Council Name Change

At the 2005 Annual Meeting of the American Medical Association (AMA), the AMA House of Delegates approved amendment of the AMA’s bylaws to change the name of the Council on Scientific Affairs to the Council on Science and Public Health. The following report explains the reasons for this change. NOTE:  This is an edited version of CSA Report 1, which was presented at the 2005 AMA Annual Meeting.

Since its inception in 1977, the Council on Scientific Affairs (CSA) devoted considerable attention to public health issues. During the first 10 years of its existence, the CSA addressed numerous public health topics including vehicle and driver safety; environmental influences on public health (acid rain, asbestos, energy sources, carcinogens, ionizing radiation, herbicides, ozone); firearms; community mental health centers; smoking (and smoking cessation); alcohol and other drug abuse; nutrition; radon in homes; adverse health effects of video display terminals; physical fitness and physical education; medical care for indigent patients; child and elder abuse and neglect; food additives and labeling; dietary fiber; antibiotics in animal feed; drugs and athletes; fire safety; treatment of diseases with high public health impact (eg, hypertension and hyperlipidemia); physician mortality and suicide;  and immunization.  The first AMA report on “acquired immune deficiency syndrome” was submitted to the AMA House of Delegates by the CSA in December 1984. This was followed by no fewer than 15 reports over the next 5 years, establishing the foundation for AMA policy on HIV infection and AIDS.

Over the next decade, the CSA continued to address important public health issues such as low-level radioactive wastes; infectious medical waste; health care needs of the homeless; medical perspectives of nuclear power; ultraviolet radiation; unsafe drinking water; pregnancy and work; global climate change; childhood sexual abuse; health education; biotechnology and the agricultural industry; reduction in environmental pollution; infant mortality; family and interpersonal violence; diet and cancer; clinical ecology; clinical preventive services; human sexuality education; and environmental tobacco smoke.

Reports and Activities Over the Last Decade

From 1996 to December 2004, the CSA submitted more than 160 reports to the AMA’s House of Delegates, the recommendations of which were adopted as AMA policy or directives. Thirty-eight Council reports developed during this time have been published in peer-reviewed literature.These reports addressed a broad range of public health and medical issues affecting physicians and their patients including:

• AIDS/HIV issues such as screening pregnant women, home test kits, bloodborne pathogen transmission from and to health care workers, chemoprophylaxis, and disability status.
• Broad public health domains such as medical considerations in air travel, environmental hazards, community syringe disposal, sporting and recreational injuries, drivers and vehicle safety, violence, and obesity.
• Consumer nutrition and food-related issues such as folate and calcium supplementation, transmissible spongiform encephalopathies, and genetically modified foods.
• Cancer screening for prostate, colorectal, or breast malignancies.
• Pediatric and adolescent health issues such as newborn screening, circumcision, lead poisoning, attention deficit hyperactivity disorder, bullying, and sexuality education.
• Clinical practice issues including diagnosis and treatment of asthma, pain management in adults, use of opioids in chronic noncancer pain, alternative medicine, folk remedies, and antibiotic resistance.
• Consumer products such as over-the-counter inhalers for asthma and antimicrobial-laced topical products.
• Hospital and health-care worker issues such as discharge criteria, reprocessing of medical devices, use of radiofrequency devices, prevention of needlestick injuries, bloodborne pathogen transmission, and chemoprophylaxis of exposed individuals.
• Mental health topics such as diagnosis and treatment of depression, Alzheimer’s disease, memories of childhood abuse, and guidelines for seclusion and the use of restraints.
• Patient education about their prescriptions and the broad topic of health literacy.
• Pharmaceutical expiration dates.
• Scientific/public policy issues such as stem cell research, cloning and embryo research, gene patenting, organ donation, tissue transplantation, blood donation and blood banking practices, clinical research, preventive services, medical marijuana, screening nonimmigrant visitors for tuberculosis, vital statistics, xenotransplantation, and gender verification of female Olympic athletes.
• Special population topics including health literacy, use of restraints in nursing homes, on-site physician home health care, and addressing the health care needs of gay men and lesbians in the United States.
• Tobacco, alcohol, and other substance abuse topics including screening for alcohol problems, reducing the nicotine content of cigarettes, harm reduction approaches, methadone maintenance, needle exchange, dextromethorphan abuse in adolescents, and substance abuse among physicians.
• Women’s health issues such as contraception, drug interactions between oral contraceptives and antibiotics, work and pregnancy, mammography screening, breast implants, alcoholism, menopause, osteoporosis, and a global view of sex- and gender-based differences in health and disease.

It is clear from this portfolio that the Council has been and remains heavily engaged in public health advocacy.

Role in Enhancing the AMA’s Profile in Disaster Preparedness

Starting with a briefing in February 1999, the CSA initiated activities and authored a series of  reports over the next 4 years that established AMA policy, and an AMA presence, on the issues of disaster and public health preparedness. These activities included a forum on Bioterrorism Preparedness in conjunction with the Section Council on Federal and Military Medicine (A-99); a regional meeting on Bioterrorism Preparedness convened by the University of San Diego College of Medicine, San Diego County, and the Johns Hopkins Center for Civilian Biodefense Studies; a key stakeholder meeting in conjunction with the 2000 Weapons of Mass Destruction conference held by the Department of Defense; an appearance before the Advisory Panel to Assess Domestic Response Capabilities for Terrorism Involving Weapons of Mass Destruction, also known as the “Gilmore Commission”; and participation in the initial meeting held by the Centers for Disease Control and Prevention on its Bioterrorism Preparedness and Response Core Capacity Project 2001.  The Gilmore Commission eventually recommended that the recommendations contained in CSA Report 11 (I-00) be implemented as part of the national approach to enhancing local disaster preparedness and emergency response.

During this time, the CSA lobbied extensively for the AMA to create a dedicated office on disaster preparedness.  The Council is pleased that this office has made substantial progress toward achieving many of the key objectives previously outlined by the Council.  The Council will assist the activities of this office in the future, where feasible.

The Council continues to work proactively with the Group on Science, Quality, and Public Health to help serve the AMA’s needs in this developing area.  In so doing, the Council intends to promote the concept that physicians have a public health role.  As an initial step in this process, the Council has established formal liaison with the American Public Health Association, the National Association of County and City Health Officials, and the Association of State and Territorial Health Officials.

Mission Statement and Activities Related to Public Health

Recently, the Council reviewed and modified principle #5 of its mission statement  to reflect its renewed commitment to public health as follows:

5. Enhance the profile and priority of science and public health within the AMA and the Federation* 

Additionally, the Council re-established a standing committee on Public Health/Disaster Preparedness to be served by two subcommittees, one devoted to review of key public health issues for potential AMA involvement, and the other to disaster preparedness.  The standing committee  will serve as a functioning liaison for intercouncil activities in this area, and assist the CSA in assuming a more proactive, advisory role to the Board of Trustees on public health issues and activities.

Comment

The Council is proud of its historical commitment to public health, and readily accepts the responsibility for further enhancing the profile of public health and public health preparedness within the AMA, and by extension to our members and the Federation of Medicine.

In developing its reports, the Council will make a concerted effort to craft recommendations that will direct or facilitate implementation of specific advocacy activities related to public health. The Council also pledges to work with communications and marketing staff to increase the “reach” of its reports, particularly those that have a public health focus.