The American Medical Association (AMA): Abstinence Motivated Agenda

by David J. Hanson, Ph.D.

The American Medical Association (AMA) first passed a resolution supporting abstinence from alcohol even before National Prohibition was imposed in 1920 and it has never rejected that resolution.

Although the moderate consumption of alcohol is associated with better health and greater longevity than either abstinence or the abuse of alcohol, 1 the AMA remains a temperance-oriented organization. This may be because so many physicians see the consequences of alcohol abuse, although the vast majority of people drink in moderation that's beneficial to their good health.

Biased and Unscientific Reports/Publications

For whatever reason, the AMA promotes a temperance-oriented agenda. In pushing that agenda, the organization publishes biased reports and editorials, and its journal (Journal of the American Medical Association, or JAMA) sometimes publishes articles that are so weak and inadequate as to be of no scientific value. For example:

Case 1

JAMA published an article on the exposure of alcohol advertisements by adolescents and youth. The study

examined advertising placements in a sample of 15 magazines from July 1997 to July 1998. However, the authors used the holdings of a local high school library and did not attempt to obtain missing issues for some of the magazines. Instead, they simply estimated the total number of ads based on the issues available at the high school or expanded the sample to include 1998-1999 ads for a few popular magazines. (The possible effects of this inconsistent sampling was not discussed in the article.) …

In their reported results, the authors simply provide a tabular ranking of the magazines according to the estimated number of alcohol and tobacco ads, which fails to account for other differences in readership demographics, such as the number of adult readers. 2

Because of this serious sampling problem, it’s hard to imagine how any reputable scientific journal could ever accept this article for publication.

Case 2

Another JAMA article on the subject examined the frequency of alcohol advertising in 35 major magazines during a five-year period. However, the study suffers from even more serious methodological inadequacies. Not surprisingly, a re-analysis of the data makes it clear that nothing valid can be concluded from the study. 3

Case 3

 An AMA newspaper editorial warns that “an increasing number of parents are actually supplying alcohol to teenagers.” 4 Such an assertion carries much weight coming from the authoritative and trusted AMA.

However, upon questioning, the AMA has acknowledged that it has absolutely no reliable or credible evidence whatsoever for its headline-grabbing declaration. It turns out that the statement is based entirely on scattered anecdotes and impressions -- and nothing more. 5

There’s also substantial evidence from research funded by the U.S. federal government, that drinking with parents is a “protective behavior” that reduces both alcohol consumption and alcohol abuse. 6

The editorial also implies that underage drinking is a growing problem, although government research repeatedly demonstrates dramatic declines in underage alcohol consumption rates over the past 25 years or so.

Case 4

The president of the American Medical Association equated parental approval of their young people drinking at home with parental approval of teen sex parties. 7 There’s a big difference between parents serving their offspring a drink with dinner and sponsoring teenage sex parties and the head of the AMA should know the difference.

Case 5

The AMA commissioned a poll, supposedly of American female college students on spring break, which its president said “has turned into a dangerous binge-fest.” The AMA said the poll demonstrated the need to restrict alcohol ads on campus and other policy changes it advocates.

The story was carried in hundreds of newspapers and websites. It was reported by the NBC Today Show, the CBS Early Show, and hundreds of reports on local television and radio newscasts. It was also reported in the New York Times and Time magazine. A typical headline read ”Girls go wild for booze, sex” (Boston Herald).

But there’s a serious problem with the AMA story. It claims that the poll results generalize to “women age 17 - 35 who currently attend college, graduated from college or attended, but did not graduate from college within the United States.” However, the results do not generalize and cannot be generalized. In short, the study and conclusions are basically worthless.

The president of the American Association of Public Opinion Research said the AMA poll “has no scientific basis…it is silly and should never have seen the light of day.” 8 Similarly, Howard Kurtz wrote in his Washington Post column that “this poll had zero scientific validity.” 9

The AMA claims that the survey used a random (probability) sample. Such a sample is carefully selected in very specific ways according to precise scientific criteria. Individuals are never self-selected. That is, people are not recruited with ads, websites, or other ways that permit them to come forth and present themselves to be sampled.

However, the AMA poll used volunteers from the Survey Spot recruitment website, where anyone can opt-in. The company that operates the site also recruits volunteers through banner ads and telephone solicitations.

Contrary to its published assertion that it used a random sample, it actually used a non-random sample. It then incorrectly asserted that its “survey has a margin of error of +/- 4.00 percent at the 95 percent level of confidence.” Non-random samples have unknown margins of error; reporting them is only appropriate for random samples.

In addition to being worthless and of no scientific value, the AMA poll is very misleading. Although it was supposedly about the dangerous behaviors of college women on spring break, only 27% of the sample had ever gone on spring break. Statistician Mark Blumenthal, who carefully investigated the scandal, observed:

The fact that only about a quarter of the respondents actually went on a spring break trip -- information missing from every broadcast and op-ed reference I encountered -- raises several concerns. First, does the study place too much faith in second-hand reports from the nearly three quarters of the women in the sample who never went on a spring break trip? Second, how many of those who reported or heard these numbers got the misleading impression that the percentages involved described the experiences of all 18-34 year old women? See the Hannah Storm quotation above. [Here the statistician is referring to a news report by Ms. Storm.] She appears to be among the misled.

One might think that the press release from the AMA would have gone out of its way to distinguish between questions asked of the full sample and those asked of the smaller subgroup that had actually been on a spring break trip. Unfortunately, not only did they fail to specify that certain percentages were based on a subgroup, they also failed to mention that only 27% of their sample had ever taken a spring break trip. Worse, the bullet-point summary of results in their press release mixes results for the whole sample with results based on just 174 respondents, a practice that could easily confuse a casual reader.

The president of the American Association for Public Opinion Research, Dr. Clifford Zukin of Rutgers University, is disturbed by the AMA’s misuse of statistics and its associated deception.

The AMA official responsible for the survey said that its methodology is standard and the survey is generalizable to the population. To this, Dr. Zukin replied:

Simply put, statistically, you are wrong. The methodology is not standard, it is not generalizable to the population. And, the reporting of a sampling error figure, as you have done in your methods statement is fanciful. Because of the way you sampled people, with a non-probability sample, there is no way can know about the accuracy of your sampling and error margin. This is simply without basis in mathematical fact. 100 out of 100 statisticians would tell you that there is no sampling error on a non-probability sample. It is beyond question that your methodological statement is factually inaccurate and misleading.
I am also troubled by the fact you actually call this study a "media advocacy tool." It is unconscionable to put something in the public domain under the guise of a scientific survey when it has such a high potential to be inaccurate and mislead. Scientific surveys should be done to measure public opinion, not to influence collective opinion. (Emphasis added)

Dr. Zukin has uncovered something much more important than the fact that the AMA survey lacks scientific value and is misleading. He uncovered the fact that the whole purpose of the survey was to influence public opinion in support of its alcohol policy agenda.

Case 6

In another survey on heavy drinking by college students,” the AMA asked respondents if they agreed that “we should stop holding young people solely responsible for heavy drinking and put some of the blame where it belongs -- on the alcohol industry.”

“On that question, and many other ‘agreement’ items, respondents had choices of ‘strongly agree, ‘somewhat agree,” or ‘disagree - giving them two ways to agree (including the middle option, which is usually ‘neutral’) and just one to disagree.” 10

Case 7

In its publication, The Minimum Legal drinking Age: Facts and Fallacies. The AMA notes that the minimum legal drinking age (MLDA) has been the most widely studied of all reduction-of-alcohol-consumption policies. Since the 1970's, at least 70 studies have examined the effects of the MLDA. 11

In its publication, the American Medical Association makes seven assertions about the effectiveness of the minimum drinking age of 21 which it says are supported by the research:

Assertion Number	Supporting References Listed
1	Wagenaar (1993)
2	Jones et al. (1992); NHTSA (1989); Wagenaar (1993)
3	Wagenaar (1993)
4	O'Malley & Wagenaar (1991)
5	Wagenaar & Wolfson (1995)
6	Wagenaar & Wolfson (1995)
7	Single (1984); Wagenaar (1993)

Why is research by Wagenaar used to support each and every assertion? Over 70 studies, according to the AMA, have been conducted on the effects of the MLDA. Why not use
some of those?

Science presents all relevant evidence, not just six 12 of at least 70 existing studies. It doesn't present only what supports a particular view while excluding all others. That's a tactic of advocacy, not "science."

Political Agenda Promotion

The Journal of the American Medical Association (JAMA) has often published junk science to support the positions it advocates. For example, to support its understandable position against smoking, the journal has published blatantly defective research, even nonsensical research on the subject. 13

Similarly, JAMA published a fatally defective study claiming that in states with laws requiring safe gun storage, accidental deaths of children by gunfire was 40% lower. And it published this defective and misleading study shortly before the vote on a law in Washington State that would have required trigger locks on all handguns sold or transferred. 14

In 1999, then-president Bill Clinton was about to be tried in the U.S. Senate for, among other things, allegedly denying under oath that he "had sex" with Monica Lewinsky. Crucial to his defense was his allegation that oral sex (fellatio or oral stimulation of the penis) didn't constitute "sex." Just before the trial began, JAMA published a study titled "60 Percent of Those Surveyed Do Not Define Oral Sex as Having 'Had Sex.'" 15 The impeachment trial was clearly irrelevant to the contents of a medical journal. And although the study was highly flawed and almost a decade old, it was very useful in promoting a political agenda.

Unscientific Surveys

An undergraduate student who conducted an Internet survey to estimate teen use of alcohol would probably receive a very low, if not a failing grade. That's because the Internet survey would necessarily be completely unscientific and violate the most basic principles of legitimate survey research. Therefore, the results would be unreliable and misleading.

Established research ethics require that the results of an Internet survey be clearly identified as unscientific in order to alert and protect the public. However, the AMA failed to disclose in its press release the unscientific nature of its widely publicized reports suggesting that most flavored malt beverage (so-called "alcopops") is consumed by teenagers and other questionable "findings.”16"

The AMA also uncritically passes off flawed and debunked "studies" by the Center on Alcohol Marketing and Youth (CAMY), which is an activist, not a scientific organization. 17

Disregard for Truth

100,000 Beer Commercials

The AMA's Office of Alcohol and other Drug Abuse repeatedly displays a reckless disregard for truth and accuracy. For example, the AMA asserts without any supporting reference that "By the time the average young person reaches age 18, he or she has seen more that 100,000 beer commercials." More specifically, the unpublished report from which this assertion is taken estimated that "between the ages of 2 and 18... American children see something like 100,000 television commercials for beer." 18

Anyone can easily calculate that to see 100,000 beer commercials on TV between the ages of two and 18, a person would have to see an average of over 17 beer commercials per day. Young people spend about 1/3 of each day sleeping, another 1/3 or so in school for most of the year, plus time traveling to and from school, eating, showering and attending to personal hygiene, dressing, studying, playing sports, visiting friends, going to movies, playing computer games, reading and, of course, watching some TV. Normal, average young people couldn't average seeing over 17 beer commercials per day. This isn't rocket science and common sense should suggest the implausibility of this unsupported assertion. Furthermore, knowledge of the bogus nature of the statistic is common knowledge among alcohol abuse prevention professionals.

Years after the AMA was alerted to the bogus nature of this "statistic," it still insists on repeating it. For example, it recently wrote that it "long has focused on how alcohol advertising affects young people, who, studies show, typically will see 100,00 beer commercials before reaching age 18." 19

Alcohol Marketing to Underage People

The AMA also asserts, without any evidence whatsoever, that alcopops are aggressively marketed to underage people. It insists that "parents should be outraged" that these beverages "clearly target" underage persons. 20 That's strong language.

However, the Federal Trade Commission (FTC) has thoroughly investigated that charge several times in recent years. It has carefully examined internal company documents, product placement in stores across the country, data presented by alcohol activist groups, and much more evident. 21

In each and every case, the FTC has found no evidence of industry targeting of those who are underage. It has found, however, that the majority of those who consume the flavored drinks in question are over the age of 27. 22

"Alcohol Advertising Causes Drinking Problems"

An AMA headline shouts: "Break needed from alcohol ads: Alcohol advertising is one of the ‘major culprits’ causing alcohol abuse…" 23 The AMA repeatedly asserts that alcohol ads cause people to drink and to abuse alcohol. However, decades of scientific research conduced by governments, health agencies and universities around the world belie the Association's claim.

Successful alcohol advertisers increase their market share, which they acquire at the expense of less successful advertisers, who lose market share. 24

Alcohol advertising doesn't increase overall alcohol beverage sales, stimulate alcohol abuse, or induce non-drinkers to become drinkers. However, that doesn't stop the AMA from making its baseless charges.

Underage drinking 'Epidemic'

The AMA repeatedly refers to an "epidemic" of underage drinking. 25 But in reality alcohol consumption by young people continues to drop. For example, among those age 12-17, about half were regular drinkers in 1979; today far fewer than one in five are, according to federal surveys. 26

According to a U.S. federal government survey, the proportion of high school seniors who have ever consumed alcohol is down. 27

The proportion of high school seniors who have consumed alcohol within the previous year is down. 28

The proportion of high school seniors who have consumed alcohol within the previous 30 days is down. 29

The proportion of high school seniors who have consumed 5 or more drinks on an occasions with the previous two weeks is down. 30

Similarly, the proportion of entering college freshmen last year who drank fell to the lowest level in the 40-year history of the American College Freshman survey conducted annually by UCLA and the American Council on Education. 31

Censorship Agenda

Currently, the AMA is calling for voluntary bans on alcohol beverage ads. However, its long-term goal is for the imposition of a ban on all virtually alcohol advertising. In its own words, “the Association has long had a policy calling for a ban on all alcohol advertising outside of liquor stores and bars. ‘The AMA still wants a ban, but you have to get half-way to your destination before you complete the trip,’ explains Dr. Scotti” of the AMA. 32

A major obstacle to the AMA’s goal of censorship is the First Amendment of the United States Constitution and its guarantee of free speech.

AMA Office of Alcohol and Other Drug Abuse

The AMA describes its Office of Alcohol and Other Drug Abuse as "a national program office of the Robert Wood Johnson Foundation." 33 Not only did the temperance-oriented Robert Wood Johnson Foundation establish the AMA's office with an initial $5 million dollar grant but also it has poured many millions of dollars more into funding its activities. 34

One of the Office's activities has been to give ten universities $9 million to implement neo-prohibitionist practices on their campuses. A comprehensive evaluation of the program by one of its boosters found that the program is completely ineffective in reducing either alcohol consumption or alcohol abuse. 35 In spite of this, the AMA continues to promote the program as if it were actually effective.

The AMA has virtually ignored the widespread steroid use and other drug abuse so common in many sports but selectively and repeatedly attacks NASCAR for permitting distillers to advertise or sponsor racecars.

NASCAR has for decades permitted beer and wine advertisements and sponsorship. Attacking NASCAR's logical decision not to discriminate against distilled spirits is totally irrational. Standard drinks of beer, wine and distilled spirits contain equivalent amounts of alcohol -- about six-tenths of an ounce. 36 A standard drink is:

• one 12-ounce bottle or can or regular beer
• a 5 ounce glass of wine
• a 1 and 1/2 ounce 80 proof distilled spirits (either straight or in a mixed drink)

Alcohol is alcohol and a drink is a drink. They're all the same to a Breathalyzer and they should be to the AMA as well. By distinguishing between these beverages, the AMA actually contributes to the dangerous myth that beer and wine are somehow "safer" than distilled spirits.

The AMA also violates established research ethics requiring that the results of any internet survey be clearly identified as unscientific in order to protect the public. For example, it failed to disclose in a recent press release the unscientific nature of two of its widely reported polls on underage drinking. 37 Not surprisingly, its invalid findings are highly inconsistent with federal and other scientific research on the subject. 38

Web pages and publications of the AMA's Office of Alcohol and Other Drug Abuse are packed with totally unsupported assertions of questionable validity. They also make use of anecdotal reports, which any physician should recognize as being of no scientific value. 39 Of course, such statements are very valuable in mobilizing public opinion through the use of emotion instead of facts and evidence.

The American Medical Association isn't an impartial, unbiased association. It has social and political agendas that it actively pursues. The AMA spends extensive time and money influencing the political process in order to further its goals. Never assume that something is true about alcohol just because the AMA says it is.

A Suggestion

The United States is experiencing a health care crisis. Millions of Americans can't afford medical care, medical insurance costs are skyrocketing and AIDS has not been conquered. As sports columnist Mark DeCotis says

Perhaps the AMA should refocus its concern on the myriad of other problems affecting Americans that it, as the main voice for physicians in this country, can control, such as affordable health care. 40

Amen.