were listed by the UMW welfare fund as participants in treating fund beneficiaries received letters from the society asking them to resign their connection with the fund.

I have a copy of one of the letters here which I will include in the record. The letter concluded with the statement:

Your failure to comply will result in disciplinary action being taken by your medical society.

That is a quote.

This discipline is exercised not in order to promote high quality care, but to protect certain narrow economic interests.

(The letter referred to follows:)

LETTER FROM THE EXECUTIVE SECRETARY OF THE STARK COUNTY (OHIO) MEDICAL SOCIETY WRITTEN IN 1960 TO A PHYSICIAN PARTICIPATING IN THE UNITED MINE WORKERS MEDICAL PROGRAM

DEAR DOCTOR: The United Mine Workers pamphlet dated June 1, 1960, “With Whom the Fund Has Business," shows you as a participant in Stark County. The council of the Stark County Medical Society at their meeting September 20 has asked you to resign in compliance with the motion passed at our regularly stated meeting last spring.

Your failure to comply will result in disciplinary action being taken by your medical society.

Yours very truly,

J. H. AUSTIN, Executive Secretary.

Mr. KING. How do you, Doctor, justify these situations in the light of your pledge, "We shall not tolerate anything but the finest quality medical care and the highest standards of professional ethics known to science"?

Dr. LARSON. Mr. King, I do not justify that action at all, provided what you have read are the facts in the matter. I am not thoroughly familiar with the situation. However, I do not see how the American Medical Association can be blamed for the action of a society which is only a part of the association.

Mr. KING. Is there nothing in the bylaws of the American Medical Association that offers disciplinary action?

Dr. LARSON. Nothing in the bylaws. That's in the code of ethics. We have just recently passed some resolutions relative to disciplinary

action.

Under the previous resolutions, bylaws, and codes of ethics of the American Medical Association action could not be initiated by the association itself. But at the meeting in New York in June, the house of delegates resolved that action could be initiated by the Judicial council of the American Medical Association and that complaints of unethical practices and such would not necessarily have to come up from the local society to the national organization.

Mr. KING. That is, at the time these letters were directed by State Societies to member physicians and surgeons there was nothing the American Medical Association could do about it?

Dr. LARSON. May I ask Mr. Stetler to comment on that?

Mr. KING. Yes.

Mr. STETLER. Congressman, you mentioned one case, a New York case. I am not familiar with the identity of the individual involved, but I think it is pertinent to this discussion to tell you that 6 years

ago, a physician in New York State by the name of Dr. Landis was censured by the county and by the New York State Medical Society. This action was brought up on appeal to the American Medical As sociation's Judicial Council.

To my knowledge, in my work with the AMA this is the only case of this type that has come before our judicial council. I think the committee should know that the Judicial Council of the AMA reversed the opinion of the New York State Medical Society and held in favor of the physician. This physician happened to be a doctor who was involved with HIP. That is the only case to my knowledge that we have had any jurisdiction over and in that case, we reversed the New York State society.

Mr. KING. However, heretofore State and local branch societies. were quite on their own as far as action taken with respect to recalcitrant surgeons within their membership?

Dr. LARSON. Yes, and I believe that that is perfectly proper. I think that on the local level, the physicians know what the situation is. I assume that you have a copy of the address that I made in New York on the subject of disciplinary action. I stressed the point that I thought every local society should appoint a so-called disciplinary committee and that it should consist of men who not only know the practice of medicine and are familiar with medical ethics, but who have the courage to deal with these problems.

Dr. ANNIS. Mr. King, may I comment on this?

Mr. KING. You may.

Dr. ANNIS. In Dade County, where I practice, and in the State of Florida, it is not necessary for a doctor to be a member of the American Medical Association to be a member of our local county society. We have disciplinary committees that review grievances any time that we hear of a patient who has been given what he felt was poor care, or not given adequate care, or overcharged. These complaints have come before disciplinary committees and the doctor is brought in. All of the facts are discussed, and if necessary, he is advised to change his policy, to scale his charges down, or various things of this kind. This is purely a local matter. From the disciplinary point of view, as far as ostracizing a man from medicine, in all of the time I have practiced the only time that I know that this has occurred is where a man has been involved in a violation of law, involving narcotics and similar legal or moral responsibility; never, never by virtue of the fact that he disagrees with the governing body on the local, on the State, or on the National policy as established by any member group of the American Medical Association.

Mr. KING. Dr. Larson, the implication would be quite heavy within the American Medical Assocition that very definite disapproval by the society would be voiced with respect to any number of doctors, wherever they may reside in the country, if they were to take a definite stand in approving H.R. 4222. Is not that the case?

Dr. LARSON. We would certainly respect the opinion of any of our members, Mr. King, and I would like right here for the record, Mr. King, to ask that if in any instance there is proof that can be given to me concerning threats or expulsions for not agreeing with the official policy of the American Medical Association, I will do what I can do run it down and I will convey to you my findings. I promise you that.

Mr. Chairman, may I ask Dr. Howard to comment on the situation which occurred yesterday which involved Dr. Howard personally?

Dr. HOWARD. I should just like to correct the record with reference to what Dr. Butler, I understand, said before this committee yesterday. It is my understanding that he accused me of taking some kind of action, of communicating with the Wayne County Medical Society and thereby hindering his application for membership in that society. I should like to make it categorically and unequivocally clear that I took no such action at any time. I have never talked to anyone in the Wayne County Medical Society about Dr. Allan Butler.

One final statement, Mr. Chairman. I actually called Dr. Bill Bromme, a member of the council of the Wayne County Medical Society, a delegate to the American Medical Association, last night and asked him this question: "Did I ever lead any member of your council to believe that I personally did not favor or that I opposed or had any position with reference to the membership of Dr. Allan Butler in your society?"

Dr. Bromme participated from beginning to end in the membership consideration of Dr. Butler and he permitted me to mention his name today and to tell this committee at no time did my name ever enter into the proceedings with reference to the membership of Dr. Butler. I would like the record of that to be absolutely clear.

Mr. KING. Doctor, in my acquaintance I have as friends several physicians and surgeons. Quite naturally, when we have met we have discussed this proposal in H.R. 4222. A few of them are inclined to favor the proposal, but in each case they were most reluctant to ever have their names mentioned publicly as being in favor. Now, that could stem from their fears that they would be on an unfavorable list of their State or local society or it could stem from a concern for their reputation in the community if they supported a bill that had been depicted as this bill has been by the society. I think that most professional men would hesitate to be affiliated with groups or individually as favoring a proposal that has been labeled in advertisements issued by the American Medical Association rating the bill, as the society does rate it, as socialism, as ruining the doctorpatient relationship, as bringing the force of great Government in to dictate the policy of operating hospitals, and all that sort of unfounded thing. I noticed in this statement last night that no mention was made that the bill was socialistic, but in practically every advertisement issued by your society that term and even worse was used regularly time after time in newspapers and magazines.

Was there any reason to prompt the deletion of the word "socialism" from this extensive statement you presented to this committee? Dr. LARSON. No; there was no reason.

Mr. KING. I looked for it and I expected to be able to find it throughout and did not find it. I was merely prompted to believe there was one method of testifying here and there would be others intended to influence people in the field. It just seemed unusual that a well-worn term has been associated with all the releases, or a great number of them, from the AMA, and yet in the official statement before the committee it is not mentioned one time, to my knowledge.

Dr. LARSON. Mr. King, with respect to the first part of your question, the explanation of the situation with respect to physicians

who may not agree with the official policy of the American Medical Association, and who may be supporters of your bill, I agree with you that there might be the feeling on the part of those individuals that they would be subject to what you call disciplinary action or ostracism, and so forth, but I do not believe, Mr. King, that that happens, and personally I do not want to see it happen. I will tell you that in any instance where I know that it has happened from the facts I am going to try to do something about it. I feel very keenly about this because I know there are a lot of physicians who do not agree with all of the policies. I do not know how many

there are.

One of the best friends I have in this country works for a labor plan. We have worked together. We do not agree. He is a member of the American Medical Association and he is a specialist, and one of the best in this country. You might say from some of these things that I would be ashamed to even associate with such a man. I am not. I appreciate everything he has done. We do not agree on everything, and certainly I would be the last one to even intimate that he should be censured by anyone. I would be the first one to defend his right to take his own position in the matter.

Mr. KING. I am pleased to hear that, Doctor, and I had never felt that you felt otherwise. I have read of your background and I am quite well acquainted with it, and I take for granted that you are the sort of person that you have just represented yourself to be with respect to this situation. I am wondering if it would not be well in view of the statements I have heard doctors making that your journal perhaps at some time in the future spell out as one of the new principles of the society what you have claimed here, that at no time will a physician or surgeon in this country be boycotted or otherwise disciplined for stating views on legislation such as this that run counter to the established views of the society itself.

Would you not think that would be helpful in view of the allegations and charges that have been repeatedly made that the AMA does have methods of disciplining doctors who do not conform in their views with those of the AMA with respect to many proposals that are presented to State legislatures and to the Congress of the United States?

Dr. LARSON. Mr. Chairman, would you allow Dr. Annis to say a word?

The CHAIRMAN. Yes.

Dr. ANNIS. I merely wanted to correct the record. This is not a new policy. This has always been the established policy of the American Medical Association. This is an example of many of the accusations to which I alluded in my opening remarks, prompted by some of the testimony presented to this committee during the week. If you tell something over and over and over again, and nobody stands up there with the record to defend it, pretty soon everyone, even members of the profession, believes these things are true. There are members of the profession who believe that AMA is opposed to social security. There are those who believe that the AMA opposed Blue Cross. I do not question, as Mr. King has indicated, that there are doctors in our association who are fearful that if they were to express a contrary opinion they might be ostracized socially or within the profession, but I can assure you-and I am sure some of the testi

mony presented by members of our association during this past week disagreed with our point of view-they have a perfect right to do soif you attend one of our house of delegates meetings in Florida, you will find divergence of opinion is not uncommon and a little bit of heat goes along in the effort to obtain a position. But this is not a new policy. This has been the policy at least since I have been a member, which has been a little over 23 years.

Mr. KING. But you acknowledge, doctor, there is evidence to the contrary?

Dr. ÅNNIS. Mr. King, I will acknowledge, as you have indicated, that there are some who feel to the contrary, but this does not make my assertion that this has been a long policy inaccurate. The fact that some people are not aware of the policy, or misinterpret it, or misunderstand it, I do not question that this is true. But that is like being ignorant of the law. It does not absolve you from the law. I would ask Dr. Howard, though, if he may want to comment on this, because he has had more experience over the country than I have.

Dr. HOWARD. The only additional comment I would like to make is that the American Medical Association for years, throughout its history, has had a body of principles and medical ethics, established more or less at the time of Hippocrates and which came down to the present day.

It is on the basis of these clearly delineated principles that the American Medical Association through its judicial council takes action with reference to its membership in disciplinary questions.

Furthermore, all of the State medical societies, which are the independent units of the American Medical Association, have their principles of medical ethics based on the AMA's principles. The fact is, if a member of the association were ever disciplined in any way simply by virtue of a difference of opinion in the legislative or socialeconomic area by any county medical society or State society, I am confident that the American Medical Association's Judicial Council, as it did in the case referred to by Mr. Stetler, would reverse the State society and would find that the disciplinary action was based on no specific provision of the principles of medicine.

Mr. KING. Would you gentlemen want to consider whether or not the policies of no disciplinary action under these circumstances where there appears to be some doubt as we have developed be published in the Journal? Do you feel it would be a good thing?

Dr. LARSON. Yes, Mr. King. I believe that if I had a copy of the remarks I made to the house of delegates-I am sorry I didn't bring it along with me— -I think that there are some sentences in there that are quite germane to this discussion. That entire speech has been published. My inaugural address has been published in the Journal of the American Medical Association within the last 2 or 3 weeks. I would be perfectly happy to insert in what is called the president's page, which comes out once a month, a statement on this very

subject.

Mr. KING. I think it would be very good, Doctor. I do not know to what extent members of the society I have talked to generally feel that is the view, but it has been charged by organizations and individuals and published, and I just think it would be well and I am pleased to know you feel as you do about it.

Dr. LARSON. Thank you.