The AMA, Rep. Akins “Legitimate Rape”, and Physician Leadership

Posted on | August 22, 2012 | 5 Comments

Mike Magee

At times like these, with Rep. Todd Akins “legitimate rape” remarks fresh in everyone’s minds, there is a natural tendency for Americans to turn to their respected leaders to re-establish sanity and reassure the public that we have not completely lost either our judgement or sense of civility. And so, we’ve heard the clear voices of our President, as well as those of some leaders of both parties.

When the controversy revolves around health and science, patients and health consumers naturally look to the most prominent organization that represents physicians, the American Medical Association, for timely information and support. Health consumers naturally expect the AMA to have their interests at heart, as well as the the interests of their physicians.

And yet  when patients so need immediate and forceful words from physicians, when one might expect that AMA messaging to be loud, clear and immediate, it is not. Now I could have missed it, but I do not see a News alert on the topic on the AMA site; do not see Akins remarks covered in this week’s American Medical News; and have not seen any mass media articles on the topic referenced in the daily news round-ups (AMA Morning News)  that I received electronically from the AMA on August 20, 21 or 22.

What I have seen so far are clear statements from the American College of Obstetrics and Gynecology (one of the AMA’s specialty partners) and from the American Women’s Medical Association. Here they are in full:

ACOG Statement on Rape and Pregnancy

August 20, 2012

Washington, DC — Recent remarks by a member of the US House of Representatives suggesting that “women who are victims of ‘legitimate rape’ rarely get pregnant” are medically inaccurate, offensive, and dangerous.

Each year in the US, 10,000–15,000 abortions occur among women whose pregnancies are a result of reported rape or incest. An unknown number of pregnancies resulting from rape are carried to term. There is absolutely no veracity to the claim that “If it’s a legitimate rape, the female body has ways to shut that whole thing down.” A woman who is raped has no control over ovulation, fertilization, or implantation of a fertilized egg (ie, pregnancy). To suggest otherwise contradicts basic biological truths.

Any person forced to submit to sexual intercourse against his or her will is the victim of rape, a heinous crime. There are no varying degrees of rape. To suggest otherwise is inaccurate and insulting and minimizes the serious physical and psychological repercussions for all victims of rape.

_______________________________________________________________________________

AUGUST 21, 2012

The American Medical Women’s Association, the voice and vision of women in medicine since 1915, sent the following letter to:
Representative Heather Wilson, a Republican from New Mexico who is running for the U.S. Senate
Senator Scott Brown (R-MA)
Senator Ron Johnson (R-WI)

The American Medical Women’s Association (AMWA) agrees with your call asking Rep. Akins to step down. Not only was his comment incorrect medically, “If it’s a legitimate rape, the female body has ways to try to shut that whole thing down,” (1) it was offensive.

The data on rape related pregnancy has been known for many years and had been reported in the American Journal of Obstetrics and Gynecology in 1996 as 5 percent. (2) This study stated that “rape-related pregnancy occurs with significant frequency. It is a cause of many unwanted pregnancies and is closely linked with family and domestic violence.”

To also question whether the particularly violent act of rape is ever not “legitimate” is demeaning to all women, especially those who have been so violated.

AMWA appreciates your ability to stand up and call for Rep. Akins removal from running for public office. It is important to do the right thing and Rep. Akins comments underscore his inability to think clearly and to be a supporter of women and our right to health care.

Women need doctors and health care providers to care for our health. Since 1915 AMWA has been a strong supporter of women’s health and those who provide that care.

Thank you for acknowledging his inappropriate comments and for calling for him to step down.

Sincerely yours,
Gayatri Devi, MD
President

[1] New York Times, August 20, 2012
[2] Holmes MM, Resnick HS, Kilpatrick DG, Best CL, Rape-related pregnancy: estimates and descriptive characteristics from a national sample of women. Am J Obstet Gynecol. 1996 Aug;175(2):320-4; discussion 324-5.

__________________________________________________________________________________

Perhaps I am expecting too much of the AMA, an organization my father believed in all his life, and an organization I’ve been a member of for over 40 years. I’d love to hear their voice as strongly at this moment as for example I have on physician reimbursement, childhood bullying or obesity .

What is the mission and strategy of today’s American Medical Association? The mission: “To promote the art and science of medicine and the betterment of public health.” The strategy: L. Madara, MD, the AMA’s chief executive officer and executive vice president, unveiled a new strategy during the AMA’s 2012 Annual Meeting. It states: “As the nation’s health care system continues to evolve, the AMA is dedicated to ensuring sustainable physician practices that result in better health outcomes for patients. This work is captured in the AMA’s five-year strategic plan, which aims to ensure that enhancements to health care in the United States are physician-led, advance the physician-patient relationship, and ensure that health care costs can be prudently managed.”

“Advance the physician-patient relationship”: A decade ago, when I studied this relationship in 6 countries, and reported out the findings to leaders of the AMA and the World Medical Association, the then president of the AMA corrected me when I said “physician-patient relationship” telling me that I should always use “patient-physician relationship” because the “patient always comes first.”

I agreed, and ever since then, in publications and speeches I refer to the patient-physiciasn relationship. By the way, the findings of those landmark studies found that both patients and physicians in Germany, South Africa, Japan, U.K., U.S., and Canada all agree that the relationship was three things – compassion, understanding, and partnership.

Which brings me back to Akin, “legitimate rape”, and the House of Medicine. Compassion, understanding, partnership. Thank you ACOG and AMWA for your forceful and timely remarks in support of women and families. But is it too much to expect that the AMA would have been visibly out front on this issue. Is there room under the new strategy – under certain circumstances (even politically charged ones such as this) to put the patient first? Perhaps the Board of Trustees might discuss this at their next meeting.

For Health Commentary, I’m Mike Magee

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