ORLANDO, Fla. — The American Medical Association (AMA), the nation’s premier physician organization, gathered physician and medical student leaders from all corners of medicine during its Interim Meeting and today voted to adopt new policies aimed at improving the health of the nation.
These new policies were adopted by a vote of the AMA’s House of Delegates. This policy-making body at the center of American medicine brings together an inclusive group of physicians, medical students and residents representing every state and medical field. Delegates work in a democratic process to create a national physician consensus on emerging issues in public health, science, ethics, business and government to continually provide safer, higher quality and more efficient care for patients and communities.
The new policy highlights include:
Support for efforts to promote environmental sustainability and halt global climate change
As climate change continues to affect public health across the world, the AMA adopted policy in support of initiatives that promote environmental sustainability and efforts to halt global climate change. The policy also calls for aiding physicians in adopting environmentally-sustainable programs in their practices and sharing these concepts with their patients and communities.
“Scientific surveys have shown clear evidence that our patients are facing adverse health effects associated with climate change. From heat-related injuries and forest fire air pollution, to worsening seasonal allergies and storm-related illness and injuries, it is important that we make every effort to put environmentally friendly practices in place to lessen the harmful impact that climate change is having on patient health across the globe,” said AMA Board Member Willarda V. Edwards, M.D.
Parity in reproductive health insurance coverage for same-sex couples
In recognition that same-sex couples have sometimes been denied access to insurance benefits that cover fertility service, the AMA adopted policy aimed at promoting parity in reproductive health insurance coverage for same-sex couples. The new policy adds to established AMA policy supporting measures providing same-sex households with the same rights and privileges to health care, health insurance, and survivor benefits, as afforded opposite-sex households.
“Regardless of the insurance industry’s rationale for doing so, denying fertility coverage to same-sex couples is discriminatory,” said AMA Board Member Maya A. Babu, M.D., M.B.A. “Our new policy recognizes that disparities exist in some health insurers’ policies that are unfair for same-sex households and supports measures to ensure all households are afforded the same access to insurance coverage for fertility services.”
Improved access to mental health services at colleges, universities
The AMA adopted new policies to improve mental health services at colleges and universities. The new policies support strategies to improve accessibility to care and reduce the stigma of mental health issues. The AMA also urged colleges and universities to emphasize to students and parents the importance, availability and efficacy of mental health resources, and to develop mechanisms of care that support timely and affordable access.
“Depression, anxiety, suicidal thoughts, and sadly, suicide are common among young people at colleges and universities. The lack of resources and stigma associated with seeking help can prevent students from getting the mental health care they need,” said AMA Board Member William E. Kobler, M.D. “By improving access to care, colleges and universities will make it easier for young people to focus on their own well-being and give them a greater chance for success on campus.”
Expanded training opportunities to treat opioid use disorders
The AMA adopted new policy that bolsters efforts to address the rate of death due to drug overdose, which reached an unprecedented 14.7 per 100,000 in 2014. Specifically, the policy calls for expansion of and funding for residency and fellowship training opportunities to provide clinical experience to treat opioid use disorders.
“The AMA supports efforts to confront the opioid and prescription drug epidemic so physicians who are on the front lines have the ability to best meet patient needs,” said AMA Board Member Jesse M. Ehrenfeld, M.D. “With an unprecedented need for treatment of opioid use disorders, it is critical that we do all we can to expand residency and fellowship training opportunities so patients have increased access to the treatment they need.”
Preventing exploitation of restricted drug distribution systems
Responding to the need for greater competition and choice in the pharmaceutical marketplace, the AMA adopted policy to prevent brand name drug manufacturers from potentially exploiting legitimate safety protocols to block generics drugs from entering the market.
Drug manufacturers can be required by the Food and Drug Administration (FDA) to establish Risk Evaluation & Mitigation Strategies (REMS) to ensure that the benefits of certain prescription drugs outweigh their risks. Such REMS can result in the creation of restricted distribution systems to stringently control the allocation of drug products that may pose potential health risks. In addition, pharmaceutical companies may establish controlled distribution channels for their products for other purposes. Misuse of this safety protocol jeopardizes competition in the pharmaceutical industry by allowing brand name drug manufacturers to block access to test samples that generic drug manufacturers need to help satisfy FDA approval requirements.
“Drug safety is a notable concern of the AMA, but drug manufactures should not be allowed to misuse restricted distribution mechanisms to block competition from rival drug makers,” said AMA Board Member William A. McDade, M.D., Ph.D. “To encourage competition and choice, the AMA supports measures that require prescription drug manufacturers to seek FDA and Federal Trade Commission approval before establishing a restricted distribution system.”
The new AMA policy also supports the mandatory provision of samples of approved out-of-patent drugs upon request to generic manufacturers seeking to perform bioequivalence assays. The AMA will also continue working on measures that expedite the FDA approval process for generic drugs.
Support for voluntary inclusion of gender identity, sex, sexual orientation options in electronic health records
To improve patient health, the AMA approved policy supporting the voluntary inclusion of a patient’s biological sex, current gender identity, sexual orientation and preferred pronoun(s) in medical documentation and related forms, including EHRs. An estimated 700,000 transgender individuals, in addition to others who identify with a nonconforming gender identity, live in the United States. Their physicians will benefit from more complete, culturally sensitive patient history records. The AMA also will advocate for collection of patient data that is inclusive of sexual orientation/gender identity for the purposes of research into patient health.
“The addition of this voluntary recordkeeping will benefit patients by giving their physicians more accurate personal health information. This is a step to ease the unique obstacles that keep the transgender population from receiving healthcare,” said Dr. Carl A. Sirio, a member of the AMA Board of Trustees.
Appropriate use of genetic testing and access to counseling services
As the number of genetic and genomic testing options available to physicians and patients grows, the AMA adopted new policy to support the appropriate use of genetic and genomic testing technologies and to promote patient access to genetic counseling services. The new policy calls for supporting the development and dissemination of guidelines with best practice standards for pre- and post-test genetic counseling. The policy also calls for research on issues in medical genetics, including genetic specialist workforce levels, physician preparedness in providing genetic testing and counseling services, and the impact of genetic testing and counseling on patient care and outcomes.
“The AMA supports the appropriate use of genetic testing and counseling, and we encourage physicians to make themselves familiar with the latest testing and counseling services available that could benefit their patients,” said AMA Board Member Albert J. Osbahr, III, M.D. “The policy adopted furthers the AMA’s work over the past decade to ensure that physicians have access to the resources and support they need to appropriately integrate personalized medicine services into practice to precisely target treatment and improve health outcomes.”
In July, the AMA launched an online program aimed at educating physicians and other health care professionals on the benefits and limitations of genetic testing and when it is appropriate to incorporate it into their practices. The 12-module series called, “Precision Medicine for Your Practice,” will be released individually over the next year and will be available online at the AMA Education Center. The modules focus on applications of genetic testing, which include expanded carrier screening, targeted therapy in oncology, genomic sequencing, cardiogenomics, neurogenomics, pharmacogenomics and ethics in precision medicine.
Strengthening policy on interoperability of electronic health records
The AMA bolstered its policy on the interoperability of health care records by ensuring that physicians who are not affiliated with hospitals or health organizations are not impaired by data blocking. The AMA has long advocated for interoperability of electronic health records and for legislation and regulations to prohibit health care organizations and networks from blocking the electronic availability of clinical data.
“Just because physicians are not affiliated with a hospital does not mean that they should not have access to patients’ records,” said Dr. Russell W. Kridel, a member of the AMA Board of Trustees. “Timely, safe and optimal care depends on physicians’ ability to access electronic health records. A cornerstone of interoperability is that data is accessible to physicians, regardless of their connection to a hospital or health organization.”
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