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cal education sponsors in the state of Illinois.

Membership Services Two noteworthy ancillary activities performed
by the ISMS are examples of typical membership services. The society first
considered the possibility of providing malpractice insurance in 1916, and
its subsidiary organization, the Illinois State Medical Inter-Insurance Ex-
change, is now the seventh largest medical malpractice insurer in the
United States. The society's biweekly newspaper, Illinois Medicine, while
serving as a general news and educational vehicle for the profession, is
also a principal advertising medium for job openings for physicians in
Illinois and the surrounding area.


The American Heart Association (AHA) traces its beginnings to the found-
ing of the Association for the Prevention and Relief of Heart Disease in
New York City in 1915. This and similar groups in several other cities


banded together to form the American Heart Association in 1924. At first
the association consisted primarily of physicians and other health profes-
sionals. By the late 1930s, the membership had become increasingly
interested in expanding its activities to reach the general public. Its first
grant funding for a public information program, on rheumatic fever, was
received from the American Legion in 1946. With this encouragement,
the association was reorganized as a voluntary association in 1948.^^ From
that time it began to involve lay persons with skills in fund raising, public
information, business management, communications, and community

The AHA's simple, straightforward mission statement is as follows:
"The mission of the American Heart Association is to reduce disability and
death from cardiovascular diseases and stroke." The AHA carries on three
principal activities in support of this mission: "cardiovascular research,
cardiovascular education, and revenue generation." In terms of the divi-
sion of functions used in this study, cardiovascular research corresponds
to the research function, and cardiovascular education embraces both the
education and the health promotion functions. The third activity, revenue
generation, represents the enormous nationwide effort conducted by the
association to raise funds for its other activities, largely through volunteer
solicitation of gifts from individuals. As of 1992, the association included
approximately 2,000 state and metropolitan affiliates, divisions, and
branches, and involved some 3.5 million volunteers.

A unique feature of the AHA organization, the fourteen councils have
a collective total of 18,200 members, primarily physicians and other
health professionals. Each council is devoted to a particular specialized
area. A few examples include councils on Cardiopulmonary and Critical
Care, Cardiovascular Nursing, and Epidemiology and Prevention. The
councils are represented on the AHA Research Committee, which over-
sees the allocation of research grants; the councils also give guidance to
the AHA's professional education and public information initiatives.

Health Promotion Function Given the general predominance of this
function in the programs of most voluntary associations, it is not surpris-
ing to find that the AHA supports a wide array of community programs to
reduce death and disability from heart and blood vessel diseases. These
programs focus on a variety of topics, including heart attack, high blood
pressure, rheumatic fever, stroke, congenital heart disease, nutrition,
smoking, and cardiopulmonary resuscitation. Specific examples include
Heart at Work, a program based in the workplace that was started in 1985
and focuses on risk factors and early warning signs of heart attack; an
extensive arsenal of informational packages for elementary and high


school audiences; and the Tobacco Free America Project, a cooperative
enterprise with the American Cancer Society and American Lung Associa-
tion. These programs collectively accounted for an expenditure of $55.9
million during the 1990-1991 fiscal year and reached nearly 25 million
people. During the same period, AHA-sponsored cholesterol screening
and blood pressure checks reached 1.3 million people.

The AHA also dispenses information to the public through print and
electronic media; over 3,700 inquiries from members of the media were
answered by the association's National Center during 1990-1991, while
thousands more were handled by local affiliates.

Education Function Perhaps reflecting its origins as a professional
society, the AHA continues to be invested in professional education to a
degree unusual for a voluntary association. Its 1990-1991 budget for this
purpose was $30 million. The annual AHA Scientific Sessions, begun in
1925, are "now one of the nation's largest gathering[s] of scientists,
physicians and other health professionals concerned about . . . cardiovas-
cular diseases. "^^ The association also publishes eight professional jour-
nals, including Arteriosclerosis and Thrombosis: A Journal of Vascular Biology,
Currents in Emergency Cardiac Care, and Heart Disease and Stroke, a journal
inaugurated in 1992 and targeted specifically at primary care physicians.

Policy Formulation and Regulation Function As noted earlier, the
involvement of voluntary associations in this function is somewhat lim-
ited, in comparison to the professional associations. The AHA is, however,
among those voluntary associations with active lobbying presences in
Washington, D.C. The AHA Office of Public Affairs was established in
1981 "to interact with Congress and federal regulatory agencies on such
issues as biomedical research funding, tobacco control and nutrition. "^^

Other Functions Not atypically for a major voluntary health associa-
tion, the AHA's indirect involvement in biomedical research is considera-
ble. In fact, the association provides more financial support for cardiovas-
cular research than any other nongovernmental body in the world,
primarily through fellowships for scientific investigators and grants-in-aid
for specific projects. The association made a major commitment to in-
creased research funding in the late 1980s, at least partly in response to
the decline in federal support for such research. The first three AHA-
Bugher Foundation Centers for Molecular Biology of the Cardiovascular
System were opened in 1986, with the support of the Henrietta B. and
Frederick H. Bugher Foundation, at Baylor University College of Medi-
cine, in Houston, Texas, the University of Texas Southwestern Medical


Center, in Dallas; and Children's Hospital, in Boston. Three additional
centers (at Brigham and Women's Hospital, in Boston, Stanford Univer-
sity, and the University of California at San Diego) were added in 1991.

"Revenue generation," of course, is hardly a function unique to the
U.S health care system. However, since the AHA (with refreshing frank-
ness) identifies this as one of its major enterprises, it might be noted in
passing that the 1990-1991 income of the AHA reached $288.5 million.
Of this total, $235.7 million was received as contributions from the
general public. The AHA has also had significant success in attracting
research funding from pharmaceutical companies and philanthropic


Not surprisingly, archival coverage of professional and voluntary health
associations is spotty at best. Of approximately 2,800 individuals listed in
the most recent (1991) membership directory of the Society of American
Archivists, fifteen, or slightly more than one half of 1 percent, were
employed by health associations. In all but one case, the employing
associations were professional organizations such as the AMA and the
American Hospital Association.^^ Of the roughly forty associations men-
tioned at one point or another in this chapter, eight are definitely known
to have ongoing archival or records management programs. These include
the American Hospital Association, AMA, American Dental Association,
American Heart Association, American Optometric Association, Illinois
State Medical Society, American Red Cross, and Planned Parenthood
Federation. Most of these programs are operated on-site by personnel of
the respective associations. In two cases, however, the association records
are instead placed in external repositories: the records of the American
Red Cross are transferred to the National Archives of the United States,
and the records of the Planned Parenthood Federation are deposited in the
Sophia Smith Collection at Smith College, in Northampton, Massachu-

Several additional organizations — the American College of Cardiol-
ogy, the Transplantation Society, and Lions Clubs International — have
accumulated collections of historical materials, but it is not certain that
these collections are managed, organized, or added to in any systematic
fashion. Two additional associations, the American Academy of Family
Physicians and the American Academy of Pediatrics, were in the process
of beginning an archival program as of spring 1992. Thus, among the forty


or SO associations mentioned in this chapter, no more than one in four
appears to maintain any sort of archival or records management program.
If applied to the entire universe of perhaps 5,000 U.S. health associations,
this ratio is in all likelihood misleadingly optimistic, given the fact that
large and well-known associations are disproportionately represented
among those treated in this chapter.

Some of the programs just mentioned, notably those of the American
Dental Association, the American Optometric Association, and the Ameri-
can Hospital Association, are devoted to documenting the history of the
respective professions as well as of the associations themselves. Several
additional medical specialty societies identify themselves as maintaining
discipline history centers for their respective specialties. These include the
American Society of Anesthesiologists, American College of Physicians
(for internal medicine), American Association of Neurological Surgeons,
American College of Obstetrics and Gynecology, Oncology Nursing Soci-
ety, American Academy of Ophthalmology, American Academy of Oto-
laryngology, and American Psychiatric Association. It is not clear, how-
ever, that the discipline history activities of these societies are always
associated with an ongoing archival program comparable in scope to those
of, for example, the American Dental Association or the American Hospi-
tal Association.

An example of a professional association archives is the American
Medical Association Archives, located in the AMA headquarters building
in Chicago, where it is staffed by one full-time employee^' and holds
approximately 3,000 cubic feet of material. The AMA Archives systemati-
cally preserves record copies of association publications as well as the
official actions of the AMA House of Delegates and subsidiary committees
and councils. The archives' holdings also include audiovisual materials
prepared for public information purposes. However, it makes no consis-
tent effort to collect unpublished material that would document the
association's activities in the policy formulation and regulation realm, or
in other areas that do not inherently involve the dispensing of informa-

Among archival or records management programs in voluntary asso-
ciations, that of the American Heart Association appears to be one of the
best organized. The AHA employs one full-time records manager, sup-
ported by a budget of $3,850.^^ The program includes a written job
description for the records manager and a multipage manual for the
records management function that lists objectives for the program, char-
acteristics of records to be targeted for preservation, and a sampling of
types of record to be preserved. The reported holdings are approximately
50,000 documents, including annual reports, AHA journals and newslet-


ters, by-laws, biographical materials, and numerous other types of docu-

These two examples are, as suggested above, highly atypical. Many
other health associations are small, shoestring operations, and it should
hardly be surprising to find that they lack the resources to place a high
priority on the systematic documentation of their operations. Others —
notably AIDS organizations — are growing explosively to meet expanding
need, but may well prefer to devote all their resources to their primary
missions rather than to documentation efforts. ^^ This interpretation seems
to be supported by one response to my request for information, that of the
Gay Men's Health Crisis, which sent an impressive total of twenty-six
pieces of AIDS information literature^'^ while passing over the issue of
archival/records management activities in complete silence. ^^

A related area of concern is the collecting of health association records
by repositories outside the associations themselves. This topic was
touched on briefly earlier in this section, with reference to the records of
the American Red Cross and the Planned Parenthood Federation, which
are deposited, respectively, in the National Archives of the United States
and the Sophia Smith Collection at Smith College. In these two cases, the
presence of the associations' records in the archives is the result of an
ongoing cooperative arrangement between association and repository.

In many other cases, however, health association records are collected
not under such continuing arrangements, but as a result of one-time
transfers to external repositories. A search of standard national biblio-
graphic resources for archival and manuscript collections revealed about
1 30 entries for health association records in external repositories — at first
blush, a mildly encouraging figure. ^^ However, the overwhelming major-
ity of these entries — 95 of 130 — represent collections from state and local
medical and specialty societies, deposited for the most part in university
libraries or local historical societies. ^^ Of the remaining thirty-five entries,
about twenty represent state and local voluntary association records,
from, for example, local Red Cross Chapters and the Wisconsin Lung
Association, also preponderantly in university and historical society col-
lections. Only about 1 5 entries represent national associations — ten pro-
fessional (e.g., the American Society for Clinical Investigation and the
American Association for Medical Systems and Informatics) and five
voluntary (e.g., the American Council on Alcohol Problems, the Associa-
tion for Voluntary Sterilization). Thus, at the national level, the collecting
of archival and manuscript material from health associations seems to be,
if anything, less commonplace among external repositories than among
the associations themselves.

It seems clear, then, that in the realm of health associations there is


need both for vastly increased documentation efforts and for shrewd
priority-setting in those efforts, which obviously must be selective in
terms of both organizations and functions targeted for documentation. It
is hoped that this chapter provides a framework for making these difficult


My first debt of gratitude is owed to Victoria A. Davis, who encouraged me
to continue her work on this project after her departure from the Ameri-
can Medical Association. I wish to thank the staffs of the AMA library and
the library systems of the University of Illinois at Chicago and Loyola
University of Chicago. For assistance in gaining access to these libraries, I
thank the late Ann Faulkner, formerly Assistant Dean of the Graduate
School at Loyola, and Karen Graves, formerly at the AMA, now acting
documents librarian at the University of Illinois at Chicago.

I also thank association staff members who went to considerable
trouble to provide me with information about their respective associa-
tions: Rebecca Rhine Gschwend, Council of Medical Specialty Societies;
Susan Lucius, American Heart Association (National Center); Lynn Gigli-
otti, American Heart Association of Metropolitan Chicago; Linda Hudson,
Illinois State Medical Society; Jerry Knoll, American Red Cross; Charlotte
A. Rancilio, American Optometric Association; Jennifer C. Wellman,
National Center for Homeopathy; Patrick F. Cannon, Lions Clubs Interna-
tional; Robert W. O'Brien, National Safety Council; Suzanne H. Howard,
American College of Cardiology; Patrick Giles, Gay Men's Health Crisis;
Gloria A. Roberts, Planned Parenthood Federation of America; Michelle
Armstrong, Association of Surgical Technologists; and J. Lee Dockerly,
American Board of Medical Specialties. I am also grateful to archival
consultant Cynthia Swank, of the Inlook Group, for information on the
Epilepsy Foundation of America, and to fellow author Peter Hirtle, of the
National Archives and Records Administration, for assistance with online
searching of the Research Libraries Information Network.


L Encyclopedia of Medical Organizations and Agencies (Detroit: Gale Research, 1987
[2nd ed.j, 1990 [3rd ed.], and 1992 [4th ed.]) (hereafter cited as EMOA-2.
EMOA-3, and EMOA-4, respectively). The actual number of listings in EMOA
is over 12,000; however, this count includes government agencies, funding


organizations, and research centers and institutes, all of which fall outside the
scope of this chapter.

2. Paul J. Feldstein, Health Associations and the Demand for Legislation: The Political
Economy of Health (Cambridge, Mass.: Ballinger, 1977), 28.

3. Paul Starr, The Social Transformation of American Medicine: The Rise of a Sovereign
Profession and the Making of a Vast Industry (New York: Basic Books, 1982), 40.

4. James M. Rosser and Howard E. Mossberg, An Analysis of Health Care Delivery
(New York: John Wiley & Sons, 1977), 33-34.

5. Page Smith, Trial by Fire: A People's History of the Civil War and Reconstruction
(New York: McGraw-Hill, 1982), 393-99.

6. Lloyd E. Burton and Hugh H. Smith, Public Health and Community Medicine
(Baltimore: Williams & Wilkins, 1970) 60. Quoted in Rosser and Mossberg,
Health Care Delivery, 29.

7. These events took place in 1924 and 1948, respectively. The American Heart
Association is discussed as a case study in a later section of this chapter.

8. Richard H. Shryock, The Development of Modern Medicine (Madison: University
of Wisconsin Press, 1979), 267, and Medicine in America: Historical Essays
(Bahimore: Johns Hopkins Press, 1966), 154, 157.

9. Homeopathy Today, April 1992 (Fairfax, Va.: National Center for Homeopathy),

10. Starr, American Medicine, 91, 109. In 1901 the AMA House of Delegates was
established, with membership drawn primarily from representatives of the
state societies in proportion to the states' membership. This replaced the
previous haphazard system that gave undue influence to physicians who
lived near the sites of annual meetings. The change provided greater
continuity and authority in the AMA's own decision-making and gave rise to
dramatic increases in the state societies' membership and influence.

11. The count of 54 includes the 50 states plus "state-type" associations in the
Distria of Columbia, Guam, Puerto Rico, and the Virgin Islands.

12. "The American Red Cross: People Helping People" (American National Red
Cross, Washington, D.C.: 1989, Brochure). This information about the Red
Cross is drawn from recent publications provided by the organization itself.

13. Since medical specialties are, by definition, health professions, there are no
voluntary associations devoted to medical specialties as such.

14. Council of Medical Specialty Societies Mission Statement (Council of Medical
Specialty Societies, Lake Forest, 111. February 1992).

15. J. Lee Dockery, M.D., Executive Vice President, American Board of Medical
Specialties, telephone conversation with author, 2 Nov. 1993. The aaual
number of distinct subspecialties in which certificates are offered is somewhat
less than 72 because of overlap among the subspecialty certificates offered by
the 24 boards; for example, the boards in family practice, internal medicine,
and pediatrics all offer subspecialty certification in sports medicine.

16. Rebecca Rhine Gschwend, Acting Executive Vice President, Council of
Medical Specialty Societies, telephone conversation with author, 18 May
1992. Informal relationships between specialty certification boards and


specialty societies reportedly run the gamut from close cooperation to mutual
suspicion and antagonism.

1 7. This is both similar to and in contrast with the relationship between the AMA
and the state and local medical societies, which are separate but related
organizations, rather than "chapters" or "branches" of the AMA.

1 8. American Heart Association, American Heart Association Scientific Councils and
Journals (Dallas: American Heart Association, 1991), 1.

19. The full name of the Shriners is the Imperial Council of the Ancient Arabic
Order of the Nobles of the Mystic Shrine for North America.

20. EMOA-2, 758.

21. EMOA-2, 235. This organization is not listed in the third or fourth editions.

22. The Bay Area Cryonics Society did not respond to my request for a statement
of its views on this issue of definition.

23. EMOA-4, 644.

24. This information is drawn from recent brochures provided by the association.

25. EMOA-4, 23.

26. Advertisement for 70th annual summer instructional program. Homeopathy
Today, April 1992, 18.

27. Harry F. Swope, and Randall Neustaedter, "Council for Homeopathic
Certification moves ahead," Homeopathy Today, April 1992, 21.

28. National Center for Homeopathy, Homeopathy: Natural Medicine for the 21st
Century (Fairfax, Va.: National Center for Homeopathy, 1992), 7-8.

29. This statement, written in 1908 by Charles V. Roman, a past president of the
NMA, is carried on the title page of every issue of the NMA Journal.

30. "GMHC: First in the Fight Against AIDS" (Gay Men's Health Crisis, New York,
1992, Brochure).

31. "Mission and Policy Statements" (Planned Parenthood Federation of
America, New York, 1990), 2.

32. National Safety Council, Looking Toward Tomorrow: 1991 Report to the Nation
(Chicago: National Safety Council, 1991), 2.

33. "Connections: 1992 Member Services Guide" (American Dental Association,
Chicago, 1992), 4.

34. EMOA-4, 269.

35. "American Optometric Association: A Look Behind the Logo" (American
Optometric Association, St. Louis, Mo., 1992, Brochure).

36. National Safety Council, Looking Toward Tomorrow, 14-15.

37. Ibid., 5-6.

38. "The American Red Cross: People Helping People" (American National Red
Cross, Washington, D.C., 1989, Brochure).

39. EMOA-4, 859.

40. EMOA-4, 546.

41. EMOA-3, 373.

42. Encyclopedia of Associations, 23rd ed. (Detroit: Gale Research, 1989), 1344.

43. Letter from Jennifer C. Wellman, National Center for Homeopathy, to the
author, 3 April 1992.

NOTES 1 77

44. "American College of Cardiology 1992 Fact Sheet" (American College of
Cardiology, Bethesda, Md., 1992).

45. EMOA-4, 884.

46. EMOA-4, 967.

47. Letter from Cynthia G. Swank to Joan Krizack, 19 Oa. 1992.

48. EMOA-2, 96. This organization is not listed in the third or fourth editions.

49. EMOA-4, 4.

50. Feldstein, Health Associations, 27. In 1965 the AMA spent more money
opposing Medicare during the first three months of the year than any other
lobbying organization spent during the entire year!

51. Feldstein, Health Associations, passim.

52. EMOA-4, 4.

53. EMOA-4, 269.

54. EMOA-4, 644.

55. EMOA-4, 544.

56. EMOA-4, 859.

57. Letter from Cynthia G. Swank to Joan Krizack, 19 Oct. 1992.

58. American Heart Association, American Heart Association History 1992 (Dallas,
Tex.: American Heart Association, 1992), 14.

59. National Safety Council, Looking Toward Tomorrow, 13.

60. The First Ten Years: Gay Men 's Health Crisis 1990-1991 Annual Report (New York:
Gay Men's Heahh Crisis, 1992), 3-7.

61. Planned Parenthood Federation of America, A Tradition of Choice: 1991 Service
Report (New York: Planned Parenthood Federation of America, 1991), 5.

62. American National Red Cross, The American Red Cross Biomedical Research and
Development Report, 1991 (Washington, D.C.: American National Red Cross,

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