American Medical Association Policy Research Articles

Reflections on a Year as President

Reflections on a Year as President

Governance system of the American Medical Association

This study aims to provide essential information to improve the organizational system of the Korean Medical Association (KMA) by reviewing the organizational structure and decision making process of the American Medical Association (AMA). This study investigated the composition and the roles and responsibilities of the AMA—the House of Delegates, the Board of Trustees, Councils, and Sections. It also reviewed the duties and privileges of the AMA officers. The AMA establishes policies through meetings with delegates who represent the diverse characteristics of its members through the House of Delegates. In addition, Council experts from various fields under the Board of Trustees create policy alternatives. These are aggregated into the AMA policy. To recognize the KMA as the best group of medical professionals, both the organizational structure and the decision-making process of the KMA must be established in order to maintain a consistent policy.

Society Advocacy Continues to Make Impact Amid Uncertainty

Society Advocacy Continues to Make Impact Amid Uncertainty

APhA continues OTC+ dialogue with AMA

APhA continues OTC+ dialogue with AMA

American Medical Association Policy—The Individual Mandate and Individual Responsibility

While the AMA has generally favored individual choice over government mandate, its policies have long noted the importance of individual responsibility to obtain health insurance and the significant role this plays in making universal health care coverage achievable.

Relationship Between Burnout and Professional Conduct and Attitudes Among US Medical Students

The relationship between professionalism and distress among medical students is unknown. To determine the relationship between measures of professionalism and burnout among US medical students. Cross-sectional survey of all medical students attending 7 US medical schools (overall response rate, 2682/4400 [61%]) in the spring of 2009. The survey included the Maslach Burnout Inventory (MBI), the PRIME-MD depression screening instrument, and the SF-8 quality of life (QOL) assessment tool, as well as items exploring students' personal engagement in unprofessional conduct, understanding of appropriate relationships with industry, and attitudes regarding physicians' responsibility to society. Frequency of self-reported cheating/dishonest behaviors, understanding of appropriate relationships with industry as defined by American Medical Association policy, attitudes about physicians' responsibility to society, and the relationship of these dimensions of professionalism to burnout, symptoms of depression, and QOL. Of the students who responded to all the MBI items, 1354 of 2566 (52.8%) had burnout. Cheating/dishonest academic behaviors were rare (endorsed by <10%) in comparison to unprofessional conduct related to patient care (endorsed by up to 43%). Only 14% (362/2531) of students had opinions on relationships with industry consistent with guidelines for 6 scenarios. Students with burnout were more likely to report engaging in 1 or more unprofessional behaviors than those without burnout (35.0% vs 21.9%; odds ratio [OR], 1.89; 95% confidence interval [CI], 1.59-2.24). Students with burnout were also less likely to report holding altruistic views regarding physicians' responsibility to society. For example, students with burnout were less likely to want to provide care for the medically underserved than those without burnout (79.3% vs 85.0%; OR, 0.68; 95% CI, 0.55-0.83). After multivariable analysis adjusting for personal and professional characteristics, burnout was the only aspect of distress independently associated with reporting 1 or more unprofessional behaviors (OR, 1.76; 95% CI, 1.45-2.13) or holding at least 1 less altruistic view regarding physicians' responsibility to society (OR, 1.65; 95% CI, 1.35-2.01). Burnout was associated with self-reported unprofessional conduct and less altruistic professional values among medical students at 7 US schools.

Implications of Viewing Obesity as a Disease

The American Medical Association (AMA) has a longstanding history of commitment to the betterment of the public health and to the eradication of obesity on all fronts that stems back even further than the Surgeon General. Call to Action [1]. AMA policy H.150.953 includes the statement that the AMA:

MSJAMA. The dilemma of confidentiality in Huntington disease.

MSJAMA. The dilemma of confidentiality in Huntington disease.

Cadaveric organ donation: encouraging the study of motivation.

Approximately 6,000 patients per year, or 16 per day, with end-stage organ failure die because of the lack of available organs. Each year only 35% to 50% of potential donors consent to donation (1). During the last 20 years, vigorous educational campaigns, both voluntary and legislative, designed to increase organ donation have failed to increase donation rates significantly. The need for organs has grown nearly five times faster than the number of cadaveric donors: the annually compounded rate (1990–2000) of increase in number of patients on waiting lists has averaged 14.1% a year, whereas the rate of increase of donors has averaged 2.9% a year (2). The American Medical Association (AMA) has been concerned about this problem for many years and has developed several policies addressing it in the past decade (3). AMA policy has supported certain forms of financial incentives for cadaveric organ donation since 1993 (Policy E-2.15, AMA Policy Database), but they have never been implemented because federal law prohibits them. AMA policy specifically prohibits payment to living donors (4). Most initiatives to increase organ donation have focused on what motivates or hinders the decision to donate. Programs to improve organ donation rates have been aimed at public and professional groups. These have included widespread educational campaigns aimed at motivating individuals to become donors. They also have included mandated choice legislation, the establishment of the Organ Procurement and Transplantation Network (OPTN), donor card programs, donor registries, and the creation of specialized organ donation teams within hospitals that discuss organ donation with families and patients. Despite these efforts, cadaveric donation rates have remained nearly stable during the past decade. This report encourages the medical and scientific communities to reexamine the motivation for cadaveric organ donation. Building on the work of the Council on Ethical and Judicial Affairs (CEJA) in 1993, which led to Opinion E-2.15, “Financial Incentives for Organ Donation,” this report identifies reasons why ethical objections to financial incentives, for cadaveric organ donation only, should be reexamined. In particular, this report considers the need to study the impact of financial incentives through limited research trials. Such studies would help measure the effect of incentives not only on donation rates but also on public perception of the transplant enterprise and of the meaning of organ donation. For the purposes of this report, donation and procurement of organs are considered completely independent from the allocation of organs. The report neither suggests nor supports any change in the current system of organ distribution, as developed and administered by the United Network for Organ Sharing (UNOS). Even if financial incentives were found to have a positive impact on cadaveric organ donation rates, allocation algorithms developed by the OPTN would continue to govern organ distribution and transplant recipients would continue to be selected according to ethically appropriate criteria related to medical need rather than ability to pay. Physicians have an obligation to hold their patients’ interests paramount and to support access for all patients to medical care (Principles VIII and IX) (5). To discharge these obligations, physicians should participate in efforts to increase organ donation, including education of their patients and the general public regarding the importance of organ donation and promotion of voluntary donation of organs. Beyond educational programs, however, physicians should support innovative approaches to encourage organ donation. Such efforts include encouragement and, if appropriate, participation in the conduct of ethically designed research studies of donor motivation. A potential impetus for cadaveric organ donation that has not been adequately explored (because of federal prohibition) is financial incentives. Such incentives are not intrinsically unethical; AMA policy has supported them since 1993. Whether a particular incentive is ethical or not depends upon the balance of benefits and harms that result, and these are currently unknown because they have never been investigated.

Sleep-Disordered Breathing in Middle-Aged Adults Predicts No Significantly Higher Rates of Traffic Violations

The American Medical Association 1 American Medical Association Policy compendium of the American Medical Association. American Medical Association, Chicago, IL1996 Google Scholar has recommended that guidelines be developed for the driving licensure of persons who have sleep-related disorders that would be based on the extent to which those disorders contribute to traffic accidents and injuries. There is concern that regulators might attempt to restrict the driving privileges of apnea patients because of “lapses of consciousness” as defined by the “inability to respond rationally to the environment (excluding psychiatric conditions).” 2 State of California Department of Motor Vehicles. Lapse of consciousness disorders. In: Division of driver safety manual. Sacramento, CA: California Department of Motor Vehicles, 1995; 18: 22–18.50 Google Scholar

Alzheimer disease. Report of the Council on Scientific Affairs.

Alzheimer disease (AD) takes a heavy economic, social, physical, and psychological toll on patients, families, and society. Because of the increasing life expectancy in the United States, AD is expected to afflict approximately 14 million people within the next few decades. There is currently no cure, only interventions that can temporarily ameliorate the profound cognitive losses and behavioral manifestations of the disorder. Community services are fragmented and underutilized. Physicians, in their traditional role as gatekeepers, can encourage more families to use supportive services. This article reviews the guidelines on the diagnosis and treatment of AD of the Agency for Health Care Policy and Research, the American Academy of Neurology, the Veterans Health Administration, and the American Psychiatric Association. Although these guidelines contain valuable information, they do not adequately address the role of the family physician and the need for continuity of care. Recommendations regarding AD from the Council on Scientific Affairs, which were adopted as American Medical Association policy in December 1997, are included in this article.

Crossover use of donated blood for autologous transfusion: report of the Council on Scientific Affairs, American Medical Association.

Controversy exists concerning whether the costs and potential risks outweigh the potential benefits of "crossover" use in the general blood supply of unutilized blood that was donated for autologous transfusion. Published articles and reports were identified through systematic search of MEDLINE and review of references cited in previously identified articles, textbooks, and reports. Consultation was made with experts in blood donation and transfusion. Additional peer review was received from the American Medical Association (AMA) Council on Scientific Affairs Concern over infectious disease transmission has led to increased interest in and support for autologous transfusion for individuals having planned surgeries. Different requirements exist for collection, labeling, and screening of blood to be used for autologous versus allogeneic transfusions; therefore, procedures for diverting autologous blood donations to the general blood supply involve considerable expense. Several cost-effectiveness studies of autologous blood donation and transfusion conclude that currently this "crossover" appears to be an expensive procedure yielding little increased benefit from a societal perspective. The recommendations in this report were adopted as AMA Policy at the AMA Annual Meeting in June 1997. The AMA does not encourage blood collection programs to "cross over" units donated for autologous use to the allogeneic blood supply. Practice guidelines are needed, and should be utilized to ensure parsimony in the use of autologous blood donations and transfusions.

Alcoholism and alcohol abuse among women: report of the Council on Scientific Affairs. American Medical Association.

We describe characteristics of women alcohol abusers, risk factors for alcoholism in women, barriers to treatment, and implications and strategies for physicians dealing with alcohol abuse in women patients, including risk assessments and intervention strategies. Alcohol abuse and alcoholism have a different physiologic effect on women than on men. Societal attitudes about women and alcohol and internal (self-perception) and external (environmental) factors can create barriers to the detection and treatment of female alcohol abusers. Physicians are in an excellent position to address the medical, psychologic, and social concomitants of alcoholism and alcohol abuse. The Council on Scientific Affairs recommends that physicians become more active in the prevention, diagnosis, and treatment of alcohol-related problems in women, including the diseases that may be associated with chronic alcohol abuse and the effect of alcohol on the developing fetus. Specific American Medical Association policy and recommendations for physician practice are included.

HIV infection, risk taking, and the duty to treat.

The paper advances a consequence-based argument in support of the American Medical Association's policy that a physician may not ethically refuse to treat a person with HIV solely because the patient is seropositive. A limited number of alternative arguments, both in support of and in opposition to this policy are also considered, but are found wanting. The paper then concludes with a discussion of some of the other obstacles to quality health care that persons with HIV must often confront.

Organ Salvage Policies

Salvaging organs from the bodies of the newly dead is a project of great medical urgency and cultural significance. The Council on Ethical and Judicial Affairs of the American Medical Association (AMA) has recently completed two reports on possible changes in public policy intended to increase the supply of transplantable organs. One of these reports, dealing with policies known as mandated choice and presumed consent, appears in this issue ofTHE Journal. 1 The other report, on financial incentives, was adopted by the AMA House of Delegates and is AMA policy, though it is not published herein. 2 See also p 809. The two AMA reports share the same good intention. There are more people in desperate need of transplantable organs than there are organs available. Lives could be extended if more organs could be obtained. In the Council's judgment, two of the policies discussed—mandated choice and a form of financial

AMA Policy Says No to Drug Legalization

AFTER her suggestion that drug legalization be reconsidered in this country, the American Medical Association (AMA) sent Surgeon General Joycelyn Elders, MD, a calling card. In response to the House of Delegates' vote at last year's Interim Meeting, AMA Executive Vice President James S. Todd, MD, reminded Elders in a letter last March of the association's stance on legalizing drugs. Specifically, the letter reiterated a policy position stating that the AMA discourages and condemns illegal drug use and encourages physicians to do all in their power to discourage the use of illegal drugs in their communities and to refuse to assist anyone in obtaining drugs for non-medical use. Todd's letter also noted that the AMA has called for the formulation of a comprehensive national drug policy that recognizes the complexity of drug abuse and prohibits drug legalization. During last year's Interim Meeting, AMA President-elect Robert E. McAfee, MD, said the

Silicone Gel Breast Implants

AT THE 1991 Annual Meeting, Resolution 259 was referred by the Board of Trustees to the Council on Scientific Affairs (CSA) for a report on the evaluation of the safety of breast implants. The recommendations of Report M prepared by the CSA were adopted as amended by the American Medical Association (AMA) House of Delegates at the Interim Meeting in 1991 in lieu of Resolution 259 (A-91) and Resolution 521 (I-91) and the remainder of the Report was filed (Policy 525.984, AMA Policy Compendium ). Report M described the Food and Drug Administration (FDA) regulatory history of breast implant devices through August 1991. Because of continuing developments, including a voluntary moratorium on their use by the FDA in November 1991, the Council elected to provide a follow-up report (Report C) on this subject. Report C covers the continuing FDA regulatory history through October 1992 and See also pp 2607 and 2608.

Attitudes of medical school faculty toward gifts from the pharmaceutical industry.

The American Medical Association (AMA) has recently published guidelines for the receipt of gifts from industry representatives. To examine faculty members' attitudes toward that AMA policy as it pertains to gifts from the pharmaceutical industry, the authors surveyed the faculty of the University of Kentucky College of Medicine in 1991. Of 462 faculty members, 248 (54%) completed the questionnaires. The faculty generally agreed with the AMA guidelines. A majority of the faculty believed that personal relationships had the potential to influence prescribing patterns but that gifts, in general, did not greatly influence prescribing behaviors. Compared with the 169 M.D. faculty, the 69 Ph.D. faculty significantly favored more restrictive policies (p less than .001). The authors discuss both the ethical considerations and the utility of guidelines for physician-industry interactions.

American Medical Association Policy Positions

American Medical Association Policy Positions

SI Units: A Wholehearted Effort Is Needed

Editorial Response.— We are sympathetic with the confusion and inefficiency so well described by the authors. The world in general has changed to SI units. Many leading American journals, which are distributed to and read by much of medicine's world, also have changed. American Medical Association policy on this transition is more than 10 years old. Because medical science and communications are multinational, there seems to be no chance to turn back. Thus, we encourage hospital medical staffs, pathologists, medical school faculty, laboratory computer companies, and others to get on with the change. Leadership from many pathologists has been lacking because of fear of economic retribution from their hospital administrators and medical staffs. Computer companies fear lack of competitiveness. I hope these groups can get together and resolve the issue because disparities between the development and dissemination of knowledge and its routine application otherwise will only widen.