thomas Reardon, chairman of the A.M.A.'s board of trustees, argued, "The A.M.A. has moved into the public health arena with much greater force, and that takes money." But the criticism must have hit home. Late last week, Reardon says, the A.M.A. decided to review several aspects of the program, including "the exclusive nature of the contract." If only belatedly, then, the A.M.A. seems poised to apply Hippocrates' maxim: Above all, do no harm.

--Reported by James L. Graff/Chicago and Alice Park/New York

With reporting by JAMES L. GRAFF/CHICAGO AND ALICE PARK/NEW YORK