Resolutions March On

Advancing new public health protections locally and nationally
By Elizabeth Sidney

At the policy grassroots, the Chicago Medical Society (CMS) contributes mightily to the work of the American Medical Association’s House of Delegates, through its individual members and as part of the Illinois team. That proud tradition continued June 11-15, with several local measures advancing to this year’s annual AMA meeting. Prior to their culmination at the AMA House, the Chicago-based resolutions won support at the state level. The Illinois State Medical Society (ISMS), which met in April, submits the measures en masse to the AMA under the Illinois banner.

Participation on the state delegation isn’t the only way CMS physicians make their presence known in the national arena. Their voices are also reinforced indirectly by their colleagues who represent their specialty societies as delegates to the AMA. Notably, CMS’ William A. McDade, MD, PhD, was elected in June to the AMA Board of Trustees as a representative from the American Society of Anesthesiology. Dr. McDade is both a CMS and ISMS past president.

Also in the spotlight, student Christiana Shoushtari, MPH, MS, was among the select 15 recipients of the AMA Foundation’s Leadership Award. A student at the University of Illinois at Chicago, Shoushtari will use the award to further develop her skills as a future leader in medicine and community affairs.

Here are the resolution highlights.

Study on Health Care Payment Models

Formerly titled “Single Payer Health Care Study,” this Illinois measure came originally from CMS member Peter Orris, MD, MPH. Dr. Orris asked the AMA to research and analyze the benefits and difficulties of a single-payer healthcare system in the United States with consideration of the impact on economic and health outcomes and on health disparities. However, in light of the passionate and mixed testimony on both sides, the AMA opted for a global study into a variety of healthcare financing models. As such, the study will also include lessons learned from other countries with various payment models.

Testimony reflected the desire to act on behalf of patients, to improve access to care and cover the uninsured. At the same time, testimony in opposition noted that the AMA has a long history of commitment to pluralism and freedom of choice. Several existing policies expressly oppose a single-payer system and support a market-based approach.

CMS launched its resolution in early 2016. With significant support from medical student members, the Council voted to research the impact of a single-payer system. The resurgence of interest in single payer speaks to the disappointment with Obamacare, difficulties in transitioning from fee-for-service to “value-based” payment, rising physician burnout, among other trends.

Gun Violence and Public Health Research

In line with CMS policy, the AMA called gun violence in the United States “a public health crisis” that requires a comprehensive public health response and solution. Also in line with CMS, the AMA voted to support congressional passage of legislation requiring criminal background checks for all gun sales, public and private.

The decisions come after CMS leaders Kathy M. Tynus, MD, and Adrienne L. Fregia, MD, authored measures to fund research into gun violence and expand criminal background checks.

CMS believes an epidemiological approach and analysis of problems associated with gun violence is the first step toward addressing the crisis.

Early this year, CMS voted to join major national medical societies in seeking increased public and private funding for the development, evaluation, and implementation of evidence-based programs and policies.

Pain as the Fifth Vital Sign

An Illinois resolution made the case that treating pain as the “fifth vital sign” has not improved treatment outcomes and has contributed to prescription drug abuse. The resolution sought the elimination of pain as the fifth vital sign from professional standards and usage.

The AMA now will work with the Joint Commission to promote evidence-based, functional and effective pain assessment and treatment measures; support timely and appropriate access to non-opioid and non-pharmacologic pain treatments, including removing barriers to such treatments when they inhibit a patient’s access to care; and urge the removal of the pain management component of patient satisfaction surveys as it pertains to payment and quality metrics.

Problematic pain survey questions was one of many issues CMS raised in meetings with Senator Richard Durbin. President Kathy M. Tynus, MD, continues to work with Durbin’s office on comprehensive solutions to the opioid epidemic. CMS supports education, policy change, and payment reform.

Dry Needling Is an Invasive Procedure

New AMA policy championed by CMS recognizes dry needling as an invasive procedure that should only be performed by practitioners with standard training and familiarity with routine use of needles in their practice, such as licensed medical physicians and licensed acupuncturists.

A CMS measure originally from David W. Miller, MD, pointed out that physical therapists are increasingly incorporating dry needling into their practice. Yet physical therapists are using this invasive procedure with as little as 12 hours of training, while the minimum industry standard for physicians to practice acupuncture is 300 hours of training. Dry needling is indistinguishable from acupuncture, and is actually considered a Western style acupuncture or Trigger Point acupuncture. Medical risks include hematoma, pneumothorax, nerve injury, vascular injury and infection.

Transparency in TV Ads of Unregulated Medications and Medical Devices

A resolution originally from CMS member B.H. Gerald Rogers, MD, will refine existing AMA efforts to increase transparency in the advertisement of unregulated medications and medical devices on TV. To help laypeople determine whether advertised products are proven to be safe or effective, new policy says that product labeling of dietary supplements and herbal remedies that bear structure/function claims should include disclaimer language that does not make prohibited disease claims. Additionally, AMA will support the FDA’s regulation and enforcement of labeling violations and the FTC’s regulation and enforcement of advertisement violations of prohibited disease claims made on dietary supplements and herbal remedies.

Preventing Hearing Loss in Children Caused by Noisy Toys

A CMS initiative, originally from Ajay Chauhan, DO, sets new safety standards for children’s toys that produce dangerously high levels of sound. Parents need to know that talking dolls and musical instruments can seriously impair hearing. Under new AMA policy, first adopted by CMS, children should avoid toys that produce more than 85 dB of SPL, or greater than 90 dB SPL, for longer than one hour. As per the CMS resolution, AMA will work with stakeholders to encourage toy manufacturers to adhere to these pediatric noise exposure standards. AMA will also advocate for the labeling of toys with the sound level produced and, when needed, a warning label that sound production exceeds safety standards (85 dB of SPL) and may result in long-term hearing loss.

Primary Care Interventions to Support Breastfeeding

Formerly titled “Baby-Friendly Health Care Delivery and Breastfeeding Rights,” this measure came from medical student James Curry. It resulted in new AMA policy that supports the evaluation and grading of primary care interventions to support breastfeeding as developed by the United States Preventive Services Task Force (USPSTF).