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AMA Delegates Call for Adding 'Physicians With Expertise' to Government Guideline Panels
USPSTF Breast Cancer Screening Recommendations Generate Lengthy Debate
The resolution was introduced by the Illinois delegation to the AMA in response to controversial screening guidelines released by the U.S. Preventive Services Task Force, or USPSTF, in November 2009.
USPSTF Guidance Proves Controversial
The task force said in its explanation of the revised recommendations that it encourages individualized, informed decision-making about when to start mammography screening and that the decision should take into account patient context, including the patient's values regarding benefits and harms.
The USPSTF also recommended a switch from annual to biennial screening mammography in women ages 50-74, with the intent of reducing the potential harms of screening.
Critics have blasted the task force's recommendations, however, with some fearing the changes might prompt payers to reject coverage for annual screening or for screening women younger than 50. Others have pointed out that the USPSTF comprises primary care physicians, epidemiologists and public health experts, but does not include subspecialist physicians.
The Illinois resolution, in fact, referred to the task force as being made up of "public health academics and medical statisticians, with no representation by physicians involved in the diagnosis or treatment of breast cancer."
AAFP Leaders Support Primary Care Experts
Goertz subsequently told AAFP News Now that primary care physicians are well suited for such independent expert panels because they don't have the biases or special interests of a surgeon or radiologist. He said it was unfortunate that both resolves were not referred for additional study.
"There was a tremendous amount of debate about whether the AMA should be involved in trying to resolve conflicting recommendations," said Goertz.
In its report, the science and technology reference committee rejected the Illinois delegation's resolve that encouraged adherence to the American Cancer Society's recommendations and instead recommended amending existing AMA policy to support evidence-based guidelines and oppose the use of guidelines by the federal government or payers to restrict access to screening.
That amendment, however, was voted down by the AMA house, and the measure was referred to the board.
The AAFP's breast cancer screening recommendations are based on the updated USPSTF guidelines, and the Academy has defended the task force in letters to Congress and HHS.
Smoking and Nutrition Measures Adopted
- electronic cigarettes, or e-cigarettes, be classified as drug delivery devices, making them subject to FDA regulation;
- state legislatures prohibit the sale of e-cigarettes that are not FDA-approved; and
- e-cigarettes be subject to smoke-free laws just as traditional cigarettes are.
- federal, state and local housing authorities and governments to prohibit smoking in multiunit housing to protect children and adult nonsmokers; and
- state and local medical societies, chapters and other health organizations to support and advocate changes in existing state and local laws and policies to achieve such prohibitions.
Delegates also directed the AMA to support efforts to decrease the price gap between inexpensive calorie-dense, nutrition-poor foods and more costly naturally nutrition-dense foods to improve health in economically disadvantaged populations. This, they said, should be done as part of the Women, Infants and Children program by encouraging expanded funding for and enrollment in existing programs that seek to improve nutrition and reduce obesity. The delegates also called on the AMA to support the application of program models that provide incentives for the consumption of such naturally calorie-dense foods.
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