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Inaugural Address

June 26, 2007

AMA Annual Meeting
Hilton Chicago Hotel
Chicago, Illinois

Ronald M. Davis, MD
American Medical Association

In Franklin Roosevelt's third inaugural address, he said: "On each national day of inauguration since 1789, the people have renewed their sense of dedication to the United States." In the same way, at each inauguration of the president of the American Medical Association, we renew our dedication to this assembly of physicians, and to the calling of our noble profession.

For the next 12 months, I'm the chief herald of the Association. And so, I'm honored to unfurl the proclamations of the AMA, and to trumpet our positions and policies on behalf of our patients. Were I skilled in the arts of music, I'd blow that trumpet myself. But I can play nary a note, nor can I carry a tune.

Some time ago, I read the best-selling book, "The Time Traveler's Wife." It tells the story of a man named Henry who has a rare genetic disorder that causes him to involuntarily travel through time. Henry can't control when or where he goes, or how long his trip will last. His condition is diagnosed as "Chrono-Displacement Disorder" by a geneticist at the University of Chicago, where I went to medical school.

Now, since Henry is the only person whose chrono-impairment has been described publicly, there's not yet an ICD-9 code for this condition. But in the interests of advancing science, I thought I should disclose to you my own long-held secret. I, too, am chrono-impaired. So for those of you who may have noticed my occasional late arrival at meetings, or even an infrequent absence, you finally understand why.

When Henry time-traveled, his destinations were tied to his subconscious, and he typically visited places where he had been earlier in life, or places he was destined to visit later in life. When I time-travel, I find that I'm drawn to places connected to my last name, Davis.

Many of my travels have been to the mid- and late 1800s, to observe, and speak with, Dr. Nathan Davis. As most of you know, Nathan Davis is considered the Father of the AMA. As a 28-year-old delegate from the Broom County Medical Society in New York, he introduced a resolution at the New York State Medical Society in 1846, calling for a National Convention of delegates from medical associations and colleges.
That resolution passed, and the first National Convention was held in Philadelphia on May 5th, 1847. Almost 250 delegates from 68 medical societies and medical colleges assembled, and they agreed to form the American Medical Association.

Nathan went on to have an extraordinary career. He eventually became the 16th and 17th president of the Association, the only person to serve two terms. In the 1870s, he helped create the AMA Judicial Council, now called the Council on Ethical and Judicial Affairs.

In the 1880s, he proposed the publication of a weekly journal to replace the annual transactions of the AMA, and he was chosen to be the first editor of the Journal of the American Medical Association. An innovator in medical education, he later became president of the Association of American Medical Colleges.

Many people have asked me during the past year how I ever found myself in a position to become president of the AMA. Well, I think my time travel produced a cosmic connection with Nathan Davis, and during a few of my trips, I was actually able to meet him and speak with him, and he gave me a heavy dose of inspiration and education. Of course no one will ever accomplish a fraction of what he achieved, but his influence seemed to mysteriously steer me in certain directions.

Nathan helped establish the Chicago Medical Society in 1850. He was a charter member of the Illinois State Medical Society when it was organized the following year, and became its president five years later. My own involvement in organized medicine began within those two medical associations.

Besides serving as editor of JAMA, Nathan Davis was also the editor of seven other journals, including the Chicago Medical Journal, the Northwestern Medical and Surgical Journal, and American Medical Examiner. Similarly, journal editing and other editorial roles have been an important part of my career.

On another of my strange time travels, I was drawn to James E. Davis, MD, the 143rd president of the AMA. Jim Davis was a surgeon from North Carolina, and the author of Davis Rules of Order, which the AMA and many other medical societies used, for many years, as their guide for parliamentary procedure. I had the pleasure of serving with Jim on the Board of Trustees when I was the resident physician member of the Board.

Anyway, just a few weeks ago, I was transported to the AMA's annual meeting in 1988, where Jim Davis was about to deliver his inaugural speech. It was quite a speech, and I was particularly interested to hear him say, "We must develop ways to reach out and care for the medically indigent. We must, strive to assure that every single American has access to proper and affordable care whenever and wherever it is needed!"

I had a private chat with Jim after his speech. After I explained to him who I was, and after the shock had worn off, I told him about our access problems in the year 2007. He was stunned to learn that almost two decades after his appeal for universal coverage, we still had 45 million Americans without health insurance.

I told him, though, that I'm proud that our association has worked for more than a decade on this issue, to develop and refine a reasonable proposal for affordable coverage, one that is individually owned and chosen by each patient or family, with financial assistance for those with low incomes.

I'm proud that we are launching an aggressive media campaign to engage our patients and the public in this issue. I'm proud that the House of Delegates has strengthened our proposal by endorsing individual responsibility, requiring consumers to purchase and own health insurance once they have the means to do so, just as people have to purchase automobile insurance in order to drive a car.

I'm proud that the AMA is one of 16 national organizations that comprise the Health Coverage Coalition for the Uninsured. The Coalition issued its recommendations in January, and when implemented, they will move us towards universal coverage, especially for our nation's children. These diverse groups, including AARP and Families USA and the Chamber of Commerce, span the entire political spectrum.

Our larger message is, if these groups can find common ground on this complex and contentious issue, then certainly Congress ought to be able to do the same. Let's see to it that reauthorization of the State Children's Health Insurance Program in the coming months becomes the springboard toward meaningful progress on covering the uninsured.

Let me return to our founder, Nathan Davis. I was delighted, a few years ago, to find myself transported to 1850, on a day when he was giving one of his famed lectures on "The Sanitary Condition of [Chicago]." He explained how this city's cholera epidemics were caused primarily by unsanitary practices. This was just one of several examples of Nathan's devotion to improving public health. He also wrote passionately and spoke often about combating alcohol abuse.

Public health is my background and my passion. Every AMA President brings a bit of his or her past to the job; we can't help it. Bill Plested brought to his presidency the confidence of a cardiothoracic surgeon wielding a sharp scalpel. I'm honored to follow this remarkable and outspoken leader.

I'm also honored by the presence of so many leaders of public health organizations on the dais behind me. By coming here, they symbolize the Medicine and Public Health Initiative. Launched by the AMA and the American Public Health Association in 1994, it was designed to bring clinical medicine and public health into closer partnership and collaboration.

One outstanding example of this fruitful collaboration is the national flu vaccine summit, which the AMA and the CDC have co-sponsored annually since 2001. Next month, those same two organizations co-sponsor their second national congress on health system readiness, designed to improve preparedness for bioterrorism, natural disasters, and pandemic influenza.

For too long, there's been a chasm between these two sectors. Stronger collaboration is especially needed to address the increasing burden of chronic illness and injuries, much of which is related to four underlying behaviors, tobacco use, alcohol abuse, poor diet, and sedentary lifestyle.

Cigarette smoking continues to be the leading preventable cause of death in our society. One week ago, I was pleased to represent the AMA in a press conference in support of increasing federal taxes on tobacco products to fund broader health insurance coverage for children in low-income families.

If I see Nathan Davis again, I plan to ask him what he'd think about our latest scourge, the obesity epidemic. We know the causes: our toxic food environment, including super-sized portions of food and beverages that are high in calories, sugar, sodium, and saturated fat; and our lack of physical activity and exercise.

How often do you see people waiting several minutes for an elevator, to go down one or two floors? And how many of us drive around a parking lot at a shopping mall for three or four minutes, looking for a parking spot to save us one minute of walking?

The AMA has produced a comprehensive primer on assessment and management of adult obesity. The American Academy of Orthopaedic Surgeons has produced two outstanding public service announcements on the importance of exercise.

The American College of Sports Medicine is launching an initiative to increase the frequency and effectiveness of exercise counseling by physicians and other health care providers. AMA policy supports that goal. The College's message is simple: "Exercise Is Medicine."

When we talk about health system reform, a major challenge for us is to redesign the system so that it embraces prevention as much as it does diagnosis, treatment, and palliation. Our nation suffers from what could be called a Prevention Deficit Disorder, and during my presidency, I'll highlight a number of remedies to mitigate that malady.

Toward the end of his career, Nathan Davis involved himself in global health. He was named the Secretary-General of the International Medical Congress, at the Eighth Congress in Copenhagen in 1884. In October of this year, I'm privileged to be part of the AMA delegation traveling to Copenhagen to attend the meeting of the World Medical Association's General Assembly.

I'm proud of the AMA's continued leadership in international health. The globalization of health care is increasing through such forces as pandemic planning, international marketing of pharmaceuticals, and "offshore" outsourcing of medical services, such as reading imaging studies. The flattening of our world, as described by writer Thomas Friedman, requires our active engagement with other national medical associations, the World Medical Association, and the World Health Organization.

My last note on Nathan Davis: In 1904, at the venerable age of 87 years, the Father of the AMA died. He was buried on June 18th, the same day I was born, 52 years later.

My most recent time travel was just this morning. I woke up and found that I'd traveled forward in time, to the year 2020. Once again, I was pulled through the space-time continuum by the name of Davis. I found myself at a family get-together on the 4th of July on a lake in northern Michigan. Each of our three sons was there, and we embraced. They knew about my condition, and so they weren't overly surprised to see me.

"How's it going?", I asked Jared and Evan. "Are you happy you became physicians?"

"Yeah, Dad, I am," Jared said. "I really enjoy surgery. It's a bit different from the public health stuff you do. When I leave the OR, having removed a tumor or repaired an aneurysm, I know I've made a huge difference in people's lives."

"What about you, Evan?" I asked.

"I'm really happy too, Dad," Evan said. "In the ER, I see people who've been hit by drunk drivers, or people who've been shot, or people who have influenza because they didn't get their flu shot. Basically, we're cleaning up the mess that you and your public health colleagues are trying to prevent."

And I said to my third son, "Connor, you once told me you wanted to have a career in computer science. Is that what you're doing now?"

And Connor said, "I sure am. In fact, I'm designing enhancements to the DaVinci robot, you know, the machine that Dr. Mani Menon used for robotic prostatectomies at Henry Ford Hospital. Nowadays, the DaVinci's used for dozens of surgical procedures in the abdomen, the thorax, the brain."

Then I said, "Okay, I may not have much longer on this time-trip. I have one more question I have to ask you."

"Jared and Evan, how are doctors getting paid in 2020? Is Medicare still using the Sustainable Growth Rate (SGR)?"

And Jared said, "Dad, relax. Congress replaced the SGR more than 10 years ago with a formula that ties Medicare physician payment to the Medicare Economic Index, the government's own index that reflects the costs of running a physician's practice."

And I said, "Wow! How the heck did that happen?"

And Evan said, "Dad, you're never going to believe this. But one of the AMA's friends in Congress, in the middle of the night, buried an amendment inside one of those giant appropriations bills, which said that the salaries for members of Congress would also be tied to the SGR. Only then did they realize how grossly unfair the SGR is. So they scrapped it for doctors and members of Congress at the same time! And doctors got the MEI instead."

"Amazing," I said.

And at that moment, I was whisked back to this morning, June 26, 2007. Were Jared and Evan telling me the truth about the SGR, I wondered, or were they pulling my leg? And then I realized that the management consulting pioneer Peter Drucker, was right: "The only way to predict the future is to create it."

We're calling for fundamental reform of our health care system. And how do we accomplish that? I think you know what it takes. We must mobilize physicians at the grassroots level. We must strengthen our coalitions. We must enroll every one of our patients in our Patients Action Network. We must hone our messages and launch our media campaigns. We must support our political action committees and engage in the political process. And we must do this together, across all organizations, all specialties, and all across America.

My friends, this afternoon, I've used a work of fiction to illuminate critical issues that challenge us, as individual physicians, as a profession, and as a nation.

Let me conclude by using a work of non-fiction, a biography, to underscore the importance of the AMA. In 2003 the Washington journalist Morton Kondracke served as emcee at an AMA Foundation awards dinner. He spoke about his book, entitled Saving Milly. It was about his wife and the enormous suffering she endured from Parkinson's disease.

My own mother had been suffering from that disease for 15 years. So I grabbed a copy of the book for my mother and one for myself, which Nadine and I both read.

My mother was always stoic about her disease and her worsening disability. She refused a cane or a walker or a wheelchair for most of the years of her illness, despite many falls and fractures. She never complained about her condition. When asked how she was doing, she would typically comment on how so many other Parkinson's patients were much worse than she was.

And so, it was shocking to me, that after my mother read Saving Milly, she told me, "Now you know what I'm going through." Mom shared that book with others in the family, so they too would know what she was going through.

That was one more AMA connection in my life, a book distributed at an AMA Foundation function opened up communication between my mother and our family, yet another way in which the AMA touches people's lives.

And that's what our patients expect. We battle the big issues, yes. We advance the frontiers of science and healing, yes. But we deal with real people, real emotions, real crisis in real families.

As you and I work through the challenges of this coming year, we need to remember the sacred responsibility we have to our patients. We will win our battles on the big issues, not for us, but for them. We will advance the frontiers of science and healing, not for us, but for them. We will stand together, stronger, not for us, but for them. For every child, every woman, every man in this nation with so much need, with so much trust in us.

In this wonderful United States of America.