In an effort to modernize the ancient ethics pledge, officials from the American Medical Association announced Tuesday an update to the Hippocratic oath that includes a vow of loyalty to national health insurance giant Blue Cross Blue Shield. This newly revised pledge requires doctors to uphold their allegiance to Blue Cross Blue Shield, to avoid pricey tests and referrals whenever possible, and to do no harm to any in-network patient so far as it remains sufficiently cost-effective, said AMA spokesperson Amanda Cummings, noting a further addition to the professional oath that obligates doctors to enforce all co-pays and coinsurance payments. The updated text also requires physicians to have a comprehensive working knowledge of their specific financial agreement with Blue Cross Blue Shield. And above all, a doctor must, at all times, avoid inflicting any injury or wrong upon the companys bottom line. Officials added that the new pledge would no longer require doctors to swear by Apollo the physician, and Aesculapius the surgeon, and likewise Hygeia and Panacea, but rather by Blue Cross Blue Shield CEO Scott Serota. 