Regulating population-level sodium intake was one of a number of hot issues medical students tackled during the AAFP National Conference of Family Medicine Residents and Medical Students held here on Aug. 1-3. The pros and cons of accelerated medical school curricula also provoked spirited debate among participants, who addressed numerous other topics, as well.
New York AFP delegate Nathaniel Lepp, M.P.H., speaks in support of a resolution asking the AAFP to create a population-level policy on dietary sodium reduction and advocate that the FDA remove sodium's "Generally Recognized as Safe" status.
After lengthy debate about softening the language in a resolution that, as submitted, asked the AAFP to create a population-level policy on dietary sodium reduction and advocate that the FDA remove sodium's "Generally Recognized as Safe" (GRAS) status, students at the National Congress of Student Members voted to adopt the original resolution. That vote contradicted a reference committee recommendation that the student congress adopt a substitute measure that removed any mention of sodium's GRAS status. In making that recommendation, committee members cited a need for an initial AAFP policy to be in place before attempting to deal with the GRAS status issue.
However, resolution co-author Orlando Sola, of the Columbia University College of Physicians and Surgeons in New York, pointed out during the Aug. 3 business session that several organizations, including the Institute of Medicine and the AMA, have developed policies asking the FDA to revoke sodium's GRAS status.
- AAFP medical student members met recently in Kansas City, Mo., to elect new student leaders and consider resolutions intended to help guide AAFP policy decisions.
- Students at the National Congress of Student Members (NCSM) adopted various public health and patient safety measures, including a resolution aimed at reducing the amount of sodium in processed foods.
- In addition, the NCSM asked the Academy to support available accelerated educational programs and to lobby for the development of business leadership educational options for family medicine residency programs.
"There is no need to wait a full year for a policy to be written before (the AAFP has) a proactive stance on (revoking sodium's GRAS status)," Sola said. "This is an issue that has been percolating since the 1980s, and waiting longer only puts more of our patients at risk for the negative effects from having too much sodium in their diet."
Nathaniel Lepp, M.P.H., of the New York Medical College School of Medicine in Valahalla, said the resolution provided the Academy with an opportunity to improve population health.
"While salt is absolutely not a dangerous substance, it is the dose that makes the poison in this case," he said. "In our current food manufacturing infrastructure, salt is overrepresented in our food supply, and it is very difficult to disentangle the salt from foods that are heavily processed and packaged and widely available."
Matthew Mullane, of the University of Texas School of Medicine at San Antonio, argued against the original language, saying that it put the AAFP on a "slippery slope."
"We are walking a fine line when we are talking about getting into regulatory policy for sodium," said Mullane. "In a state like Texas, that is so passionate about personal freedoms, for us to create a very strong policy advocating limitations on salt -- I don't think that would work. As this is the American Academy of Family Physicians, we need to be thinking about what can work across all of the states and what we can advocate for together in order that we can really reduce salt intake for our patients in a way that our patients will be receptive to."
But Andrew Birkhead, of the Tulane University School of Medicine in New Orleans, disagreed that salt, in the context of the debate, involved such personal liberty issues.
"Salt is added to a lot of products, most often many of the cheaper food items that people use," Birkhead said. "It is not really an issue of personal liberty when there is too much salt in our diet. It isn't a personal decision when something is being put in (food) without your knowledge."
Students also voted to adopt a substitute resolution that asks the Academy to consider establishing a policy that specifically supports residency programs that participate in three-year medical school accelerated curricula in family medicine, and encourages family medicine residencies to investigate three-year accelerated programs at affiliated medical schools based on currently successful models.
Douglas Borst, of the University of Miami Miller School of Medicine, was one of several students who opposed adopting the substitute resolution based on concerns that a shortened medical school track would add to the misperception that family medicine is a "lesser" specialty.
"I am, if anything, in favor of increasing the number of years that family medicine physicians need to go through school to even increasing residency requirements," he said during the business session. "That may be a minority opinion, but I think that the creation of the three-year track program fuels the perception that family physicians are 'Doctors Lite.'"
Charles "Chaz" Willnauer, M.D., M.B.A., of the Texas Tech Family Medicine Residency at Lubbock, countered by saying that in terms of debt load, the three-year, direct-path-to-residency program at Texas Tech University was really beneficial to him.
"For me, costs were cut in half, and I got a year off so I can go do a fellowship or go into practice sooner," he said. "I'm glad I didn't have to do all of the other rotations that I thought may not be relevant to what I want to pursue.
"I think this is one answer, not the answer -- as I know some people want that fourth year -- but for me, this was beneficial, and I think that this is a piece of the puzzle for … increasing (the number of) people going into primary care. I think it is a great option, and I would love to see the AAFP support it."
Students also adopted resolutions and substitute resolutions that call on the Academy to
- work with other professional organizations, such as the American Board of Family Medicine, to lobby for the development of a master's degree in business administration or medical management curriculum that could easily be adopted by family medicine residency programs;
- support medical student education in motivational interviewing to effectively modify and improve patient health behaviors in a patient-centered manner;
- support proper training and certification of therapy animals and acknowledge the benefits of hospital and patient use of these animals;
- support the implementation of "traveler thrombosis" safety tips in airline pamphlets and videos and encourage family physicians to counsel patients on thrombosis prevention before traveling, as well as encourage further research on recommendations for prevention of travel-related thrombosis;
- explore avenues to give a voice to the international medical student population at the National Congress of Student Members; and
- support the nationwide implementation of standardized, mandatory reporting requirements for health care professionals who suspect abuse or neglect in elderly patients.
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