Somebody Help Me, Please

By Michael Applebaum, MD, JD, FCLM

I am trying to understand something here.  But I can’t, so help me, please.

Here is the issue.

The American Medical Association claims to be the organization for “Physicians dedicated to the health of America.”  Okay.

It has a Code of Medical Ethics.  “For more than 155 years, the AMA Code of Medical Ethics has been considered the most comprehensive ethics guide for physicians on a wide range of patient-physician issues.”  Okay.

The AMA has nine Principles of Medical Ethics which were Adopted by the AMA's House of Delegates June 17, 2001.  “The nine principles are standards of conduct which define the essentials of honorable behavior for the physician and are the basis for the opinions that make up the Code.”  Okay.  

The Preamble to the Principles reads:

The medical profession has long subscribed to a body of ethical statements developed primarily for the benefit of the patient. As a member of this profession, a physician must recognize responsibility to patients first and foremost, as well as to society, to other health professionals, and to self. The following Principles adopted by the American Medical Association are not laws, but standards of conduct which define the essentials of honorable behavior for the physician.

Okay. 

Among the Principles are:

III. A physician shall respect the law and also recognize a responsibility to seek changes in those requirements which are contrary to the best interests of the patient.

VII. A physician shall recognize a responsibility to participate in activities contributing to the improvement of the community and the betterment of public health.

VIII. A physician shall, while caring for a patient, regard responsibility to the patient as paramount.

Okay.

On its “Medical Ethics” web page, the AMA has a link to the “Public Health” page.  Presumably they are related.  Okay. 

From the “Public Health” web page the AMA has a link to the “Obesity” page. Presumably they are related.  Okay.

On the “Obesity” web page, the following is posted:

U.S. Surgeon General Richard Carmona, MD called it the greatest threat to public health today. It kills more Americans every year than AIDS, all cancers and all accidents combined. And it's causing problems in children that were unthinkable 20 years ago. That is why the American Medical Association (AMA) is working to halt the spread of obesity.

Leaders in the field of preventive health, pediatrics, family practice, nutrition and more, convened at AMA headquarters in Chicago for the first meeting of the AMA Working Group on Managing Childhood Obesity. Their goal: to develop a set of strategies to help physicians more effectively work with families, youth-serving organizations, school health professionals, public health organizations and community groups to reduce overweight and obesity and to eliminate racial and ethnic disparities in childhood obesity.

The AMA has also been collaborating with the U.S. Department of Health and Human Services to produce a series of publications entitled, Roadmaps for Clinical Practice – Case Studies in Disease Prevention and Health Promotion. Roadmaps help physicians and other health professionals identify and reduce health disparities by integrating focused interventions into routine medical care. The latest edition, Assessment and Management of Adult Obesity is now available online.

Okay.

In order to qualify for funding under the Child Abuse Prevention and Treatment Act (CAPTA) (Jan. 1996 version), 42 U.S.C. 5101, et seq., all 50 states have passed some form of a mandatory child abuse and neglect reporting law.  The Act was originally passed in 1974.  It has been amended several times and was amended and reauthorized on October 3, 1996, by the Child Abuse Prevention and Treatment and Adoption Act Amendments of 1996 (P.L. 104-235).

Per CAPTA, “the term ‘child abuse and neglect’ means, at a minimum, any recent act or failure to act on the part of a parent or caretaker, which results in death, serious physical or emotional harm, sexual abuse or exploitation, or an act or failure to act which presents an imminent risk of serious harm.”

States require certain professionals and institutions to report suspected child abuse, including health care providers and facilities.

Failure to report suspected child abuse can result in civil liability or criminal liability (although the liability is typically a misdemeanor punishable by a fine).

CAPTA requires states to enact legislation that provides for immunity from prosecution arising out of the reporting abuse or neglect. In most states, a person who reports in "good faith," i.e., not maliciously, is immune from criminal and civil liability.

Okay.

But here is where I get stuck.

Isn’t the AMA saying that overweight or obesity “results in…serious physical…harm” to children?

Now if the AMA really believed that obesity is

“the greatest threat to public health today,”
“kills more Americans every year than AIDS, all cancers and all accidents combined” and is
“causing problems in children that were unthinkable 20 years ago”

wouldn’t it

“respect the law,”
“recognize a responsibility to participate in activities contributing to the improvement of the community and the betterment of public health” and
“regard responsibility to the patient as paramount”

by “working to halt the spread of obesity” and call for physicians, i.e., health care providers, to report obese children (at the very least) to the authorities under CAPTA?

If physicians “must recognize responsibility to patients first and foremost, as well as to society,” following the law would seem like a good beginning.

This certainly seems like one way “to help physicians more effectively work …to reduce overweight and obesity…”

What am I missing here?  Somebody help me, please.