The American Medical Association House of Delegates narrowly approved controversial guidelines for a growing number of physicians who sell nonprescription health products in their offices.
Criticized by some physicians as too weak and by others as too rigid, the measure was saved from defeat by six votes in the 494-member policymaking body during its annual meeting in Chicago last month.
The guidelines call for physicians to "make useful health-related products readily available to patients free of charge or at cost," and recommend physicians disclose to patients their financial arrangements with suppliers.
Some physicians argued that they don't have systems in place to track the costs of selling products. Others said the guidelines' language appeared contradictory, asking physicians to refrain both from selling products that can be obtained at a local drug store and from engaging in exclusive distributorships.
Ethics leaders argued the urgency for guidance to restore patient trust. "We must stop the hemorrhaging of our professionalism," said Robert Tenery Jr., M.D., chair of the AMA's Council on Ethical and Judicial Affairs.
In other actions, the House voted to:
* Establish a permanent body to oversee membership and carry out recommendations of a temporary task force that was formed to address declining membership. According to a task force report, the percentage of U.S. physicians who are AMA members has declined to 34% from 45% a decade ago. Penetration will sink to 23% by 2010 if current trends continue, according to the task force.
* Adopt guidelines for prescribing drugs on the Internet.
* Amend bylaws to prevent an officer or trustee from taking the position of executive vice president until three years following completion of a term in office. The change ended a past AMA practice of promoting trustees to the executive post and was consistent with recommendations of an ad hoc governance committee created in following a controversial product endorsement deal with Sunbeam Corp. in 1997.
* Defeat a measure to oppose the denial of hospital privileges because a physician does not admit "enough" patients or perform "enough" procedures. Opponents of the measure argued it contradicts accreditation practices meant to encourage clinical competency.