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June 19, 2009

Is it time to Stop Worrying and Love the AMA?
Forgive me if I can't get all rah-rah about the American Medical Association's recent "vote" in support of sustainable, local, organic food systems. As Sam Fromartz observed, they hit industrial food pretty hard in their report on the food system:
The current US food system is highly industrialized, focusing on the production of animal products and federally subsidized commodity crops, such as corn and soybeans. This has resulted in a highly processed, calorie-dense food supply, instead of one rich in a variety of fruits vegetables, and whole grains ... The poor quality diets supported by this system contributes to four of the six leading causes of death in the United States: heart disease, stroke, diabetes and some cancers.
The AMA then made three "resolutions":
  • That our AMA support practices and policies in medical schools, hospitals, and other health care facilities that support and model a healthy and ecologically sustainable food system, which provides food and beverages of naturally high nutritional quality.
  • That our AMA encourage the development of a healthier food system through the US Farm Bill and other federal legislation.
  • That our AMA consider working with other health care and public health organizations to educate the health care community and the public about the importance of healthy and ecologically sustainable food systems.
I appreciate mention of of the US Farm Bill, which of course institutionalizes the industrial, monoculture-based agriculture that has gotten us in such a pickle. But the best they can come up with is to "encourage" reform. How very civil of them.

I realize that the AMA doesn't represent all, or even most, doctors. As ThinkProgress reported recently, they use accounting tricks to boost their membership numbers and actually get a big chunk of their budget directly from drug companies (these would be the same drug companies that look at the diabetes epidemic and see opportunity rather than a crisis, by the way). But the AMA has outsized influence in health debates -- and it's not just because people trust doctors (which they undoubtedly do).

The fact is that the AMA spends about $20 million annually lobbying Congress, which doctors' "authority" probably amplifies even more. If the AMA were to shift some of those dollars to lobbying House and Senate Agriculture Committee members to support real reform of the Farm Bill, the school lunch program and CAFO regulation; if they were to start spending serious money working over the EPA, the FDA and the USDA to support real restrictions on the hazardous chemicals that industrial ag pours on their fields (and thence into our water, viz. the Gulf of Mexico); if they were to take an active role opposing the GMO crops that have demonstrated minimal benefit but maximal risk -- THEN maybe I'd grant that the AMA is serious.

But even if that should come to pass, as a political scientist recently observed to me, you simply can't overlook the AMA's decades of opposition to health care reform, specifically provider payment reform, just because they're putting out nice press releases about the food system. The AMA didn't just work to kill the Clinton health plan. This is the group that opposed Medicare, for Pete's sake. And that opposition, which has -- in my view -- led to Americans spending such an outsized amount of their income on health care, ends up contributing to the development of the very food system that the AMA is criticizing now.

As I wrote about for Grist last week, we spend less of our income on food than any other industrialized nation. I observed that for many Americans, raises have come in the form of processed food. But it's also true that people find it easier to skimp on food purchases -- or at least spend as little as possible -- and harder to skimp on medical care for their children. The AMA can't escape some measure of responsibility for that.

If the AMA really wants to help change the food system, they should stop lobbying Congress over their opposition to health care cost controls and start lobbying Congress and the administration in direct opposition to Big Ag. Now that would be worth a little rah-rah.

[Update]: Apparently, I was too hard on the AMA. Ezra Klein says allowing doctors to backstop claims about the problems of our industrial food system is simply a good thing. And I guess I can't disagree with that. I will say that if nothing else it's a clear sign of the mainstreaming of the debate over food -- I just think the AMA needs to show this represents a sustained, serious engagement on these issues. For the fact remains that the real fixes are in Congress, the USDA, the EPA and the FDA. And the good guys keep losing. The other day, Big Meat managed to get themselves exempted from food safety reform. And they're getting the EPA banned from measuring their CAFO's GHG emissions while House Ag Rep. Collin Peterson is looking more and more like he really will he'll derail the Waxman/Markey climate bill. And that was just last week! I want to win some battles in Washington. Is that too much to ask?

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