Jane Orient is aware that her critics describe her and her associates as whackos. The feeling is mutual, she says.
Orient is a Tucson doctor who happens to be the executive director of a national organization that's getting a lot of attention lately, thanks to the Tea Party movement and the debate over health-care reform.
When you watch Fox News coverage on health-care reform, there's a good chance that the doctor talking about the evils of the Democratic Party's plans is part of the Association of American Physicians and Surgeons (AAPS).
Orient, who did her undergraduate studies in mathematics and chemistry at the UA and earned her doctorate at Columbia University, has been executive director of the AAPS since 1989. During her tenure, Orient says, membership of the organization has doubled twice, and this year, she estimates it's gone up about 10 percent.
The group often gets described as a bunch of John Birchers who care more about politics than medicine. Orient says the organization—which started in 1943 in reaction to the failed Wagner-Murray-Dingell legislation to create a national health-care program—fights for freedom, limited government and the sanctity of the patient-physician relationship.
The organization was heavily involved when Hillary Clinton led health-care-reform efforts during her husband's first presidential term. In 1993, the AAPS sued Hillary Clinton to force her to disclose participants in a behind-closed-doors health-care task force. Orient says they won, sort of, since the suit forced the government to release the names of some task-force members, but the Clintons' work continued until its ultimate failure.
Now, more than 16 years later, Orient's group has witnessed a perfect storm: the health-care debate mixed with the Tea Party fervor championed by Glenn Beck and Fox News. As a result, the AAPS has earned criticism from the left. On her MSNBC show, Rachel Maddow recently referred to an article in Mother Jones magazine ("The Tea Party's Favorite Doctors," Nov. 18) that took an extra-close look at the Tucson-based organization.
"A very snarky person, she is," says Orient about Maddow.
Regarding the Mother Jones article, Orient accuses the reporter and magazine of defaming the organization and printing lies, although the reporter notes that calls to AAPS for comment were not returned. Orient says that when they saw the story, she went through all messages and found nothing from Mother Jones.
The AAPS has been front and center in the health-care-reform debate, holding protests in Washington, D.C., and other cities with MDs in white coats and scrubs to showcase a lack of support from doctors.
The Mother Jones story questioned what kind of doctors are part of AAPS, noting that the group advocates for doctors to have a cash-only practice, with no third-party billing to insurance, Medicare or Medicaid.
Then there is the organization's journal, of which Orient is managing editor—the Journal of American Physicians and Surgeons—and the slew of articles it publishes that are often cited in debates on immigration, abortion and the link between early childhood vaccines and autism.
Former CNN pundit Lou Dobbs got himself in trouble when he cited an AAPS journal claiming that illegal immigrants bring leprosy into the United States.
"You may look at our journal and conclude that I'm a whacko who brought up a different point of view," says Orient, although she counters that the journal publishes a statement that the opinions expressed do not necessarily reflect the opinions of AAPS.
"I think people go to our journal, and they look at the table of contents, and they think, 'What a bunch of whackos. Everybody knows that science is settled on all of these things.' You don't dare question. For example, nobody of any credibility would ever believe that HIV does not cause AIDS. Well, there are some questions about that hypothesis, and they are worth looking at, especially when we are giving people too many drugs based on a fallacy, and people are getting hurt."
She brings up other articles that have created a buzz, such as one on abortion and possible links to breast cancer.
"Well, there is evidence that women who've had abortions have a higher incidence of breast cancer. We're not saying that abortion causes breast cancer, but it put them at about a 30 percent higher risk. Shouldn't women want to know about that?" Orient says.
During the Tucson Weekly's interview with Orient, in her modest red-brick midtown home, the only time her voice rises is when asked about accusations in the Mother Jones story that Orient and her organization are directly linked to Philip Morris and the tobacco industry. She calls the accusations in the story "just a bald-faced lie."
In the story, Orient is painted as a shill for tobacco by helping Philip Morris with a campaign against indoor-smoking bans. She says that's completely false, and even hinted at legal action against Mother Jones.
"I think our person in D.C. is going to do an interview with the reporter," says Orient, referring to the AAPS lawyer, Andrew Schlafly, son of Equal Rights Amendment nemesis and conservative darling Phyllis Schlafly.
"The only thing we could figure out is that they were going back through a Philip Morris lawsuit, and they quoted something we wrote. But to say that I worked for them, that's just not true. How they came up with that idea, I don't know, but I'd like her to cough up the evidence. It's just plain not true. I've been going over and over in my mind that maybe a tobacco company was a sponsor at a meeting I spoke at. But we've never taken any money from them. I have never worked for them."
However, it is true that the AAPS is against indoor-smoking bans. This is a policy point that may make Orient friends at bars throughout Tucson.
"Is that really the right thing to do—intruding into people's rights for fake hazards? Where does it stop?" asks Orient. "But I'm not advocating (smoking). I don't smoke, and Philip Morris is not sending me a check."
Orient goes on to claim that evidence against secondhand smoke is lousy, and that some of the evidence even suggests that a tiny bit of exposure to secondhand smoke might be beneficial, "just like a tiny exposure to other things is beneficial for the immune system. ... Shouldn't we now do a cost-benefit analysis to look at these things?
"That's what science was all about for some who were considered whacko, but they turned out to be right."
Orient started her private practice in 1981, after finishing a four-year stint at the Tucson Veterans Affairs Hospital. She opened her practice in a medical park off Tucson Boulevard; that space now serves as the office for the AAPS, while she has an examining-room space on La Cholla Boulevard that she uses for her practice.
Shortly after starting her practice, Orient says, she heard about the AAPS, went to a meeting and liked what she discovered.
"They are a group of horse-and-buggy doctors who care for their patients. I learned a lot from them," says Orient.
It was much better than what she says she experienced at the VA, where she felt like a gatekeeper forced to keep patients from receiving services. The AAPS taught her that she could be a better advocate for her patients, and that one of the best ways to do that is to maintain a cash-only practice. Orient doesn't take health insurance, Medicare or Medicaid.
"Most people go into medicine to take care of patients, but they are frustrated, because it is getting very difficult these days. But you can actually make a living. I've had to cut my expenses, but I'm able to more than manage," says Orient. "I don't have to fight with people to get paid. I don't have to fill out claims or risk my life for putting down the wrong (reimbursement) codes."
It probably helps that Orient is paid well for her work as the AAPS executive director. According to the AAPS 990 tax records covering 2004 to 2007, Orient has received $150,000 per year for 25 hours of work per week. Orient says that isn't a salary; she is paid as an independent contractor, and she has to cover her own expenses as executive director.
All AAPS members are encouraged to practice this no-insurance business philosophy. Orient says some doctors moving in that direction go cold-turkey, while others change their practices gradually. The other benefit to this model is that doctors can spend more time with patients.
"They are not rich people ordinarily," says Orient about the patients she sees. "Maybe they don't want all their information in an electronic record for a third party to look at; maybe they can't get to their doctor. If you want something perhaps that's different, a noncompliant patient can be a threat to a doctor."
This is the way to practice medicine, she professes—not a single-payer system or the mandatory insurance system that just passed in the U.S. Senate.
Orient says she's not alone. She claims 60 percent of the country agrees with her.
The Association of American Physicians and Surgeons now has about 4,000 members. Orient says she thinks that number will continue to grow as doctors learn more about what will be required of them thanks to the health-reform legislation. She claims those who will benefit the most are big insurance companies.
"They want to force people to buy their product. What could be a better deal for them? All these physicians who do not like managed care, who support this plan, are really out there stumping for a plan that is the mother of all HMOs—it's just managed care to the max. To think the government running it is going to be better?" asks Orient.
Because most doctors are dependent on third-party payment systems, they have to fight to get paid, she says, and she doesn't expect that to get any better with a health-reform plan.
"Who in America voluntarily works and has to fight to get paid? You try to portray AAPS as a bunch of nuts. But I'm surprised more people aren't looking at the health-care reform law and saying, 'That's what's crazy,' because it is."
That's the kind of talk that's made the organization popular with Tea Party types. It's also led to criticism from mainstream doctors regarding the ethics behind some of the questionable articles published in its journal. In the end, critics say, it all shows the organization has a political agenda that has little to do with patient care or medicine.
David Gorski, a surgeon at the Barbara Ann Karmanos Cancer Institute at Wayne State University in Michigan, has been highly critical of the AAPS and, in particular, critical of its journal findings.
Gorski is managing editor of the blog Science-Based Medicine (www.sciencebasedmedicine.org), and he has used this platform to call attention to the AAPS.
"Sometimes they even make their way into the mainstream press as though they were legitimate scientific studies," Gorski wrote in 2008 about the AAPS journal findings. (It should be noted that the Weekly cited the journal in a 2005 article about health-care problems being caused by illegal immigrants.) "Make no mistake, though, when it comes to medical science, this organization deserves every harsh word that I am about to write because it is a major booster of antivaccinationism, HIV/AIDS denialism, and the now discredited hypothesis that abortion causes breast cancer, while on its pages it regularly attacks the very concept of evidence-based medicine and peer-review. That it is an organization of physicians is all the more appalling."
As a result of his attacks, Gorski has also faced criticism, especially from autism organizations who feel there may indeed be a link between vaccinations and the disorder.
"You start criticizing people like this, and you can expect that there will be nastiness, particularly regarding vaccines," says Gorski.
Gorski's observations over the years have led him to conclude that the AAPS has no interest in promoting real science.
"When I first came upon the organization, I think it was because of the anti-vaccine stuff. As you know, I'm really opposed to the anti-vaccine movement. As I learned more, I came across all the other stuff—the abortion and breast-cancer link. ... They even claim that a doctor shouldn't be bound by rules or restrictions and should practice medicine anyway they want," says Gorski. "There is no other profession in the world that doesn't have some degree of regulation. I know doctors. Most of us are great people, but there are many who aren't. There does need to be regulation."
Gorski says he does not understand why the AAPS journal is now publishing stories against global warming.
"What the hell does that have to with medicine? I think they are far more political than medical, but I guess that shouldn't surprise anyone. Their most famous member is Ron Paul. But medicine should be based in science and medicine. If you can't understand that, then you shouldn't be a doctor."
Orient says she doesn't understand why a medical journal wouldn't want to look at global warming. The New England Journal of Medicine, she says, has printed articles on the subject—although they were biased.
"Part of science is questioning, and someone should be out there printing other perspectives. That's important," Orient says.
Orient and the AAPS do have ties to those who work to debunk global warming—in particular, the Oregon Institute of Science and Medicine, founded by Arthur B. Robinson. According to the OISM Web site, Orient is a medical adviser for the organization.
The organization is mostly known for a petition signed by scientists who questioned global warming, although some have claimed that many of those signatures were false. Orient says she worked on that petition, and has every petition card that was returned. Each signature is accounted for, although she admits it's possible some signatures could have been forged.
The OISM has also published two books that make the case that the dangers of nuclear weapons have been "distorted and exaggerated," a topic that may have helped bring Orient and Robinson together.
In 1990, Orient started Physicians for Civil Defense, which developed kits for rural law-enforcement agencies to help detect high levels of radiation in the event of a nuclear attack.
Orient says she was inspired to start the organization when she went to a lecture in 1983 at the UA given by Australian pediatrician Helen Caldicott (author of Nuclear Madness), known for being outspoken in favor of nuclear disarmament during the height of the Cold War.
"She was talking about the hazards of radiation, and I was appalled. I wanted to say, 'I taught physics, and I know what you are saying is utter nonsense.' I was really angry that a physician was up there frightening people to death and actively obstructing measures that would project them in the event of a catastrophe," Orient says.
"Why are you not taught that the first thing you do when you see a flash of light is you hit the floor? You are eight times more likely to live. If you stand by the window, you'd be blinded by flying glass. You have a few seconds, because light travels faster. Will the world come to an end? No, it will not. It absolutely will not. Most of the time, there will be fallout, but there are things you can do to protect yourself."
Orient uses the Chernobyl accident of 1986 as an example. The biggest cause of death after Chernobyl, she claims, was abortions, because women were afraid that something was probably wrong with their unborn children. She says any risk, however, was insignificant.
"We don't do a cost-benefit analysis. It is (about the) demon ... radiation is a demon; tobacco is a demon. ... We are scared, scared, scared of these things, and we are not taught the basic things we can do to protect ourselves. Radiation will surely kill you if you get too much of it, but how do you know you're getting too much of it, or whether you are in an adequate shelter?"
While doctors like Gorski consider the AAPS to be on the far, far right, it's interesting that the AAPS sometimes finds common ground with organizations on the left.
In 2006, the AAPS joined forces with the American Civil Liberties Union to protest a provision in the Patriot Act regarding government access to patient medical records without probable cause or a warrant.
And now, the AAPS agrees—sort of—with Physicians for a National Health Program (PNHP), a progressive organization that recently called for the rejection of the health-reform bill that requires mandatory insurance. The PNHP, however, would be considered a bunch of socialists by Orient and the AAPS, because they want a single-payer system.
George Pauk, a retired doc who lives in Phoenix, says the PNHP has about 17,000 members across the country and has existed since the 1980s to promote a single-payer health-care system.
"When I started out, people (in medicine) gave away services to low-income or poor people. But now that's changed, and people are being put back into a time when they didn't have (health) care or had to beg for it. That's what would happen with these extreme libertarian points of view," Pauk says, referring to the AAPS and others fighting health-care reform.
"We believe in a basic principle that all citizens have a right to health care—the same quality—and that everyone in our nation gets health care. We know most physicians feel the same way."
Pauk says recent surveys show that more than 60 percent of physicians in the United States want to see health-care reform and support a single-payer system.
"We're pretty much opposed to this new bill. It will give a lot of money to insurance companies and is not very progressive," Pauk says. "Right now, we're sort of in agreement with Republicans who want to kill anything, and we want to start over."
Orient says it's wrong to assume her members don't care about poor people. She knows of several who volunteer or run free clinics, and she says county hospitals used to help meet the needs of the poor and working class. However, Orient also notes that Tucson no longer has a county hospital.
"Socialized medicine hurts poor people more, and it results in the scarcity of medical services. Plus, those best at fighting a system are generally not people in the street," says Orient.
With health-care reform still a hot topic, Orient and AAPS will continue to garner attention. The recent debate has helped revitalize a California chapter of the organization, and a chapter in Pennsylvania recently put up a new Web site, says Orient.
The Tea Party movement, of course, has provided a big boost.
"I think we're working for the same common goal: restoring our freedom for allowing our physicians and patients to continue working together, without these know-it-alls and know-nothings to dictate how we practice medicine and what type of medical treatment we can get," says Orient.
"Right now, we are right in the mainstream of America."