AMERICAN MEDICAL ASSOCIATION MEDICAL STUDENT

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					          AMERICAN MEDICAL ASSOCIATION MEDICAL STUDENT SECTION (I-11)


                              Report of MSS Reference Committee

                                      David Savage, Chair


 1   Your Reference Committee recommends the following consent calendar for acceptance:
 2
 3   RECOMMENDED FOR ADOPTION
 4
 5   Recommendations of GC Report A - Financial Aid Dependency Status of Medical
 6   Students
 7
 8   Recommendations of GC Report B - Transparency in the Role of Regional Delegate
 9
10   Recommendations of GC Report C - Physician-Based Education to Combat Obesity on
11   the Local Level
12
13   Recommendations of GC Report D - Policy Sunset Report for 2006 AMA-MSS Policies
14
15   Resolution 24 - Strategies to Improve Care for Underinsured Patients
16
17
18   RECOMMENDED FOR ADOPTION AS AMENDED OR SUBSTITUTED
19
20   Resolution 1 - Studying Medical Student Work Hours
21
22   Resolution 2 - Health Policy Education in Medical School and Residency
23
24   Resolution 3 - Medical Student Access to Comprehensive Mental Health and Substance
25   Abuse Treatment
26
27   Resolution 4 - Increased Emphasis on Mental Health and Psychosocial Support in
28   Medical School Curriculum
29
30   Resolution 5 - Preliminary Year Program Placement
31
32   Resolution 6 - Investigating Adverse Public Health Outcomes Relating to Chronic GME
33   Funding Shortages
34
35   Resolution 8 - Federal Government Professional Student Loan Changes
36
37   Resolution 9 - Increasing Organ Donation Discussions Through Medical Education
38
39   Resolution 12 - Effect of Computers in the Exam Room on the Physician-Patient
40   Communication
41
42   Resolution 13 - Lesbian, Gay, Bisexual, and Transgender Patient-Specific Training
43   Programs for Healthcare Providers
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 1
 2   Resolution 15 - Cost Savings Sharing of Physician Led Quality Improvement Projects
 3
 4   Resolution 17 - Support of Multilingual Digital Assessment Tools for Medical
 5   Professionals
 6
 7   Resolution 20 - Reducing Barriers to Preventive Health Care Delivery and
 8   Compensation
 9
10   Resolution 23 - Recognizing Socioeconomic Status as a Determinant of Health
11
12   Resolution 26 - On-site Employer Medical Clinics
13
14   Resolution 27 - AMA Grading of Safe, Effective Smartphone Apps
15
16   Resolution 29 - Support for Drug Courts
17
18   Resolution 30 - Reduced Incarceration and Improved Treatment of Individuals with
19   Mental Illness or Illicit Drug Dependence
20
21   Resolution 31 - Recognition of Addiction as Pathology, Not Criminality
22
23   Resolution 32 - Support Of Medical Amnesty Policies For Underage Alcohol Intoxication
24
25   Resolution 33 - Improving Mental Health Services for Pregnant and Postpartum Mothers
26
27   Resolution 34 - Advocacy for 9/11 Early Responder Health Coverage of Cancer
28
29   Resolution 36 - Promoting Prevention of Fatal Opioid Overdose
30
31   Resolution 37 - Pitcher Safety in Little League & High School Baseball/Softball Leagues
32
33   Resolution 38 - Providing Free Access to Smoking Cessation Treatments
34
35   Resolution 41 - AMA Support for Implementation of Image Gently and FDA Efforts to
36   Reduce Computed Tomography Radiation in Children
37
38   Resolution 42 - HPV Vaccination Access for Minors
39
40   Resolution 45 - Support for Service Animals, Animals in Healthcare, and Medical
41   Benefits of Pet Ownership
42
43   Resolution 47 - Regulations on the Patenting of Endogenous Human DNA
44
45
46   RECOMMENDED FOR REFERRAL
47
48   Resolution 21 - Tax Deductions for State-Based Health Insurance Exchange Policies
49
50   Resolution 22 - Value-Based Insurance Design
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 1
 2
 3   RECOMMENDED FOR NOT ADOPTION
 4
 5   Resolution 14 - Eliminating Gifts to Physicians from Industry
 6
 7   Resolution 16 - Regulatory Reform of In Vitro Medical Diagnostics
 8
 9   Resolution 19 - Preferential Support for Less Invasive Measures in Medical Care
10
11   Resolution 25 - Investigating Transportation and Accessibility to Free Medical Clinics
12
13   Resolution 35 - Education and Funding Allocation for the Muscular Dystrophies
14   Proportionate to Incidence
15
16   Resolution 43 - Increasing Healthcare Capacity In Resource Limited Settings Through
17   the President’s Emergency Plan for AIDS Relief
18
19   Resolution 46 - Recognition of Patient Uniqueness in Medical Treatment
20
21
22   RECOMMENDED FOR REAFFIRMATION IN LIEU OF
23
24   Resolution 7 - Improving Access to Subsidized Graduate Student Loans
25
26   Resolution 10 - Advocating for a Greener Medical School
27
28   Resolution 11 - Securing Quality Clinical Education Sites for US-Accredited Schools
29
30   Resolution 18 - Protecting the Doctor-Patient Relationship
31
32   Resolution 28 - Closer Monitoring of Emergency Medical Kits on Passenger Aircrafts
33
34   Resolution 39 - Reducing Second-Hand Smoke in Apartment Complexes
35
36   Resolution 40 - Physician Position to Novel Tobacco Markets
37
38   Resolution 44 - Amendment to Existing MSS Policy Opposing Legislation Which May
39   Interfere with Physicians’ Pain Management Strategies
40
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 1   (1)    GC REPORT A - FINANCIAL AID DEPENDENCY
 2          STATUS OF MEDICAL STUDENTS
 3
 4          RECOMMENDATION:
 5
 6          Mr. Speaker, your Reference Committee recommends that
 7          the recommendations of Governing Council Report A be
 8          adopted and the remainder of the report be filed.
 9
10
11   GC Report A asks the AMA-MSS to 1) encourage medical schools to institute an
12   appeals procedure that allows individual students with extenuating familial
13   circumstances to apply for institutional financial aid without parental tax information
14   taken into consideration, such as students whose non-custodial parents’ whereabouts
15   are unknown or students who have an established history of non-support from their
16   parents; and 2) work to ensure adequate dissemination of information on educational
17   funding sources available to medical students.
18
19   Your Reference Committee considered testimony both in support of adoption of GC
20   Report A and recommending further study. The Reference Committee agreed with the
21   recommendations of the report, and with the compelling testimony of the Vice Chair of
22   the Committee on Legislation and Advocacy that indicated the nature of available
23   sources for finding additional information. As a result, your Reference Committee
24   recommends that the recommendations of GC Report A be adopted and the remainder
25   of the report be filed.
26
27
28   (2)    GC REPORT B – TRANSPARENCY IN THE ROLE OF
29          REGIONAL DELEGATE
30
31          RECOMMENDATION:
32
33          Mr. Speaker, your Reference Committee recommends that
34          the recommendations of Governing Council Report B be
35          adopted and the remainder of the report be filed
36
37   GC Report B recommends that the AMA-MSS amend its IOPs to reflect the proposes
38   structure and rules of the Medical Student Section Caucus to the AMA House of
39   Delegates.
40
41   Your Reference Committee received substantial online testimony regarding GC Report
42   B, which was unanimously in support of the recommendations for structuring the MSS
43   Caucus. Your Reference Committee agrees, and recommends that the
44   recommendations are adopted and the remainder of the report filed.
45
46
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 1   (3)    GOVERNING COUNCIL REPORT C - PHYSICIAN-
 2          BASED EDUCATION TO COMBAT OBESITY ON THE
 3          LOCAL LEVEL
 4
 5          RECOMMENDATION:
 6
 7          Mr. Speaker, your Reference Committee recommends that
 8          the recommendations of Governing Council Report C be
 9          adopted and the remainder of the report be filed.
10
11   Governing Council Report C recommends that 150.018MSS and 150.020MSS be
12   reaffirmed and that the remainder of the report be filed.
13
14   Your Reference Committee received minimal testimony on GC Report C. Your
15   Reference Committee found the report to be extremely informative on the physician role
16   in combating obesity, and recommends adoption of the report recommendations and
17   filing of the remainder of the report.
18
19
20   (4)    GOVERNING COUNCIL REPORT D - POLICY SUNSET
21          REPORT FOR 2006 AMA-MSS POLICIES
22
23          RECOMMENDATION:
24
25          Mr. Speaker, your Reference Committee recommends that
26          the recommendations of Governing Council Report D be
27          adopted and the remainder of the report be filed.
28
29   GC Report D recommends 1) That the policies specified for retention in Appendix 1 of
30   the report be retained as official, active policies of the AMA-MSS; and 2) that the policy
31   consolidation actions specified in Appendix 2 of this report be retained as official, active
32   policies of the AMA-MSS.
33
34   Your Reference Committee did not receive online testimony on GC Report D. Your
35   Reference Committee examined the policies recommended for retention and rescission,
36   and agreed with all proposed actions. Additionally, your Reference Committee found the
37   consolidation to be an appropriate combination of policy without removing any potential
38   implementation.     As a result, your Reference Committee recommends that the
39   recommendations of GC Report D be adopted and the remainder of the report be filed.
40
41   (5)    COMMITTEE ON LONG-RANGE PLANNING REPORT A -
42          STUDY OF THE STRUCTURE OF THE ANNUAL AND
43          INTERIM MEETINGS
44
45          RECOMMENDATION:
46
47          Mr. Speaker, your Reference Committee recommends that
48          Committee on Long-Range Planning Report A be filed.
49
50   COLRP Report A recommends that the informational report be filed.
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 1
 2   Your Reference Committee heard a large amount of testimony on this report, which
 3   varied in its support. The Reference Committee found many of the proposed structural
 4   changes to be of interest and potentially beneficial. Additionally, as explained by
 5   corresponding testimony of the GC, the report is simply an informational offering of
 6   potential fixes, and does not claim to be exhaustive. As a result, the Reference
 7   Committee supports the filing of the report.
 8
 9
10   (6)    RESOLUTION 1 - STUDYING MEDICAL STUDENT
11          WORK HOUR POLICIES
12
13          RECOMMENDATION A:
14
15          Mr. Speaker, your Reference Committee recommends that
16          Resolution 1 be amended by insertion and deletion on
17          page 1, line 28-29 as follows:
18
19          RESOLVED, That our AMA-MSS should survey U.S.
20          medical schools and report on medical student work hour
21          policies and possible implications of such policies on
22          patient care, and quality of education, and student well-
23          being.
24
25          RECOMMENDATION B:
26
27          Mr. Speaker, your Reference Committee recommends that
28          Resolution 1 be adopted as amended.
29
30   Resolution 1 asks the AMA-MSS to comprehensively survey US medical schools and
31   report on medical student work hour policies and possible implications of such policies
32   on patient care and student wellbeing.
33
34   Your Reference Committee received some online testimony in favor of the proposed
35   study, while other testimony questioning whether the study presents any additional value
36   that is not already provided by previous Council on Medical Education (CME) reports
37   and recommendations. Your Reference Committee believes that the issue of medical
38   student work hours has been effectively examined by CME in CME Report 5-I-04.
39   However, the Reference Committee also recognizes that this study took place prior to
40   implementation of revised LCME standards requiring schools to “develop and implement
41   policies regarding the amount of time medical students spend in required activities,
42   including the total number of hours medical students are required to spend in clinical and
43   educational activities during clinical clerkships.” Additionally, your Reference Committee
44   recognizes the concern that osteopathic medical schools are not affected by LCME
45   accreditation revisions, and believes a survey would help identify work hour policies
46   affecting the concerns of these students. As a result, your Reference Committee
47   recommends that Resolution 1 be adopted as amended.
48
49
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 1   (7)    RESOLUTION 2 - HEALTH POLICY EDUCATION IN
 2          MEDICAL SCHOOL AND RESIDENCY
 3
 4          RECOMMENDATION:
 5
 6          Mr. Speaker, your Reference Committee recommends that
 7          the following Substitute Resolution 2 be adopted:
 8
 9          That our AMA-MSS amend policy 295.153MSS by insertion and deletion as
10          follows:
11
12          295.153MSS Health Policy Education in Medical Schools: AMA-MSS will monitor
13          progress on the development of the Association of American Medical College's
14          behavioral and social science core competencies and report back at A-11. upon
15          release of the competencies.
16
17   Resolution 2 asks (1) the AMA to work with the Association of American Medical
18   Colleges, the Liaison Committee on Medical Education, the American Association of
19   Colleges of Osteopathic Medicine, the Commission on Osteopathic Colleges
20   Accreditation, and other interested bodies to develop a basic set of competencies any
21   medical school or residency curriculum on health policy should include; (2) the AMA to
22   work with the Association of American Medical Colleges, the Liaison Committee on
23   Medical Education, the American Association of Colleges of Osteopathic Medicine, the
24   Commission on Osteopathic Colleges Accreditation, and other interested bodies to
25   create a sample health policy curriculum voluntarily available, without a fee, to medical
26   schools and residency programs, based upon a published set of core competencies; and
27   (3) the AMA and collaborators to monitor the national implementation of health policy
28   into the medical school and residency curriculum and frequently report to the Medical
29   Student Section and the House of Delegates on its implementation.
30
31   Your Reference Committee received substantial testimony on this topic. While the
32   consensus amongst those testifying was that this issue is of importance to the MSS
33   Assembly, there was question as to whether it would be a proper use of AMA resources
34   to engage in the recommended action. The first resolve clause asks the AMA to
35   develop a sample curriculum for use by medical schools and residency programs. Your
36   Reference Committee believed this to be beyond the scope of action for the AMA, as the
37   AMA generally does not develop educational programs for medical schools.
38   Additionally, as posted by several members, the MSS already has researched health
39   policy in medical school in GC Report D-A-10. In that report, the Governing Council
40   explained that the AAMC is currently in the process of developing a core competency for
41   behavioral and social sciences. As was expressed in that report, the AMA should not
42   engage in any development of an educational program when the organization with
43   greater expertise in the matter already is performing such a task. As a result, your
44   Reference Committee believes that 295.153MSS already addressed this issue, and
45   recommends updating this policy to require reporting after the AAMC competencies are
46   completed.
47
48   Thus, your Reference Committee recommends adoption of Substitute Resolution 2.
49
50
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 1   (8)   RESOLUTION 3 - MEDICAL STUDENT ACCESS TO
 2         COMPREHENSIVE MENTAL HEALTH AND SUBSTANCE
 3         ABUSE TREATMENT
 4
 5         RECOMMENDATION A:
 6
 7         Mr. Speaker, your Reference Committee recommends that
 8         Policies H-185.974, D-345.992, and D-345.996, and H-
 9         285.956 be reaffirmed in lieu of the second resolve of
10         Resolution 3:
11
12         H-185.974 Parity for Mental Illness, Alcoholism, and
13         Related Disorders in Medical Benefits Programs: Our
14         AMA supports parity of coverage for mental illness,
15         alcoholism and substance use.
16
17         D-345.992 Promoting Parity for the Treatment of Mental
18         Illness and Substance Use Disorders: Our AMA will work
19         in conjunction with interested state and specialty societies
20         to prepare a report which includes a summary and analysis
21         of existing parity legislation and a review of the research
22         on the impact of parity on access, quality, and the cost of
23         health care at both the state and federal level.
24
25         D-345.996 Depression and Suicide on College Campuses:
26         Our AMA will: (1) work in conjunction with all appropriate
27         specialty societies to prepare a report on depression,
28         substance abuse, and suicide on college campuses and
29         will include in its report a review of available scientific data
30         on the efficacy of prevention programs aimed at reducing
31         the incidence of depression, substance abuse, and suicide
32         on college campuses; (2) review the existing data on
33         access to and utilization of college mental health and
34         substance abuse services; and (3) advocate for the
35         development of guidelines concerning appropriate access
36         to psychiatric, addiction medicine, and other mental health
37         and substance abuse services on college campuses.
38
39         H-285.956 Mental Health "Carve-Outs": Our AMA is
40         opposed to mental health carve-outs. However, in order to
41         protect the large number of patients currently covered by
42         carve-out arrangements, the AMA advocates that all
43         managed care plans that provide or arrange for behavioral
44         health care adhere to the following principles, and that any
45         public or private entities that evaluate such plans for the
46         purposes of certification or accreditation utilize these
47         principles in conducting their evaluations: (1) Plans should
48         assist participating primary care physicians to recognize
49         and diagnose the behavioral disorders commonly seen in
50         primary care practice. (2) Plans should reimburse qualified
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 1   participating physicians in primary care and other non-
 2   psychiatric physician specialties for the behavioral health
 3   services provided to plan enrollees. (3) Plans should utilize
 4   practice guidelines developed by physicians in the
 5   appropriate specialties, with local adaptation by plan
 6   physicians as appropriate, to identify the clinical
 7   circumstances under which treatment by the primary care
 8   physician, direct referral to psychiatrists or other addiction
 9   medicine physicians, and referral back to the primary care
10   physician for care of behavioral disorders is indicated, and
11   should pay for all physician care provided in conformance
12   with such guidelines. In the absence of such guidelines,
13   direct referral by the primary care physician to the
14   psychiatrist or other addiction medicine physician should
15   be allowed when deemed necessary by the referring
16   physician. (4) Plans should foster continuing and timely
17   collaboration and communication between primary care
18   physicians and psychiatrists in the care of patients with
19   medical and psychiatric comorbidities. (5) Plans should
20   encourage a disease management approach to care of
21   behavioral health problems. (6) Participating health
22   professionals should be able to appeal plan-imposed
23   treatment restrictions on behalf of individual enrollees
24   receiving behavioral health services, and should be
25   afforded full due process in any resulting plan attempts at
26   termination or restriction of contractual arrangements. (7)
27   Plans using case managers and screeners to authorize
28   access to behavioral health benefits should restrict
29   performance of this function to appropriately trained and
30   supervised health professionals who have the relevant and
31   age group specific psychiatric or addiction medicine
32   training, and not to lay individuals, and in order to protect
33   the patient's privacy and confidentiality of patient medical
34   records should elicit only the patient information necessary
35   to confirm the need for behavioral health care.
36   (8) Plans assuming risk for behavioral health care should
37   consider "soft" capitation or other risk/reward-sharing
38   mechanisms so as to reduce financial incentives for
39   undertreatment. (9) Plans should conduct ongoing
40   assessment of patient outcomes and satisfaction, and
41   should utilize findings to both modify and improve plan
42   policies when indicated and improve practitioner
43   performance through educational feedback.
44
45   RECOMMENDATION B:
46
47   Mr. Speaker, your Reference Committee recommends that
48   Resolution 3 be adopted as amended.
49
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 1   Resolution 3 asks the AMA-MSS to (1) strongly encourage the Association of American
 2   Medical Colleges and the Liaison Committee on Medical Education to conduct research
 3   into the number of US medical students with mental health and/or substance abuse
 4   concerns who either: 1. do not seek treatment due to the cost involved, or 2. have
 5   sought treatment, but do not feel that it has been adequate due to yearly visit and
 6   dollar limits placed on their care by their insurance plan; and (2) strongly encourage all
 7   US medical schools to facilitate greater access to mental health and substance abuse
 8   treatment for their students by modifying their student health insurance policies to
 9   eliminating cost-sharing and coinsurance required for a student’s first visit to a
10   mental health or substance abuse specialist, and/or eliminating yearly visit and dollar
11   limits on treatment for mental health and substance abuse issues.
12
13   Your Reference Committee considered testimony in support of Resolution 3 and agreed
14   with the spirit of the resolution. With mental health being of serious concern, and
15   treatment of these issues in medical students being important to the future of medical
16   care, the MSS should encourage the AAMC and the LCME to study whether current
17   protocol encourages students to seek appropriate treatment. As a result, your Reference
18   Committee supports the first resolve.
19
20   With regard to the second resolve, your Reference Committee believes that current AMA
21   policy already has established support for parity in coverage. Rather than adopt
22   redundant policy, your Reference Committee believes that current AMA policy should
23   simply be reaffirmed on this matter. As a result, your Reference Committee believes
24   that the MSS should reaffirm H-185.974, D-345.992, and D-345.996 in lieu of the second
25   resolve.
26
27   For these reasons, the reference committee recommends adoption of Resolution 3 as
28   amended.
29
30
31   (9)    RESOLUTION 4 - INCREASED EMPHASIS ON MENTAL
32          HEALTH AND PSYCHOSOCIAL SUPPORT IN MEDICAL
33          SCHOOL CURRICULUM
34
35          RECOMMENDATION:
36
37          Mr. Speaker, your Reference Committee recommends that
38          the following Substitute Resolution 4 be adopted:
39
40          That our AMA-MSS ask the AMA to amend policy H-
41          345.984 by insertion as follows:
42
43          H-345.984 Awareness, Diagnosis and Treatment of
44          Depression and Other Mental Illnesses.
45          (1) Our AMA encourages: (a) medical schools, primary
46          care residencies, and other training programs as
47          appropriate to include the appropriate knowledge and skills
48          to enable graduates to recognize, diagnose, and treat
49          depression and other mental illnesses, both when it occurs
50          by itself and when it occurs with another general medical
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 1          condition; (b) all physicians providing clinical care to
 2          acquire the same knowledge and skills; and (c) additional
 3          research into the course and outcomes of patients with
 4          depression who are seen in general medical settings and
 5          into the development of clinical and systems approaches
 6          designed to improve patient outcomes. Furthermore, any
 7          approaches designed to manage care by reduction in the
 8          demand for services should be based on scientifically
 9          sound outcomes research findings. (2) Our AMA will work
10          with the National Institute on Mental Health and
11          appropriate medical specialty and mental health advocacy
12          groups to increase public awareness about depression and
13          other mental illnesses, to reduce the stigma associated
14          with depression and other mental illnesses, and to
15          increase patient access to quality care for depression and
16          other mental illnesses.
17
18   Resolution 4 asks the AMA to (1) encourage all medical schools to assess the inclusion
19   and quality of mental health content in preclinical curriculum, as well as its impact on
20   medical student understanding of the prevalence of mental health conditions and
21   medical student attitudes towards patients with mental health conditions; and (2) further
22   encourage medical schools that find significant stigma or lack of understanding among
23   their medical student population regarding mental health conditions to devise strategies
24   to alter these perceptions through adjustment of preclinical curriculum and experiences.
25
26   Your Reference Committee considered substantial testimony on this resolution, both in
27   support and opposition. One of the main concerns of opponents to this resolution was a
28   fear that it would be seeking a curricular requirement, which is of concern due to the
29   already loaded amount of requirements placed on students. Authors, however, testified
30   that, as the resolution states, they merely want to encourage schools to provide the
31   option of instruction so that students could obtain this knowledge. Ultimately, your
32   Reference Committee agreed that providing educational opportunities on mental health
33   conditions is of great importance. Your Reference Committee believed that, rather than
34   adopt overlapping policy that would cause redundancy in AMA policy, the MSS should
35   seek revision of AMA policy H-345.984. This policy already encourages depression
36   education for medical students, so it could be easily amended to broaden its scope to
37   cover all mental illness.
38
39   For these reasons, your Reference Committee recommends adoption of Substitute
40   Resolution 4.
41
42
43   (10)   RESOLUTION 5 – PRELIMINARY YEAR PROGRAM
44          PLACEMENT
45
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 1          RECOMMENDATION A:
 2
 3          Mr. Speaker, your Reference Committee recommends that
 4          Resolution 5 be amended by insertion and deletion on
 5          page 1, lines 24-27 as follows:
 6
 7          RESOLVED, That the AMA collaborate with encourage the
 8          Accreditation Council for Graduate Medical Education, the
 9          American Osteopathic Association, and other involved
10          organizations to strongly encourage residency programs
11          that now require a preliminary year to match residents for
12          their specialty and then arrange with another department
13          or another medical center for the preliminary year of
14          training unless the applicant chooses to pursue preliminary
15          year training separately.
16
17          RECOMMENDATION B:
18
19          Mr. Speaker, your Reference Committee recommends that
20          Resolution 5 be adopted as amended.
21
22   Resolution 5 asks the AMA to collaborate with the Accreditation Council for Graduate
23   Medical Education to strongly encourage residency programs that now require a
24   preliminary year to match residents for their specialty and then arrange with another
25   department or another medical center for the preliminary year of training unless the
26   applicant chooses to pursue preliminary year training separately.
27
28   Your Reference Committee received substantial testimony on Resolution 5. While most
29   people were in support of the spirit of the resolution, many believed that the issue of
30   preliminary placement into these programs would best be addressed by the Resident
31   and Fellow Section of the AMA. The Reference Committee believes that, while this
32   issue could come from the RFS, it will most directly affect members of the MSS that are
33   applying for residencies. As a result, your Reference Committee believes it to be proper
34   for the MSS to initiate action on the matter. Your Reference Committee was concerned,
35   however, with the feasibility of the AMA collaborating with the Accreditation Council for
36   Graduate Medical Education (ACGME) and the American Osteopathic Association
37   (AOA) on this matter, and believes that the AMA should recognize the ACGME and AOA
38   authority on these issues, and simply encourage them to act rather than work in
39   collaboration.
40
41   Your Reference Committee received additional significant testimony at the on-site
42   hearing. It was proposed that the proposed language did not effectively include the
43   concerns of osteopathic students in accreditation programs. As a result, your Reference
44   Committee inserted the AOA into the resolved clause. Additionally, your Reference
45   Committee received testimony seeking a more focused resolution that requested a
46   resolution providing a single match process for all preliminary and transitional programs;
47   However, your Reference Committee elected not to revise the resolution due to fears of
48   incompatibility with existing matching processes.
49
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 1   For these reasons, the reference committee recommends that Resolution 5 be adopted
 2   as amended.
 3
 4
 5   (11)    RESOLUTION 6 - INVESTIGATING ADVERSE PUBLIC
 6           HEALTH OUTCOMES RELATING TO CHRONIC GME
 7           FUNDING SHORTAGES
 8
 9           RECOMMENDATION A:
10
11           Mr. Speaker, your Reference Committee recommends that
12           the second resolve of Resolution 6 be amended by
13           deletion on page 1, line 28 as follows:
14
15           RESOLVED, That this resolution be forwarded immediately
16           to the House of Delegates at I-11.
17
18           RECOMMENDATION B:
19
20           Mr. Speaker, your Reference Committee recommends
21           Resolution 6 be adopted as amended.
22
23   Resolution 6 asks (1) the AMA to act to encourage appropriate stakeholder
24   organizations to study and quantify the public health impacts of cuts to GME funding
25   sources, including the effects on, but not limited to, the physician shortage, spending on
26   public health initiatives, and availability and quality of care; and (2) that this resolution be
27   forwarded immediately to the House of Delegates at I-11.
28
29   Your Reference Committee heard substantial testimony on resolution 6, all of which
30   seemed to support the intent of the resolution. The reference committee agrees that
31   studying the impact that can be caused by budgetary proposals that continue to
32   underfund GME is important. Your Reference Committee recognized the benefit of
33   looking into the public health impact of reduced GME funding. The Reference
34   Committee received testimony that this study may already be underway by the AAMC.
35   However, this information was currently unverifiable. Your Reference Committee
36   encourages the presentation of further information to the Assembly if such a study is
37   currently being implemented (thereby making further study unnecessary).
38
39   Although the second resolve requests immediate forwarding of this resolution to the
40   HOD, the Reference Committee believes that the resolution would fail to meet the HOD
41   definition of advocacy and/or urgency, which would cause the resolution not to be
42   considered until A-12.
43
44   For these reasons, the reference committee recommends that Resolution 6 be adopted
45   as amended.
 1   (12)   RESOLUTION 7 - IMPROVING ACCESS TO
 2          SUBSIDIZED GRADUATE STUDENT LOANS
 3
 4          RECOMMENDATION:
 5
 6          Mr. Speaker, your Reference Committee recommends that
 7          Policy D-305.993 be reaffirmed in lieu of Resolution 7.
 8
 9          D-305.993 Medical School Financing, Tuition, and Student
10          Debt: (1) The Board of Trustees of our AMA will pursue the
11          introduction of member benefits to help medical students,
12          resident physicians, and young physicians manage and
13          reduce their debt burden. This should include
14          consideration of the feasibility of developing a web-based
15          information on financial planning/debt management;
16          introducing a loan consolidation program, automatic bill
17          collection and loan repayment programs, and a rotating
18          loan program; and creating an AMA scholarship program
19          funded through philanthropy. The AMA also should collect
20          and disseminate information on available opportunities for
21          medical students and resident physicians to obtain
22          financial aid for emergency and other purposes. (2) Our
23          AMA will vigorously advocate for ongoing, adequate
24          funding for federal and state programs that provide
25          scholarship or loan repayment funds in return for service,
26          including funding in return for practice in underserved
27          areas, participation in the military, and participation in
28          academic medicine or clinical research. Obtaining
29          adequate support for the National Health Service Corps
30          and similar programs, tied to the demand for participation
31          in the programs, should be a focus for AMA advocacy
32          efforts. (3) Our AMA will collect and disseminate
33          information on successful strategies used by medical
34          schools to cap or reduce tuition. (4) Our AMA will
35          encourage medical schools to provide yearly financial
36          planning/debt management counseling to medical
37          students. (5) Our AMA will urge the Accreditation Council
38          for Graduate Medical Education (ACGME) to revise its
39          Institutional Requirements to include a requirement that
40          financial planning/debt management counseling be
41          provided for resident physicians. (6) Our AMA will work
42          with other organizations, including the Association of
43          American Medical Colleges, residency program directors
44          groups, and members of the Federation, to develop and
45          disseminate standardized information, for example,
46          computer-based modules, on financial planning/debt
47          management for use by medical students, resident
48          physicians, and young physicians. (7) Our AMA will work
49          with other concerned organizations to promote legislation
50          and regulations with the aims of increasing loan deferment
51          through the period of residency, promoting the expansion
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 1          of subsidized loan programs, eliminating taxes on aid from
 2          service-based programs, and restoring tax deductibility of
 3          interest on educational loans.
 4
 5   Resolution 7 asks the AMA to work with medical schools, state medical societies and
 6   specialty societies to expand availability of low-cost, subsidized student loans for
 7   medical students to replace the federal subsidized Stafford student loan program
 8   through other sources.
 9
10   Your Reference Committee recognized the importance of this issue, as the recent
11   removal of the Stafford Loan program has caused an increased economic hardship on
12   some students. As a result, your Reference Committee supports the spirit of this
13   resolution. Your Reference Committee believes, however, that the AMA already has
14   sufficient policy on this matter, as D-305.993 already directs the AMA to work toward the
15   expansion of subsidized loan programs and promoting favorable legislation for student
16   debt concerns.
17
18
19   (13)   RESOLUTION 8 - FEDERAL GOVERNMENT
20          PROFESSIONAL STUDENT LOAN CHANGES
21
22          RECOMMENDATION
23
24          Mr. Speaker, your Reference Committee recommends that
25          the following Substitute Resolution 8 be adopted:
26
27          RESOLVED, That the AMA-MSS research the effect that
28          recent changes to the federal student loan program will
29          have on current and future medical students and their
30          patients, including but not limited to the effect on future
31          student enrollment, socioeconomic diversity of medical
32          students, loan defaults, repayment schedules, and total
33          student indebtedness.
34
35   Resolution 8 asks the AMA-MSS to (1) strongly oppose and ask the AMA to lobby
36   against any further changes to current federal student loan options which may negatively
37   affect medical students and their patients including but not limited to, increasing the cost
38   of borrowing by raising current fees or creating new fees which will be passed on to the
39   student or alterations in the current available options; and (2) conduct research into the
40   effect recent changes to the federal student loan program will have and the effect any
41   further alterations of current federal student loan practice will have on current and future
42   medical students and their patients including but not limited to: 1. Citing the impact on
43   student indebtedness that the 2012 federal government budget proposal will have in
44   abolishing all subsidized loans for graduate students, in particular, medical students 2.
45   Studying whether a greater increase in student indebtedness at the time of medical
46   school graduation will impact the number of students choosing to go into primary care
47   versus choosing a higher paying specialty, thereby increasing the nationwide deficit in
48   primary care physicians. 3. The amount of debt which would prevent students from
49   pursuing a career in medicine, especially those from low income/minority backgrounds
50   and those with other financial responsibilities. 4. Determining whether a higher debt
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 1   burden will discourage talented students of a lower socioeconomic bracket from
 2   pursuing medicine, thereby decreasing the amount of diversity within medicine to better
 3   serve the diverse American population. 5. Discovering whether higher debt will lead to
 4   an increase in loan defaults. 6. Compounding these changes with rapidly increasing
 5   tuition how the increased debt burden will affect the ability of residents to pay off student
 6   debt in a reasonable amount of time.
 7
 8   Your Reference Committee received substantial online testimony on Resolution 8. Your
 9   Reference Committee believes that the resolution addresses some interesting points
10   that are worth further action. With regard to the first resolve, your Reference Committee
11   believes that the AMA and the MSS each have sufficient policy calling for lobbying for
12   easing the financial hardships associated with medical student loans. As a result, your
13   Reference Committee does not feel that additional policy is needed.
14
15   With regard to resolve 2, your Reference Committee believes that the resolution
16   presents an opportunity for a study that could result in the collection of useful
17   information. As a result, your Reference Committee believes the resolution to be well
18   founded. Your Reference Committee does, however, recommend amending this resolve
19   in order to reduce perception that the resolution is already telling researchers what the
20   results of their study will be. As recommended on the online community, the substitute
21   resolution captures the desires of the author’s initial resolution without potentially
22   projecting conclusions onto the requested study. As a result, your Reference Committee
23   recommends adoption of Substitute Resolution 8.
24
25
26   (14)   RESOLUTION 9 - INCREASING ORGAN DONATION
27          DISCUSSIONS THROUGH MEDICAL EDUCATION
28
29          RECOMMENDATION A:
30
31          Mr. Speaker, your Reference Committee recommends that
32          the first resolve of Resolution 9 be amended by insertion
33          on page 1, line 24 as follows:
34
35          RESOLVED, That our AMA-MSS encourage the
36          Accreditation Council for Graduate Medical Education, the
37          Association of American Medical Colleges, and the Liaison
38          Committee on Medical Education to include training on
39          organ donation discussions in undergraduate and graduate
40          medical education.
41
42          RECOMMENDATION B:
43
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 1          Mr. Speaker, your Reference Committee recommends that
 2          the second resolve be amended by substitution as follows:
 3
 4          RESOLVED, That our AMA compile current materials into
 5          a comprehensive resource and make them available for
 6          the development of a Continuing Medical Education
 7          Activity educating physicians on how to conduct organ
 8          donation discussions with patients; and be it further
 9
10          RECOMMENDATION C:
11
12          Mr. Speaker, your Reference Committee recommends that
13          the third resolve of Resolution 9 be amended by deletion
14          and insertion on page 1, lines 24-26 as follows:
15
16          That our AMA-MSS promote support the development of
17          billing codes for physician-patient organ donation
18          discussions.
19
20          RECOMMENDATION D:
21
22          Mr. Speaker, your Reference Committee recommends that
23          Resolution 9 be adopted as amended.
24
25   Resolution 9 asks the AMA to (1) encourage the Accreditation Council for Graduate
26   Medical Education, the Association of American Medical Colleges, and the Liaison
27   Committee on Medical Education to include training on organ donation discussions in
28   undergraduate and graduate medical education; (2) make its resources on physician
29   participation in the organ donation process readily available in the “Physician
30   Resources” section of the AMA website; and (3) promote the development of billing
31   codes for physician-patient organ donation discussions.
32
33   Your Reference Committee received testimony on this matter, which generally was in
34   support of the idea behind the resolution. The Reference Committee agrees with this
35   resolution and testimony, though recommends some modifications. With regard to the
36   first resolve, the Reference Committee believes that the AMA already has a large
37   amount of policy on educating physicians and disseminating information to these
38   organizations. Your Reference Committee agrees with testimony suggesting that this
39   clause be made internal, which would allow the MSS Governing Council to act in a more
40   timely manner.
41
42   With regard to the second resolve, this generally is not an act requiring a resolution.
43   While increasing the availability of these resources is important, specific website layout
44   may not be something on which we should act.
45
46   The third resolve also raises an important issue. Since these codes are created
47   internally, and since this resolution would not fit the HOD requirements of urgency or
48   advocacy needed for consideration at this meeting, the Reference Committee suggests
49   making this policy internal, which would allow the MSS views to be passed along to
50   those creating new billing codes in a more timely manner.
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 1
 2   As a result, your Reference Committee recommends resolution 9 be adopted as
 3   amended.
 4
 5
 6   (15)   RESOLUTION 10 - ADVOCATING FOR A GREENER
 7          MEDICAL SCHOOL
 8
 9          RECOMMENDATION:
10
11          Mr. Speaker, your Reference Committee recommends that
12          Policy 135.013MSS be reaffirmed in lieu of Resolution 10.
13
14          135.013MSS Statement of Sustainability Principles: AMA-
15          MSS will (1) develop a model sustainability statement that
16          medical schools can use as a template for creating
17          institution-specific sustainability mission statements; and
18          (2) encourage all medical schools to adopt mission
19          statements which promote institutional sustainability
20          initiatives such as consumption awareness, waste
21          reduction, energy and water conservation, and the
22          utilization of reusable/recyclable goods. (MSS Res 2, A-
23          10)
24
25   Resolution 10 asks the AMA-MSS to (1) study current and potential practices in medical
26   education that promote sustainability and issue a report to the Association of American
27   Medical Colleges and medical school administrators describing and promoting the best
28   practices in sustainability; and (2) support sustainable initiatives across the medical
29   community.
30
31   Your Reference Committee considered minimal online testimony on Resolution 10. The
32   reference committee believes that green initiatives are extremely important, but feels
33   existing policy and research already achieves the intent of this resolution. In 2008, the
34   AMA Council on Science and Public Health completed extensive research on green
35   initiatives used throughout the medical community, including clinics and educational
36   institutes. Through this report, the Council recommended and the HOD created policy
37   H-135.939, which support green initiatives throughout the medical community. The
38   reference committee believes that this report sufficiently covers the issue. In order to
39   ensure that this report is implemented throughout medical schools, the MSS has created
40   a sustainability statement, which has been drafted and is being disseminated to medical
41   schools (135.013MSS).
42
43   Although your Reference Committee received substantial testimony on Resolution 10
44   on-site, the Assembly was split as to whether the proposed study would reveal beneficial
45   results. With the sustainability statement encouraging schools to adopt practices that
46   best promote environmentally concious green initiatives, your Reference Committee
47   does not feel that generalized research would create further benefit. Since each medical
48   school will inevitably have differing environmental concerns, your Reference Committee
49   believes that individual schools would best be able to identify areas in which progress
50   can be made for their institution. As a result, your Reference Committee believes that
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 1   promoting adoption of sustainability mission statements to be the appropriate action, and
 2   thus recommends reaffirmation.
 3
 4
 5   (16)   RESOLUTION 11 - RESOLUTION 11 - SECURING
 6          QUALITY CLINICAL EDUCATION SITES FOR US-
 7          ACCREDITED SCHOOLS
 8
 9          RECOMMENDATION:
10
11          Mr. Speaker, your Reference Committee recommends that
12          Policy D-295.320 be reaffirmed in lieu of Resolution 11.
13
14          D-295.320 Factors Affecting the Availability of Clinical
15          Training Sites for Medical Student Education
16          1. Our American Medical Association will work with the
17          Association of American Medical Colleges and the
18          American Association of Colleges of Osteopathic Medical
19          Education to encourage local and state governments and
20          the federal government, as well as private sector
21          philanthropies, to provide additional funding to support
22          infrastructure and faculty development for medical school
23          expansion. 2. Our AMA will encourage medical schools
24          and the rest of the medical community within states or
25          geographic regions to engage in collaborative planning to
26          create additional clinical education resources for their
27          students. 3. Our AMA will support the expansion of medical
28          education programs only when educational program
29          quality, including access to appropriate clinical teaching
30          resources, can be assured. 4. Our AMA will advocate for
31          regulations that would ensure clinical clerkship slots be
32          given first to students of US medical schools that are
33          Liaison Committee on Medical Education- or Commission
34          on Osteopathic College Accreditation-approved. (CME
35          Rep. 4, I-09)
36
37   Resolution 11 asks the AMA to (1) encourage local teaching hospitals to secure access
38   to clinical clerkship positions for medical students educated in US Liaison Committee on
39   Medical Education/Commission on Osteopathic College Accreditation accredited
40   medical schools before allocating positions to medical students from non-accredited
41   schools; (2) oppose extraordinary payments by any medical school for access to clinical
42   rotations; and (3) That this resolution be immediately forwarded to AMA House of
43   Delegates for consideration at I-11.
44
45   Your Reference Committee received substantial commentary on Resolution 11, which
46   varied from opposition to outright support. Your Reference Committee believes that the
47   AMA already has sufficient policy on this matter, as D-295.320 specifically allows the
48   AMA to advocate for clinical positions to be given to LCME and/or COCA accredited
49   institutions. The proposed policy requests the same steps be taken.
50
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 1   Your Reference Committee received an enormous amount of testimony on Resolution
 2   11 at the on-site hearing. Many members of the Assembly called attention that the
 3   request of the second resolve, which sought AMA opposition to extraordinary payments
 4   by medical schools for access to clinical rotations, as something that current policy does
 5   not cover. While your Reference Committee recognizes that the specific language is not
 6   spelled out in the policy, it believes that, by advocating that these slots be given to
 7   students of LCME and COCA accredited institutions, the AMA already has sufficient
 8   grounds to oppose these payments, as these payments are a vehicle to provide slots to
 9   non-accredited programs. The Reference Committee believes that the appropriate
10   action would be to contact AMA or AMA-MSS leaders to inquire about how to implement
11   this policy to oppose these payments in an effective manner. As a result, your
12   Reference Committee recommends reaffirmation of D-295.320.
13
14
15   (17)   RESOLUTION 12 - EFFECT OF COMPUTERS IN THE
16          EXAM ROOM ON THE PHYSICIAN-PATIENT
17          COMMUNICATION
18
19          RECOMMENDATION A:
20
21          Mr. Speaker, your Reference Committee recommends that
22          Resolution 12 be amended by insertion and deletion on
23          page 1, lines 21-23 as follows:
24
25          That the AMA study the effect of computers electronic
26          devices, including but not limited to computers and tablets,
27          in the exam room on doctor-patient communication with an
28          emphasis on alternatives and modifications that might
29          mitigate their negative effects. improve the process.
30
31          RECOMMENDATION B:
32
33          Mr. Speaker, your Reference Committee recommends that
34          Resolution 12 be adopted as amended.
35
36   Resolution 12 asks the AMA to study the effect of computers in the exam room on
37   doctor-patient communication with an emphasis on alternatives and modifications that
38   might mitigate their negative effects.
39
40   Your Reference Committee heard online testimony on Resolution 12, which was
41   generally in support of the proposed study. There was some discussion as to whether
42   the study should be kept internal, or whether it would be better achieved via HOD action.
43   Due to this issue being important throughout the medical community, your Reference
44   Committee believes it should be addressed by an HOD study surveying physicians. The
45   Reference Committee agreed with the proposed change to the tone of the resolution.
46
47   Your Reference Committee received on-site testimony expressing the concern that
48   tablets and other electronic data processing devices might not be included. As a result,
49   the resolution language was clarified and broadened.
50
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 1   For these reasons, we recommend adoption of Resolution 12 as amended.
 2
 3
 4   (18)   RESOLUTION 13 - LESBIAN, GAY, BISEXUAL, AND
 5          TRANSGENDER (LGBT) PATIENT-SPECIFIC TRAINING
 6          PROGRAMS FOR HEALTHCARE PROVIDERS
 7
 8          RECOMMENDATION A:
 9
10          Mr. Speaker, your Reference Committee recommends
11          Policy H-160.991 be reaffirmed in lieu of the first resolve.
12
13          H-160.991 Health Care Needs of the Homosexual
14          Population: 1. Our AMA: (a) believes that the physician's
15          nonjudgmental recognition of sexual orientation and
16          behavior enhances the ability to render optimal patient
17          care in health as well as in illness. In the case of the
18          homosexual patient this is especially true, since
19          unrecognized homosexuality by the physician or the
20          patient's reluctance to report his or her sexual orientation
21          and behavior can lead to failure to screen, diagnose, or
22          treat important medical problems. With the help of the gay
23          and lesbian community and through a cooperative effort
24          between physician and the homosexual patient effective
25          progress can be made in treating the medical needs of this
26          particular segment of the population; (b) is committed to
27          taking a leadership role in: (i) educating physicians on the
28          current state of research in and knowledge of
29          homosexuality and the need to take an adequate sexual
30          history; these efforts should start in medical school, but
31          must also be a part of continuing medical education; (ii)
32          educating physicians to recognize the physical and
33          psychological needs of their homosexual patients; (iii)
34          encouraging the development of educational programs for
35          homosexuals to acquaint them with the diseases for which
36          they are at risk; (iv) encouraging physicians to seek out
37          local or national experts in the health care needs of gay
38          men and lesbians so that all physicians will achieve a
39          better understanding of the medical needs of this
40          population; and (v) working with the gay and lesbian
41          community to offer physicians the opportunity to better
42          understand the medical needs of homosexual and bisexual
43          patients; and (c) opposes, the use of "reparative" or
44          "conversion" therapy that is based upon the assumption
45          that homosexuality per se is a mental disorder or based
46          upon the a priori assumption that the patient should
47          change his/her homosexual orientation. 2. Our AMA will
48          (a) educate physicians regarding: (i) the need for women
49          who have sex exclusively with women to undergo regular
50          cancer and sexually transmitted infection screenings due
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 1          to their comparable or elevated risk for these conditions;
 2          and (ii) the need for comprehensive screening for sexually
 3          transmitted diseases in men who have sex with men; and
 4          (b) support our partner medical organizations in educating
 5          women who have sex exclusively with women on the need
 6          for regular cancer screening exams, the risk for sexually
 7          transmitted infections, and the appropriate safe sex
 8          techniques to avoid that risk. 3. Our AMA will use the
 9          results of the survey being conducted in collaboration with
10          the Gay and Lesbian Medical Association to serve as a
11          needs assessment in developing such tools and online
12          continuing medical education (CME) programs with the
13          goal of increasing physician competency on gay, lesbian,
14          bisexual, and transgender health issues. 4. Our AMA will
15          continue to explore opportunities to collaborate with other
16          organizations, focusing on issues of mutual concern in
17          order to provide the most comprehensive and up-to-date
18          education and information to physicians to enable the
19          provision of high quality and culturally competent care to
20          gay men and lesbians. (CSA Rep. C, I-81; Reaffirmed:
21          CLRPD Rep. F, I-91; CSA Rep. 8 - I-94; Appended: Res.
22          506, A-00; Modified and Reaffirmed: Res. 501, A-07;
23          Modified: CSAPH Rep. 9, A-08)
24
25          RECOMMENDATION B:
26
27          Mr. Speaker, your Reference Committee recommends that
28          the second resolve of Resolution 13 be amended by
29          insertion and deletion on page 2, lines 11-12 as follows:
30
31          That the AMA advocate for supports the training of
32          healthcare providers in cultural competency as well as in
33          physical health needs for lesbian, gay, bisexual, and
34          transgender patient populations.
35
36          RECOMMENDATION C:
37
38          Mr. Speaker, your Reference Committee recommends that
39          Resolution 13 be adopted as amended.
40
41   Resolution 13 asks (1) the AMA, along with the appropriate body, to standardize a
42   training program for healthcare providers in order to make physicians more sensitive and
43   knowledgeable about the specific needs of lesbian, gay, bisexual, and transgender
44   patients; and (2) the AMA to advocate for training of healthcare providers in cultural
45   competency as well as in physical health needs for lesbian, gay, bisexual, and
46   transgender patient populations.
47
48   Your Reference Committee received substantial amounts of testimony on this
49   Resolution, the majority of which supported the second resolved clause of the resolution,
50   but did not support the AMA involvement in the development of a standardized training
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 1   program. Your Reference Committee agrees with this view that the AMA should allow
 2   other organizations to develop a standardized training program, as the AMA does not
 3   have the expertise necessary to be involved in this process. We believe that the current
 4   policy H-160.991 “Healthcare Needs of the Homosexual Population” sufficiently covers
 5   the concerns without requiring AMA development of a program.
 6
 7   With regard to the second resolve, your Reference Committee agrees with the spirit of
 8   this resolution. Your Reference Committee suggests changing the clause so that it
 9   supports the training rather than advocating. Your Reference Committee was concerned
10   that, by using the term advocacy, the AMA would be limited to only legislative lobbying.
11   Through passing a policy supporting such training, the AMA policy could be used to
12   petition a wider audience, such as state medical societies and schools. For these
13   reasons, your Reference Committee recommends adopting Resolution 13 as amended.
14
15
16   (19)   RESOLUTION 14 - ELIMINATING GIFTS TO
17          PHYSICIANS FROM INDUSTRY
18
19          RECOMMENDATION:
20
21          Mr. Speaker, your Reference Committee recommends that
22          Resolution 14 be not adopted.
23
24   Resolution 14 asks the AMA to encourage physicians to take measures to decrease
25   industry influence by refusing all gifts (defined as contributions whose primary benefit is
26   not directly to patients: pens & pads, modest meals, direct sponsorship of conference
27   expenses) while maintaining that patient-centered donations (defined as drug samples,
28   educational/diagnostic tools) are acceptable.
29
30   Your Reference Committee heard online testimony regarding this resolution, a large
31   amount of which recognized that the Council on Ethical and Judicial Affairs had already
32   looked into this issue. Due to the existing opinion of CEJA, your Reference Committee
33   believes that the only available request on this matter would be to ask that CEJA
34   reconsider this issue. In addition, CEJA reconsidered the financial relationships of
35   physicians and industry in CEJA Report 1 at the 2011 Annual meeting, and did not
36   change the recommendations of the policy considered in this resolution. Due to the
37   extensive reports that has already been filed on this matter, your Reference Committee
38   does not believe an additional report is necessary. As a result, your Reference
39   Committee recommends that Resolution 14 be not adopted.
40
41
42   (20)   RESOLUTION 15 - COST SAVINGS SHARING OF
43          PHYSICIAN LED QUALITY IMPROVEMENT PROJECTS
44
45          RECOMMENDATION A:
46
47          Mr. Speaker, your Reference Committee recommends that
48          Resolution 15 be amended by insertion and deletion on
49          page 1, lines 27-31 as follows:
50
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 1          That our AMA gather a repository of Quality Improvement
 2          Project (QIP) quality measures and financial benefits by
 3          identifying and contacting physician QIP leaders and
 4          inviting them to contribute their prior and ongoing data from
 5          QIP for analysis of QIP quality measures and financial
 6          benefits, with the goal of allowing other physicians, who
 7          practice in a wide range of practice settings and
 8          specialties, to review these quality measures and financial
 9          benefits and approximate how a similar project could
10          financially benefit their own healthcare organization.
11
12          RECOMMENDATION B:
13
14          Mr. Speaker, your Reference Committee recommends that
15          Resolution 15 be adopted as amended.
16
17   Resolution 15 asks the AMA to gather a repository of Quality Improvement Project (QIP)
18   financial benefits by identifying and contacting physician QIP leaders and inviting them
19   to contribute their prior and ongoing data from QIP for analysis of QIP financial benefits,
20   with the goal of allowing other physicians, who practice in a wide range of practice
21   settings and specialties, to review these financial benefits and approximate how a similar
22   project could financially benefit their own healthcare organization.
23
24   Your Reference Committee received significant testimony on this resolution. As stated
25   in some online testimony, the resolution’s focus on the financial aspects of QIP projects
26   is a bit misguided. While financial aspects are important, physicians priority should be
27   quality improvement, with financial benefits a secondary concern. As a result, the
28   Reference Committee believes that the resolution should be broadened in scope to
29   indicate the importance of quality. Beyond this concern, your Reference Committee
30   supported the proposal, as it is in line with current AMA activities in this area, while
31   expanding the usefulness of QIP information.
32
33   As a result, your Reference Committee recommends that Resolution 15 be adopted as
34   amended.
35
36
37   (21)   RESOLUTION 16 - REGULATORY REFORM OF
38          IN VITRO MEDICAL DIAGNOSTICS
39
40          RECOMMENDATION:
41
42          Mr. Speaker, your Reference Committee recommends that
43          resolution 16 be not adopted.
44
45   Resolution 16 asks the AMA to (1) advocate for the creation of a specialized center
46   within the Food and Drug Administration (FDA) for the evaluation and research of in vitro
47   and laboratory medical diagnostics on equal par with the three extant centers for the
48   evaluation and research of drugs, biologics and medical devices; and (2) That our AMA
49   urge the Food and Drug Administration to reclassify appropriate in vitro medical
50   diagnostics from current drug, biologic or device classifications to a new medical
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 1   diagnostic classification upon the creation of an FDA specialized center for the
 2   evaluation and research of in vitro and laboratory medical diagnostics to optimize and
 3   encourage new medical diagnostic research and development.
 4
 5   Your Reference Committee received substantial online and on-site testimony on this
 6   issue. The Reference Committee appreciated that this resolution brought such an
 7   interesting issue before your Reference Committee. Of the testimony provided, the AMA
 8   gave an enormous amount of deference to the opinion of the AMA’s Senior Scientist on
 9   Genetics and Molecular Medicine, who indicated that this issue is already being looked
10   at by the AMA staff. Her recommendation was that any formal action at this point would
11   be premature, as the AMA is currently evaluating various developments in in vitro
12   medical diagnostics. Since the AMA is currently in the process of evaluating this area,
13   we agree that this resolution be not adopted.
14
15
16   (22)   RESOLUTION 17 – SUPPORT OF MULTILINGUAL
17          DIGITAL ASSESSMENT TOOLS FOR MEDICAL
18          PROFESSIONALS
19
20          RECOMMENDATION A:
21
22          Mr. Speaker, your Reference Committee recommends that
23          Policy H-160.924 be reaffirmed.
24
25          RECOMMENDATION B:
26
27          Mr. Speaker, your Reference Committee recommends that
28          Resolution 17 be amended by insertion and deletion on
29          page 1, lines 27-39 as follows:
30
31          That our AMA support encourage the publication and
32          validation of standard patient assessment tools in multiple
33          languages. and support the creation of software versions
34          of such tools that can run on portable electronic devices
35          commonly carried by healthcare professionals.
36
37          RECOMMENDATION C:
38
39          Mr. Speaker, your Reference Committee recommends that
40          Resolution 17 be adopted as amended.
41
42   Resolution 17 asks the AMA to support the publication of standard patient assessment
43   tools in multiple languages and support the creation of software versions of such tools
44   that can run on portable electronic devices commonly carried by healthcare
45   professionals.
46
47   Your Reference Committee received minimal testimony on Resolution 17. Your
48   Reference Committee supports the resolution, though it feels that current policy already
49   effectively covers the second request: H-160.924 already encourages physicians to
50   resourcefully use electronic developments in translation services. Your Reference
                                                            MSS Reference Committee (I-11)
                                                                            Page 26 of 55


 1   Committee recognizes that standard patient assessment tools cannot simply be
 2   translated and immediately used, as they must be sufficiently tested and validated as to
 3   whether they are effective as translated. As a result, your Reference Committee
 4   suggests the clarifying amendment as proposed above.
 5
 6   For these reasons, your Reference Committee recommends that Resolution 17 be
 7   adopted as amended.
 8
 9
10   (23)   RESOLUTION 18 – PROTECTING THE DOCTOR-
11          PATIENT RELATIONSHIP
12
13          RECOMMENDATION:
14
15          Mr. Speaker, your Reference Committee recommends that
16          Policy H-373.995 be reaffirmed in lieu of Resolution 18.
17
18   Resolution 18 asks the AMA-MSS to (1) vigorously supports the physician-patient-family
19   relationship and actively opposes any state and/or federal effort to interfere in the
20   content of the discussion between a physician and his/her patient during a clinical
21   encounter; and (2) advocate against any interference by government or other third
22   parties that compromise a physician’s ability to use his or her medical judgment as to the
23   information or treatment that is in the best interest of their patients.
24
25   Your Reference Committee received minimal testimony on this resolution, all of which
26   recognized that the AMA already has sufficient policy in place on this issue. As
27   explained in testimony, the AMA recently adopted policy H-373.995 at the 2011 Annual
28   meeting of the HOD. At the meeting, H-373.995 was carefully crafted to address the
29   exact issue of which the resolution is concerned in the most appropriate manner. As a
30   result, reaffirmation of existing policy is the proper course of action.
31
32   For these reasons, your Reference Committee recommends reaffirmation of H-373.995
33   in lieu of Resolution 18.
34
35
36   (24)   RESOLUTION 19 - PREFERENTIAL SUPPORT FOR
37          LESS INVASIVE MEASURES IN MEDICAL CARE
38
39          RECOMMENDATION:
40
41          Mr. Speaker, your Reference Committee recommends that
42          Policies H-425.991, H-425.988, and H-460.995 be
43          reaffirmed in lieu of Resolution 19.
44
45          H-425.991 Support for Preventive Medicine: The AMA
46          reaffirms its commitment to preventive medicine.
47
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 1          H-425.988 The US Preventive Services Task Force Guide
 2          to Clinical Preventive Services: It is the policy of the AMA:
 3          (1) to continue to work with the federal government,
 4          specialty societies, and others, to develop guidelines for,
 5          and effective means of delivery of, clinical preventive
 6          services; and (2) to continue our efforts to develop and
 7          encourage continuing medical education programs in
 8          preventive medicine. (CME Rep. I, A-90; Reaffirmed by
 9          CME Rep. 5, I-95; Reaffirmed and Modified with change in
10          title: CME Rep. 2, A-05; Reaffirmation A-07)
11
12          H-460.995 Support for Careers in Research: Our AMA: (1)
13          recognizes the serious decline in the number of physicians
14          seeking to prepare for a career in research, which is
15          fundamental to the advancement of the practice of
16          medicine, and urges that: (a) medical students be made
17          aware of the challenging and important career option of
18          biomedical research, and (b) schools of medicine be made
19          aware of the impending shortage and provide increased
20          opportunities for students to participate in research; and (2)
21          supports policies and legislation designed to increase the
22          number of physician-investigators. Such support should
23          include encouragement for training of physicians in careers
24          in biomedical research and for supportive legislation to
25          make physician-investigators eligible for forgiveness in
26          certain government scholarship and loan programs for
27          qualified candidates in numbers consistent with national
28          needs. (Sub. Res. 79, I-79; Reaffirmed: CLRPD Rep. B, I-
29          89; Reaffirmed: Sunset Report, A-00; Reaffirmation A-09)
30
31   Resolution 19 asks the AMA-MSS to encourage the preferential use of less invasive
32   interventional methods in medicine in situations where more invasive methods are not
33   likely to increase quality or duration of life by comparison; (2) support scientific
34   advancement and legislation that advance preventive care and reduces the invasiveness
35   of current and future interventional treatments; and (3) support research elucidating the
36   complexity of informed consent with regard to issues including 1. the effect of physician
37   bias on patients’ decision making, and 2. the nature of patient satisfaction with informed
38   consent procedures after iatrogenic complications following invasive interventional
39   methods.
40
41   Your Reference Committee heard considerable testimony on Resolution 19, much of
42   which highlighted the same concerns raised by your Reference Committee. While this
43   resolution is well intended, it contains several problematic requests.
44
45   With regard to the first resolve, your Reference Committee is concerned that any
46   encouragement as to a specific procedure that should be used fails to account for the
47   necessary patient involvement in procedures. Physicians’ best course of care is to
48   approach each patient with the available options, and to discuss which type of care is in
49   the best interest of the individual. Asking for physicians to enter this conversation with a
50   preexisting directive to avoid invasive care is improper.
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 1
 2   With regard to the second resolve, this policy does not seem to be necessary. The AMA
 3   already has extensive policy supporting preventive care (H-425.991; H-425.988) and
 4   advancement in medical care (H-460.995). As a result, the crux of this clause is already
 5   being implemented by the AMA.
 6
 7   With regard to Resolve 3, the reference committee recognizes the concern of ensuring
 8   patient knowledge of informed consent, but does not believe this study to be a proper
 9   utilization of AMA resources. The AMA already supports physicians acting in
10   accordance with their ethical policies, and the basics of the physician-patient relationship
11   are addressed within E-10.01 and E-10.015. Even if a study were to be conducted, the
12   results being sought would support of maintaining a proper physician-patient
13   relationship. Since this is already policy, there is no need to study this issue.
14   Additionally, your Reference Committee fears that this study would be biased, as the
15   AMA would be relying on physicians to report a bias towards their maintenance of proper
16   informed consent. It was requested that the MSS reaffirm existing ethical opinions. This
17   is, however, unnecessary, as ethical opinions are not subject to sunset, and remain
18   active policy of the AMA unless repealed/revised.
19
20   For these reasons, your Reference Committee recommends that Resolution 19 be not
21   adopted.
22
23
24   (25)   RESOLUTION 20 - REDUCING BARRIERS TO
25          PREVENTIVE HEALTH CARE DELIVERY AND
26          COMPENSATION
27
28          RECOMMENDATION A:
29
30          Mr. Speaker, your Reference Committee recommends that
31          the first resolve of Resolution 20 be deleted on page 1,
32          lines 14-16 as follows:
33
34          RESOLVED, That our AMA-MSS ask the AMA to support
35          both the reduction of financial barriers to the delivery of
36          cost-saving preventive health care services, and the
37          implementation of financial incentives for cost-saving
38          preventive medical care; and be it further
39
40          RECOMMENDATION B:
41
42          Mr. Speaker, your Reference Committee recommends that
43          the second resolve of Resolution 20 be amended by
44          deletion on page 1, line 18 as follows:
45
                                                             MSS Reference Committee (I-11)
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 1          That our AMA-MSS ask the AMA to conduct a study
 2          examining the effects of improvements in financial
 3          incentives for the delivery of cost-saving preventive care,
 4          and to make information from such study available through
 5          avenues including but not limited to the AMA web site to
 6          better educate physicians and the public about the benefits
 7          of preventive health care services.
 8
 9          RECOMMENDATION C:
10
11          Mr. Speaker, your Reference Committee recommends that
12          Resolution 20 be adopted as amended.
13
14   Resolution 20 asks the AMA to (1) support both the reduction of financial barriers to the
15   delivery of cost-saving preventive health care services, and the implementation of
16   financial incentives for cost-saving preventive medical care; and (2) conduct a study
17   examining the effects of improvements in financial incentives for the delivery of cost-
18   saving preventive care, and to make information from such study available through
19   avenues including but not limited to the AMA web site to better educate physicians and
20   the public about the benefits of preventive health care services.
21
22   Your Reference Committee received substantial testimony on Resolution 20, which
23   varied greatly on the issue. Your Reference Committee believes that the first resolve is
24   already supported by existing AMA policy (H-425.997; H-425.992, H-425.991).
25   Additionally, the AMA supports the Patient Protection and Affordable Care Act, which, as
26   stated in online testimony, already proposes for removing financial barriers to preventive
27   care access by 2014.
28
29   With regard to the second resolve, your Reference Committee believes this proposal
30   merits further action. Reference Committee research has revealed that there already is
31   a wide range of information available on financial barriers to healthcare access. As a
32   result, this study should seek to utilize existing information and promote dissemination of
33   its findings. As proposed by the chair of the MSS Committee on Economics and Quality
34   in Medicine, this study should be performed by the MSS committees. As a result, we
35   recommend requesting an internal study.
36
37   Your Reference Committee received a large amount of on-site testimony regarding
38   Resolution 20. One of the main proposals was that, since the AMA’s current policy does
39   not cover supporting financial incentives for physicians to offer preventive care, the
40   Assembly should propose the action contained in the first resolve. Your Reference
41   Committee does not, however, believe that a proposal should focus on physician
42   financial benefits, as the primary motivation guiding a physicians’ professional decisions
43   should be quality of care rather than financial consequences.
44
45   For these reasons, your Reference Committee recommends that Resolution 20 be
46   adopted as amended.
47
48
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 1   (26)   RESOLUTION 21 - TAX DEDUCTIONS FOR STATE-
 2          BASED HEALTH INSURANCE EXCHANGE POLICIES
 3          RECOMMENDATION:
 4
 5          Mr. Speaker, your Reference Committee recommends that
 6          Resolution 21 be referred.
 7
 8   Resolution 21 asks the AMA to (1) reaffirm AMA policy on Individual Health Insurance H-
 9   165.920 specifically relating to new state-based insurance exchanges; (2) advocate for
10   federal and state tax deductions for all individual policy purchasers, and specifically
11   those on new state-based health insurance exchanges, that are equivalent to the tax
12   breaks provided to employers who purchase policies for their employees; and (3)
13   advocate that federal and state tax laws should not penalize individuals and small
14   business owners who purchase their own insurance on state-based health insurance
15   exchanges, but rather that tax laws should be applied equitably, relative to employees
16   who receive employer-sponsored benefits.
17
18   Your Reference Committee received testimony on this resolution, primarily from the
19   resolution author in support of the resolution. While policy establishing tax breaks for
20   individuals purchasing their own insurance could be beneficial, your Reference
21   Committee is unclear as to how this resolution is established within PPACA, what the
22   justification behind the creation of such a tax policy could be, and whether the AMA
23   current policy sufficiently addresses this issue. Additionally, your Reference Committee
24   was concerned as to whether the passage of this policy could potentially hurt patients by
25   causing employers to limit their employee offered insurance coverage, as was proposed
26   in testimony. Background information provided to your Reference Committee proved
27   overly confusing. As a result, your Reference Committee would like to see this issue
28   referred for study, at which a time a more informed action can be taken by the Assembly.
29
30   On-site, your reference committee was encouraged not to refer, as sufficient information
31   is already available on which to act. Your Reference Committee believes, however, that
32   the Assembly does not have the familiarity with such information so as to make an
33   informed decision.
34
35   For these reasons, your Reference Committee recommends referral for study.
36
37
38   (27)   RESOLUTION 22 - VALUE-BASED INSURANCE DESIGN
39
40          RECOMMENDATION
41
42          Mr. Speaker, your Reference Committee recommends that
43          Resolution 22 be referred.
44
45   Resolution 22 asks the AMA to (1) advocate for the implementation and inclusion of
46   value-based insurance design modalities in new private-sector health insurance benefits;
47   (2) advocate for the implementation and inclusion of value-based insurance design
48   modalities in future legislative health reform efforts; and (3) recommend to the AMA
49   Insurance Agency that value-based insurance design be studied for future inclusion in
50   Agency health insurance products.
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 1
 2   Your Reference Committee received significant testimony on Resolution 22. Although
 3   your Reference Committee appreciated the extensive work put into this resolution, we do
 4   not feel that that recommending the proposed action is appropriate at this time. As
 5   explained by a member of the AMA-MSS Committee on Economics and Quality in
 6   Medicine, the issue of Value-Based Insurance carries a significant number of financial,
 7   quality, and ethical concerns. Your Reference Committee believes these issues should
 8   be further investigated prior to formal MSS action on this issue. For this reason, we
 9   recommend that Resolution 22 be referred.
10
11   On-site, your reference committee was encouraged not to refer, as sufficient information
12   is already available on which to act. Your Reference Committee believes, however, that
13   the Assembly does not have the familiarity with such information so as to make an
14   informed decision.
15
16   (28)   RESOLUTION 23 - RECOGNIZING SOCIOECONOMIC
17          STATUS AS A DETERMINATE OF HEALTH
18
19          RECOMMENDATION A:
20
21          Mr. Speaker, your Reference Committee recommends that
22          Resolution 23 be amended by deletion on page 2, lines 1-2
23          as follows:
24
25          RESOLVED, That our AMA recognize social-economic
26          status as one of the greatest predictors of health
27          outcomes; and be it further
28
29          RECOMMENDATION B:
30
31          Mr. Speaker, your Reference Committee recommends that
32          Resolution 23 be adopted as amended.
33
34   Resolution 23 asks the AMA to (1) recognize social-economic status as one of the
35   greatest predictors of health outcomes; and (2) encourage state legislatures and the
36   Congress of the United States to develop a health equity surveillance system
37   administered by the Department of Health and Human Services that will monitor, at the
38   county level, the effect of social economic status on health-related risk factors, quality of
39   care, access to interventions, and other factors impacting health.
40
41   Your Reference Committee received a large amount of testimony regarding resolution
42   23. While your Reference Committee agrees that socioeconomic status is an important
43   factor in the delivery of health care, we believe that the AMA already has extensive
44   policy (H-450.961) and programs which reflect their concerns with the effects of
45   socioeconomic status on health.
46
47   With regard to the second resolve, your Reference Committee receieved extensive on-
48   site testimony in support of the second resolve. Although many programs exist that
49   address economic health disparities, there is not currently a sufficient mechanism for
50   gathering information on socioeconomic disparities at the local or county level.
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 1   As a result, your Reference Committee recommends adoption of Resolution 23 as
 2   amended.
 3
 4
 5   (29)   RESOLUTION 24 - STRATEGIES TO IMPROVE CARE
 6          FOR UNDERINSURED PATIENTS
 7
 8          RECOMMENDATION:
 9
10          Mr. Speaker, your Reference Committee recommends that
11          Resolution 24 be adopted.
12
13   Resolution 24 asks the AMA to study successful strategies for improving patient access
14   to quality and timely health care, and report back at Interim 2012 with examples of
15   successful models and recommendations for expanding these models nationally.
16
17   Your Reference Committee received extensive commentary on this resolution, which
18   varied in testimony supporting adoption to testimony questioning the usefulness of the
19   collected information. Your Reference Committee considered the usefulness of this
20   study, as several comments indicated that it may be best to wait until after the Patient
21   Protection and Affordable Care Act (PPACA) has been implemented, as PPACA will
22   drastically change the ways in which the underinsured receive adequate care. The
23   concern of commenters is that any information gathered now will be rendered obsolete
24   due to the drastic change in underinsured health care that will occur with the
25   implementation of PPACA. While your Reference Committee recognized this concern, it
26   also believed that any information gathered in such a study could help the medical
27   community implement PPACA effectively. As a result, your Reference Committee
28   believes this to be a useful study worth undertaking, and, thus, recommends adoption of
29   Resolution 24.
30
31
32   (30)   RESOLUTION 25 - INVESTIGATING TRANSPORTATION
33          AND ACCESSIBILITY TO FREE MEDICAL CLINICS
34
35          RECOMMENDATION:
36
37          Mr. Speaker, your Reference Committee recommends that
38          Resolution 25 not be adopted.
39
40   Resolution 25 asks the AMA to (1) study the role of transportation and access to free
41   clinics and the potential hindrance to patients seeking health care; and (2) study the
42   location of free clinics in the context of patient accessibility and the location of their
43   target patient population.
44
45   Your Reference Committee received online testimony that, while recognizing the
46   importance of free clinics, did not recommend the proposed studies as an effective use
47   of AMA resources. Based on this commentary and first-hand experience of its
48   members, your Reference Committee believes that clinics are already aware of the need
49   to be located in an accessible area. Your Reference Committee also recognized that
50   free clinics often have limited budgets, which would make a study into accessibility of
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 1   low priority, as well as potentially make the study results less useful, since clinics already
 2   have more pressing budgetary issues to address with their limited funds.
 3
 4   Testimony at the reference committee hearing supported your Reference Committee’s
 5   initial recommendation that Resolution 25 not be adopted.
 6
 7
 8   (31)   RESOLUTION 26 - ON-SITE EMPLOYER MEDICAL
 9          CLINICS
10
11          RECOMMENDATION :
12
13          Mr. Speaker, your Reference Committee recommends that
14          the following Substitute Resolution 26 be adopted:
15
16          RESOLVED, That our American Medical Association study
17          the effect of on-site employer medical clinics on employee
18          preventative health benefits and health access benefits;
19          and be it further
20
21          RESOLVED, That our American Medical Association
22          develop guidelines for the operation of on-site employer-
23          sponsored medical clinics, ensuring that employee privacy,
24          safety, and access to preventive health are not
25          compromised.
26
27   Resolution 26 asks the AMA to (1) study the role and effect of on-site employer medical
28   clinics on health care costs and employee health; and (2) encourage employers to adopt
29   strict health record privacy policies to protect their employees.
30
31   Your Reference Committee received substantial online testimony on Resolution 26,
32   which generally recognized the usefulness of this idea, but found the resolution to
33   require revision. With regard to the first resolve, due to concerns as to whether the
34   proposed study would be feasible due to the Health Insurance Portability and
35   Accountability Act (HIPAA) restrictions, your Reference Committee felt that employee
36   health benefits and cost savings benefits are established based on cited sources, but is
37   concerned that employers could cut other employee health benefits to the net detriment
38   of employee health. While the Reference Committee believes there to be sufficient
39   evidence that on-site clinics are beneficial to employee health, we are concerned about
40   whether their implementation comes at the expense of other employee benefits.
41   Utilizing an online proposed revision, your Reference Committee believes that looking at
42   general employee health benefits in companies using on-site clinics to be a useful study
43   without the HIPAA concerns.
44
45   The second resolve, as proposed, seemed to be a simple endorsement of the HIPAA
46   security requirements, which your Reference Committee believed not to be required.
47   However, your Reference Committee believed that rather than specific security
48   instructions, the AMA could develop general guidelines for utilization by employers
49   looking to create and implement on-site medical clinics, which would help ensure that
50   employee patient health care needs are met.
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 1
 2   Testimony at the reference committee hearing supported the commttee’s initial
 3   recommendation that Substitute Resolution 26 be adopted.
 4
 5
 6   (32)   RESOLUTION 27 - AMA GRADING OF SAFE,
 7          EFFECTIVE SMARTPHONE APPS
 8
 9          RECOMMENDATION A:
10
11          Mr. Speaker, your Reference Committee recommends that
12          the first resolve of Resolution 27 be amended by insertion
13          and deletion on page 1, lines 30-32 as follows:
14
15          RESOLVED, That the AMA-MSS collaborate with app
16          distributors work with the AMA Business Development staff
17          to look into the feasibility of developing to develop a
18          mechanism for official AMA grading of medical apps
19          submitted by app developers and found to be appropriate
20          for clinical usage.
21
22          RECOMMENDATION B:
23
24          Mr. Speaker, your Reference Committee recommends that
25          the second resolve of Resolution 27 be amended by
26          insertion on page 1, lines 34-35 as follows:
27
28          RESOLVED, That the AMA-MSS support ongoing
29          research on the safety and efficacy of medical apps used
30          in clinical settings in terms of patient outcomes and
31          physician performance and efficiency.
32
33          RECOMMENDATION C:
34
35          Mr. Speaker, your Reference Committee recommends that
36          Resolution 27 be adopted as amended.
37
38   Resolution 27 asks the AMA-MSS to (1) collaborate with app distributors to develop a
39   mechanism for official AMA grading of medical apps submitted by app developers and
40   found to be appropriate for clinical usage; and (2) support ongoing research on the
41   safety and efficacy of medical apps in terms of patient outcomes and physician
42   performance and efficiency.
43
44   Your Reference Committee received some testimony on this resolution, which was
45   generally in support of receiving AMA input on the various applications available for
46   smartphones, though it also expressed some concerns. Your Reference Committee
47   questioned how the AMA-MSS would work directly with app distributors in developing
48   such a mechanism, as there are an extremely large number of medical applications.
49   Recognizing that the specifics of the implementation would be difficult for the AMA-MSS
50   to develop with app developers on its own, your Reference Committee believed it would
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 1   be best for the MSS to work with the business development staff of the AMA to work out
 2   the logistics. Through working with the staff, the AMA-MSS could create an appropriate
 3   process, that could potentially be presented to the AMA Board for future implementation.
 4
 5   Additionally, Your Reference Committee saw it fit to insert the proposed language into
 6   the second resolve to clarify that the resolution seems to be aiming to deal with clinical
 7   applications, not medical applications that are available to the general population for
 8   use.
 9
10   Some testimony at the reference committee hearing indicated that the grading of
11   medical apps was beyond the scope of the AMA and better developed by other
12   organizations or government agencies, such as the Federal Trade Commission.
13   However, the AMA’s Business Development area expressed an interest in programs for
14   evaluating medical apps and your Reference Committee recommends that they consider
15   possible activities, including a scan of potential competitors. Any proposed programs
16   would have to be approved by the Board of Trustees prior to implementation. For the
17   above reasons, your Reference Committee recommends that Resolution 27 be adopted
18   as amended.
19
20
21   (33)   RESOLUTION 28 - CLOSER MONITORING OF
22          EMERGENCY MEDICAL KITS ON PASSENGER
23          AIRCRAFTS
24
25          RECOMMENDATION:
26
27          Mr. Speaker, your Reference Committee recommends
28          that Policy H-45.981 be reaffirmed in lieu of Resolution 28.
29
30          H-45.981 Improvement in US Airlines Aircraft Emergency
31          Kits: Our AMA urges federal action to require all US air
32          carriers to report data on in-flight medical emergencies,
33          specific uses of in-flight medical kits and emergency
34          lifesaving devices, and unscheduled diversions due to in-
35          flight medical emergencies; this action should further
36          require the Federal Aviation Administration to work with the
37          airline industry and appropriate medical specialty societies
38          to periodically review data on the incidence and outcomes
39          of in-flight medical emergencies and issue
40          recommendations regarding the contents of in-flight
41          medical kits and the use of emergency lifesaving devices
42          aboard commercial aircraft.
43
44   Resolution 28 asks the AMA to (1) recommend that the Federal Aviation Administration
45   (FAA) to adopt a standardized recording system for all in-flight medical emergencies so
46   that lessons learned from management of in-flight medical emergencies can be utilized
47   for care of future passenger(s) that become ill during a flight; (2) work closely with the
48   American College of Emergency Physicians (ACEP), American Society of Aerospace
49   Medicine Specialists (ASAMS) and the FAA to determine the optimal content of the first
50   aid kits on passenger airplanes and urge that the standardized emergency medical kits
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 1   with identical elements be stored in identical location on every flight; and (3) recommend
 2   that the FAA mandate a regulation for medical emergency kits to be fully stocked to the
 3   existing standards onboard all commercial flights before each flight.
 4
 5   Your Reference Committee received online testimony on this report, the majority of
 6   which felt that the AMA’s current policy regarding in-flight emergencies (H-45.981)
 7   sufficiently addressed these issues. The AMA has worked to have FAA regulations
 8   updated in the past, with the FAA adopting additional regulations regarding the contents
 9   of emergency kits. While your Reference Committee recognizes the testimony that was
10   concerned with current regulations not being enforced sufficiently, your Reference
11   Committee agreed with commentary explaining that the solution to an unenforced
12   mandate is not another mandate. Although there was limited testimony at the reference
13   committee hearing in support of the original resolution, your Reference Committee
14   believes that its initial decision to reaffirm existing policy continues to be correct.
15
16
17   (34)   RESOLUTION 29 - SUPPORT FOR DRUG COURTS
18          RECOMMENDATION A:
19
20          Mr. Speaker, your Reference Committee recommends that
21          the second resolve of Resolution 29 be amended by
22          insertion and deletion on page 2, line 1 as follows:
23
24          RESOLVED, that the AMA work with encourage legislators
25          to establish drug courts at the state and local level in the
26          United States.
27
28          RECOMMENDATION B:
29
30          Mr. Speaker, your Reference Committee recommends that
31          Resolution 29 be adopted as amended.
32
33   Resolution 29 asks the AMA to (1) support the establishment of drug courts as an
34   alternative to incarceration and as a more effective means of overcoming drug addiction
35   for drug-abusing individuals convicted of nonviolent crimes; and (2) work with legislators
36   to establish drug courts at the state and local level in the United States.
37
38   Your Reference Committee received limited testimony on Resolution 29, much of which
39   recognized existing policy on the issue of drug courts. With regard to the first resolve,
40   AMA Policy H-420.970 recognizes that drug addiction is a disease amenable to
41   treatment rather than criminalization and H-430.989 recommends consideration by
42   judicial authorities of sentencing drug abusers to treatment programs as part of their
43   sentence. As explained in the resolution, the purpose of drug courts is to put people in
44   such rehabilitative programs. Although current AMA policy noted above supports the
45   concept of drug courts, they are not explicitly included in the policy.
46
47   With regard to the second resolve, your Reference Committee believes that its
48   suggested amendment gives the AMA the tools to implement the policy at the state and
49   local levels. For these reasons, your Reference Committee recommends that
50   Resolution 29 be adopted as amended.
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 1
 2
 3   (35)   RESOLUTION 30 - REDUCED INCARCERATION AND
 4          IMPROVED TREATMENT OF INDIVIDUALS WITH
 5          MENTAL ILLNESS OR ILLICIT DRUG DEPENDENCE
 6
 7          RECOMMENDATION:
 8
 9          Mr. Speaker, your Reference Committee recommends that
10          the following Substitute Resolution 30 be adopted:
11
12          RESOLVED, That our AMA-MSS ask the AMA to amend
13          policy H-430.989 by insertion and deletion as follows:
14
15          H-430.989 Disease Prevention and Health Promotion in
16          Correctional Institutions: Our AMA urges state and local
17          health departments to develop plans that would foster
18          closer working relations between the criminal justice,
19          medical, and public health systems toward 1. the
20          prevention and control of HIV/AIDS, substance abuse,
21          tuberculosis and hepatitis,2. the management and
22          treatment of psychiatric disorders such as drug
23          dependence, and 3. a reduction in reincarceration rates
24          related to drug abuse and psychiatric disorders. Some of
25          these plans should have as their objectives: (a) an
26          increase in collaborative efforts between parole officers,
27          and drug treatment center staff and psychiatric care center
28          staff in case management aimed at helping patients to
29          continue in treatment and to remain drug free; (b) an
30          increase in direct referral by correctional systems of
31          parolees with a history of intravenous drug use to drug
32          treatment centers; and (c) consideration by judicial
33          authorities of assigning individuals to drug treatment
34          programs, as well as inpatient or outpatient psychiatric
35          treatment programs, as a sentence or in connection with
36          sentencing."
37
38   Resolution 30 asks the AMA to (1) support states’ investments in cost-effective mental
39   health and drug abuse treatment programs for individuals meeting DSM-IV criteria; (2)
40   support states investment in effective bridge programs for released prisoners seeking
41   long-term psychiatric therapy and drug abuse treatment; (3) research the economic and
42   public health advantages of mental health and drug abuse treatment programs over
43   incarceration; and (4) support state efforts to define the appropriate utilization of mental
44   health and drug abuse programs in lieu of correctional facilities.
45
46   Your Reference Committee heard substantial testimony on Resolution 30, much of
47   which supported the idea of the resolution, but believed it to be sufficiently covered by
48   existing AMA policy. As stated, the intent of this resolution is largely captured by H-
49   430.989. The Reference Committee agrees, however, that H-430.989 does not address
50   psychiatric disorders in conjunction with drug abuse, which is an important distinction.
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 1   Rather than pass redundant policy, your Reference Committee agrees that revision of
 2   existing policy is appropriate. As a result, your Reference Committee agrees with
 3   amending H-430.989 to adequately reflect these concerns. In addition, your Reference
 4   Committee believes broad policy to be more effective in its application and also
 5   recognizes that DSM IV will become outdated upon the publishing of future DSM
 6   guidelines.
 7
 8   For these reasons, the AMA recommends that Substitute Resolution 30 be adopted.
 9
10
11   (36)   RESOLUTION 31 - RECOGNITION OF ADDICTION AS
12          PATHOLOGY, NOT CRIMINALITY
13
14          RECOMMENDATION A:
15
16          Mr. Speaker, your Reference Committee recommends that
17          the following Substitute Resolution 31 be adopted:
18
19          RESOLVED, That our AMA-MSS supports encouraging
20          the federal government to re-examine the enforcement-
21          based approach to illicit drug issues (“war on drugs”) and
22          to prioritize and implement policies that treat drug abuse
23          as a public health threat and drug addiction as a
24          preventable and treatable disease.
25
26          RECOMMENDATION B:
27
28          Mr. Speaker, your Reference Committee recommends that
29          Policy H-420.970 be reaffirmed.
30
31          H-420.970 Treatment Versus Criminalization - Physician
32          Role in Drug Addiction During Pregnancy: It is the policy
33          of the AMA (1) to reconfirm its position that drug addiction
34          is a disease amenable to treatment rather than a criminal
35          activity; (2) to forewarn the U.S. government and the
36          public at large that there are extremely serious implications
37          of drug addiction during pregnancy and there is a pressing
38          need for adequate maternal drug treatment and family
39          supportive child protective services; (3) to oppose
40          legislation which criminalizes maternal drug addiction or
41          requires physicians to function as agents of law
42          enforcement - gathering evidence for prosecution rather
43          than provider of treatment; and (4) to provide concentrated
44          lobbying efforts to encourage legislature funding for
45          maternal drug addiction treatment rather than prosecution,
46          and to encourage state and specialty medical societies to
47          do the same.
48
49   Resolution 31 asks (1) our AMA-MSS consider the problem of personal drug, alcohol,
50   and tobacco abuse 1. to be an issue of public health and mental health rather than
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 1   criminal justice, and 2. to be better treated by public health and mental health measures
 2   and methodology than by criminal measures, especially when abuse coincides with co-
 3   morbid pathology such as depression, anxiety, pain, or other mental health conditions;
 4   and (2) our AMA support legislation which 1. limits the criminality of possession and use
 5   of drugs, alcohol, and tobacco which is clearly for personal use, so long as other laws
 6   remain unbreached, 2. creates, encourages, and/or funds programs which treat the
 7   pathology of drug, alcohol, and tobacco addiction and abuse when appropriate, 3.
 8   encourages judicial referrals of drug and alcohol addiction and abuse to appropriate
 9   public health and mental health treatment rather than criminal justice admission, so long
10   as other laws remain unbreached, and 4. opposes legislative and judicial trends which
11   have exponentially increased prosecution and incarceration of non-violent drug
12   offenders, and support efforts to shift funding from incarceration of drug-abusers to
13   mental health efforts directed to help these patients recover.
14
15   Your Reference Committee considered testimony in support of this resolution, as well as
16   testimony believing this to be a reaffirmation of existing policy. Your Reference
17   Committee concurs that much of this resolution is already covered by existing policies
18   and recommends the reaffirmation of Policy H-420-970.
19
20   In addition, your Reference Committee recognizes a largely identical resolution being put
21   forth in the HOD at the 2011 Interim Meeting. In order to support the basic tenants of
22   Resolution 31 and provide a clear direction to delegates in the HOD, the Reference
23   Committee recommends adoption of internal policy reflecting support for the Resolution
24   933 in the HOD. For this reason, your Reference Committee also recommends adoption
25   of Substitute Resolution 31.
26
27
28   (37)   RESOLUTION 32 - SUPPORT OF MEDICAL AMNESTY
29          POLICIES FOR UNDERAGE ALCOHOL INTOXICATION
30
31          RECOMMENDATION:
32
33          Mr. Speaker, your Reference Committee recommends that
34          the following Substitute Resolution 32 be adopted:
35
36          RESOLVED, That our American Medical Association
37          support efforts among universities, hospitals, and
38          legislators to establish medical amnesty policies that
39          protect underage drinkers from punishment when seeking
40          emergency medical attention for themselves or others.
41
42   Resolution 32 asks the AMA-MSS to support, in conjunction with current preventative
43   practices, efforts among universities, hospitals, and legislators to establish carefully
44   adjudicated medical amnesty policies that protect underage drinkers from punishment
45   when seeking emergency medical attention for themselves or another.
46
47   Your Reference Committee received minimal online testimony regarding Resolution 32.
48   Your Reference Committee believes that the resolution addresses a valid concern and
49   would be a beneficial policy. This policy would add to the extensive AMA policy
50   concerned with alcohol abuse. Your Reference Committee agrees with online testimony
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 1   supporting this resolution being presented to the HOD for adoption rather than keeping it
 2   as internal.
 3
 4
 5   (38)   RESOLUTION 33 - IMPROVING MENTAL HEALTH
 6          SERVICES FOR PREGNANT AND POSTPARTUM
 7          MOTHERS
 8
 9          RECOMMENDATION:
10
11          Mr. Speaker, your Reference Committee recommends that
12          the following Substitute Resolution 33 be adopted:
13
14          RESOLVED, That our American Medical Association
15          support improvements in current mental health services for
16          women during pregnancy and postpartum; and be it further
17
18          RESOLVED, That our American Medical Association
19          support advocacy for inclusive insurance coverage of
20          mental health services during gestation, and extension of
21          postpartum mental health services coverage from 6 weeks
22          to 1 year postpartum; and be it further
23
24          RESOLVED, That our American Medical Association
25          support appropriate organizations working to improve
26          awareness and education among patients, families, and
27          providers of the risks of mental illness during gestation and
28          postpartum.
29
30   Resolution 33 asks the AMA (1) to work with appropriate organizations to improve
31   current mental health services for women during pregnancy and postpartum; (2) to
32   advocate for inclusive insurance coverage of mental health services during gestation,
33   and extension of postpartum mental health services coverage from 6 weeks to 1 year
34   postpartum; and (3) to take initiative and work with appropriate organizations to improve
35   awareness and education among patients, families, and providers of the risks of mental
36   illness during gestation and postpartum.
37
38   Your Reference Committee considered substantial testimony on Resolution 33, all of
39   which was in strong support of the objectives of this resolution. Your Reference
40   Committee believes that post-partum care and mental health of mothers is an extremely
41   important issue, and is worthy of the support of the AMA. Upon discussion with AMA
42   staff, the Reference Committee was informed that the AMA does not have the resources
43   nor expertise to actively develop and advocate for mental health issues. Current
44   protocol for the AMA is to request action by and support organizations with the
45   resources and expertise to address these concerns. As a result, your Reference
46   Committee recommends a substitute resolution to accomplish these purposes.
47
48
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 1   (39)   RESOLUTION 34 - ADVOCACY FOR 9/11 EARLY
 2          RESPONDER HEALTH COVERAGE OF CANCER
 3
 4          RECOMMENDATION A:
 5
 6          Mr. Speaker, your Reference Committee recommends that
 7          Resolution 34 be amended by deletion of the second
 8          resolve on page 2, lines 10-11 as follows:
 9
10          RESOLVED, That our AMA petition the administrator of the
11          WTC Health Program to include cancer in the list of WTC-
12          Related health conditions
13
14          RECOMMENDATION B:
15
16          Mr. Speaker, your Reference Committee recommends that
17          Resolution 34 be adopted as amended.
18
19   Resolution 34 asks the AMA to (1) encourage further study of the association between
20   post-September 11, 2001 World Trade Center attack exposure and cancer incidence;
21   and (2) petition the administrator of the WTC Health Program to include cancer in the
22   List of WTC-Related Health Conditions.
23
24   Your Reference Committee received significant testimony regarding Resolution 34,
25   which universally supported the first resolve, while expressing concern with the second
26   Resolve being potentially premature. Your Reference Committee believes that further
27   study into the World Trade Center attack and cancer incidence is important research to
28   be conducted. With regard to the second resolve, your Reference Committee concurs
29   with the testimony believing this to be premature. If a resolution asks for a study to be
30   conducted to determine whether there is a causal link between the attacks and cancer
31   incidence, it is improper to have already reached a conclusion. As a result, your
32   Reference Committee believes the study should be conducted, with further action being
33   left until results of the study can be analyzed.
34
35   For these reasons, your Reference Committee recommends that Resolution 34 be
36   adopted as amended.
37
38
39   (40)   RESOLUTION 35 - EDUCATION AND FUNDING
40          ALLOCATION FOR THE MUSCULAR DYSTROPHIES
41          PROPORTIONATE TO INCIDENCE.
42
43          RECOMMENDATION:
44
45          Mr. Speaker, your Reference Committee recommends that
46          Resolution 35 not be adopted.
47
48   Resolution 35 asks the AMA (1) to advocate for education of medical students,
49   residents, and lawmakers on all forms of muscular dystrophy, including myotonic
50   muscular dystrophy; and (2) to advocate for inclusion of all prevalent forms of muscular
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 1   dystrophy, including myotonic muscular dystrophy, for language used in government-
 2   originating funding and/or policy.
 3
 4   Your Reference Committee appreciates the concerns put forth by Resolution 35, and
 5   understands the concern that other forms of Muscular Dystrophy may receive less
 6   recognition than others. Your Reference Committee received substantial online
 7   testimony on this resolution, including compelling commentary from the MSS student on
 8   the Council for Science and Public Health, which indicated, “The funding of research is
 9   an incredibly complex field. Most of the distribution of NIH funding is decided by each
10   institute based off many different factors (i.e., prevalence of disease and competitive
11   grant submissions)”. Similar testimony was presented at the reference committee
12   hearing.
13
14   Unfortunately, with budget cuts or stagnation, the NIH is wholly underfunded and many
15   diseases are not studied optimally. The formation of the MDCC appears to be an
16   appropriate means to ensure that MD is properly funded in the future. Your Reference
17   Committee believes the proposed action to not be proper at this time and that the AMA
18   should not take extensive and costly action on such a specific disease.
19
20   As a result, your Reference Committee recommends that Resolution 35 not be adopted.
21
22
23   (41)   RESOLUTION 36 - PROMOTING PREVENTION OF
24          FATAL OPIOID OVERDOSE
25
26          RECOMMENDATION A:
27
28          Mr. Speaker, your Reference Committee recommends that
29          Resolution 36 be amended by deletion of the first
30          resolveon page 2, lines 6-8 as follows:
31
32          RESOLVED, That our AMA propose a standardized opioid
33          overdose prevention plan through the use of naloxone in
34          hospitals, community health settings, and homeless
35          shelters located in an urban setting; and be it further
36
37          RECOMMENDATION B:
38
39          Mr. Speaker, your Reference Committee recommends that
40          the second resolve of Resolution 36 be amended by
41          insertion and deletion on page 2, lines 10-11 as follows:
42
43          RESOLVED, That our AMA encourage the establishment
44          of new pilot programs in specific urban settings directed
45          towards heroin overdose treatment with naloxone; and be
46          it further
47
48          RECOMMENDATION C:
49
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 1          Mr. Speaker, your Reference Committee recommends that
 2          third resolve of Resolution 36 be amended by insertion and
 3          deletion on page 2, lines 13-14 as follows:
 4
 5          RESOLVED, That our AMA advocate for encourage the
 6          education of health care workers and opioid users about
 7          the use of naloxone in preventing opioid overdose
 8          fatalities.
 9
10          RECOMMENDATION D:
11
12          Mr. Speaker, your Reference Committee recommends that
13          Resolution 36 be adopted as amended.
14
15   Resolution 36 asks the AMA to (1) propose a standardized opioid overdose prevention
16   plan through the use of naloxone in hospitals, community health settings, and homeless
17   shelters located in an urban setting; (2) support new pilot programs in specific urban
18   settings directed towards heroin overdose treatment with naloxone; and (3) advocate for
19   the education of health care workers and opioid users about the use of naloxone in
20   preventing opioid overdose fatalities.
21
22   Your Reference Committee received minimal testimony on this resolution, which
23   generally supported the idea but had concerns with some of the specific actions
24   requested. Although some commentary suggested a study into how naloxone can be
25   utilized, your committee believes that naloxone has been significantly studied to this
26   point. With regard to the first resolve, your Reference Committee believes that a
27   standardized prevention plan to be premature prior to looking at the results of pilot
28   programs. Additionally, The decision as to how to utilize naloxone should be left to
29   individual physicians, and such a broad standardization may limit physician ability to
30   individualize treatment. Additionally, standardization of a plan for all of these
31   organizations fails to take into account the specific and varying concerns of these
32   institutions. As a result, your Reference Committee supports not adopting the first
33   resolve.
34
35   The second resolve addresses a useful project, as pilot programs would potentially
36   establish useful procedures to consider when implementing heroin overdose treatment
37   programs. The Reference Committee agreed with proposed commentary that the clause
38   was unnecessarily specific, and believes the decision as to where the programs should
39   be launched should be left up to those implementing the policy.
40
41   The third resolve also is an important matter that the AMA should address in its policy.
42   The Reference Committee agreed with the intent of the clause, but felt that the AMA
43   should encourage the education of health care workers in preventing opioid overdose
44   fatalities, as legislation may not be the appropriate manner in which to address this
45   concern.
46
47   For these reasons, your Reference Committee recommends adoption of Resolution 36
48   as amended.
49
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 1   (42)   RESOLUTION 37 - PITCHER SAFETY IN LITTLE
 2          LEAGUE & HIGH SCHOOL BASEBALL/SOFTBALL
 3          LEAGUES
 4
 5          RECOMMENDATION:
 6
 7          Mr. Speaker, your Reference Committee recommends that
 8          the following Substitute Resolution 37 be adopted:
 9
10          RESOLVED, That MSS Policy 10.012MSS be amended to
11          read as follows:
12
13          Sledding and Helmet Safety: AMA-MSS will ask the AMA
14          to amend H-470.974 by insertion and deletion as follows:
15          Athletic Helmets: 1. Our AMA urges the Consumer Product
16          Safety Commission to establish standards that athletic and
17          recreational helmets, including but not limited to football,
18          baseball, hockey, horse back riding, bicycle and
19          motorcycle riding, lacrosse, and skiing, produced or sold in
20          the United States provide protection against head injury;
21          and that the AMA advocate the use of appropriate and
22          safe clear face guards as a permanent installation on the
23          current bilateral ear protective batter's helmet to be worn
24          by all baseball and softball players as required safety
25          equipment in all organized baseball and softball for those
26          children from 5 to 14 18 years of age; that the AMA
27          encourage the use of protective helmets and face shields
28          to be worn by all baseball and softball pitchers in
29          organized leagues from 5 to 18 years of age. 2. Our AMA:
30          (a) supports legislation requiring the use of helmets by
31          children ages 17 and younger while engaged in potentially
32          dangerous athletic activities, including but not limited to
33          sledding, snow skiing, or and snowboarding; (b)
34          encourages the use of helmets in adults while engaged in
35          potentially dangerous athletic activities, including but not
36          limited to sledding, snow skiing or and snowboarding; (c)
37          encourages physicians to educate their patients about the
38          importance of helmet use while engaged in potentially
39          dangerous athletic activities, including but not limited to
40          sledding, skiing and snowboarding; and (d) encourages
41          the availability of rental helmets at all commercial sledding,
42          skiing and snowboarding areas.
43
44   Resolution 37 asks the AMA to (1) determine the frequency and severity of head injury
45   patterns in baseball and softball pitchers ages 5-18 and (2) study the potential benefits
46   of mandating pitcher’s helmets for use in baseball and softball leagues in children ages
47   5-18 in order to determine the overall reduction in injury rates and subsequent cost-
48   saving measures to our healthcare system
49
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 1   Your Reference Committee received extensive online testimony on Resolution 37 that
 2   generally recognized the usefulness of the proposed policy. Your Reference Committee
 3   agrees with the spirit of the resolution and believes that it will be a beneficial addition to
 4   existing AMA helmet policy. As explained in online testimony, the MSS just adopted a
 5   helmet safety policy (10.012MSS) at the last meeting (A-11). This policy will be
 6   presented to the HOD as a resolution at the 2012 Annual meeting and request
 7   amendments to HOD policy H-470.974. As a result, your Reference Committee
 8   recommends inserting the desired language into the existing MSS policy (10.012MSS) in
 9   order to transmit one cohesive resolution to the HOD for consideration at the next
10   meeting.
11
12
13   (43)   RESOLUTION 38 - PROVIDING FREE ACCESS TO
14          SMOKING CESSATION TREATMENTS
15
16          RECOMMENDATION:
17
18          Mr. Speaker, your Reference Committee recommends that
19          the following Substitute Resolution 38 be adopted:
20
21           PROVIDING FULL COVERAGE TO SMOKING
22           CESSATION TREATMENTS
23
24           RESOLVED, That our AMA-MSS support working with
25           state and local medical societies to formally request that
26           state lawmakers allocate at least the Centers for Disease
27           Control and Prevention-recommended minimum amount
28           of the state’s Tobacco Settlement Fund award annually
29           to tobacco cessation programs; and be it further
30
31           RESOLVED, That our AMA-MSS recommend that third-
32           party payers and government agencies involved in
33           medical care offer full coverage for smoking cessation
34           products to smokers seeking counseling for quitting.
35
36   Resolution 38 asks the AMA to recommend that third-party payers and government
37   agencies involved in medical care offer free smoking cessation products to smokers
38   seeking counseling for quitting.
39
40   Your Reference Committee heard significant testimony on this resolution, both on-line
41   and at the reference committee hearing, which generally was in support of its objectives
42   while recognizing a similar resolution before the HOD at the 2011 Interim meeting
43   (Resolution 211). Your Reference Committee supports providing smoking cessation
44   products and programs to those seeking to quit, and believes current AMA policy
45   justifies our continued support. As proposed in online testimony, this resolution
46   addresses an a similar subject matter to Resolution 211.
47
48   The authors of the original resolution offered new wording at the reference committee
49   hearing, which your Reference Committee believes strengthens MSS policy and
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 1   provides our MSS Delegate to the HOD with a clear indication as to the support of the
 2   MSS Assembly for Resolution 211.
 3
 4   For these reasons, we recommend adoption of Substitute Resolution 38.
 5
 6
 7   (44)   RESOLUTION 39 - REDUCING SECOND-HAND SMOKE
 8          IN APARTMENT COMPLEXES
 9
10          RECOMMENDATION:
11
12          Mr. Speaker, your Reference Committee recommends
13          Policy H-490.907 be reaffirmed in lieu of Resolution 39.
14
15          H-490.907 Tobacco Smoke Exposure of Children in Multi-
16          Unit Housing. Our AMA: (1) encourages federal, state and
17          local housing authorities and governments to adopt
18          policies that protect children and non-smoking adults from
19          tobacco smoke exposure by prohibiting smoking in multi-
20          unit housing; and (2) encourages state and local medical
21          societies, chapters, and other health organizations to
22          support and advocate for changes in existing state and
23          local laws and policies that protect children and non-
24          smoking adults from tobacco smoke exposure by
25          prohibiting smoking in multi-unit housing. (Res. 403, A-10)
26
27   Resolution 39 asks the AMA to (1) support legislation that would permit landlords to
28   have a geographically distinct apartment complex(es) deemed “smoke-free”; and (2)
29   encourage its members to inform patients who live in multi-unit housing with children the
30   risks of secondhand smoke and the indirect exposure occurring in multiunit housing.
31
32   Your Reference Committee received limited testimony on Resolution 39, all of which
33   believed that current AMA policy sufficiently covered the intentions of this resolution.
34   With the AMA already encouraging governments and housing authorities to protect non-
35   smoking residents in multi-unit housing, your Reference Committee also concurs that
36   this is a clear reaffirmation of H-490.907.
37
38
39   (45)   RESOLUTION 40 – PHYSICIAN POSITION TO NOVEL
40          TOBACCO MARKETS
41
42          RECOMMENDATION:
43
44          Mr. Speaker, your Reference Committee recommends that
45          Policies H-495.985 and H-495.987 be reaffirmed in lieu of
46          Resolution 40.
47
48          H-495.987 Tobacco Taxes. (1) Our AMA will work for and
49          encourages all levels of the Federation and other
50          interested groups to support efforts, including education
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 1   and legislation, to pass increased federal, state, and local
 2   excise taxes on tobacco in order to discourage tobacco
 3   use. (2) An increase in federal, state, and local excise
 4   taxes for tobacco should include provisions to make
 5   substantial funds available that would be allocated to
 6   health care needs and health education, and for the
 7   treatment of those who have already been afflicted by
 8   tobacco-caused illness, including nicotine dependence,
 9   and to support counter-advertising efforts. (3) Our AMA
10   continues to support legislation to reduce or eliminate the
11   tax deduction presently allowed for the advertisement and
12   promotion of tobacco products; and advocates that the
13   added tax revenues obtained as a result of reducing or
14   eliminating the tobacco advertising/promotion tax
15   deduction be utilized by the federal government for
16   expansion of health care services, health promotion and
17   health education.
18
19   H-495.985 Smokeless Tobacco. Given that the use of
20   smokeless tobacco (snuff and chewing tobacco) is
21   associated with health risks, our AMA: (1) supports
22   publicizing the increasing evidence that the use of snuff or
23   chewing tobacco is associated with adverse health effects
24   and encourages ongoing research to further define the
25   health risks associated with snuff and chewing tobacco,
26   including the risk of developing cardiovascular disease,
27   and the effectiveness of cessation and prevention
28   programs; (2) objects strongly to the introduction of
29   "smokeless" cigarettes; (3) opposes the use of smokeless
30   tobacco products by persons of all ages; (4) urges that the
31   same requirements and taxes placed on cigarette sales
32   and advertising be applied to smokeless tobacco products;
33   (5) supports legislation to prohibit the sale of smokeless
34   tobacco products to minors and encourages states to
35   enforce strictly the prohibition on purchasing and
36   distributing all tobacco products to individuals under the
37   age of 21 years; (6) supports public and school
38   educational programs on the health effects of smokeless
39   tobacco products; (7) urges the commissioners of
40   professional athletic organizations to discourage the open
41   use of smokeless tobacco by professional athletes and
42   recommends that professional athletes participate in media
43   programs that would discourage the youth of America from
44   engaging in this harmful habit; and (8) is committed to
45   exerting its influence to limit exposure of young children
46   and teenagers to advertising for smokeless tobacco and
47   look-alike products, and urges that manufacturers take
48   steps to diminish the appeal of snuff and chewing tobacco
49   to young persons.
50
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 1   Resolution 40 asks (1) the AMA to study the emerging trend of Snus Tobacco marketing
 2   promotion and use, especially among younger aged tobacco consumers; (2) the AMA-
 3   MSS to strongly support any measures to increase tobacco taxation and tobacco
 4   taxation parity between all tobacco forms; and (3) AMA-MSS and the AMA to continue to
 5   educate the medical community and the public through any means about the dangers of
 6   oral tobacco use with a new emphasis on novel tobacco products such as Snus Tobacco
 7   due to its growing prevalence and use.
 8
 9   Your Reference Committee considered significant online testimony on Resolution 40,
10   which uniformly supported the idea of the resolution, but differed as to whether current
11   AMA policy sufficiently addressed the issue. Your Reference Committee did not see a
12   great benefit of additional study into this topic for two reasons: First, your Reference
13   Committee believes that the results of the study will invariably ask the AMA to oppose
14   advertising to youth markets, so the need is not clear. Secondly, and perhaps more
15   importantly, is the commentary from the AMA Council on Science and Public Health
16   student representative, who indicated that the council has just recently studied
17   smokeless tobacco, making this request for a study likely to seem redundant at the
18   AMA.
19
20   With regard to the second and third resolves, your Reference Committee believes H-
21   495.985 and H-495.987 already allow the AMA sufficient grounds to support tax parity
22   and educate the medical community on snus tobacco. Although “snus” is not
23   specifically mentioned in these policies, it is a form of smokeless tobacco, making it fully
24   within the context of the policy. Additionally, with regard to tax parity, your Reference
25   Committee believes that H-495.985 (4) supports tax parity, as it urges the same taxes
26   imposed on cigarettes be applied to smokeless tobacco products.
27
28   For these reasons, your Reference Committee recommends reaffirmation of H-495.985
29   and H-495.987.
30
31
32   (46)   RESOLUTION 41 - AMA SUPPORT FOR
33          IMPLEMENTATION OF IMAGE GENTLY AND FDA
34          EFFORTS TO REDUCE COMPUTED TOMOGRAPHY
35          RADIATION IN CHILDREN
36
37          RECOMMENDATION:
38
39          Mr. Speaker, your Reference Committee recommends that
40          the following Substitute Resolution 41 be adopted:
41
42          AMA SUPPORT FOR IMPLEMENTATION OF FDA
43          EFFORTS TO REDUCE COMPUTED TOMOGRAPHY
44          RADIATION IN CHILDREN
45
                                                              MSS Reference Committee (I-11)
                                                                              Page 49 of 55


 1          RESOLVED, That our AMA-MSS support the current US
 2          Food and Drug Administration policy including; promoting
 3          the safe use of medical imaging devices, supporting
 4          informed clinical decision making and increasing patient
 5          awareness; and be it further
 6
 7          RESOLVED, That our AMA-MSS support working with all
 8          relevant parties to advocate for inclusion of an individual
 9          registry containing the patient’s historical (test and
10          procedure-based) cumulative radiation dose, as well as
11          research the fiscal impact such a registry would incur; and
12          be it further
13
14          RESOLVED, That our AMA-MSS encourage the continued
15          development and use of standardized electronic medical
16          record systems that will help physicians track the number
17          of imaging procedures a patient is receiving and that will
18          help physicians discuss the potential dangers of high level
19          of radiation exposure with patients; and be it further
20
21          RESOLVED, That our AMA-MSS support initiatives to
22          increase awareness of ionizing radiation exposure from
23          medical imaging and practices that lower radiation
24          exposure from medical imaging.
25
26   Resolution 41 asks the AMA to (1) strongly support the prompt and efficient enactment
27   of efforts to reduce unnecessary and harmful radiation exposure in children through
28   promotion of safe usage of medical imaging devices, informed clinical decision making,
29   and patient education, as outlined in the current version of the FDA’s Initiative to Reduce
30   Unnecessary Radiation Exposure from Medical Imaging; and (2) study the
31   implementation of the Image Gently intervention campaign and assess the benefits
32   and/or risks seen with the adoption of the program’s CT protocol recommendations and
33   safety limits.
34
35   Your Reference Committee considered revealing online testimony on this resolution.
36   While testimony was in support of this resolution, it also highlighted an extremely similar
37   resolution going before the HOD at the Interim Meeting. Your Reference Committee,
38   upon reviewing this HOD resolution (Resolution 923), agreed as to the similarity and felt
39   that the language used in the resolution from the Resident and Fellow Section provided
40   a more clear plan of action. As a result, your Reference Committee recommends
41   adopting internal policy that mirrors the objectives of Resolution 923 and will enable our
42   MSS Delegate to clearly convey our support to the HOD.
43
44   For these reasons, your Reference Committee recommends adoption of Substitute
45   Resolution 41.
46
47
                                                            MSS Reference Committee (I-11)
                                                                            Page 50 of 55


 1   (47)   RESOLUTION 42 - HPV VACCINATION ACCESS FOR
 2          MINORS
 3
 4          RECOMMENDATION:
 5
 6          Mr. Speaker, your Reference Committee recommends that
 7          the following Substitute Resolution 42 be adopted:
 8
 9          RESOLVED, That the AMA develop and support model
10          state legislation allowing HPV vaccination consent by a
11          unemancipated minor, independent of parental
12          involvement.
13
14   Resolution 42 asks the AMA to develop and support model legislation to the federal
15   government allowing HPV vaccination consent by a minor, independent of parental
16   involvement, to be considered as an instance where unemancipated minors enjoy the
17   privilege of decision making capacity.
18
19   Your Reference Committee received limited testimony on Resolution 42, which generally
20   was in support of the objectives of the resolution. Your Reference Committee agrees
21   that this topic is worthy of MSS support due to the beneficial nature of access to HPV
22   vaccination. As suggested virtually, your Reference Committee offers a friendly
23   substitute resolution.
24
25
26   (48)   RESOLUTION 43 - INCREASING HEALTHCARE
27          CAPACITY IN RESOURCE LIMITED SETTINGS
28          THROUGH THE PRESIDENT’S EMERGENCY PLAN
29          FOR AIDS RELIEF
30
31          RECOMMENDATION:
32
33          Mr. Speaker, your Reference Committee recommends that
34          Resolution 43 not be adopted.
35
36   Resolution 43 asks the AMA to endorse the Global Health Service Corps (GHSC) as
37   an additional mechanism for the President’s Emergency Plan for AIDS Relief (PEPFAR)
38   to assist strengthening African healthcare workforces; with the stipulation that the GHSC
39   only be supported with existing funds already allocated to PEPFAR’s current funding
40   allocation mandate to support healthcare workforce capacity building and training
41   activities in resource limited settings.
42
43   Your Reference Committee considered richly debated commentary on Resolution 43.
44   While the idea of such an organization like the Global Health Service Corps seems
45   intriguing, the Reference Committee does not wish to support an organization prior to its
46   establishment. In addition, we are concerned about using PEPFAR funding for this
47   program, as it is unclear why spending on this idea is better than funding current
48   PEPFAR projects. Additionally, the Reference Committee took note that a similar
49   proposal calling for the establishment of the Global Health Service Corps was
50   considered and not adopted by the MSS Assembly as recently as last meeting. This,
                                                             MSS Reference Committee (I-11)
                                                                             Page 51 of 55


 1   coupled with the fact that the only online support for such an idea came from its author,
 2   indicated that adoption of this policy is not in the best interests of the Assembly.
 3
 4   For these reasons, your Reference Committee recommends that Resolution 43 be not
 5   adopted.
 6
 7
 8   (49)   RESOLUTION 44 - AMENDMENT TO EXISTING POLICY
 9          OPPOSING LEGISLATION WHICH MAY INTERFERE
10          WITH PHYSICIANS’ PAIN MANAGEMENT STRATEGIES
11
12          RECOMMENDATION:
13
14          Mr. Speaker, your Reference Committee recommends that
15          Policy H-120.960 be reaffirmed in lieu of Resolution 44.
16
17          H-120.960 Protection for Physicians Who Prescribe Pain
18          Medication. Our AMA supports the following: (1) the
19          position that physicians who appropriately prescribe and/or
20          administer controlled substances to relieve intractable pain
21          should not be subject to the burdens of excessive
22          regulatory scrutiny, inappropriate disciplinary action, or
23          criminal prosecution. It is the policy of the AMA that state
24          medical societies and boards of medicine develop or adopt
25          mutually acceptable guidelines protecting physicians who
26          appropriately prescribe and/or administer controlled
27          substances to relieve intractable pain before seeking the
28          implementation of legislation to provide that protection; (2)
29          education of medical students and physicians to recognize
30          addictive disorders in patients, minimize diversion of opioid
31          preparations, and appropriately treat or refer patients with
32          such disorders; and (3) the prevention and treatment of
33          pain disorders through aggressive and appropriate means,
34          including the continued education of doctors in the use of
35          opioid preparations. Our AMA opposes harassment of
36          physicians by agents of the Drug Enforcement
37          Administration in response to the appropriate prescribing of
38          controlled substances for pain management.
39
40   Resolution 44 asks the AMA-MSS to amend policy 270.009MSS by insertion as follows:
41
42                AMA-MSS will ask the AMA to: (1) support the idea that
43                physicians who prescribe pain medication to relieve
44                acute or chronic pain of both malignant and non-
45                malignant origins should be freed from the burden of
46                excessive legislative or regulatory scrutiny and censure;
47                and (2) seek to implement legislation protecting
48                physicians who treat acute and chronic pain of malignant
49                and non-malignant origins.
50
                                                              MSS Reference Committee (I-11)
                                                                              Page 52 of 55


 1   Virtual Reference Committee testimony on Resolution 44 was a little thin. As indicated
 2   by commentary from our Governing Council, the MSS policy revisions that are being
 3   proposed have already been adopted by the HOD in policy H-120.960. Since its
 4   adoption, H-120.960 has been revised to cover both acute and chronic pain, thereby
 5   addressing the concern of Resolution 44. As a result of this revision, Resolution 44 is
 6   sufficiently covered by current AMA policy, and your Reference Committee recommends
 7   reaffirmation of H-120.960 accordingly.
 8
 9
10   (50)   RESOLUTION 45 - SUPPORT FOR SERVICE ANIMALS,
11          ANIMALS IN HEALTHCARE, AND MEDICAL BENEFITS
12          OF PET OWNERSHIP
13
14          RECOMMENDATION A :
15
16          Mr. Speaker, your Reference Committee recommends that
17          Resolution 45 be amended by deletion of the third and
18          fourth resolves on page 1, lines 22-27 as follows:
19
20          RESOLVED, That our AMA-MSS support legislation or
21          educational measures which encourage the allowance of
22          trained, hygienic, service animals in schools, hospitals, and
23          all public locations when a physician has determined it to
24          be vital to the health or functioning of the patient; and be it
25          further
26
27          RESOLVED, That our AMA-MSS support educational
28          measures to reduce fear and prejudice towards trained
29          service animals.
30
31          RECOMMENDATION B:
32
33          Mr. Speaker, your Reference Committee recommends that
34          Resolution 45 be adopted as amended.
35
36   Resolution 45 asks the AMA-MSS to (1) recognize the potential medical benefits of dogs
37   as animal companions; (2) encourage research into the use and implementation of
38   service animals as both a therapeutic and management technique of disorders and
39   handicaps when expert opinion and the scientific literature show a potential benefit; (3)
40   support legislation or educational measures which encourage the allowance of trained,
41   hygienic, service animals in schools, hospitals, and all public locations when a physician
42   has determined it to be vital to the health or functioning of the patient; and (4) support
43   educational measures to reduce fear and prejudice towards trained service animals.
44
45   Your Reference Committee received minimal testimony on Resolution 45. Your
46   Reference Committee was generally in support of creating internal policy on the potential
47   medical benefits of dogs as companions. In addition, your Reference Committee is in
48   support of the proposed research to the degree that it could reveal additional benefits of
49   service animals for human patients. As a result, your Reference Committee agrees with
50   the first and second resolves.
                                                             MSS Reference Committee (I-11)
                                                                             Page 53 of 55


 1
 2   With regard to the third resolve, your Reference Committee does not believe such policy
 3   to be necessary. The Americans with Disabilities Act is clear in its support for allowing
 4   service animals to assist patients in public settings. Although testimony indicates that
 5   there are always instances of noncompliance with the law, it is difficult to imagine MSS
 6   policy causing those in violation to change their actions. Your Reference Committee
 7   does not believe the MSS need adopt policy in support of a firmly established law.
 8
 9   With regard to the fourth resolve, there does not appear to be evidence of a widespread
10   fear and prejudice toward service animals. As a result, this policy does not appear
11   necessary. For these reasons, your Reference Committee recommends adoption of
12   Resolution 45 as amended.
13
14
15   (51)   RESOLUTION 46 - RECOGNITION OF PATIENT
16          UNIQUENESS IN MEDICAL TREATMENT
17
18          RECOMMENDATION:
19
20          Mr. Speaker, your Reference Committee recommends that
21          Resolution 46 not be adopted.
22
23   Resolution 46 asks the AMA-MSS to (1) support attempts to standardize care only if they
24   recognize 1. the changing nature of expert opinion on best practices and 2. the necessity
25   that physicians be given the autonomy to use their own judgment in how to implement
26   these standards for patients’ unique biochemical and personal needs; and (2) recognize
27   that each patient is biochemically and psycho-socially an individual and encourage
28   physicians to consider this when planning treatment, in lieu of rigid methods of care
29   which do not treat patients as individuals.
30
31   Your Reference Committee received interesting online testimony on Resolution 46,
32   including compelling commentary from Rhode Island that stated, “Standards of care are
33   an informative and effective part of medicine as a first step for considering treatment
34   because, by their very definition, they are based on studies of more than just the
35   individual but do still change to reflect current findings and population differences.
36   Physicians already inherently recognize patient individuality and uniqueness while
37   considering standards of care so that typically the physician's instincts with regard to
38   these two things are effective for providing proper care. Also, as stated above, existing
39   AMA and MSS policy already recognizes patient uniqueness to a degree sufficient for
40   addressing the main concerns of this resolution.” Your Reference Committee beliefs
41   echo the statements made by Rhode Island.
42
43   A request of reaffirmation of E-10.02, as it recognizes patient uniqueness, was proposed
44   via on-site testimony. Since ethical policy is not subject to sunset, reaffirmation is not
45   necessary.
46
47   As a result, we recommend that Resolution 46 not be adopted.
48
49
                                                            MSS Reference Committee (I-11)
                                                                            Page 54 of 55


 1   (52)   RESOLUTION 47 - REGULATIONS ON THE PATENTING
 2          OF ENDOGENOUS HUMAN DNA
 3
 4          RECOMMENDATION:
 5
 6          Mr. Speaker, your Reference Committee recommends that
 7          the following Substitute Resolution 47 be adopted:
 8
 9          RESOLVED, That our AMA oppose the patenting of
10          endogenously occurring human DNA or RNA sequences,
11          including specific alleles of such sequences found
12          anywhere within the human population, or DNA and RNA
13          products derived from these sequences.
14
15   Resolution 47 asks the AMA to (1) recommend that the United States Patent and
16   Trademark Office (USPTO) specify a standard level of modification from naturally
17   occurring DNA or mRNA sequences, as well as minimum nucleotide length, that must be
18   met before such sequence be patentable; and (2) oppose the patenting of endogenously
19   occurring human DNA or RNA sequences, including specific alleles of such sequences
20   found anywhere within the human population, or DNA and mRNA products made from
21   these sequences, which do not differ from the endogenous DNA or its complementary
22   strand enough to give them “new forms, qualities, properties, or combinations” as
23   defined by the United States Patent and Trademark Office.
24
25   Your Reference Committee received limited online testimony on this resolution. The
26   general sentiment of the MSS was shared by your Reference Committee, which is that
27   the topic of this resolution is extremely confusing and in need of further review.
28   Testimony at the reference committee mirrored these sentiments. In order to help clarify
29   the issues, your Reference Committee contacted the AMA’s Senior Scientist on
30   Genetics and Molecular Medicine, who offered the proposed Substitute Resolution 47.
31   Your Reference Committee appreciates her contribution and recommends adoption of
32   the substitute language rather than referral to the Governing Council for study.
                                                        MSS Reference Committee (I-11)
                                                                        Page 55 of 55



1   Mr. Speaker, this concludes the report of MSS Reference Committee . I would like to
2   thank Robert David Graham, Helen Myers, Doug Phelan, Jamie Sparling, Laura Stone,
3   and all those who testified before your Reference Committee.




    Robert David Graham                          Jamie Sparling
    University of South Florida College of       Boston University School of Medicine
    Medicine




    Helen Myers                                  Laura Stone
    University of Iowa Roy J. and Lucille A.     University of Miami Miller School of
    Carver College of Medicine                   Medicine




    Doug Phelan                                  David Savage
    Philadelphia College of Osteopathic          University of Texas, Medical School at
    Medicine                                     Houston
                                                 Chair

				
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