The American Medical Association (AMA), which celebrated its 150th anniversary in 1997, has a history that is marked by both accomplishment and failure.

On the plus side, the AMA, with 300,000 members, is the largest medical society in the United States, the wealthiest ($208 million operating revenue in 1996) and the most likely to get the ear of legislators.

On the negative side, only about 40 percent of practicing medical doctors are members of the organization -- a dramatic decline from its 75 percent membership 30 years ago. And the AMA became enmeshed in controversy last year after its chief executive decided to approve a marketing arrangement with Sunbeam Corp. that was decried for the appearance of commercializing the group's name and led to the the resignation of its several officers.

In its formative years, the AMA had even greater problems. The most pressing in 1847 was the lack of standards for training doctors. The few universities with medical departments were vastly outnumbered by private medical schools designed to make money for owners by attracting large numbers of students -- for whom even a high school education was not a prerequisite -- with short courses and nonsupervised apprenticeships.

States for the most part had laissez faire policies with respect to medical schools, staying out of the regulatory arena. In Maryland, for example, an 1838 law permitted any individual the right to charge and be compensated for performing medical services.

By the 1880s, the AMA began to gain ground in its campaign for stricter medical licensing laws, which had as its goal restricting medical practice to those with MD's. Although the statutes varied enormously in their rigor, medical education still left much to be desired until John D. Rockefeller donated about $50 million in the early twentieth century to support schools with higher educational standards. The result was a drastic and rapid decrease in "diploma mill" institutions from 147 to 95.

What ultimately made the AMA powerful, however, were its nationwide campaigns against abortion and alcohol.

As early as 1859, for instance, the AMA urged a "general suppression" of all abortions. Of course, the campaign was not one free of self-interest. By refusing to perform abortions, medical doctors could solidify their attempt to control the practice of medicine.

Allying with newspapers that catered to sensational stories of back-alley abortions, the AMA by 1900 had gotten every state except Kentucky to enact antiabortion laws. And most of the statutes allowed only AMA-sanctioned practitioners to decide on the rare instances in which an abortion could be performed.

Self-interest also prevailed in the effort to ban alcohol. Recognizing the opportunity for its physicians to get the exclusive right to prescribe alcohol to patients in an otherwise dry country, the AMA campaigned vigorously for prohibition, denouncing alcohol in a 1917 House of Delegates resolution:

"Whereas, We believe that the use of alcohol as a beverage is detrimental to the human economy, and

"Whereas, its use in therapeutics, as a tonic or stimulant or as a food, has no scientific basis, therefore be it

"Resolved, that the American Medical Association opposes the use of alcohol as a beverage, and be it further

"Resolved, that the use of alcohol as a therapeutic agent should be discouraged."

After Prohibition, the Eighteenth Amendment of the U.S. Constitution, became the law of the land, only licensed doctors could prescribe liquor. Even patent medicines with the slightest amount of alcohol could be had legally only with a doctor's permission. During Prohibition's 14-year existence, an average of 10 million prescriptions a year were written.

The AMA's rise to dominance in the medical profession during the early part of the century led to criticism of the fee-for-service standard that the association had long regarded as sacrosanct. By the 1920s, critics were urging that medical service be provided by groups of physicians so that charges could be reduced, aided by insurance. Although the AMA opposed the recommendation, the emergence of Blue Cross insurance for the payment of hospital expenses moved the association to drop its opposition.

The organization then turned its focus to more radical proposals, such as that by President Truman to extend Social Security into compulsory health insurance. Dubbing the plan "socialized medicine," the AMA waged a campaign against its enactment that stretched from the Truman presidency through the Kennedy administration.

The AMA also successfully fought against patent medicines. When Hadacol, an over-the-counter preparation conspicuous mostly for its high alcohol content, was touted in 1950 as a dietary supplement to avoid scrutiny by the Food and Drug Administration, the AMA led a fight that ultimately resulted in Hadacol's demise. In the January 13, 1951, issue of the Journal of the American Medical Association, the organization declared that "no doctors of medicine will be uncritical enough to join in the promotion of Hadacol as an ethical preparation."

Yet during the AMA's heyday in the 1950s, forces were at work to lessen its influence. The growth of specialization among physicians made membership in specialty associations in many cases more important than being part of the AMA. States began to permit a broader variety of health practitioners to render care, at least in part to create competition that would lead to lower costs. The AMA fought the trend until these carriers became significant in their own fields by qualifying for payment for government and private insurers. Not until 1978, for example, did the AMA abandon its blanket condemnation of chiropractors. Thomas V. DiBacco is a historian at American University.