Protecting the Public at the National Level
At the Annual American Medical Association (AMA) House of Delegates held in Chicago on June 10-14, the AMA debated numerous public health proposals, including some that had their origin at the Chicago Medical Society and the Illinois State Medical Society. (For general highlights of the AMA meeting, please see “AMA: Health Reform at a Crossroads” on page 28). Here is a summary of new public health measures emerging from the annual conference. The descriptions are adapted from the online AMA Wire.
Evidence has consistently shown a link between consumption of sugar-sweetened beverages (SSBs) and an increase in type 2 diabetes and coronary heart disease. As a result, the AMA adopted policy as part of a comprehensive report on SSBs, aimed at reducing the amount of sugar Americans consume. New policy supports evidence-based strategies to reduce the consumption of SSBs, including excise taxes on them, removing options to purchase SSBs in primary and secondary schools, the use of warning labels to inform consumers about the health consequences of SSB consumption, and the use of plain packaging.
The AMA policy also urges continued research into other strategies that may be effective in limiting SSB consumption, such as controlling portion sizes, limiting options to purchase or access SSBs in early childcare settings, workplaces, and public venues, and changes to the agricultural subsidies system. Under the new policy AMA also encourages hospitals and medical facilities to offer healthier beverages for purchase in place of SSBs. Additionally, the policy calls for these facilities to make calorie counts visible next to the price of beverages sold in their vending machines. Physicians are also encouraged to counsel their patients about the health consequences of SSB consumption and importance of replacing SSBs with healthier beverage choices.
The AMA adopted policies aimed at protecting children’s health by addressing vaccine policy. In recognition that vaccinations are safe and effective, and that their benefits far outweigh any risks, the AMA adopted policy that supports the rigorous scientific process of the Advisory Committee on Immunization Practices as well as its development of recommended immunization schedules for the nation; recognizes the substantial body of scientific evidence that has disproven a link between vaccines and autism; and opposes the creation of a new federal commission on vaccine safety whose task is to study an association between autism and vaccines.
According to research cited in an HOD resolution, myopia is “the leading cause of visual impairment globally.” The resolution also stated that nearsightedness might “lead to lower quality of life, financial burden, retinal detachment and macular degeneration” in children. To help prevent myopia onset and progression in school children and adolescents, delegates adopted policy supporting efforts aimed at encouraging children to spend more time outside participating in various outdoor activities instead of remaining indoors. The new policy would also promote other activities that have been shown to reduce the onset of myopia in children and adolescents.
Lead in domestic water remains a problem in many communities across the United States. According to an HOD resolution, 4.9% of children in Flint, Michigan, “were found to have lead poisoning in 2015.” Even if many communities have not experienced the same devastation as Flint, lead pipes remain in dozens of communities around the country, according to data cited in the resolution.
Testimony in support of this resolution said the focus should include multiple possible sources of lead poisoning, not just in water sources. Delegates adopted policy to support requiring “an environmental assessment of dwellings, residential buildings or child-care facilities following the notification that a child occupant or frequent inhabitant has a confirmed elevated blood lead level.” This complete environmental assessment will help determine the potential source of lead poisoning in those children, whether through the testing of the water supply or another origin.
In 2015, the Detergent Poisoning and Child Safety Act was introduced to require the U.S. Consumer Product Safety Commission to set mandatory safety standards for liquid laundry packets to prevent ocular burns in children. The AMA supported the legislation.
This new resolution, offered by the American Academy of Ophthalmology, argued that a voluntary American Society for Testing and Materials “standard neither requires a reformulation of liquid laundry packets to make them less caustic to children, nor do they require changes in color and design to make them less attractive to children.” To ensure the voluntary ASTM standard adequately protects children from injury, such as ocular burns, the HOD directed AMA to “encourage the Consumer Product Safety Commission, in conjunction with the American Association of Poison Control Centers, to study the impact of ASTM’s standard that is currently in place.”
Delegates voted in support of WHO’s designation of infertility as a disease state with multiple etiologies requiring a range of interventions to advance fertility treatment and prevention. The declaration could have a broad impact on how patients, insurers and society at large view infertility. Infertility affects 15% of couples and is recognized as a complex disease by WHO and ASRM. Some of the largest health insurance companies in the U.S., including Cigna, Optum Health and Aetna, cover some treatments. However, not all insurance companies cover treatment. Delegates offered unanimous testimony supportive of this resolution, with an emphasis on how this classification would promote insurance coverage and payment.
A resolution adopted by the AMA supports evidence-based amounts of choline in all prenatal vitamins. Adequate levels of choline—an important nutrient that helps a baby’s brain and spinal cord to develop properly—are necessary to maintain normal pregnancy including neural development of the fetus and reducing the incidence of birth defects. Inadequate choline levels during pregnancy are thought to negatively affect cognitive development. Neural tube and hippocampus development also are dependent on adequate choline intake. Prenatal vitamins only contain 0–55 mg of choline, leaving the majority of pregnant and lactating women without enough dietary choline to protect the health and development of their babies, according to data cited in a resolution adopted by the HOD.
The HOD took several actions aimed at improving research on and payment for preventive care. Newly adopted policies encourage expert committees making preventive-services recommendations to follow transparent, evidence-based processes, encourage comparative-effectiveness research on secondary prevention and advocate that all payers be required to provide first-dollar coverage of routine preventive pediatric care.
Delegates also voted to support requiring Medicare to waive coinsurance for colorectal screening and any interventions required during the procedure, such as polyp removal, and support removing insurance barriers to securing coverage for HIV pre-exposure prophylaxis (PrEP). More than 100 tests and treatments are paid for without cost-sharing as directed by the Affordable Care Act based on the recommendations of the expert committees, the AMA report says. The HOD adopted new policy asking these expert committees to develop evidence reviews with enough specificity to inform cost-effectiveness analysis, work together to identify preventive services that are not cost-effective and consider development of recommendations for secondary prevention.
- Discuss medicine’s response to the public health crisis of undertreated and mistreated pain
- Explore and make recommendations for augmenting medical education designed to educate healthcare providers on how to help patients suffering from pain with evidence-based treatment options.
- Discuss strategies that may prevent or mitigate acute pain, educate physicians about these strategies, and suggest research to study if these strategies prevent the development of chronic pain.
The National Spotlight
Resolutions describe a problem and propose a solution. If you would like to see your resolution debated on the national stage where it will have the most impact, at the American Medical Association’s House of Delegates, now is the time to get started.
Any Chicago Medical Society member can author a resolution on an issue of wide concern to physicians. Once vetted by CMS, most resolutions move on for debate at the ISMS House of Delegates, which meets every April, and then to the AMA House of Delegates, which meets twice a year, in June and in November. During both the ISMS and AMA meetings, assigned reference committees hear testimony and suggest improvements. At the final stage, often on the House floor, delegates vote to pass, or amend, or refer a resolution for study.
The resolutions you see here had humble beginnings with a single member at a local medical society putting a proposal in writing. Be sure to participate in this important process now!
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