AMA House of Delegates

Physicians should be on any panels that develop practice guidelines, says Steven Chen, MD, a surgical oncologist. Photo by Peter Wynn Thompson / www.peterthompsonphoto.com

AMA meeting: Delegates want disease experts on government panels

■ Action was taken in response to controversy generated by recently issued mammography guidelines.

By Victoria Stagg Elliott — Posted June 28, 2010

Chicago -- Government task forces and committees addressing certain diseases should include physicians who have expertise in those illnesses, according to policy adopted June 15 by the American Medical Association House of Delegates at the organization's Annual Meeting.

"It is essential that physicians with expertise be on these panels," said Steven Chen, MD, a surgical oncologist from Sacramento, Calif., and an alternate delegate for the AMA Young Physicians Section.

The action was taken in response to the breast cancer screening guidelines by the U.S. Preventive Services Task Force in the Nov. 17, 2009, Annals of Internal Medicine. They caused a firestorm then and continue to stir controversy. The line of doctors wanting to comment on the issue when it came up at a committee session stretched out the door.

The task force statement recommended against routine screening mammography in women age 40 to 49 and called for women age 50 to 74 to receive the procedure every two years. The recommendations were an update of the 2002 guidelines, which said women age 40 and older should consider having a screening mammography every one to two years.

The task force is sponsored by the U.S. Agency for Healthcare Research and Quality and develops guidelines for preventive services in the primary care setting. Members are experts on prevention in the primary care setting. But many delegates felt that physicians who treat women with breast cancer, such as radiation oncologists, should have been represented.

The AMA also debated whether to endorse the American Cancer Society's mammography guidelines, which recommend annual mammograms starting at age 40, continuing as long as a woman is in good health. "With all due respect to the able men and women who serve on the U.S. Preventive Services Task Force, we believe that the American Cancer Society guidelines serve the health and well-being of our patients," said Milton Guiberteau, MD, a delegate from the American College of Radiology and a radiologist in Houston.

That issue was referred to the AMA Board of Trustees for a decision.

Many delegates, including those from the ACS, felt that in light of the many evidence-based guidelines from many different groups, the AMA should not recommend one over another. "This is not the place to be debating whose guideline is a better guideline," said oncologist Len Lichtenfeld, MD, a delegate from the American College of Physicians and deputy chief medical officer of the ACS.

Delegates were also concerned about how the task force guidelines influenced insurers' willingness to pay for the service. The guideline does not say women age 40 to 49 should be barred from mammography; rather, any decision on screening before age 50 should be made by a woman and her doctor.

"Guidelines are designed for one thing, and that has nothing to do with determining payment," said John F. Schneider, MD, PhD, an internist from Flossmoor, Ill., who spoke for the Illinois State Medical Society. "They provide information to enable a physician to provide the best, most appropriate care to his or her patient."

ADDITIONAL INFORMATION

Meeting notes: Public health

Issue: Despite efforts to educate parents about the safety of vaccines, a 2010 Pediatrics study found that 25% of American parents still believe that some immunizations cause autism in healthy children.

Proposed action: Ask the Office of the Surgeon General to offer a definitive repudiation of the link between either thimerosol-containing vaccines or the measles, mumps and rubella vaccine and developmental disorders, such as autism. [Adopted]

Issue: People of color are significantly affected by skin cancer, but awareness of prevention and screening is low.

Proposed action: Encourage and support efforts that increase awareness of skin cancer risks and sun-protective behavior in communities of color. [Adopted]

Issue: Prescription monitoring programs help physicians track the narcotics their patients are on, but confidentiality rules mean that those medications given as part of opioid treatment programs are not included.

Proposed action: Seek changes to allow states more flexibility in requiring reporting to prescription monitoring programs. [Adopted]

Issue: An increasing number of children and adolescents are being treated with atypical antipsychotic medications, but there is limited evidence on their safety and efficacy in this age group.

Proposed action: Ask the AMA Council on Science and Public Health to prepare a report on the safety and appropriate use of drugs in the pediatric population. [Adopted]

Issue: Unused over-the-counter and prescription drugs are getting into the hands of those who shouldn't have them, such as children. They also are polluting the environment.

Proposed action: Support initiatives designed to promote safe and proper disposal of unused medications. [Adopted]

Issue: Adolescents are not getting enough sleep, and this is leading to a host of health problems.

Proposed action: Identify insufficient sleep and sleepiness in adolescents as a public health issue. [Adopted]

Issue: The adult film industry is an $11 billion industry in the U.S., and performers in this occupation are subject to public health concerns, including multiple sex partners during short periods. More than 2,850 cases of sexually transmitted diseases, including HIV, were diagnosed among 2,000 such performers from 2004 to 2008.

Proposed action: Support legislation that requires mandatory condom use in the production of adult films. That would make it easier for local health departments and the Occupational Safety and Health Administration to investigate and control occupational exposures to infectious diseases and enforce workplace regulations in a timely manner. Urge that occupational standards be enforced to reduce exposure to infectious diseases within the adult film industry. [Adopted]