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FP Report

September 1999
News for members of the American Academy of Family Physicians

Risks may outweigh benefits

Postpone use of rotavirus vaccine

Don't administer the rotavirus vaccine until more information is available. That's the latest recommendation from the AAFP, Centers for Disease Control and Prevention, and American Academy of Pediatrics.

The recommendation responds to several studies that suggest a possible increased rate of intussusception among infants who have received rotavirus immunization compared with unvaccinated infants. The AAFP encourages the use of the Vaccine Adverse Event Reporting System -- (800) 822-7967 -- to report this or any other adverse event after vaccination.

"Rotavirus usually occurs in the winter. At this time, there is more risk in giving the vaccine than in holding off until we have more information," said AAFP President Lanny Copeland, M.D., of Albany, Ga. He encouraged FPs to educate parents of rotavirus-immunized infants about intussusception symptoms -- persistent vomiting, bloody stools, black stools, abdominal distention and/or severe colic pain.

AAFP's rotavirus policy never mandated the vaccine but said the decision to use the vaccine should be made by the parent or guardian in consultation with a physician or other health care provider.

For a packet of information on the latest recommendations regarding rotavirus, polio, influenza and Lyme disease vaccines, as well as the presence of mercury in vaccines, use AAFP Express and request item #7008 (see Express). Get informed so you can educate your patients and ensure that their babies have the necessary childhood immunizations.

EVP: 'This is the best job in medicine, and I'll miss it.'

EVP Robert Graham, MD
EVP Robert Graham, M.D., says he plans to leave AAFP; President Lanny Copeland, M.D., listens.

Robert Graham, M.D., told AAFP employees July 26 that he would leave the staff next year, after a new EVP is selected.

"This is the best job in medicine, and I'll miss it, but the time is right to move on," Graham said.

He has directed the Academy staff since 1985. He said three key elements are in place: AAFP's financial condition is excellent, its senior management team is strong and stable, and arrangements have been completed for building and financing the Academy's new headquarters in Leawood, Kan., in the Kansas City metropolitan area.

On a personal note, Graham's departure from the staff will allow him and his wife, Jane Henney, M.D., to share the same home base. She is the FDA commissioner, and she and Graham have had a commuter marriage for eight years.

AAFP President Lanny Copeland, M.D., of Albany, Ga., thanked Graham for heading up the Academy since 1985 and said he was appointing an EVP search committee. It will be chaired by President-elect Bruce Bagley, M.D., of Albany, N.Y., and Deputy EVP Michael Miller, J.D.

Graham first worked on the AAFP staff in the mid-1970s as field representative and then assistant director of the Education Division. He served in the Public Health Service in Washington, D.C., from 1976 to 1985, becoming head of the Health Resources and Services Administration and assistant surgeon general.

"It is with decidedly mixed emotions that the Board has started discussions about a search process for a new EVP," said Board Chair Neil Brooks, M.D., of Rockville, Conn. "The Board would have been more than happy to see Bob's tenure extend into the next decade. However, we understand and respect the reasons for his decision."

Mental Health 2000: Annual Clinical Focus

The Academy's Annual Clinical Focus for the coming year -- Mental Health 2000 -- will kick off Sept. 17 at the Annual Assembly in Orlando, Fla. The ACF is an educational initiative designed to bring members state-of-the-art information about a specific subject area each year.

A news conference that morning will feature AAFP President Lanny Copeland, M.D., of Albany, Ga.; ACF Medical Director Stephen Spann, M.D., of Houston; and other leaders in the mental health field.

CME programs for Mental Health 2000 will be offered at Assembly and throughout the coming year. An ACF Web site -- at http://www.aafp.org/acf/ -- will host a mental health e-mail discussion group beginning Jan. 1.

Other components of Mental Health 2000 include monographs, patient education handouts, articles in AAFP publications, a CD-ROM of ACF program elements at the end of the ACF year, and additional elements such as a chapter lecture series, a plenary lecture at the Conference on Patient Education and programs at the Family Practice Board Reviews.

Family physicians at the Annual Assembly may pick up a free copy of the Mental Health 2000 Video CME program "Prevention and Early Detection of Mental Illness," obtain a copy of the ACF 1998 CD-ROM "Prevention and Management of Cardiovascular Disease," and order the ACF 1999 CD-ROM "Management and Prevention of the Complications of Diabetes."

Mental Health 2000 was developed in cooperation with the National Institute of Mental Health, American Psychiatric Association, National Alliance for the Mentally Ill and National Mental Health Association. The 2000 ACF is supported by more than $1.5 million in educational grants from Bristol-Myers Squibb Co., Schering Laboratories/Key Pharmaceuticals, Eli Lilly & Co., Janssen Pharmaceutica Products L.P. and SmithKline Beecham Pharmaceuticals.

News from Headquarters

Donate to ASPN and double your money

Want to boost the specialty's practice-based research efforts?

Here's how. Donate to the Ambulatory Sentinel Practice Network, and the AAFP Foundation will match your funds.

ASPN closed the doors of its Denver office May 28 because of financial problems, but it continues to exist as a corporate entity until the end of this year. Outside contractors are completing its research projects, and its annual convocation will be held Dec. 2-5 in Colorado Springs, Colo.

As reported in the June FP Report, the Academy provided about $480,000 this spring to help ASPN cover most of its debts and honor its research commitments. To further assist ASPN, the AAFP Foundation Board of Trustees decided to match up to $20,000 in individual and organizational contributions.

At press time, the foundation had already matched $5,000 from the North American Primary Care Research Group and $5,000 from the Association of Departments of Family Medicine.

ASPN's 750 practice-based researchers included some 700 family physicians in the United States and Canada. The Academy is exploring the feasibility of opening a new practice-based research network in 2000.

To donate to ASPN, send your tax-deductible donation to the AAFP Foundation, 8880 Ward Parkway, Kansas City, MO 64114-2797. To contribute by credit card, call the AAFP Foundation at (800) 274-2237, Ext. 4462.

Products/Services

Scan this area for AAFP products, services and meetings that might help you and your patients. Order these items from the AAFP order department at (800) 944-0000 unless otherwise noted; a shipping and handling fee might apply.

Resident/Student News

Tar Wars Presentation

(Above) Chris Lupold, a medical student from Philadelphia, analyzed a tobacco ad with Kansas City youngsters, from left, Gary Stallings, age 11; Tysean Broils, age 15; and Terrence Dumas, age 12, during a Tar Wars presentation at the resident-student meeting. (Below) Residents, students and guests circled, promenaded and do-si-doed at the conference's annual picnic and square dance.


Square Dance

Annual meeting: New name, new offerings

The largest-ever meeting for family practice residents and medical students was July 28-Aug. 1 in Kansas City, Mo. It boasted a new name and new educational offerings.

Called the National Conference of Family Practice Residents and Medical Students, the meeting's innovations included the Procedures Lecture Center, the Doctors' Lounge® and four plenary addresses.

An all-time-high number of residents -- 845 -- attended the AAFP meeting, as well as 899 students. Guests, staff and exhibitors, including many from residency programs, boosted total registration to a record 3,253.

The residents and students sent 45 resolutions to the AAFP Committee on Resident and Student Affairs. They also sent resolutions to the Congress of Delegates on these topics:

Next year's resident-student meeting will be Aug. 2-6. Mark your calendar and ask your constituent chapter's help in gaining one of about 70 scholarships to attend.

Congresses elect officers, other leaders

The National Congress of Family Practice Residents and National Congress of Student Members elected the following new leaders July 31.

Representatives to AAFP Board of Directors:
David Meyers, M.D., of Washington, D.C.; Marguerite Duane of Stony Brook, N.Y.

NCFPR/NCSM chairs:
Jennifer Aloff, M.D., of Midland, Mich.; Kerri Harting of Springfield, Ill.

Alternate delegates to AAFP Congress:
Marc Ramsue, M.D., of Jacksonville, Fla.; Marti Taba, M.D., of Hilliard, Ohio; Andrew Mills of Tulsa, Okla.; Jameelah Gater of Ann Arbor, Mich.

Observers to the Society of Teachers of Family Medicine Board of Directors:
Glenna Hendricks, M.D., of Alexandria, La.; Kathy Woo of Minneapolis.

National coordinator of family medicine interest groups:
Saria Carter of Gainesville, Fla.

Observer to the Association of Family Practice Residency Directors Board of Directors:
David Hutcheson-Tipton, M.D., of Denver.

Representative to the Residency Review Committee for Family Practice:
Jim Little, M.D., of Portland, Ore.

Residents have right to organize, says AAFP

At the request of the 1998 National Congress of Family Practice Residents, the AAFP Board of Directors recently endorsed residents' right to form associations.

"The AAFP supports the right of residents to form associations which represent and advocate their interests and can negotiate on their behalf; these interests include, but are not limited to, patient care issues, working conditions and educational concerns. The AAFP does not support the right of residents to strike or withhold professional services." So says the policy the Board adopted during its mid-July meeting in Santa Fe, N.M.

(Below left) Sam Blackadar, M.D., of Silverdale, Wash., testified at the National Congress of Family Practice Residents. (Below right) Kyja Stygar, M.D., right, of Neenah, Wis., gives pointers to Anastasia Misakian, a medical student from Boston, during a soft-tissue surgery workshop at the conference.
Sam Blackadar, MD Kyja Stygar, MD

In 1976, the National Labor Relations Board said residents in private hospitals did not come under the protections of the National Labor Relations Act. Residents in public hospitals, considered more as employees than students, have continued to come under the NLRA.

Last year, the NCFPR asked the Academy to support residents' right to organize but not to strike, and the policy quoted above is the result.

"We hope all residents can approach their institutions about patient care issues and working conditions, such as lack of adequate supervision, and work with their faculty to address these issues," says David Meyers, M.D., of Washington, D.C., the 1999 NCFPR chair. "But when residents' concerns are continually ignored, organizing may be the only way to get things done."

News from Washington

Watch for 'Nutrition Care Alerts'

Nursing homes and regional health offices will receive a written tool this fall launching a campaign to improve nutrition for the elderly.

Melvin Gerald, MD
Melvin Gerald, M.D.

The "Nutrition Care Alerts" statement tackles four nutrition-related conditions: unintended weight loss, dehydration, pressure ulcers and tube-feeding complications. The Nutrition Screening Initiative, founded by groups including the AAFP, developed the alerts to help improve the health of the estimated 40 percent of nursing home residents who are malnourished. The alerts list warning signs for the four conditions and action steps for care-givers.

AAFP Director Melvin Gerald, M.D., of Washington, D.C., participated in a press conference announcing the "Nutrition Care Alerts" Aug. 5 in Washington. "This health education tool can improve the quality of care by reinforcing basic, simple components of nutrition care by nursing assistants, family members and the entire care team, including physicians," said Gerald.

The Health Care Financing Administration, Ross Products Division of Abbott Laboratories and health groups will distribute the alerts this fall, and the AAFP will make the tool available to members. It may be used in home care situations and physicians' offices as well as nursing homes.

AAFP, others write Supreme Court ...

Yes, FDA should regulate tobacco

In a legal brief filed in July, the Academy and 46 other public health advocates defend the Food and Drug Administration's right to regulate tobacco products.

"Nearly one in five eighth-graders and one in three 12th- graders smoke cigarettes," says the brief. "Each year, an estimated 1 million adolescents start smoking, and one-third of those adolescents will die prematurely as a result."

The brief's 47 signers support FDA's jurisdiction over the sale and advertising of tobacco products as a way to reduce children's access to tobacco and exposure to industry efforts to entice them to use tobacco.

"Manufacturers carefully engineer their tobacco products to deliver doses of nicotine to consumers, to create and satisfy nicotine addiction," says the brief. It upholds FDA's finding that the nicotine in tobacco products is "intended to affect the structure or any function of the body," thus bringing nicotine within the definition of "drugs."

The November 1998 settlement reached by 46 state attorneys general and major tobacco companies "does virtually nothing to restrict the sale of tobacco products to minors ... (and) does not require tobacco companies to disclose or alter their products' ingredients and additives, whereas the FDA could promulgate regulations on those topics," says the brief.

It seeks a reversal of the Fourth Circuit Court's ruling in August 1998 that the Food, Drug and Cosmetic Act does not authorize the FDA to regulate the sale and promotion of tobacco products. The Supreme Court is expected to consider the case, FDA vs. Brown and Williamson Tobacco Corp., et al., late this year or in 2000.

Letters

HCFA audits

To the editor:

In response to your article "Idaho FPs Speak Out Against HCFA Audits" (July FP Report): The revelation from Stephen Gleason, D.O., that over 2,000 hours of initial training and 500 hours per year of continuing education is required to learn and keep up with issues related to the Health Care Financing Administration really puts this issue into perspective for me.

Most full-time, 40-hour weeks contract for about 2,080 hours per year. Thus, it takes about a full year to learn about these changes, then one-fourth of a working year to keep up with these changes. If one adds in the requirements of managed care contracts, CME for recertification, etc., it could be concluded that one cannot practice medicine and be adequately trained to do so simultaneously.

ROLF NALEY, M.D.
Irving, Texas

Universal coverage

To the editor:

Was the juxtaposition of "Idaho FPs Speak Out Against HCFA Audits" and "Medical Groups Seek Universal Coverage" in the July FP Report meant to be instructional, or was it an accident? Although many people think that the eventual emergence of a single-party payer is inevitable, I recall that it was thought to be just around the corner when I started to practice in 1974. Must we be so shortsighted as to support something which has at least as much negative as positive?

Physicians are all too willing to relinquish their autonomy, professional status and ability to influence the course of evolution of our health care delivery system when they practically volunteer to become federal employees.

While the AAFP might well have to help its members learn to deal with increasing government involvement in health care, I dislike seeing my society's support of universal coverage.

On a related question, the letter by Richard Gage, M.D., "Drop in Match," while quietly understated, should not be ignored. I, myself, have advised students to avoid primary care.

JAMES CRICHTON, M.D.
Helena, Mont.

The reason: money

To the editor:

Regarding the letter from Richard Gage, M.D., in the July FP Report, Dr. Gage came close to (the source of) the problem of expanding competition from nonphysicians -- but he failed to point out why an FP or other provider would employ these folks. MONEY, plain and simple. They're worried about the loss of an office visit. The advanced registered nurse practitioners, certified registered nurse anesthetists and "nurse-wives" are petitioning the states for independent practice privileges because the M.D.s who used them have proved that they can provide services cheaper without the M.D.

One other thing. HMOs and hospitals have been pushing for all of their provider M.D.s to be boarded, theoretically to provide a higher level of quality and expertise to their enrollees. Then why do they allow their providers to hire less-qualified nonphysicians to see patients and make rounds?

JULIAN FIELDS, M.D.
Marianna, Fla.

Genetics, spirituality, end-of-life care

To the editor:

I was pleased to see the July FP Report's special section on human genetics and also the articles on spirituality and discussing the patient's faith. These are all areas that I have thought needed more attention, and I'm pleased to see progress in each area.

The quality of FP Report's coverage of end-of-life care, which appeared in the June 1998 issue, and of human genetics has been excellent. Best wishes on AAFP's continued progress in these areas.

WILLIAM REICHEL, M.D.
Timonium, Md.

To the editor:

Regarding the issue of "spirituality" (see the July FP Report), several points should be kept in mind. If spirituality is completely subjective, and therefore not "real" except as a figment of the imagination, then physicians may well be justified in paying it little attention. If, on the other hand, spirituality is a manifestation of some aspect of reality, then it (spirituality) has a certain nature, just as all aspects of reality have a certain nature (e.g., a tree has a plant nature, etc.). What is the reality of this nature? Is it solely caused by the matter and energy in the universe, perhaps mediated by human brains?

It is unwise to meddle with things we don't understand, unless we are reasonably sure that the outcome is positive. If we in our profession, both individually and as a group, just blindly recommend or approve of "spirituality" without investigating the nature, claims, and evidence for and against the various brands, we do our patients a disservice. For instance, if the Christian view on these subjects is correct, then other views are incorrect. A wrong choice in that case would have disastrous consequences!

JEREMY KLEIN, M.D.
Louisa, Ky.

Other News

Academy moves next month to Leawood, Kan.

Starting Oct. 5, the Academy will have a new address.

It's 11400 Tomahawk Creek Parkway, Leawood, KS 66211-2672. The new post office box address is P.O. Box 11210, Shawnee Mission, KS 66207-1210.

While the toll-free number stays the same -- (800) 274-2237 -- AAFP will have a new "local" telephone number -- (913) 906-6000 -- and new telephone extensions, too.

Even though it's in a different state, the Academy's new headquarters site is just a few miles away from the "old" Academy headquarters in Kansas City, Mo.

American Academy of Family Physicians
11400 Tomahawk Creek Parkway
Leawood, KS 66211-2672

(effective Oct. 5)

FPs satisfied with care they deliver, with AAFP

How Satisfied Are You?

The annual AAFP member attitude survey leads with the question, "Compared to other medical organizations you are familiar with, how satisfied are you with the AAFP?"

"Very satisfied," said 51 percent of this year's 346 respondents -- a percentage that has gradually increased from the 1995 response of 31 percent. Other snippets from the sample survey:

Seventy-four percent of respondents agreed that, if they had it all to do over, they would still become family physicians. And 79 percent said FPs provide higher-quality health care now than 10 years ago.

Members, however, are not expecting bigger bucks. Only 27 percent of respondents agreed with the statement, "I expect to make more money from my practice this year than last year."

FP Report is published by the AAFP News Department. Copyright © 1999 by American Academy of Family Physicians.


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