Human Rights Campaign

From Wikipedia, the free encyclopedia

Human Rights Campaign

Abbreviation	HRC
Motto	"Working for Lesbian, Gay, Bisexual and Transgender Equal Rights"
Formation	1980; 39 years ago
Founder	Steve Endean
Type	Nonprofit advocacy organization
Purpose	LGBTQ rights
Headquarters	Washington, D.C.
President	Chad Griffin
Affiliations	Human Rights Campaign Foundation, Human Rights Campaign PAC
Revenue (2018)	$45,636,641
Expenses (2018)	$43,167,397
Website	www.hrc.org

The Human Rights Campaign (HRC) is the largest LGBTQ civil rights advocacy group and political lobbying organization in the United States. The organization focuses on protecting and expanding rights for LGBTQ individuals, most notably advocating for marriage equality, anti-discrimination and hate crimes legislation, and HIV/AIDS advocacy. The organization has a number of legislative initiatives as well as supporting resources for LGBTQ individuals.

Structure

HRC is an umbrella group of two separate non-profit organizations and a political action committee: the HRC Foundation, a 501(c)(3) organization that focuses on research, advocacy and education; the Human Rights Campaign, a 501(c)(4) organization that focuses on promoting lesbian, gay, bisexual, transgender, and queer (LGBTQ) rights through lobbying Congress and state and local officials for support of pro-LGBTQ bills, and mobilizing grassroots action amongst its members; and the HRC Political Action Committee, a super PAC which supports and opposes political candidates.

Leadership

The Human Rights Campaign's leadership includes President Chad Griffin. HRC's work is supported by three boards: the Board of Directors, which is the governing body for the organization; the HRC Foundation Board, which manages the foundation's finances and establishes official policies governing the foundation; and the Board of Governors, which manages the organization's local outreach nationwide.

History

Human Rights Campaign headquarters in Washington, D.C.

 

Steve Endean, who had worked with a previously established Gay Rights National Lobby from 1978, established the Human Rights Campaign Fund political action committee in 1980. The two groups eventually merged. In 1983, Vic Basile, at the time one of the leading LGBT rights activists in Washington, D.C., was elected as the first executive director. In October 1986, the HRC Foundation (HRCF) was formed as a non-profit organization.

In January 1989, Basile announced his departure, and HRC reorganized from serving mainly as a political action committee (PAC) to broadening its function to encompass lobbying, research, education, and media outreach. HRC decided on a new Statement of Purpose: "For the promotion of the social welfare of the gay and lesbian community by drafting, supporting and influencing legislation and policy at the federal, state and local level." Tim McFeeley, a Harvard Law School graduate, founder of the Boston Lesbian and Gay Political Alliance, and a co-chair of the New England HRC Committee, was elected the new executive director. Total membership was then approximately 25,000 members.

In 1992, HRC endorsed a presidential candidate for the first time, Bill Clinton. In March 1993, HRC began a new project, National Coming Out Day. From January 1995 until January 2004, Elizabeth Birch served as the executive director of the HRC. Under her leadership, the institution more than quadrupled its membership to 500,000 members.

In 1995, the organization dropped the word "Fund" from its name, becoming the Human Rights Campaign. That same year, it underwent a complete reorganization. The HRC Foundation added new programs such as the Workplace Project and the Family Project, while HRC itself broadly expanded its research, communications, and marketing/public relations functions. The organization also unveiled a new logo, a yellow equal sign inside of a blue square.

The Human Rights Campaign often has a large presence at LGBT-related events such as the Chicago Pride Parade as seen above.

 

As part of the activities surrounding the Millennium March on Washington, the HRC Foundation sponsored a fundraising concert at Washington, D.C.'s RFK Stadium on April 29, 2000. Billed as a concert to end hate crimes, "Equality Rocks" honored hate crime victims and their families, such as featured speakers Dennis and Judy Shepard, the parents of Matthew Shepard. The event included Melissa Etheridge, Garth Brooks, Pet Shop Boys, k.d. lang, Nathan Lane, Rufus Wainwright, Albita Rodríguez, and Chaka Khan.

Elizabeth Birch's successor, Cheryl Jacques, resigned in November 2004 after only 11 months as executive director. Jacques said she had resigned over "a difference in management philosophy".

In March 2005, HRC announced the appointment of Joe Solmonese as the president. He served in that position until stepping down in May 2012 to co-chair the Barack Obama presidential campaign.

HRC launched its Religion and Faith Program in 2005 to mobilize clergy to advocate for LGBT people, and helped form DC Clergy United for Marriage Equality, which was involved in the legalization of same-sex marriage in the District of Columbia. On March 10, 2010, the first legally recognized same-sex weddings in the District of Columbia were held at the headquarters of the Human Rights Campaign.

On August 9, 2007, HRC and Logo TV co-hosted a forum for 2008 Democratic presidential candidates dedicated specifically to LGBT issues.

In 2010, HRC lobbied for the repeal of the United States' ban on HIV-positive people's entry into the country for travel or immigration.

In September 2011, it was announced that Joe Solmonese would step down as president of HRC following the end of his contract in 2012. Despite initial speculation that former Atlanta City Council president Cathy Woolard would be appointed, no replacement was announced until March 2, 2012, when American Foundation for Equal Rights co-founder Chad Griffin was announced as Solmonese's successor. Griffin took office on June 11, 2012.

In 2012, HRC said that it had raised and contributed $20 million to re-elect President Obama and to advance same-sex marriage. In addition to the Obama re-election campaign, HRC spent money on marriage-related ballot measures in Washington, Maine, Maryland and Minnesota, and the election of Democratic Senator Tammy Baldwin in Wisconsin.

In 2013, HRC conducted a postcard campaign in support of the Employment Non-Discrimination Act (ENDA).

In 2019, HRC joined with 42 other religious and allied organizations in issuing a statement opposing Project Blitz, an effort by a coalition of Christian right organizations to influence state legislation.

Executive Directors

Years	Name
1980–1983	Steve Endean
1983–1989	Vic Basile
1989–1995	Tim McFeeley
1995–2004	Elizabeth Birch
2004–2004	Cheryl Jacques
2005–2012	Joe Solmonese
2012–present	Chad Griffin

Annual fundraisers

Each year since 1997, HRC has hosted a national dinner that serves as the organization's single largest annual fundraiser. In 2009, President Barack Obama spoke at HRC's 13th Annual National Dinner. In his speech, President Obama reaffirmed his pledge to repeal "Don't Ask, Don't Tell" and the Defense of Marriage Act (DOMA), as well as his commitment to passing the Employment Non-Discrimination Act. He gave the keynote speech in 2011 as well, reiterating his pledge to fight for DOMA repeal and for the passage of ENDA, and to combat bullying of LGBT youth. Other featured speakers at past dinners have included Bill Clinton, Maya Angelou, Kweisi Mfume, Joseph Lieberman, Hillary Clinton, Richard Gephardt, John Lewis, Rosie O'Donnell, Nancy Pelosi, Tim Gunn, Suze Orman, Sally Field, Cory Booker, Tammy Baldwin, and Betty DeGeneres.

HRC historical records

The historical records of the Human Rights Campaign are maintained in a collection at the Cornell University Library. Arriving at Cornell in 2004, the records include strategic planning documents, faxes, minutes, e-mails, press releases, posters, and campaign buttons. Taking up 84 cubic feet (2.4 m³), the archive is the second largest in the library's Division of Rare and Manuscript Collections, Human Sexuality Collection. In February 2007, the archive was opened to scholars at the library, and selected records were organized into an online exhibit called "25 Years of Political Influence: The Records of the Human Rights Campaign".

Programs

According to the organization, the Human Rights Campaign "is organized for the charitable and educational purposes of promoting public education and welfare for the lesbian, gay, bisexual and transgender community."

The HRC Foundation provides resources on coming out, transgender issues, LGBT-related healthcare topics, and information about workplace issues faced by LGBT people, including the Corporate Equality Index.

HRC has lobbied for the passage of anti-discrimination and hate crime laws. The organization supported the passage of the Matthew Shepard and James Byrd, Jr. Hate Crimes Prevention Act, which expanded federal hate-crime law to allow the Justice Department to investigate and prosecute crimes motivated by a victim's actual or perceived gender, sexual orientation, gender identity, or disability.

The organization's work on health issues traditionally focused on responding to the HIV/AIDS epidemic. In recent years, HRC has addressed discrimination in health care settings for LGBT employees, patients and their families. Since 2007, the Human Rights Campaign Foundation has published the "Healthcare Equality Index", which rates hospitals on issues such as patient and employee non-discrimination policies, employee cultural competency training, and hospital visitation rights for LGBT patients' families.

Lobbyists from the Human Rights Campaign worked with the Obama administration to extend hospital visitation rights to same-sex partners. HRC lobbied extensively for the repeal of the Don't Ask Don't Tell (DADT) law, which barred gay and lesbian people from serving openly in the United States military.

Logo

The official logo of the HRC, adopted in 1995, consists of a yellow equals sign imposed onto a blue background. The logo was created in 1995 by design firm Stone Yamashita. The previous logo used by the HRC (then known as the HRCF) featured a stylized flaming torch. HRC uses the term Equality Flag for flags bearing their logo.

Same-sex marriage logo

The HRC equal sign logo reworked in red and pink to show particular support for same-sex marriage.

 

HRC shared a red version of its logo – selected by marketing director Anastasia Khoo because the color is synonymous with love – on social network services on March 25, 2013, and asked its supporters to do the same to show support for same-sex marriage in light of two cases that were before the U.S. Supreme Court (United States v. Windsor and Hollingsworth v. Perry). The logo went viral, and Facebook saw a 120% increase in the number of profile photo changes on March 26. Celebrities such as George Takei, Beyonce, Sophia Bush, Padma Lakshmi, Martha Stewart, Macklemore, Ryan Lewis and Ellen DeGeneres shared the logo with their millions of followers on social network services and politicians like Senator Claire McCaskill (D-MO), Jay Rockefeller (D-WV), and Kay Hagan (D-NC) did the same.

Brands and corporations showed their support for same-sex marriage with creative recreations of the red HRC logo. Supporters included Bud Light, Bonobos, Fab.com, Kenneth Cole, L'Occitane en Provence, Maybelline, Absolut, Marc Jacobs International, Smirnoff, Martha Stewart Weddings, and HBO's True Blood.

Major print and online news sources reported on the success of the viral campaign, including MSNBC, Time, Mashable, and The Wall Street Journal.

Controversies

Critics have taken HRC to task for its working environment. In the fall of 2014, HRC commissioned outside consultants to conduct a series of focus groups and surveys with the organization's staff. In the report, which was obtained by BuzzFeed, staff of the organization described the working environment at HRC as "judgmental", "exclusionary", "sexist", and "homogenous". The report stated that "Leadership culture is experienced as homogenous — gay, white, male." Acknowledging the report, HRC president Chad Griffin said: "Like many organizations and companies throughout our country, HRC has embarked on a thoughtful and comprehensive diversity and inclusion effort with the goals of better representing the communities we serve." In August 2015, Pride at Work, an LGBT affiliate of the AFL–CIO, approved a resolution that calls on member organizations to stop funding HRC until the group addresses what Pride at Work sees as problems with HRC's Corporate Equality Index.

HRC has been accused of overstating the number of its actual members in order to appear more influential in politics. Former HRC President Joe Solmonese responded, saying that "[m]embership is about more than contributions ... [i]t's about sending e-mails to elected officials, volunteering time or lobbying members of Congress" and more than half of its members made contributions during the previous two years. Earlier, HRC spokesperson Steven Fisher stated that its membership includes anyone who has donated at least $1.

HRC has also been criticized for exceedingly generous executive salaries.

Some transgender people have criticized the HRC for its stance on the 2007 version of ENDA, which at the time included sexual orientation as a protected category but not gender identity and expression. Once the legislation was submitted by Rep. Barney Frank, HRC officially neither opposed nor supported it. This followed a speech by former HRC President Joe Solmonese at the transgender Southern Comfort Conference the previous month, where he said that HRC "oppose[d] any legislation that is not absolutely inclusive". HRC later explained that it could not actively support a non-inclusive bill, but did not oppose it because the legislation would strategically advance long-term efforts to pass a trans-inclusive ENDA. However, in a letter to U.S. Representatives, HRC did express support for the bill, stating that while HRC is "greatly disappointed that the current version of ENDA is not fully-inclusive ... we appreciate the steadfast efforts of our ... allies ... even when they are forced ... to make progress that is measured by inches rather than yards."

Endorsement of Republican candidates

Critics of the HRC have accused the organization of favoring the Democratic Party. Andrew Sullivan, a gay political columnist and blogger, has been critical of the HRC, calling it "a patronage wing of the Democratic party." It has received backlash and criticism for several nominations of Republicans, when their Democratic opponents scored higher on HRC's own index.

HRC was criticized for its endorsement of New York Republican Al D'Amato in his 1998 campaign for re-election to the U.S. Senate. HRC defended the endorsement because of D'Amato's support for the Employment Non-Discrimination Act (ENDA) and the repeal of "Don't Ask, Don't Tell". However, many liberal LGBT leaders objected to D'Amato's conservative stances, including his opposition to affirmative action and abortion, and felt that HRC should have taken those positions into account when deciding on the endorsement.

In 2014, long-time supporter of same-sex marriage Shenna Bellows was nominated for a U.S. Senate seat in Maine. HRC endorsed her opponent, incumbent Republican Senator Susan Collins, who had previously lacked a history of supporting marriage equality initiatives. However, Collins later clarified her view in support of LGBT marriage equality.

On March 11, 2016, HRC voted to endorse Republican US Senator Mark Kirk over his Democratic Party challenger Representative Tammy Duckworth in his re-election bid to the US Senate. Though Kirk later announced his support for same-sex marriage, the endorsement was met with widespread surprise and criticism in news media and social media as HRC had given Kirk a score of 78 percent out of 100 percent on LGBT issues, while it had awarded Duckworth a score of 100 percent. David Nir at Daily Kos called the endorsement as "appalling as it is embarrassing" and "pathetic and stupid", while Slate observed that Democratic control of the Senate was effectively necessary for passing the Equality Act of 2015 and beneficial for many other LGBT equality issues, and thus it would be in line with the organization's stated goals for Duckworth to be elected rather than Kirk. Meanwhile, The New Republic stated that, in light of a recent internal report revealing HRC's "serious diversity problem", "Choosing the white male candidate in this race over the Asian-American female candidate—someone who happens to have a better voting record anyway—is probably the worst way of convincing your detractors that you are taking a core problem seriously." HRC president Chad Griffin defended the endorsement in a column published by the Independent Journal Review, describing the senator's work on behalf of LGBT equality issues, including co-sponsoring the Equality Act of 2015. Griffin stated: "The truth is we need more cross party cooperation on issues of equality, not less", adding "when members of Congress vote the right way and stand up for equality — regardless of party — we must stand with them. We simply cannot ask members of Congress to vote with us, and then turn around and try to kick them out of office."

On October 28, 2016, on the day following Mark Kirk's controversial debate comment on Tammy Duckworth's heritage, HRC explicitly stated their endorsement of Kirk "remains unchanged" while asking him to "rescind" his comment. Slate stated this proved HRC's "worst critics right" and that HRC "is simply irredeemable". On October 29, two days after the comment, HRC described Kirk's statement as "deeply offensive and racist," revoked its endorsement of Kirk, and instead endorsed Duckworth for the U.S. Senate.

2016 United States presidential endorsement

On January 19, 2016, the Human Rights Campaign's 32-person Board of Directors voted to endorse Hillary Clinton for president. This resulted in considerable controversy, causing thousands of users on HRC's Facebook page to post comments critical of the decision. Many cited HRC's own "congressional scorecard" (which records a 100% rating for her rival for the Democratic nomination, Bernie Sanders, while Clinton herself only scores 89%) as inconsistent with their endorsement. Additional scrutiny was also placed upon the connections Clinton herself has to the organization when it was revealed that HRC's President, Chad Griffin, had previously been employed by Clinton's husband, former US President Bill Clinton.

2018 New York gubernatorial election endorsement

On January 31, 2018, the Human Rights Campaign endorsed incumbent governor Andrew Cuomo. However, Cynthia Nixon, who is bisexual, announced that she was running on March 25, 2018. Despite this, HRC still supported Cuomo. In response, HRC received criticism for not supporting an LGBTQ+ candidate, and supporting her opponent instead. Jimmy Van Bramer, a gay New York City Council Member who endorsed Nixon, said, "The HRC endorsement hurts Cynthia Nixon's chances," and that "coming out against a viable progressive queer woman is the wrong thing to do."

Smallpox vaccine

From Wikipedia, the free encyclopedia

Smallpox vaccine

The smallpox vaccine diluent in a syringe alongside a vial of Dryvax dried smallpox vaccine
Vaccine description
Target disease	Smallpox
Clinical data
AHFS/Drugs.com	Multum Consumer Information/acam2000
Pregnancy category	US: C (Risk not ruled out)
Legal status
Legal status	US: ℞-only

Smallpox vaccine, the first successful vaccine to be developed, was introduced by Edward Jenner in 1796. He followed up his observation that milkmaids who had previously caught cowpox did not later catch smallpox by showing that inoculated cowpox protected against inoculated smallpox.

Types

Dryvax

Smallpox vaccine being administered. Note the bifurcated needle.

 

Dryvax is a freeze-dried calf lymph smallpox vaccine. It is the world's oldest smallpox vaccine, created in the late 19th century by American Home Products, a predecessor of Wyeth. By the 1940s, Wyeth was the leading US manufacturer of the vaccine and the only manufacturer by the 1960s. After world health authorities declared smallpox had been eradicated from nature in 1980, Wyeth stopped making the vaccine.

The US Centers for Disease Control and Prevention (CDC) kept a stockpile for use in case of emergency. In 2003 this supply helped contain an outbreak of monkeypox in the United States. In February 2008 the CDC disposed of the last of its 12 million doses of Dryvax. Its supply is being replaced by ACAM2000, a more modern product manufactured in laboratories by Acambis, now a division of Sanofi Pasteur.

Dryvax is a live-virus preparation of vaccinia prepared from calf lymph. Trace amounts of the following antibiotics (added during processing) may be present: neomycin sulfate, chlortetracycline hydrochloride, polymyxin B sulfate, and dihydrostreptomycin sulfate.

The vaccine is effective, providing successful immunogenicity in about 95% of vaccinated persons. Dryvax has serious adverse side-effects in about 1% to 2% of cases.

ACAM2000

ACAM2000 is a smallpox vaccine developed by Acambis. It was approved for use in the United States by the U.S. Food and Drug Administration (FDA) on 31 August 2007. It contains live vaccinia virus, cloned from the same strain used in an earlier vaccine, Dryvax. While the Dryvax virus was cultured in the skin of calves and freeze-dried, ACAM2000s virus is cultured in kidney epithelial cells (Vero cells) from an African green monkey. Efficacy and adverse reaction incidence are similar to Dryvax. The vaccine is not routinely available to the US public; it is, however, used in the military and maintained in the Strategic National Stockpile.

A droplet of ACAM2000 is administered by the percutaneous route (scarification) using 15 jabs of a bifurcated needle. ACAM2000 should not be injected by the intradermal, subcutaneous, intramuscular, or intravenous route.

Calf lymph

Calf lymph was the name given to a type of smallpox vaccine used in the 19th century, and which was still manufactured up to the 1970s. Calf lymph was known as early as 1805 in Italy, but it was the Lyon Medical Conference of 1864 which made the technique known to the wider world. In 1898 calf lymph became the standard method of vaccination for smallpox in the United Kingdom, when arm-to-arm vaccination was eventually banned (due to complications such as the simultaneous transmission of syphilis).

Safety

Although Jenner used cowpox, the vaccine now contains a virus immunologically related to cowpox and smallpox viruses called vaccinia which causes a mild infection. The vaccine is infectious, which improves its effectiveness, but causes serious complications for people with impaired immune systems (for example chemotherapy and AIDS patients, and people with eczema), and is not yet considered safe for pregnant women. A woman planning on conceiving within one month should not receive smallpox immunization until after the pregnancy. In the event of an outbreak, the woman should delay pregnancy if possible. Vaccines that only contain attenuated vaccinia viruses (an attenuated virus is one in which the pathogenicity has been decreased through serial passage) have been proposed, but some researchers have questioned the possible effectiveness of such a vaccine. According to the Centers for Disease Control and Prevention (CDC), "vaccination within 3 days of exposure will prevent or significantly lessen the severity of smallpox symptoms in the vast majority of people. Vaccination 4 to 7 days after exposure likely offers some protection from disease or may modify the severity of disease." This, along with vaccinations of so-called first responders, is the current plan of action being devised by the United States Department of Homeland Security (including Federal Emergency Management Agency) in the United States. 

Starting in early 2003, the United States government vaccinated 500,000 volunteer health care professionals throughout the country. Recipients were healthcare workers in emergency departments, intensive care units, anesthesiologists, and health care workers in other settings who would be crucial first-line responders in the event of a bioterrorist attack using smallpox. Many healthcare workers refused, worried about vaccine side effects, but many others volunteered. It is unclear how many actually received the vaccine.

In 2002, the Israeli Army, in a similar attempt at mass vaccination, found many soldiers unwilling to volunteer.

In May 2007, the Vaccines and Related Biological Products Advisory Committee of the FDA voted unanimously that a new live virus vaccine produced by Acambis, ACAM2000, is both safe and effective for use in persons at high risk of exposure to smallpox virus. However, due to the high rate of serious adverse effects, the vaccine will only be made available to the CDC (a part of the United States Department of Health and Human Services) for the Strategic National Stockpile.

History

Variolation

The mortality of the severe form of smallpox—variola major—was very high without vaccination, up to 35% in some outbreaks. A method of inducing immunity known as inoculation, insufflation or "variolation" was practiced before the development of a modern vaccine and likely occurred in Africa and China well before the practice arrived in Europe. It may also have occurred in India, but this is disputed; other investigators contend the ancient Sanskrit medical texts of India do not describe these techniques. The first clear reference to smallpox inoculation was made by the Chinese author Wan Quan (1499–1582) in his Douzhen xinfa (痘疹心法) published in 1549. Inoculation for smallpox does not appear to have been widespread in China until the reign era of the Longqing Emperor (r. 1567–1572) during the Ming Dynasty. In China, powdered smallpox scabs were blown up the noses of the healthy. The patients would then develop a mild case of the disease and from then on were immune to it. The technique did have a 0.5–2.0% mortality rate, but that was considerably less than the 20–30% mortality rate of the disease itself. Two reports on the Chinese practice of inoculation were received by the Royal Society in London in 1700; one by Dr. Martin Lister who received a report by an employee of the East India Company stationed in China and another by Clopton Havers. According to Voltaire (1742), the Turks derived their use of inoculation from neighbouring Circassia. Voltaire does not speculate on where the Circassians derived their technique from, though he reports that the Chinese have practiced it "these hundred years".

Variolation was also practiced throughout the latter half of the 17th century by physicians in Turkey, Persia, and Africa. In 1714 and 1716, two reports of the Ottoman Empire Turkish method of inoculation were made to the Royal Society in England, by Emmanuel Timoni, a doctor affiliated with the British Embassy in Constantinople, and Giacomo Pylarini. Lady Mary Wortley Montagu, wife of the British ambassador to Ottoman Constantinople, is widely credited with introducing the process to Great Britain in 1721. Source material tells us on Montagu; "When Lady Mary was in the Ottoman Empire, she discovered the local practice of inoculation against smallpox called variolation." In 1718 she had her son, aged five variolated. He recovered quickly. She returned to London and had her daughter variolated in 1721 by Charles Maitland, during an epidemic of smallpox. This encouraged the British Royal Family to take an interest and a trial of variolation was carried out on prisoners in Newgate Prison. This was successful and in 1722 Princess Augusta, the Princess of Wales, allowed Maitland to vaccinate her children. The success of these variolations assured the British people that the procedure was safe.

Stimulated by a severe epidemic, variolation was first employed in North America in 1721. The practice had been known in Boston since 1706, when Cotton Mather (of Salem witch trial fame) discovered his slave, Onesimus had been inoculated while still in Africa, and many slaves imported to Boston had also received inoculations. The practice was, at first, widely criticized. However, a limited trial showed six deaths occurred out of 244 who were variolated (2.5%), while 844 out of 5980 died of natural disease (14%), and the process was widely adopted throughout the colonies.

The inoculation technique was documented as having a mortality rate of only one in a thousand. Two years after Kennedy's description appeared, March 1718, Dr. Charles Maitland successfully inoculated the five-year-old son of the British ambassador to the Turkish court under orders from the ambassador's wife Lady Mary Wortley Montagu, who four years later introduced the practice to England.

An account from letter by Lady Mary Wortley Montagu to Sarah Chiswell, dated 1 April 1717, from the Turkish Embassy describes this treatment:

The small-pox so fatal and so general amongst us is here entirely harmless by the invention of ingrafting (which is the term they give it). There is a set of old women who make it their business to perform the operation. Every autumn in the month of September, when the great heat is abated, people send to one another to know if any of their family has a mind to have the small-pox. They make parties for this purpose, and when they are met (commonly fifteen or sixteen together) the old woman comes with a nutshell full of the matter of the best sort of small-pox and asks what veins you please to have opened. She immediately rips open that you offer to her with a large needle (which gives you no more pain than a common scratch) and puts into the vein as much venom as can lye upon the head of her needle, and after binds up the little wound with a hollow bit of shell, and in this manner opens four or five veins. . . . The children or young patients play together all the rest of the day and are in perfect health till the eighth. Then the fever begins to seize them and they keep their beds two days, very seldom three. They have very rarely above twenty or thirty in their faces, which never mark, and in eight days time they are as well as before the illness. . . . There is no example of any one that has died in it, and you may believe I am very well satisfied of the safety of the experiment since I intend to try it on my dear little son. I am patriot enough to take pains to bring this useful invention into fashion in England, and I should not fail to write to some of our doctors very particularly about it if I knew any one of them that I thought had virtue enough to destroy such a considerable branch of their revenue for the good of mankind, but that distemper is too beneficial to them not to expose to all their resentment the hardy wight that should undertake to put an end to it. Perhaps if I live to return I may, however, have courage to war with them.

Early vaccination

Dr Edward Jenner performing his first vaccination on James Phipps, a boy of age 8. May 14th, 1796. Painting by Ernest Board (early 20th century).

 

In the early empirical days of vaccination, before Pasteur's work on establishing the germ theory and Lister's on antisepsis and asepsis, there was considerable cross-infection. William Woodville, one of the early vaccinators and director of the London Smallpox Hospital is thought to have contaminated the cowpox matter—the vaccine—with smallpox matter and this essentially produced variolation. Other vaccine material was not reliably derived from cowpox, but from other skin eruptions of cattle. In modern times, an effective scientific model and controlled production were important in reducing these causes of apparent failure or iatrogenic illness.

During the earlier days of empirical experimentation in 1758, American Calvinist Jonathan Edwards died from a smallpox inoculation. Some of the earliest statistical and epidemiological studies were performed by James Jurin in 1727 and Daniel Bernoulli in 1766. In 1768 Dr John Fewster reported that variolation induced no reaction in persons who had had cowpox. Fewster was a contemporary and friend of Jenner. Dr. Rolph, another Gloucestershire physician, stated that all experienced physicians of the time were aware of this.

An 1802 caricature by James Gillray depicting the early controversy surrounding Jenner's vaccination theory

 

Edward Jenner was born in Berkeley, England. At the age of 13, he was apprenticed to apothecary Daniel Ludlow and later surgeon George Hardwick in nearby Sodbury. He observed that people who caught cowpox while working with cattle were known not to catch smallpox. Jenner assumed a causal connection but the idea was not taken up at that time. From 1770 to 1772 Jenner received advanced training in London at St Georges Hospital and as the private pupil of John Hunter, then returned to set up practice in Berkeley. When a smallpox epidemic occurred he advised the local cattle workers to be inoculated, but they told him that their previous cowpox infection would prevent smallpox. This confirmed his childhood suspicion, and he studied cowpox further, presenting a paper on it to his local medical society. 

Perhaps there was already an informal public understanding of some connection between disease resistance and working with cattle. The "beautiful milkmaid" seems to have been a frequent image in the art and literature of this period. But it is known for certain that in the years following 1770, at least six people in England and Germany (Sevel, Jensen, Jesty 1774, Rendall, Plett 1791) tested successfully the possibility of using the cowpox vaccine as an immunization for smallpox in humans. In 1796, Sarah Nelmes, a local milkmaid, contracted cowpox and went to Jenner for treatment. Jenner took the opportunity to test his theory. He inoculated James Phipps, the eight-year-old son of his gardener, with material taken from the cowpox lesions on Sarah's hand. After a mild fever and the expected local lesion James recovered after a few days. About two months later Jenner inoculated James on both arms with material from a case of smallpox, with no effect; the boy was immune to smallpox.

Diagram A: Exposure to the cowpox virus builds immunity to the smallpox virus. 1a.Cowpox virus is injected into the bloodstream. 2a.The virus enters the cells and a mild fever develops. 3a.T-cells recognize the antigen as a threat. 4a.Activated T-cells replicate, and their offspring become memory T-cells. 5a.Antibodies are produced and destroy the virus. Diagram B: When exposed to the smallpox virus, the immune system is resistant. 1b.Smallpox virus is injected into the bloodstream. 2b.Memory T cells recognize the virus. 3b.Antibodies are produced and destroy the virus.

 

The process above shows the steps taken by Edward Jenner to create vaccination. Jenner did this by inoculating James Phipps with cowpox, a similar virus to smallpox, to create immunity, unlike variolation, which used smallpox to create an immunity to itself.

 

Jenner sent a paper reporting his observations to the Royal Society in April 1797. Its contents are unknown. It was not submitted formally and there is no mention of it in the Society's records. Jenner had sent the paper informally to Sir Joseph Banks, the Society's president, who asked Everard Home for his views. His report, published for the first time in 1999, was sceptical and called for further vaccinations. These were done and in 1798 Jenner published an analysis of 23 'cases' including several individuals who had resisted natural exposure after previous cowpox. It is not known how many Jenner vaccinated or challenged by inoculation with smallpox virus; e.g. Case 21 included 'several children and adults'. Crucially all of at least four who Jenner deliberately inoculated with smallpox virus resisted it. These included the first and last patients in a series of arm-to-arm transfers. He concluded that cowpox inoculation was a safe alternative to smallpox inoculation, but rashly claimed that the protective effect was lifelong. This last proved to be incorrect. Jenner also tried to distinguish between 'True' cowpox which produced the desired result and 'Spurious' cowpox which was ineffective and/or produced severe reaction. Modern research suggests Jenner was trying to distinguish between effects caused by what would now be recognised as noninfectious vaccine, a different virus (e.g. paravaccinia/milker's nodes), or contaminating bacterial pathogens. This caused confusion at the time, but would become important criteria in vaccine development. A further source of confusion was Jenner's belief that fully effective vaccine obtained from cows originated in an equine disease, which he mistakenly referred to as grease. This was criticised at the time but vaccines derived from horsepox were soon introduced and later contributed to the complicated problem of the origin of vaccinia virus, the virus in present-day vaccine.

The introduction of the vaccine to the New World took place in Trinity, Newfoundland, in 1798 by Dr. John Clinch, boyhood friend and medical colleague of Jenner. The first smallpox vaccine in the United States was administered in 1799. The physician Valentine Seaman gave his children a smallpox vaccination using a serum acquired from Jenner. By 1800, Jenner's work had been published in all the major European languages and had reached Benjamin Waterhouse in the United States — an indication of rapid spread and deep interest. Despite some concern about the safety of vaccination the mortality using carefully selected vaccine was close to zero, and it was soon in use all over Europe and the United States.

The Balmis Expedition took the vaccine to Spanish America in 1804

 

In 1804 the Balmis Expedition, an official Spanish mission commanded by Francisco Javier de Balmis, sailed to spread the vaccine throughout the Spanish Empire, first to the Canary Islands and on to Spanish Central America. While his deputy, José Salvany, took vaccine to the west and east coasts of Spanish South America, Balmis sailed to Manila in the Philippines and on to Canton and Macao on the Chinese coast. He returned to Spain in 1806.

The question of who first tried cowpox inoculation/vaccination cannot be answered with certainty. Most, but still limited, information is available for Benjamin Jesty, Peter Plett and John Fewster. In 1774 Jesty, a farmer of Yetminster in Dorset, observing that the two milkmaids living with his family were immune to smallpox, inoculated his family with cowpox to protect them from smallpox. He attracted a certain amount of local criticism and ridicule at the time then interest waned. Attention was later drawn to Jesty, and he was brought to London in 1802 by critics jealous of Jenner's prominence at a time when he was applying to Parliament for financial reward. During 1790–92 Peter Plett, a teacher from Holstein, reported limited results of cowpox inoculation to the Medical Faculty of the University of Kiel. However, the Faculty favoured variolation and took no action. John Fewster, a surgeon friend of Jenner's from nearby Thornbury, discussed the possibility of cowpox inoculation at meetings as early as 1765. He may have done some cowpox inoculations in 1796 at about the same time that Jenner vaccinated Phipps. However Fewster, who had a flourishing variolation practice, may have considered this option but used smallpox instead. He thought vaccination offered no advantage over variolation, but maintained friendly contact with Jenner and certainly made no claim of priority for vaccination when critics attacked Jenner's reputation. It seems clear that the idea of using cowpox instead of smallpox for inoculation was considered, and actually tried in the late 18th century, and not just by the medical profession. Therefore, Jenner was not the first to try cowpox inoculation. However, he was the first to publish his evidence and distribute vaccine freely, provide information on selection of suitable material, and maintain it by arm-to-arm transfer. The authors of the official World Health Organization (WHO) account Smallpox and its Eradication assessing Jenner's role wrote:

Publication of the Inquiry and the subsequent energetic promulgation by Jenner of the idea of vaccination with a virus other than variola virus constituted a watershed in the control of smallpox for which he, more than anyone else deserves the credit.

As vaccination spread, some European countries made it compulsory. Concern about its safety led to opposition and then repeal of legislation in some instances. Compulsory infant vaccination was introduced in England by the 1853 Vaccination Act. By 1871, parents could be fined for non-compliance, and then imprisoned for non-payment. This intensified opposition, and the 1898 Vaccination Act introduced a conscience clause. This allowed exemption on production of a certificate of conscientious objection signed by two magistrates. Such certificates were not always easily obtained and a further Act in 1907 allowed exemption by a statutory declaration which could not be refused. Although theoretically still compulsory, the 1907 Act effectively marked the end of compulsory infant vaccination in England.

In the United States vaccination was regulated by individual states, the first to impose compulsory vaccination being Massachusetts in 1809. There then followed sequences of compulsion, opposition and repeal in various states. By 1930 Arizona, Utah, North Dakota and Minnesota prohibited compulsory vaccination, 35 states allowed regulation by local authorities, or had no legislation affecting vaccination, whilst in ten states, including Washington, D.C. and Massachusetts, infant vaccination was compulsory. Compulsory infant vaccination was regulated by only allowing access to school for those who had been vaccinated. Those seeking to enforce compulsory vaccination argued that the public good overrode personal freedom, a view supported by the U.S. Supreme Court in Jacobson v. Massachusetts in 1905, a landmark ruling which set a precedent for cases dealing with personal freedom and the public good.

Louis T. Wright, an African American and Harvard Medical School graduate (1915), introduced intradermal vaccination for smallpox for the soldiers while serving in the Army during World War I.

Developments in production

Until the end of the 19th century, vaccination was performed either directly with vaccine produced on the skin of calves or, particularly in England, with vaccine obtained from the calf but then maintained by arm-to-arm transfer; initially in both cases vaccine could be dried on ivory points for short term storage or transport but increasing use was made of glass capillary tubes for this purpose towards the end of the century. During this period there were no adequate methods for assessing the safety of the vaccine and there were instances of contaminated vaccine transmitting infections such as erysipelas, tetanus, septicaemia and tuberculosis. In the case of arm-to-arm transfer there was also the risk of transmitting syphilis. Although this did occur occasionally, estimated as 750 cases in 100 million vaccinations, some critics of vaccination e.g. Charles Creighton believed that uncontaminated vaccine itself was a cause of syphilis. Smallpox vaccine was the only vaccine available during this period, and so the determined opposition to it initiated a number of vaccine controversies that spread to other vaccines and into the 21st century. 

Sydney Arthur Monckton Copeman, an English Government bacteriologist interested in smallpox vaccine investigated the effects on the bacteria in it of various treatments, including glycerine. Glycerine was sometimes used simply as a diluent by some continental vaccine producers. However, Copeman found that vaccine suspended in 50% chemically-pure glycerine and stored under controlled conditions contained very few "extraneous" bacteria and produced satisfactory vaccinations. He later reported that glycerine killed the causative organisms of erysipelas and tuberculosis when they were added to the vaccine in "considerable quantity", and that his method was widely used on the continent. In 1896, Copeman was asked to supply "extra good calf vaccine" to vaccinate the future Edward VIII.

Vaccine produced by Copeman's method was the only type issued free to public vaccinators by the English Government Vaccine Establishment from 1899. At the same time the 1898 Vaccination Act banned arm-to-arm vaccination, thus preventing transmission of syphilis by this vaccine. However, private practitioners had to purchase vaccine from commercial producers. Although proper use of glycerine reduced bacterial contamination considerably the crude starting material, scraped from the skin of infected calves, was always heavily contaminated and no vaccine was totally free from bacteria. A survey of vaccines in 1900 found wide variations in bacterial contamination. Vaccine issued by the Government Vaccine Establishment contained 5,000 bacteria per gram, while commercial vaccines contained up to 100,000 per gram. The level of bacterial contamination remained unregulated until the Therapeutic Substances Act, 1925 set an upper limit of 5,000 per gram, and rejected any batch of vaccine found to contain the causative organisms of erysipelas or wound infections. Unfortunately glycerolated vaccine soon lost its potency at ambient temperatures which restricted its use in tropical climates. However, it remained in use into the 1970s where a satisfactory cold chain was available. Animals continued to be widely used by vaccine producers during the smallpox eradication campaign. A WHO survey of 59 producers, some of whom used more than one source of vaccine, found that 39 used calves, 12 used sheep and 6 used water buffalo, whilst only 3 made vaccine in cell culture and 3 in embryonated hens' eggs. English vaccine was occasionally made in sheep during World War I but from 1946 only sheep were used.

In the late 1940s and early 1950s, Leslie Collier, an English microbiologist working at the Lister Institute of Preventive Medicine, developed a method for producing a heat-stable freeze-dried vaccine in powdered form. Collier added 0.5% phenol to the vaccine to reduce the number of bacterial contaminants but the key stage was to add 5% peptone to the liquid vaccine before it was dispensed into ampoules. This protected the virus during the freeze drying process. After drying the ampoules were sealed under nitrogen. Like other vaccines, once reconstituted it became ineffective after 1–2 days at ambient temperatures. However, the dried vaccine was 100% effective when reconstituted after 6 months storage at 37 °C (99 °F) allowing it to be transported to, and stored in, remote tropical areas. Collier's method was increasingly used and, with minor modifications, became the standard for vaccine production adopted by the WHO Smallpox Eradication Unit when it initiated its global smallpox eradication campaign in 1967, at which time 23 of 59 manufacturers were using the Lister strain.

In a letter about landmarks in the history of smallpox vaccine, written to and quoted from by Derrick Baxby, Donald Henderson, chief of the Smallpox Eradication Unit from 1967–77 wrote; "Copeman and Collier made an enormous contribution for which neither, in my opinion ever received due credit".

Smallpox vaccine was inoculated by scratches into the superficial layers of the skin, with a wide variety of instruments used to achieve this. They ranged from simple needles to multi-pointed and multi-bladed spring-operated instruments specifically designed for the purpose.

A major contribution to smallpox vaccination was made in the 1960s by Benjamin Rubin, an American microbiologist working for Wyeth Laboratories. Based on initial tests with textile needles with the eyes cut off transversely half-way he developed the bifurcated needle. This was a sharpened two-prong fork designed to hold one dose of reconstituted freeze-dried vaccine by capillarity. Easy to use with minimum training, cheap to produce ($5 per 1000), using four times less vaccine than other methods, and repeatedly re-usable after flame sterilization, it was used globally in the WHO Smallpox Eradication Campaign from 1968. Rubin estimated that it was used to do 200 million vaccinations per year during the last years of the campaign. Those closely involved in the campaign were awarded the "Order of the Bifurcated Needle". This, a personal initiative by Donald Henderson, was a lapel badge, designed and made by his daughter, formed from the needle shaped to form an "O". This represented "Target Zero", the objective of the campaign.

Eradication of smallpox

Smallpox eradication promotional poster

Smallpox was eradicated by a massive international search for outbreaks, backed up with a vaccination program, starting in 1967. It was organised and co-ordinated by a World Health Organization (WHO) unit, set up and headed by Donald Henderson. The last case in the Americas occurred in 1971 (Brazil), south-east Asia (Indonesia) in 1972, and on the Indian subcontinent in 1975 (Bangladesh). After two years of intensive searches, what proved to be the last endemic case anywhere in the world occurred in Somalia, in October 1977. A Global Commission for the Certification of Smallpox Eradication chaired by Frank Fenner examined the evidence from, and visited where necessary, all countries where smallpox had been endemic. In December 1979 they concluded that smallpox had been eradicated; a conclusion endorsed by the WHO General Assembly in May 1980. However, even as the disease was being eradicated there still remained stocks of smallpox virus in many laboratories. Accelerated by two cases of smallpox in 1978, one fatal (Janet Parker), caused by an accidental and unexplained containment breach at a laboratory at the University of Birmingham Medical School, the WHO ensured that known stocks of smallpox virus were either destroyed or moved to safer laboratories. By 1979 only four laboratories were known to have smallpox virus. All English stocks held at St Mary's Hospital, London were transferred to more secure facilities at Porton Down and then to the US at the Centers for Disease Control and Prevention (CDC) in Atlanta, Georgia in 1982, and all South African stocks were destroyed in 1983. By 1984 the only known stocks were kept at the CDC in the US and the State Research Center of Virology and Biotechnology (VECTOR) in Koltsovo, Russia. These states report that their repositories are for possible anti-bioweaponry research and insurance if some obscure reservoir of natural smallpox is discovered in the future.

Terminology

The word "vaccine" is derived from Variolae vaccinae (i.e. smallpox of the cow), the term devised by Jenner to denote cowpox and used in the long title of his An enquiry into the causes and effects of Variolae vaccinae, known by the name of cow pox. Vaccination, the term which soon replaced cowpox inoculation and vaccine inoculation, was first used in print by Jenner's friend, Richard Dunning in 1800. Initially, the terms vaccine/vaccination referred only to smallpox, but in 1881 Louis Pasteur proposed that to honour Jenner the terms be widened to cover the new protective inoculations being introduced.

Vaccine stockpiles

In late 2001, the governments of the United States and the United Kingdom considered stockpiling smallpox vaccines, even while assuring the public that there was no "specific or credible" threat of bioterrorism. Later, the director of State Research Center of Virology and Biotechnology VECTOR warned that terrorists could easily lure underpaid former Soviet researchers to turn over samples to be used as a weapon, saying "All you need is a sick fanatic to get to a populated place. The world health system is completely unprepared for this."

In the United Kingdom, controversy occurred regarding the company which had been contracted to supply the vaccine. This was because of the political connections of its owner, Paul Drayson, and questions over the choice of vaccine strain. The strain was different from that used in the United States. Plans for mass vaccinations in the United States stalled as the necessity of the inoculation came into question.

American Medical Association

From Wikipedia, the free encyclopedia

Formation	May 7, 1847; 171 years ago
Type	Professional association
Purpose	"To Promote the art and science of medicine and the betterment of public health"
Headquarters	Chicago, Illinois, U.S.
Location	United States
Membership	240,359 as of 2016
Official language	English
President	Barbara L. McAneny, M.D.
Key people	Board Chair Jack Resneck, Jr., M.D. ; CEO & EVP James Madara, M.D.
Website	http://www.ama-assn.org/

The American Medical Association (AMA), founded in 1847 and incorporated in 1897, is the largest association of physicians—both MDs and DOs—and medical students in the United States.

The AMA's mission is "to promote the art and science of medicine and the betterment of public health." The Association also publishes the Journal of the American Medical Association (JAMA). The AMA also publishes a list of Physician Specialty Codes which are the standard method in the U.S. for identifying physician and practice specialties.

The American Medical Association is governed by a House of Delegates as well as a board of trustees in addition to executive management. The organization maintains the AMA Code of Medical Ethics that is the guide to ethical practice of medicine and the AMA Physician Masterfile containing data on United States Physicians. The Current Procedural Terminology coding system was first published in 1966, and is maintained by the Association. It has also published works such as the Guides to Evaluation of Permanent Impairment and established the American Medical Association Foundation and the American Medical Political Action Committee.

History

1847–1900

In 1847, the American Medical Association was founded in Philadelphia by Nathan Smith Davis as a national professional medical organization. The organization was established not only to advance scientific research and improve medical education standards but to improve public health. The AMA established the world's first national code for ethical medical practice, the AMA Code of Medical Ethics. The organization educated people about the dangers of patent medicines and called for legislation regulating their production and sale. One resulting legislation was the Drug Importation Act of 1848. In May 1848, the AMA held its first meeting in Baltimore. The resulting Committee on Surgery produced the report Transactions of the American Medical Association which included lists and reports of cases of physiological effects of ether and chloroform at the Massachusetts General Hospital in Boston, the New York Hospital and the clinics of the University of Pennsylvania and Jefferson Medical College. In 1846, the organization created a committee dedicated to analyzing the methodology of vital records registration. It urged state governments to adopt measures to register births, marriages and deaths within their populations.

At the organization's second meeting in 1849, Thomas Wood suggested a committee on medical science to establish a board to analyze quack remedies and nostrums to be published in order to inform the public about the dangers of such remedies. The AMA's attempts to expose quack remedies aided the passage of the first Pure Food and Drug Act in 1906.

The AMA Committee on Ethics advocated for recognition of qualified female physicians in 1869, and the AMA inducted its first female member, Sarah Hackett Stevenson, as an Illinois State Medical Society delegate in 1876.

The Journal of the American Medical Association was launched in 1883. The organization's founder, Nathan Smith Davis, served as the first editor of the publication.

In 1897, the American Medical Association was incorporated in the state of Illinois. The Association's Committee on National Legislation established the Committee on Medical Legislation in 1899. Also in 1899, the Association appointed a committee to report on tuberculosis, included its communicability and prevention. The Committee on Tuberculosis presented its report in October 1900.

AMA pushed for laws requiring compulsory smallpox vaccinations in 1899.

1901–1920

In 1901, the AMA was reorganized with its central authority shifted to a House of Delegates, a board of trustees, and executive offices. The House of Delegates was modeled after the United States House of Representatives and included representatives from medical organizations across the United States as a formal, reform-minded legislative body. The organization's new president appointed a Committee on Medical Education in order to evaluate medical education in the United States and make recommendations for its improvement.

AMA created the Council on Pharmacy and Chemistry in 1905 to set standards for drug manufacturing and advertising. That same year, the Association began a voluntary program of drug approval, which would remain in effect until 1955. Drug companies were required to show proof of the effectiveness of their drugs to advertise them in AMA's journal.

In 1906, the American Medical Association established a Physician Masterfile designed to contain data on physicians in the United States as well as graduates of American medical schools and international graduates who are in the United States. Each file is established when an individual either enters medical schools or enters the United States.

The AMA established the Council for the Defense of Medical Research in 1908.

AMA's Council on Medical Education and Hospitals first published its annual list of hospitals approved for internships in 1914.

The American Medical Association established a policy of opposition to compulsory health insurance by state or federal government in 1920.

1921–1960

In May 1922, the Woman's Auxiliary to the American Medical Association was organized. The following year, the AMA established standards for medical specialty training residency programs. The Association later published its first list of hospitals approved for residency training in 1927.

In 1927, Congress passed the Caustic Poison Act, lobbied by the American Medical Association, which required product labels to include warnings if they included lye or 10 other caustic chemicals.

The Normal Diet, a comprehensive listing of what Americans should be eating, was published by the AMA in 1938.

A formal partnership between the AMA and the Association of American Medical Colleges formed the Liaison Committee on Medical Education in 1942 in order to establish requirements for certification of medical schools. In 1951, the Joint Commission on Accreditation of Hospitals was created through merging the Hospital Standardization Program with quality standards from the American College of Physicians, the American Hospital Association, and the American Medical Association. The Commission, established for evaluation and accreditation of healthcare organizations in the United States, governed by a board of commissioners including physicians, consumers and administrators.

AMA publicly endorsed the principle of fluoridation of community and water supplies in 1951.

The Physicians Advisory Committee on Television, Radio and Motion Pictures was established by the AMA in 1955 in order to maintain medical accuracy in media. The American Medical Association's Committee on Alcoholism issued a statement in 1956 calling alcoholism an illness and encouraging medical personnel and institutions to admit and treat alcoholic patients.

1961–1980

In 1961, the American Medical Association opposed the King-Anderson bill proposing Medicare legislation and took out advertisements in newspapers, radio and television against government health insurance. The Association established the American Medical Political Action Committee, which was separate from AMA though the Association nominated its board of directors. The AMA's efforts to defeat Medicare legislation was called Operation Coffee Cup and included secretive meetings in which the vinyl LP "Ronald Reagan Speaks Out Against Socialized Medicine" was played. The AMA created an "Eldercare" proposal rather than hospital insurance through Social Security.

The AMA first published the Current Procedural Terminology coding system in 1966. The system was created for uniform reporting of outpatient physician services. The first manual was 163 pages and contained only four-digit codes with descriptions of each. A second edition of the book was published in 1970 with a fifth digit added.

In 1969, AMA proposed the Medicredit program. The program was created to be flexible so that all people had an option for health insurance.

The American Medical Association published the first Guides to the Evaluation of Permanent Impairment in 1971. The guides were later republished in 1977 before the AMA Council on Scientific Affairs created 12 committees to review the guides before the second edition was published in 1984.

The AMA spoke out against gender discrimination in medical institutions in the 1970s. In the 1970s, the AMA spoke out against gender discrimination in medical institutions. In 1972, the AMA launched a "war on smoking" and supported legislation that would prohibit tobacco sample disbursement. The following year, in 1973, the AMA urged physicians to combat hypertension through a national program. In 1975, the American Medical Association adopted a policy stating that "unequivocal-discrimination based on sexual orientation is improper and unacceptable by any part of the federation of medicine." It adopted a resolution to repeal all state sodomy laws.

In 1976, the AMA began encouraging all public facilities to have handicap access.

1981–2000

The AMA released a survey in 1981 that found two short-term effects of dioxin on humans and recommended further studies. By 1983, the Association accused the news media of conducting a "witch hunt" against the toxic chemical and launched a public information campaign to counter media hysteria.

In the early 1980s, the American Medical Association advocated for raising the national legal drinking age to 21. The Supreme Court of the United States upheld Federal Trade Commission order that allowed doctors and dentists to advertise without professional associations interfering in 1982. The order restrained the American Medical Association from obstructing agreements between physicians and health maintenance organizations.

In May 1983, the Journal of the American Medical Association published a report that reviewed cases of childhood AIDS. The American Medical Association called for a ban on advertising and promotion of all tobacco products in any form of media. The AMA also proposed declaring snuff and chewing tobacco a health hazard, increasing the tax on cigarettes, prohibiting smoking on public transportation and urged medical facilities to ban smoking on their premises.

A Federal district judge ruled that the AMA had violated the Sherman Antitrust Act in 1987 by depriving chiropractors access to the Association. The lawsuit, filed by four chiropractors, accused AMA of conspiring to prevent chiropractors from practicing in the United States.

In 1990, AMA published Health Assess America, which proposed improved access to affordable health care for citizens without healthcare insurance.

The Journal of the American Medical Association first documented that Joe Camel cartoons reached more children than adults in December 1991. The Association called for the R. J. Reynolds Tobacco Company to stop using the Joe Camel character in its advertising because of its appeal to youth.

In 1995, Lonnie R. Bristow became the first African-American president of the American Medical Association. Before he became president, Bristow was the first African-American member of the Board of Trustees and first African-American chairman of the Board. The AMA campaigned against health plan "gag clauses" in 1996, stating that the stipulations inhibit the communication of information and restrict the care doctors can give their patients. The clauses were removed from 5 leading providers, and laws prohibiting such clauses were passed in 16 states.

In 1997, the AMA established the National Patient Safety Foundation as an independent, nonprofit research and education organization focused on patient safety. Nancy W. Dickey was named president of the American Medical Association in June 1998. She was the first woman to head the organization and had been part of AMA's leadership since 1977.

2000–present

In 2002, the American Medical Association released a report that found a medical liability insurance crisis in at least a dozen states forcing physicians to either close practices or limit services. The association called for Congress to take action and campaigned for national reform. The American Medical Association launched the "Voice for the Uninsured" campaign in 2007 to promote coverage for uninsured citizens.

In 2007, AMA called for state and federal agencies to investigate potential conflicts of interest between the retail clinics and pharmacy chains. The American Medical Association issued a formal apology for previous policies that excluded African-Americans from the organization and announced increased efforts to increase minority physician participation in the AMA in 2008.

In 2009, the American Medical Association released a public letter to the United States Congress and President Barack Obama endorsing his proposed overhaul to the public health care system, including universal health coverage. The following year, it offered "qualified support" for the Patient Protection and Affordable Care Act.

The AMA officially recognized obesity as a disease in 2013 in an attempt to change how the medical community approaches the issue. In 2014, the Association created the AMA Opioid Task Force to evaluate prescription opioid use and abuse. The American Medical Association supported the Medicare Access and CHIP Reauthorization Act of 2015 which introduced Medicare reforms and replaced the SGR formula with increased Medicare physician reimbursement.

In 2015, the AMA declared there is no medically valid reason to exclude transgender individuals from serving in the U.S. military. The Human Rights Campaign lauded the decision. The Association announced its opposition to replacing the federal health care law in March 2017, claiming millions of Americans would lose health care coverage.

Policy positions

The AMA has one of the largest political lobbying budgets of any organization in the United States. Its political positions throughout its history have often been controversial. In the 1930s, the AMA attempted to prohibit its members from working for the health maintenance organizations established during the Great Depression, which violated the Sherman Antitrust Act and resulted in a conviction ultimately affirmed by the US Supreme Court. The American Medical Association's vehement campaign against Medicare in the 1950s and 1960s included the Operation Coffee Cup, supported by Ronald Reagan. Since the enactment of Medicare, the AMA reversed its position and now opposes any "cut to Medicare funding or shift [of] increased costs to beneficiaries at the expense of the quality or accessibility of care". However, the AMA remains opposed to any single-payer health care plan that might enact a National Health Service-style organization in the United States, such as the United States National Health Care Act. In the 1990s, the organization was part of the coalition that defeated the health care reform advanced by Hillary and Bill Clinton.

The AMA has also supported changes in medical malpractice law to limit damage awards, which, it contends, makes it difficult for patients to find appropriate medical care. In many states, high risk specialists have moved to other states that have enacted reform. For example, in 2004, all neurosurgeons had relocated out of the entire southern half of Illinois. The main legislative emphasis in multiple states has been to effect caps on the amount that patients can receive for pain and suffering. These costs for pain and suffering are only those that exceed the actual costs of healthcare and lost income. At the same time however, states without caps also experienced similar results; suggesting that other market factors may have contributed to the decreases. Some economic studies have found that caps have historically had an uncertain effect on premium rates. Nevertheless, the AMA believes the caps may alleviate what is often perceived as an excessively litigious environment for many doctors. A recent report by the AMA found that in a 12-month period, five percent of physicians had claims filed against them.

Claims that the AMA generates $70 million in revenue through its stewardship of Current Procedural Terminology (CPT) codes appear to be a mischaracterization. The estimate is based on a distortion of the transparent financial information the AMA voluntarily offers in its Annual Report. The AMA has publicly reported this figure represents income from its complete line of books and products, which include more than 100 items, not just CPT.

The AMA sponsors the Specialty Society Relative Value Scale Update Committee which is an influential group of 29 physicians, mostly specialists, who help determine the value of different physicians' labor in Medicare prices.

Collections of the association's papers dating from the late 1860s to the late 1960s are held at the National Library of Medicine.

Criticism

During the Civil Rights Movement, the American Medical Association's policy of allowing its constituent groups to be racially segregated in areas with widespread prejudice faced opposition from doctors as well as other healthcare professionals. Pressure from organizations such as the Medical Committee for Human Rights (MCHR) resulted in changed policies by the late 1960s. The AMA was also criticized for the lack of newly licensed foreign-trained medical professionals after Adolf Hitler came to power, who were fleeing to the U.S. from Nazi-controlled Germany and adjacent nations.

Nobel Memorial Prize-winning economist Milton Friedman as well as his wife, Rose Friedman, have claimed that the organization acts as a guild and has attempted to increase physicians' wages and fees by influencing limitations on the supply of physicians and competition from non-physicians. In the book Free to Choose, the Friedmans stated that "the AMA has engaged in extensive litigation charging chiropractors and osteopathic physicians with the unlicensed practice of medicine, in an attempt to restrict them to as narrow an area as possible." Profession and Monopoly also criticized the AMA for limiting the supply of physicians and inflating the cost of medical care in the U.S as well as its influence on hospital regulation.

In a 1987 antitrust court case, a federal district judge called the AMA's behavior toward chiropractors "systematic, long-term wrongdoing". The AMA was accused of limiting the associations between physicians and chiropractors. In the 1960s and 1970s, the association's Committee on Quackery was said to have targeted the chiropractic profession, and for many years the AMA held that it was unethical for physicians to refer patients to chiropractors or to receive referrals from chiropractors.

Structure

The AMA is composed of various internal groups that discuss policy twice a year. There is an annual meeting, always held in Chicago, IL and an Interim meeting set on a rotating schedule for different locations. Within the AMA, there are sections that can make up the total AMA. These sections include Medical Students, Resident and Fellows, Academic physicians, Medical School Deans and Faculty, Physicians in group practice setting, Retired and Senior Physicians, International Medical graduates, Woman physicians, Physician Diversity and Minority health, GLBT, USAN, AMA board of Trustees, Foundation and Council. Externally to the AMA, there are organizations that come to these meetings by sending representatives. These representatives meet two a year in the House of Delegates at the Interim and/or annual meeting. Representatives come from medical societies that are either from a state, specialty or the federal services/government services. These organizations are called AMA member organizations.

Charitable activities

The AMA Foundation provides approximately $1,000,000 annually in tuition assistance to financially needy students. This has to be seen on the background that in 2007, graduating medical students carried a mean debt load of $140,000 which rose to $220,000 after four years of negative amortization during residency medical student debt has increased by 7% each successive year. By the time debt is paid off, it is sometimes almost half a million dollars.