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CHICAGO -- The American Medical Association quietly adopted a number of new policies during its House of Delegates meeting here without debate, including recommendations regarding prescription drug prices, sugar-sweetened beverages, and firearms.
The meeting closed Wednesday but not before the House voted to assist physicians in counseling patients regarding firearm safety.
It specifically advised AMA to help develop "guidance on when and how to ask sensitive questions about firearm ownership, access, and use, and clarification on the circumstances under which physicians are permitted or may be required to disclose the content of such conversations to family members, law enforcement, or other third parties."
AMA also decided, when scheduling its future meetings, to consider whether potential locations have so-called "gag laws" (banning physicians from raising certain topics with patients, such as firearm safety) in effect.
But the House declined to adopt a measure that would use the phrase "gun violence prevention" when referencing gun violence in its policies. The American Academy of Pediatrics had pushed AMA to use the word "prevention" during a hearing Sunday, calling gun control a public health issue. But the House instead chose to simply remove the phrase "gun control" from existing AMA policies on gun violence, to better reflect American politics.
Drug Prices
AMA also approved a few measures designed to make prescription drugs more affordable and accessible for patients, voting to support laws and regulations that:
- Allow Medicare and Medicaid to negotiate prices with drug companies
- Require companies to state retail prices during consumer drug ads
- Require manufacturers to explain why they are increasing the price of any drug by 10% or more "each year or per course of treatment," and notify the public before increasing the price
- Authorize the federal government "to take legal action to address price gouging by pharmaceutical manufacturers and increase access to affordable drugs"
- Expedite "review of generic drug applications and prioritize review of such applications when there is a drug shortage, no available comparable generic drug, or a price increase of 10% or more"
- Increase affordable access to the opioid overdose antidote naloxone, in addition to supporting naloxone regulation and legislation
The AMA committee that reviewed these measures before the House approved them "strongly believes that transparency of prescription drug prices is important and needed along a continuum of stakeholders," it wrote in a report; it also "strongly believes there is a need to address price gouging and anti-competitive behaviors by pharmaceutical companies."
"The common thread is drugs cost too much money in too many instances," Tom Peters, MD, speaking for the American Society of Transplant Surgeons, said during a committee hearing Sunday.
War on Sugary Drinks
A few measures to counter sugar-sweetened beverage consumption also passed the House, calling for AMA to:
- Encourage physicians to counsel patients about why sweetened beverages are unhealthy and what healthier beverage options are available.
- Encourage hospitals and medical facilities to serve healthier beverages instead of sweetened beverages, and display beverage calorie counts next to prices in their vending machines.
- Push to remove these beverages from schools
- Advocate research into other strategies to limit sweetened beverage consumption.
- Support state and local excise taxes on sweetened beverages, using that tax revenue to invest in public health programs addressing obesity and to help medical societies advocate for excise taxes on the beverages.
The House declined to rule on a measure asking AMA to push for federal legislation requiring parental informed consent discussing sports injury risk, before school-age athletes can compete. The resolution would also have called for AMA to introduce model state legislation and education, particularly around traumatic brain injury.
"The development of model state legislation was proposed and should be considered," an AMA committee wrote, and the House accepted the committee's recommendation to refer this measure for a later decision.
AMA last year had approved the policy Reduction of Sports-Related Injury and Concussion -- promising to "work with appropriate state and specialty medical societies to enhance opportunities for continuing education regarding professional guidelines and other clinical resources to enhance the ability of physicians to prevent, diagnose, and manage concussions and other sports-related injuries."
While AMA already supported selling health insurance across state lines, this week it agreed to push for plans to have patient and provider protection that match the state laws where the patient lives.
"Health care markets need increased competition," AMA Board Member Russell W. H. Kridel, MD, said in an AMA press release. "But in expanding these opportunities, we must ensure that the insurance products being sold comply with state laws intended to protect consumers."
Mental Health
The House also approved parts of a resolution introduced by the Resident and Fellows Section that would amend mental health disclosures on physician licensing applications and recommended others for study. These included a policy to encourage state medical board to recognize that having a mental health condition "does not necessarily equate with an impaired ability to practice medicine."
A second recommendation, asking state licensure boards to require disclosures from applicants only when their mental or physical health history is "likely to impair" the applicants' practice or "present a public health danger," was referred for study.
Michael Miller, MD, a Wisconsin delegate, argued that referral of this particular recommendation around disclosures was necessary so that model language for licensure questions could be identified.
Miller also worried that since many physicians see themselves as advocates for their patients, they may have difficulty being objective.
A delegate from Illinois countered that the AMA code of ethics requires that physicians practice objectivity and therefore bias should not be an issue.
But Wisconsin delegate, Tosha Wetterneck, MD, seconded Miller, saying that while the issue is time-critical, it's better to get it right than to get it approved.
She noted that Wisconsin's licensure could serve as a potential model. The questions are precise and nuanced and can differentiate between a past mental health problem or one being successfully managed versus something more problematic, she said.
Ultimately, the House sided with the Wisconsin delegates and voted to refer that policy in a 305-149 vote.
Docs in Flight
On Monday, the issue of in-flight emergencies prompted a lengthy debate over whether doctors should be required to show their credentials before tending to a patient on a plane.
The resolution at issue sought support for advocating "[t]hat flight crews will no longer be required to verify a medical professional's credentials before allowing that person to assist with an inflight medical emergency." The resolution also included a recommendation the the AMA offer "medical education courses to prepare for addressing inflight emergencies during its meetings" or offer similar courses at state and local branches.
In October, Tamika Cross, MD, an African American obstetrician-gynecologist, was because the flight attendant did not believe Cross was a physician. Her story went viral, the hashtag "#ThisIsWhatADoctorLooksLike" began trending on Twitter.
Arlene Seid, an American Academy of Public Health Physicians delegate, said she'd also volunteered twice to help in a medical emergency in flight. Once she was allowed to help, the second time she was turned away. Seid said the problem was "an issue of racism and of sexism."
But another delegate suggested that flight attendants have a right to be skeptical. Neither was there any consensus on courses addressing in-flight emergencies. Ultimately, the House voted to send the resolution back to the committee and the AMA's current policies were reaffirmed.
The House also voted to pull membership from two specialty societies, the American Association of Hip and Knee Surgeons and the American Society of Neuroimaging, because not enough of their members are also AMA members. Once their AMA membership level reaches the level specified in AMA's bylaws, they can apply for reinstatement.