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AMA Adopts New Policies at Annual Meeting

For immediate release:
June 19, 2012

CHICAGO – The American Medical Association (AMA), the nation's largest physician organization, voted today during its annual policy-making meeting to adopt the following new policies:

Adverse Health Effects of Nighttime Lighting
The AMA today adopted policy recognizing that exposure to excessive light at night can disrupt sleep, exacerbate sleep disorders and cause unsafe driving conditions. The policy also supports the need for developing lighting technologies that minimize circadian disruption and encourages further research on the risks and benefits of occupational and environmental exposure to light at night.

"The natural 24-hour cycle of light and dark helps maintain alignment of circadian biological rhythms along with basic processes that help our bodies to function normally," said AMA board member Alexander Ding, M.D. "Excessive exposure to nighttime lighting disrupts these essential processes and can create potentially harmful health effects and hazardous situations."

"This type of disruption especially impacts those employed by industries requiring a 24-hour workforce as well those faced with unsafe driving conditions caused by artificial lights on cars and roadway illumination. By supporting new technologies that will reduce glare and minimize circadian disruption, the AMA is taking steps to improve both public health and public safety."

Sales Of Tobacco In Pharmacies
Expanding on current policy opposing the sale of tobacco by pharmacies, the AMA today adopted policy that would create a recognition program for pharmacies that voluntarily eliminate the sale of tobacco.

"Pharmacies that simultaneously sell tobacco cessation products alongside cigarettes and tobacco products are sending a mixed message to consumers, and the AMA wants to publicly recognize those pharmacies that put the health of their customers first by not selling tobacco," said Dr. Ding. "Tobacco remains the leading preventable cause of death and disease in our country, and the AMA is committed to helping smokers quit and preventing kids from picking up this deadly habit."

AMA to Evaluate ICD-11 as a New Diagnostic Coding System
Delegates at the AMA's Annual Meeting today adopted policy to evaluate ICD-11 as a possible alternative to replace ICD-9. The AMA will conduct more research on this issue and will report back to the House of Delegates in 2013.

"ICD-10 coding will create unnecessary and significant financial and administrative burdens for physicians," said AMA President-elect Ardis Dee Hoven, M.D. "It is critical to evaluate alternatives to ICD-9 that will make for a less cumbersome transition for physicians and allow physicians to focus on their primary priority - patient care. AMA voted today to consider ICD-11 as a possible alternative. The policy also asks the AMA and other stakeholders, such as the Centers for Medicare and Medicaid Services, to examine other options."

Opposing Legislation to Exempt Cigars from FDA Oversight
Cigars are being marketed to youth in a range of attractive flavors like candy, alcohol, fruit and chocolate. Cigar smoking is the second most common form of tobacco use among youth, and each day almost 3,000 children under 18 years old try cigar smoking for the first time. The AMA passed policy today to block legislation that would exempt flavored cigars from Food and Drug Administration oversight.

"Tobacco use can lead to serious cardiovascular conditions and remains the leading cause of preventable death and disease in the United States," said Dr. Hoven. "The AMA has long held policy against flavored tobacco and marketing it to youth. It is important that we help our children make good decisions so that they may lead healthy lives."

Drug Courts as Incarceration Alternative for Nonviolent Criminals
New AMA policy encourages the establishment of drug courts at the state and local level as an alternative to incarceration and a means of overcoming addiction for individuals with addictive disease convicted of nonviolent crimes. According to the National Association of Drug Court Professionals, drug courts are an alternative to individuals with addictive disease, providing them with intensive treatment and regular drug testing. A 2009 study of the National Institute of Justice found that drug court participants had significantly fewer positive drug tests and reported better improvements in their family relationships.

"Individuals with addictive disease require treatment," said Dr. Hoven. "When an individual is convicted of a nonviolent crime, drug courts can provide the medical attention, support and accountability needed to help them conquer their addiction and turn their lives around."

Dispensing Medically Appropriate Quantities of Formulary Medications: Pharmacy benefit managers and insurers institute prescription drug quantity limits that dictate the number of dosage units of a particular drug that will be covered by the plan for a specific period of time. The AMA voted today to work with third party payers to create an exceptions process to ensure that patients can access higher or lower quantities of medically necessary drugs or testing and treatment supplies.

"It is imperative that medication quantity limits do not prevent a patient from getting the medication they need when they need it," said AMA Board Member Carl A. Sirio, M.D. "In patients with bipolar disorder or schizophrenia, for example, physicians need the flexibility to prescribe different medications in different doses and combinations to meet the unique needs of each individual patient. To avoid the dire consequences that can result if patients are not able to immediately and easily access medically required drugs, an exceptions process must be created to ensure that patients can get the medications their physician prescribes."

Solutions For National Drug Shortages
A drug shortage may compromise and delay treatments, leading to the progression of diseases, adverse outcomes or therapeutic failures. While this is a complex problem that will require a multi-pronged approach to solve, there is evidence that advance notification of potential problems can help prevent or resolve drug shortages. Today, the AMA voted to require manufacturers of FDA approved drugs to give the agency at least 6 months notice, or as soon as is practicable, of anticipated voluntary or involuntary, permanent or temporary, discontinuance of the manufacture or marketing of such a product. The policy also supports the creation of a task force to enhance the HHS Secretary's response to preventing and mitigating drug shortages and to create a strategic plan to address ongoing aspects of drug shortages.

"National drug shortages often prevent patients from getting the right drugs at the right time, threatening patient care and safety," said AMA board member Patrice A. Harris, M.D. "The AMA is committed to solving this complex problem, and we will continue to work with stakeholders to advocate for solutions that protect the health of our patients."

Promoting Prevention of Fatal Opioid Overdose
Opioid addiction and prescription drug abuse places a great burden on patients and society, and the number of fatal poisonings involving opioid analgesics more than tripled between 1999 and 2006. Naloxone is a drug that can be used to reverse the effects of opioid overdose. The AMA today adopted policy to support further implementation of community-based programs that offer naloxone and other opioid overdose prevention services. The policy also encourages education of health care workers and opioid users about the use of naloxone in preventing opioid overdose fatalities.

"Fatalities caused by opioid overdose can devastate families and communities, and we must do more to prevent these deaths," said Dr. Harris. "Educating both physicians and patients about the availability of naloxone and supporting the accessibility of this lifesaving drug will help to prevent unnecessary deaths."

Updating Mammography Screening Recommendations
Mammography is the most reliable breast cancer screening tool for the general population, but it also has limitations. As a result, several organizations have recommended various mammography screening guidelines. Today, the AMA has adopted policy that starting at age 40, all women should be eligible for screening mammography. The policy also supports insurance coverage for this screening.

"Early detection of breast cancer increases the odds of a patient's survival, and mammography screenings are an important tool in discovering this cancer," said Dr. Harris. "All patients are different and have varying degrees of cancer risk, and patients should regularly talk with their doctors to determine if mammography screening is right for them."

Easing the Burdens for Physicians to Treat Across State Lines
For a physician to practice medicine as a volunteer in a neighboring state, the physician must be licensed to practice in that state. The AMA passed policy today to support the development of state programs that allow out-of-state physicians to provide their professional services across state lines at free clinics and in underserved communities.

"We become physicians so that we can help patients lead healthier lives, but licensing barriers can prevent physicians from helping patients in neighboring states," said AMA board member Stephen Permut, M.D. "Creating programs for out-of-state physicians to practice medicine in free clinics in other states will help improve access to health care, particularly in underserved communities."

Preserving the Opportunity to Moonlight
The average medical student who graduated in 2010 had $157,944 in medical school debt and 17% of medical student graduates had debt surpassing $200,000. The AMA passed policy today that recommends it work with the Accreditation Council for Graduate Medical Education, American Osteopathic Association and graduate medical education programs to allow resident and fellow physicians who are in good standing with their programs the opportunity for external and internal moonlighting.

"The amount of medical school loan debt continues to grow, and medical residents are looking for opportunities to reduce this debt burden," said board member Jordan VanLare. "It is important that we provide medical residents and fellows who are in good standing the chance to gain valuable extra experience, and also earn the additional income they need to cover expenses related to these loans and day-to-day living."

Securing Quality Educational Sites for U.S.–Accredited Schools of Medicine and Osteopathic Medicine
Many for-profit, unaccredited medical schools that are not in the U.S. have begun making substantial payments to U.S. teaching hospitals in exchange for training positions in those hospitals for their students.  As a result, many U.S. schools of medicine and osteopathic medicine are facing difficulty in securing training sites for U.S. students.  Today, the AMA adopted policy to advocate for federal and/or state legislation or regulations opposing this practice. Over the past several years, U.S. medical and osteopathic schools have increased their classes by 30%, making the availability of such training sites critical. 

"Clinical training in U.S. teaching hospitals is a key component of medical education. The actions taken by for-profit unaccredited medical schools are making it difficult for U.S. medical and osteopathic medical schools to secure clinical training sites for their students in U.S. hospitals," said Dr. Permut. "The AMA passed policy today that will advocate against this practice."

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