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recent years, the American Medical Association has seen controversy
and decline. As its new chief, can Yank Coble turn things around?
Ask recently installed American Medical Association President Yank
Coble Jr. ’59, M.D. ’62 to describe the challenges
he faces in his new leadership post, and this veteran diabetes
specialist and family practitioner doesn’t miss a beat. Says
Coble, who’s been traveling the country nonstop in recent
months to beat the drums for the 290,000-member AMA, “We’re
facing some extraordinary opportunities for medical breakthroughs
right now, in areas such as stem-cell research, gene therapy, and
more effective management of chronic diseases like diabetes and
asthma.”
And, of course, there are national issues to address, “including 40 million
Americans without health insurance, and falling reimbursements from the federal
government for Medicare services. At the same time, the AMA is being challenged
as never before, internally, as we struggle with a recent decline in enrollment
and some controversial issues within our own organization.”
Although he describes the obstacles that lie ahead as “quite formidable,” Coble
says he doesn’t feel “the least bit intimidated” by them. He
sounds surprisingly upbeat for a man about to sail into what several AMA executives
humorously describe as “a perfect storm” of political controversy.
“
Our job at the AMA is to ‘promote the art and science of medicine’ in
order to continually improve American health,” says Coble. “And education
is terribly important in order to accomplish that mission. If they want to provide
the best care, doctors need to know the science. And the public has to be educated
about prevention issues and disease management, as well.”
While preparing for his swearing-in as president of the Chicago-based AMA last
June, he devoted several days a week to the Herculean task of restoring the tarnished
luster of an organization whose ranks—and influence—have declined
precipitously in recent years. Battered by internal dissension and sometimes
criticized as irrelevant, the AMA has lost more than a third of its membership
since the early 1970s, when 72 percent of the nation’s 800,000 physicians
were dues-paying members. These days, the troubled organization has 291,000 members
and faces increasing financial pressures as a result. While losing $8 million
in 2000 and $15 million the year before, the nation’s foremost medical
organization has been wracked by internal lawsuits and policy disputes over issues
ranging from malpractice liability insurance reform to the ethics of stem-cell
research to its recent and controversial support for gun-control legislation.
The doughty AMA does appear to have entered a zone of fierce turbulence that
may threaten its very survival in the years ahead. In recent years, the 1,000
professional and clerical employees at the AMA’s Chicago headquarters have
been faced with internal disagreement about business and policy decisions. The
last two presidents of the organization ran into severe problems—one left
his post early, and the other is now suing the organization. Outside the AMA
bureaucracy itself, many U.S. doctors are asking themselves if the organization
is truly relevant in an era dominated by high-speed communications and the Internet.
Given all of these caveats, it’s easy to understand why physicians and
other medical professionals from Maine to California have been asking themselves,
why would anyone want to sign on for the job of president of the struggling AMA?
Are the association’s days numbered?
“
It’s true that our overall membership has declined,” says Coble, “but
that’s not really as significant as some might think. Even though fewer
than half of the country’s physicians are what we call ‘direct members,’ the
fact remains that 95 to 98 percent of U.S. doctors belong to the association
through their ‘specialty societies,’ which represent such groups
as the endocrinologists and surgeons. There’s still only one single organization
that represents the entire medical profession today—and that’s the
AMA.”
Coble insists that the AMA’s role is more important than ever. “We’re
facing some very threatening public-health problems in this country right now,
such as increasing obesity and diabetes. And the surge in obesity is especially
troubling among children. We’ve got millions of kids in this country who
are spending as much time in front of the TV each year as they’re spending
in the classroom. So now we have this extraordinary epidemic among children and
young adults. And of course, being overweight is closely associated with the
rise in diabetes. We’ve got at least 16 million diabetics out there right
now—and half of them don’t even know they’ve got the illness.”
He recites a litany of public-health problems: a significant increase in asthma,
the growing resistance to antibiotics among disease germs, AIDS, and heart disease.
Coble says expanding physician education is an important task for the AMA. He’d
like to see the organization committing itself to providing more continuing medical
education courses for member-physicians, as well as “better devising systems
to quickly inform members about complex medical topics, such as cloning and stem-cell
research.”
He comes to his new post and his common-sense opinions naturally. Born and raised
in Burlington, North Carolina, Coble was named after a “family friend from
up North.” His family struggled to make ends meet, he says, but received “some
powerful help” from his beloved grandmother. “Nana was one of the
most important influences on my life. She had a sixth-grade education, and her
husband had died when my mother was only one year old. She supported her family
by sewing socks in a one-room apartment in Burlington, where I grew up.
“
Nana didn’t have a lot of book-learning, but she was a great caregiver.
She’d put mustard plasters on you for a chest cold, or rub tobacco in spit
to put on a bee sting. Regardless of her lack of formal education, she understood
the art of healing very well. As a matter of fact, I think the basic health message
from the AMA today is the same message my grandmother gave us when we were growing
up.
“
She told us we needed to eat well—three nutritious meals a day, without
taking in a lot of empty calories. She insisted that we eat plenty of fruits
and vegetables, and that we get plenty of exercise. Nana really understood what
was required for health and longevity. As the president of the AMA, I’m
really going to be pushing her message: the idea that prevention via healthy
living habits is the key to staying well.”
While treating many of her neighbors with her famed “home remedies,” Nana
kept urging her young grandson to study medicine. “As far back as I can
remember,” he recall, “all I wanted was to be a doctor. Nana encouraged
that. And several of the doctors in town also inspired me—along with helping
me land an [A.B. Duke] scholarship to Duke. Fortunately, the campus wasn’t
located too far away, so I could bring my laundry home and get a good meal now
and then.”
At Duke, Coble soon “fell in love” with the study of human physiology—and
with the immensely complex workings of the human metabolism. “I studied
chemistry and physiology, and it didn’t take me long to realize that you
would never be able to learn it all. I think my decision to become an endocrinologist
probably got its start in those labs at Duke. I became utterly fascinated with
the workings of metabolic chemistry, and I still am today.”
After earning his M.D., Coble completed his residency at the New York Hospital
Cornell Medical Center—then went on to win a coveted fellowship from the
National Institutes of Health International Research Program. While serving as
U.S. liaison to foreign health-care research projects in Egypt, Nigeria, England,
and elsewhere over a period of several years, he would earn a degree in clinical
medicine of the tropics from the London School of Hygiene and Tropical Medicine.
Returning to this country in the mid-Sixties, the endocrinologist spent the next
three decades as a family physician and diabetes specialist in Jacksonville,
Florida. He also taught human physiology and biochemistry to hundreds of students
at the University of Florida Medical School. In recent years, Coble took on several
high-profile volunteer assignments at the AMA, including election to its board
in 1994.
How will he do as president of the struggling AMA? “Yank Coble is an enormously
dedicated physician, and he’s totally committed to improving public health,” says
AMA CEO Michael Maves. “But he’s also one of the most down-to-earth,
unassuming guys I’ve ever met. You won’t see a lot of public fireworks
from Yank. He’s quiet—and yet he’s enormously effective at
pulling the levers of power in order to achieve his goals for public health.”
Charles Hayes, a Florida nephrologist who has worked with Coble on several medical
boards, says “He’s certainly not a limelight seeker. He prefers to
remain in the wings, and keep a low profile. But then you look around and you
suddenly discover that he’s accomplished whatever goals he set for himself.”
According to Coble, these descriptions of his “low-key” persona are
right on target. “Back when I was at Duke, I had a job at a summer resort.
Well, the manager called me over and he said, ‘I’ve got an assignment
for you; you’re gonna be the entertainment director.’ I looked at
him and I said, ‘I think you’ve got me mixed up with somebody else.
I can’t sing, and I can’t dance.’ But you know what? That manager
insisted that I was the right man for the job. And he told me something I’ve
never forgotten: ‘I don’t want you to be the show—I want you
to manage it. I want you to produce the very best entertainment we’re capable
of.’
“
That’s exactly how I feel about my new assignment at the AMA. We’ve
got all kinds of talented people in the organization, and they’re just
as eager as I am to get to work on the challenges ahead.”
--Tom Nugent is a freelance writer living in Michigan.
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