Wednesday, September 09, 2015

The ABIM and Big Tobacco - A Love Story

Some of us were shooting spitballs in class in 1963, more interested in the political machinations of the playground than we were with those affecting our future professions. But for those of us trying to understand now how the American Board of Internal Medicine (ABIM) and the American Board of Medical Specialties (ABMS) have run so far afield of representing the average working physician in America today, that is the time in history we have to return to.

It turns out ABIM popped its cherry with Big Tobacco in 1963.  Before then, its aims were more educational and helped to serve the public interest, that is until it climbed into bed with the likes of RJ Reynolds and Phillip Morris.

This morning, I woke to an anonymous blog contributor who offered the story of Dr. Thomas Brem, former Chair of the ABIM and President of the "Advisory Board of Medical Specialties" (our current ABMS) stumping for Big Tobacco. Included in the link is Dr. Brem's curriculum vitae. Turns out, Dr. Brem heard the siren song of stumping for profit-making companies on the basis that the "rate of increase" of cancer incidence that declined year after year despite mounds of evidence that the total incidence of lung cancer was increasing annually since the introduction of cigarette smoking.

So when it seems shocking that the ABIM got this far purchasing condos, lobbying Congress and filing false tax forms while hiding tax dollars, we should realize that the corruption in ABIM and the ABMS has been more than 50 years in the making.

But it's not how specialty boards started.

And it certainly is not how we have to continue.

-Wes

11 comments:

Paul Kempen said...

Yes, it is time to ask what Certification should be............and certianly NOT what it is or what any board is proposing. For them it is all about the $$$$$$$$$$$$$$$$$$$$$$$$$$

Anonymous said...

Questionable and highly controvertible evidence was allowed into Brem's governmental testimony on cancer.

Brem, as an expert witness for big tobacco, proffered only two citations to back his claim that there was no evidence linking cancer and cigarette smoking.

You will note that Brem, as former Chairman and board member of the ABIM, was under oath before the House Committee that day. The same corrupted author/lobbyist writing on behalf of tobacco wrote both of Brem's sources which he cited.

A historical purview of ABIM/ACP published contributors and their "annals" from decades earlier is enlightening as well for perspective.

Anonymous said...

ABIM/ABMS's Thomas Brem, MD, as a medical bureaucrat advised also on matters of concern for the Veteran's Administration. This should give us baulk over the Choosing Wisely program and it's blatant targeting of seniors and veterans to reduce costs. CW has no place in a "membership society", as Brem referred to the ABIM, or their failed commitment to serve as a certification board.

The true nature of the specialty boards if investigated even superficially should eventually bring many SB individuals to appear under oath to answer hard questions and get substantive statements with real answers.

What history clearly shows us is that around 1965 the ABIM set the ground in their articles of incorporation, by writing into the bylaws an "executive director independent of the board." Thomas Brem put his corrupt pen to this new position of presidency and eventually its combination as CEO.

This was the seed of administrative corruption, which made possible the dynastic control of the ABIM. This was the seed for future quality measurement corporations and forums corrupting and expanding the medical bureaucracy in the United States.

This made possible the emerging medical societies most of the quality measurement financial/political power structures which evolved under a milieu of corruption and new pecuniary rules of the game ignoring ethics and the law.

ABIM set itself up as a foreign corporation in Pennsylvania in 1965 for favorable political environment and associative legal clout there.

In 1975 Saul Farb and John Benson paved the way for "non-dissolution" of the organization which was set to be dissolved administratively in 1986. Benson acting as treasurer and "president elect" set the stage for a series of self-appointed leadership and the continuance of the further corruption of the organization by amending the articles in 1975 to state "in perpetuity."

Anonymous said...

cont.-

1975 articles and their alteration mark an important timeline event and must be studied. John Benson from OHSU was groomed by two key ABIM mentors for the new position as ABIM president. Kimball next and OHSU's Christine Cassel came next in the dynasty of mentored self-appointed leadership followed by Baron today. All were groomed as well as the board chairman. Vetting was by a committee of the few. No outside vetting was allowed into the closed circle of "self-proctored" leadership transitions.

ABIM positions, as any official board member knew at the time of 1965 and 1975, was time limited to one, two and three-year terms. This traditional check of power was corrupted and violated consciously.

Benson started the new dynasty of leaders as Bob Wachter pointed out in his recent blog discussions over the past two years. Bob Wachter as an astute and moral physician should have put his foot down on many of the actions at the ABIM, but he did not. Wachter erroneously stated recently that the ABIM accumulated money over 100 years. Nonsense. Robert Wachter stated also for the public record that the ABIM Foundation was not a "piggy bank" for the ABIM. This latter statement is also erroneous and should be investigated.

We cannot condone silence on the matters relevant to this study of the ABIM/ABMS, no matter what distortion of facts or alibi is produced online for the public by the ABIM and ABMS regarding personal financial endowment and what special interests have been severed.

We can understand better the politics, financial relationships, and the personal psychologies involved when we delve deeply into the matters presented here. Many decent individuals who once practiced medicine or considered themselves "professors of medicine" were groomed to serve not the public but served their own personal inurement. (i.e., pecuniary gains not in keeping with the non-pecuniary aims and self-sacrificing traditions established by the membership societies and strict tax-exempt law.)

Thorough studies of the documents, personal interviews with leadership and board members, statement releases, and other public documents in Iowa, Pennsylvania and the federal government support these findings outlined above.

We have a history of apparent conscious and volitional will exerted over medicine and its practitioners by the grooming of candidates through a subtle milieu of financial allurement and corrupted institutions led by profit motives and "special interests."

Anonymous said...

Wes:

Your investigation dovetails with current tectonic shifts occurring in our country regarding attitudes towards the smoking of marijuana. Where are the medical societies such as the American Heart Association and the American College of Cardiology broadcasting the dangers of smoking with the inherent risks of heart and lung disease? Whenever I went to an ACC meeting, our so called leaders announced repeatedly that it is always about the patient as if they were trying to convince themselves.

The silence from the ACC is deafening on this critical issue of public health. So what policies have our benevolent leaders (most from California) of the ACC been pursuing?

New cholesterol treatment recommendations that move away from targeted numbers and more towards using high potency medications and ignoring LDL levels achieved even if they are poorly controlled.

Does anyone else think that it looks fishy that a new expensive medication (PCSK9 inhibitors) is coming to market that would increase expenses of insurance companies (think Kaiser in California) and the ACC is in essence saying that they are not needed? Don't worry insurance companies. The ACC has your back.

Your medical society at work. Pay your dues and move along. Nothing to see here.

Anonymous said...

As suggested , physicians need to be more vocal ! What occurred since 1965 -- where were you ,, relative to smoking , obesity , movement disorders , use of research $'s ! Now is a time in which all those " older " docs can help bring back the profession ! What have you got to lose ? You benefited ( prior to the ' take over ' by government ,anti vaccine doofus's, lawyer TV ads, certain societies malfeasance , carriers ) --- so, band together ! Use the power of the trust patients still have in your profession ! We should be in a new renaissance of medical science -----nano, genome directed therapies, 24/7 wireless monitoring , DNA 'adjustments', skill use management protocols ( PA's,RNP, super techs, boutique drugs , organ growth replication, 3D printer device production , 3D printer MRI tissue replication prior to Neuro surgery ,,,,,,,,,,,,,,, ! So much ! So little speed of adoption ! Please !

Anonymous said...

Academia has always controlled ABIM and related organizations. We must' now realize that our Gods' have clay feet. Like Dr. Brem they will say anything,do anything if paid something.
Rather than another Board has one ever considered a takeover of ABIM. We provide it financial sustenance.

Anonymous said...

ABIM and the Moral High Ground
Physician Charter (2002)

"The Charter has as its fundamental principles:
1. The primacy of patient welfare
2. Patient autonomy
3. Social justice

The Charter also articulates professional commitments of physicians and health care professionals, including:
A. Improving access to high quality health care
B. Advocating for a just and cost-effective distribution of finite resources,
C. Maintaining trust by managing conflicts of interest."

ABIM motto? (Date unknown.)
"Of the profession, for the public."

+++++++++
"The Allegations Against the Board (from Wachter's World)

Having sat through every meeting of the ABIM Board for nine years (and, more recently, those of the ABIM Foundation), I can tell you that the depiction of the Board as aloof, money grubbing, and corrupt is entirely off target. That certainly doesn’t mean that all our decisions were good ones, or were politically astute. But our motives were always to do the best we could to live up to the Board’s motto: to be 'of the profession, for the public.'
Here is where the critics are mistaken, often taking matters out of context to bolster their points. Unfortunately, in the world of social media, these half-truths and distortions make for good sound bites, and the casual observer can be forgiven for believing them.

Let’s take a few of the more egregious allegations:

'The Board is All About the Money'

The ABIM is a not-for-profit entity, meaning there are no shareholders. But it does need a positive bottom line to stay in business and to do its work. As Board members, we constantly struggled with balancing our fiduciary responsibility to the organization (including to pay the salaries and the costs of doing the Board’s current work and innovating) with the burden to the diplomates."

+++++++++
Chris Cassel and the Financial High Ground

Payments to CEO Raise New Conflicts at Top Health Quality Group

The top executive at the country’s pre-eminent health care quality organization is being paid hundreds of thousands of dollars by two large medical companies that have a stake in the group’s work.
The payments to Dr. Christine Cassel raise new conflict-of-interest concerns at the National Quality Forum, which endorses benchmarks that Medicare uses to compensate hospitals based on performance.
http://www.propublica.org/article/payments-to-ceo-raise-new-conflicts-at-top-health-quality-group

Citing ‘Distraction,’ Quality Forum CEO Resigns Board Seats

Dr. Christine Cassel said she is voluntarily stepping down from directorships at two health care companies that have an interest in the National Quality Forum’s work.
http://www.propublica.org/article/citing-distraction-quality-forum-ceo-resigns-board-seats

President's Council of Advisors on Science and Technology Report

December 8, 2010 (Chris Cassel introduces future Kaiser Permanente CEO 30:00")
Health and Human Services Secretary Kathleen Sebelius, White House Economic Adviser Lawrence Summers, and others talked about information technology...
http://www.c-span.org/video/?296980-1/presidents-council-advisors-science-technology-report

Anonymous said...

ABIM and the Moral High Ground...cont.

“The Salaries are Outrageous, and Then There’s The Condo” (From Wachter's World)

Here, the allegations are flying fast and furious. The latest concerns CEO Richard Baron’s salary. Rich is one of the smartest and most committed people I’ve met in medicine. He is a person of unending integrity. The fact that the critics have now seen fit to take him on with caricatures and half-truths is cynical and sickening.

Part of the reason that Rich emerged as our preferred candidate was his real-world experience, which we felt was crucial as the Board worked to connect better to physicians engaged in the day-to-day practice of medicine. Rich’s current base pay of $579,000, with a bonus opportunity of another 20 percent, is significantly lower than that of his predecessor (Dr. Cassel’s salary was higher because she was recruited from a prior job as the dean of a major medical school and she served as ABIM CEO for a decade). The salary I offered Rich (as chair, I led the negotiations) was in the range recommended by consultants after a detailed analysis of salaries of other CEOs of healthcare nonprofits. It is a lot of money (and more than twice what Rich earned as a primary care physician), but he is paid to run a large, complex organization in a swirling political environment. In the grand scheme of things, taking into account what other healthcare executives earn, it seems fair to me.

If there is one money issue that has become a piƱata, it has got to be “The Condo.” Like many large, complex organizations, the ABIM often has consultants coming into Philadelphia to help it with its work. When Chris Cassel was CEO, after analyzing the costs of putting these folks up in hotels, she decided to purchase a condo to serve the same function. This was designed to be revenue neutral, and it has been. But, of course, it creates a hanging curveball for those looking for profligacy. Do I wish we had never bought it? Of course; politically it was a dumb thing to do. Is it a scandal? No."

+++++++++

Cassel had no intention of staying at OHSU in the position of Dean.

Note about Cassel's salary and COI at the ABIM:
Casell was active with the ABIM from nearly a decade earlier than when she took over as CEO in 2004. She was being groomed just as her predecessors were groomed (Benson and Kimball); just as the Kaiser Permanente vice-president was being groomed for the highest position as president and CEO. To say that conflict of interests were not a major problem at the ABIM shows Wachter's fallibility as an observer and exponent of fact to say the least. (Cassel was a leader for years at Kaiser Permanente's Board.)


Renowned Expert in Geriatrics and Medical Ethics to Head OHSU School of Medicine
10/05/01 Portland, Ore.
Dr. Christine Cassel returns to Oregon as medical school's dean
http://www.ohsu.edu/xd/about/news_events/news/2001/10-05-renowned-expert-in-geria.cfm

Christine Cassel to Step Down as School of Medicine Dean to Head American Board of Internal Medicine
02/19/03 Portland, Ore.
Peter Kohler names Joe Robertson interim dean of School of Medicine
http://www.ohsu.edu/xd/about/news_events/news/2003/02-19-christine-cassel-to-step.cfm

+++++++++


OHSU School of Medicine Appoints New Associate Dean for Planning and Administration
05/02/02 Portland, Ore.
http://www.ohsu.edu/xd/about/news_events/news/2002/05-02-ohsu-school-of-medicine.cfm


OHSU School of Medicine Appoints Assistant Dean of Minority Affairs
09/04/02 Portland, Ore.
http://www.ohsu.edu/xd/about/news_events/news/2002/09-04-ohsu-school-of-medicine.cfm

Anonymous said...

ABIM's Seventeenth-Floor Gang
(A Title is Worth a Thousand Words)

ABIM as a Membership Society of the Politically-Motivated Few: A "Certification Corporation's" Experiments in Social Engineering Using Medical Propaganda and Corporate Commercials.

Two More Award-Winning Faces Behind ABMS' Executive Leadership:

David Benson and Harry Kimball

https://www.ohsu.edu/xd/education/schools/school-of-medicine/about/benson-112410.cfm

http://www.abim.org/news/medical-education-and-professionalism.aspx

E-delivery anyone? Shhhh! before Altria's stock price goes up!
http://www.usatoday.com/story/money/business/2015/04/11/cigarettes-and-marijuana/70746772/

ABIM Bathroom Graffiti said...


"Rich, man, you're nothing but a poor man with money."

- W.C. Fields was here... ... .

Phone pool's communal bathroom.