If you should hear a cry of anguish, it may be the American Medical Association stepping on its stethoscope - big time! On behalf of its 293,695 physicians, resident physicians and students, and declining financial resources - a projected $8 million deficit this year, $18 million last year - the AMA took time out to squash a single small information provider, alleged (and at best marginal) copyright infringer Timothy Pickering and his Web site, Myhealthscore.com. The specific information over which the AMA claims a copyright has to do with how much Medicare is supposed to pay for medical procedures.

Each treatment is assigned a code number, so public and private health insurers know what to shell out for a medical procedure.

Numbers and prices were assigned, the reasoning went, so that Medicare, the private insurance providers and the doctors were all using a uniform pay scale, to prevent over- or undercharging, fraud and unnecessary, costly duplicate labor. One would think Medicare material would be exempt because Medicare materials are commissioned by the federal government and are therefore supposed to be the property of U.S. taxpayers for the express use and benefit of U.S. taxpayers. One might think that, but one should, apparently, think again.

The AMA claims it made up the numbers. To this non-lawyer, making up numbers and assigning them to a medical procedure doesn't seem all that creative or innovative. The AMA even trademarked the process: Current Procedure Terminology, it calls it. The Department of Health and Human Services was, by law, prohibited from developing its own terminology. If DHHS had written the regulations, they couldn't be copyrighted. If the AMA wrote them, the AMA could claim copyright. Is that the invisible hand of lobbyists at work?

Why bother your pretty head?

Why would anyone in his right mind want to know the numbers, procedures and payout dollars? Well, if you were a thoughtful consumer, you might be interested in knowing if your doctor is over- or undercharging you. So, when Pickering and Myhealthscore.com posted those CPT numbers and their attendant explanations without shelling out $10 per query per year to the AMA, the good doctors chopped him off at the knees. So to speak.

Did I tell you the AMA makes big money - $71 million last year, to be exact - from its sales of books, products and royalties? That's a matter of public record, but the AMA is shy about saying how much money CPT brings in.

The AMA informed me that the information is available in any public library in a book called Medicare RBRVS. But it isn't. Three large, first-class suburban libraries I called said they'd never heard of it. The AMA also said it was available online at Health Care Financing Administration. It is - but at the most user-unfriendly site ever created and carefully designed to frustrate even the most skilled Web viewers - including some I talked with at DHHS.

Two mistakes for price of one

The AMA is hurting for money, according to Chicago Sun-Times reporter Howard Wolinksy, who's been following its misfortunes for more than a decade. There have been lots of cutbacks, multimillion-dollar deficits, staff firings and little first-class travel. It sold off the last of its valuable Chicago real estate this year. Three years ago, in a moneymaking effort, the AMA got into the trademark business with "Chainsaw" Al Dunlap, then-chairman of Sunbeam and a man known for ruthless cost-cutting. Under Dunlap, Sunbeam's stock climbed as high as $52 per share before it tumbled back to $15.75 under a cloud of questions about the company's auditing practices.

The AMA cut a five-year licensing agreement with Sunbeam that would have had the AMA attach its serpent-on-a-staff logo to endorse Sunbeam's Health@Home product line. One complete top level of AMA executives was shown the exit following that boondoggle.

Kiss copyright goodbye

In 1993 John Gilmore was credited with saying, "The Net treats censorship as damage and routes around it." Today, that holds true perhaps more than ever. While the Web appears to be open and free to all, it isn't. There are tools that have, as Lorrie Cranor, Aviel Rubin and Marc Waldman posit, "the ability to stop publication, destroy published materials or prevent the distribution of publications." In short, censorship tools.

These three computer scientists, fighting what they see as censorship, have created Publius - the pen name used by the authors of the Federalist Papers: Alexander Hamiliton, John Jay and James Madison. Publius is a publishing system co-developed by AT&T and Waldman, a graduate student at New York University, that takes a message - or document like the copyrighted and trademarked Current Procedure Terminology, or a whistleblower's files or a human rights dissident's reports - and chops it into many small pieces, encrypts those pieces, then spreads them to volunteer computers around the world. Using a special technique, the contents of the document are easily reassembled and sent to a person asking for it. By spreading the content over hundreds, perhaps thousands of computers and allowing the offending document to be reassembled with only a few computers, Publius could prevent the AMA or any other powerful entity from suppressing or keeping information secret. No court could suppress such a vast number of computers located around the world. Only a few computers, from among those thousands of computers, could put the document back together. The Publius system will not know which computers hold what information; only that a special code, similar to a Web site address, holds the encrypted information.

With Publius and a Pickering or other concerned citizen on your side, you just might be able to see the AMA's Current Procedures Terminology whether or not they want you to.