CHICAGO-How dumb was it? Let me count the ways.   From the chairman of the AMA’s Board of Trustees to its lowliest public relations functionary, self-flagellation was the fallback position in the notorious Sunbeam marketing deal. Stupid, idiotic, incredible screwup. No vilification was too much for the AMA to heap on its own actions.   Phlebotomy was the therapy of choice. The AMA cut loose three senior officials, most prominently its deputy executive VP and chief operating officer, Kenneth Monroe, a 27-year AMA veteran and highest-ranking nonphysician. Also out the door went the group VP for business and management services, James Rappel, and the marketing VP who was point man on the deal, Larry Jellen.   It was Monroe who signed the contract for the AMA, committing the association to an exclusive endorsement of several Sunbeam health-care products in return for royalties, projected at nearly $2 million a year, if the AMA cachet boosted sales. The money would go for public-health projects, which the AMA is loath to fund out of general revenue.   In the extraordinary protest that followed, the AMA renounced the deal. In response, Sunbeam sued for breach of contract to the tune of $20 million. Sunbeam’s chairman, Albert Dunlap, known as Chainsaw Al, decried AMA “arrogance” for halting the arrangement unilaterally.   None of the physicians who run the AMA took a fall. Dr. P. John Seward, the executive VP who presided at the press conference when the Sunbeam deal was announced, survived a 12-hour emergency board meeting where the other execs got cashiered, but it wasn’t clear for how long. He was considered to be on probation. Though he denies it, Dr. George Lundberg, the editor of JAMA, was reported to be positioning himself as a successor. Insiders did not see his ascension happening.   One board member said that Dr. Seward, a former board chairman, hadn’t realized how the deal’s product-endorsement and exclusivity features violated AMA policy. Dr. Seward hailed a “significant day and landmark occasion for the AMA.”   Dr. Thomas Reardon, chairman of the 14-physician AMA board, said he himself was only dimly aware of the deal till after it was announced.   Indeed, AMA statements portrayed a runaway marketing staff, abetted by a cooperative chief operating officer, that was able to blindside the executive VP and board. Dr. Reardon called it a “systemic breakdown of the AMA’s internal systems” that failed to bring a “significant initiative” to the board for approval.   Yet Dr. Robert McAfee of Portland, Me., a former AMA board member and recent president, said it was routine in his day for product-endorsement deals to be presented to the board and then turned down.   The AMA lawyer who signed off on the contract, Joseph Simonaitis, says he only did it because he’d been assured that the board had approved the deal. The AMA’s general counsel, Kirk Johnson, led the probe into how the AMA went off the rails.   Meanwhile, Johnson himself survived a scare, not so much for impropriety as for the appearance of it at a bad moment. On the day the board met, the Chicago Sun-Times described how Johnson, with the help of his wife, a former senior AMA staffer then working for a health-care ad firm, had developed a multisponsored campaign 18 months earlier with the U.S. Olympic Committee to promote physical fitness. Roche was first in line as a $2.5-million sponsor.   Unlike in the Sunbeam deal, there was no overt AMA product endorsement involved. The question was whether AMA showed possible favoritism toward Johnson’s wife, Wendy Borow-Johnson, and why Johnson, whose interests lie in health policy, became enmeshed in the arrangement. Later the campaign fell through.   The board backed Johnson. Dr. Reardon said the board had been fully informed of the USOC campaign, which it called proper, and of Borow-Johnson’s involvement. Johnson said he pushed for the fitness campaign in his role as chairman of the AMA’s public-health advocacy team.   Meanwhile, an early 1977 memo to the board described a deal with First Aid Only of Vancouver, Wash., which included the AMA’s First Aid Guide. The kit was aimed at national drug chains. The memo also said Chevrolet Lumina would send all new 1998 buyers an AMA/First Aid Only kit. The memo projected sales of 10,000 kits but no dollar estimate.   That same memo to the board mentioned a budding partnership arrangement with Sunbeam.   When the Sunbeam deal was announced in mid-August, it was attacked almost immediately. A New York Times editorial said it reduced physicians to the level of celebrity hucksters. Consumer Reports pointed out that Sunbeam’s blood-pressure monitors ranked low on the list when tested against competitors.   Public Citizen’s Dr. Sidney Wolfe, characterizing the deal as a “crude money-grubbing scheme,” called it “one of the top three or four dumbest moves the AMA has ever taken.”   Dr. Arnold Relman, the editor emeritus of the New England Journal, who has been an AMA member throughout his career, was appalled by what he viewed as still another inroad of business into medicine. He and 13 ethicists signed a statement reminding the AMA that it’s a professional organization, not a trade group. “The AMA cannot speak with moral authority in defense of professional values if it sells endorsements,” they said, “regardless of how the gains may be used.” -Mark Bloom