Organizational Issues Spark Delegates’ Debate

To accept gifts and samples from the pharmaceutical industry or not to accept them; to change the AAFP’s new governance structure or not to change it -- these are only two of many organizational questions the AAFP Congress of Delegates wrestled with this week.

The Reference Committee on Organization and Finance heard opposing testimony Sept. 26 on various topics, and delegates voted on the issues Sept. 27. Here’s a sampling of organizational measures the delegates addressed.

The Congress referred to the AAFP Board of Directors three industry-related resolutions. One resolution with three “resolved” clauses called for AAFP members to refuse to accept any gifts from the industry. Delegate James Raczek, M.D., of Bangor, Maine, urged, “Our academic colleagues have taken the lead (in banning gifts in academic settings), and our Academy should take the lead for practicing physicians.” The Jan. 25 issue of the Journal of the American Medical Association carries academics’ proposals for distancing medicine from the pharmaceutical industry.

The reference committee report said, however, that the resolution might be unenforceable -- drug companies would keep bestowing gifts such as pens and coffee mugs, and members would keep taking them. Delegates dropped the measure on banning gifts.

Another clause in the resolution won referral to the Board. The clause asks the AAFP to work with the Pharmaceutical Research and Manufacturers of America to explore ways to improve PhRMA’s patient assistance program to try to reduce or remove the need for physicians to rely on drug samples.

In a second resolution referred to the Board, delegates ask the AAFP to stop selling lists of Scientific Assembly registrants or change registrants’ current “opt out” system to an “opt in” system for sharing contact information.

A third resolution asks the AAFP delegation to the AMA House of Delegates to call for the AMA to stop selling physicians’ prescribing information to commercial organizations. The AAFP Board will consider the measure. Physicians already can opt out of AMA’s data-sharing process (see box).

AAFP’s new governance structure, which the 2005 Congress reviewed, took effect in January. Last year, delegates called for a Bylaws amendment to be prepared on re-establishing an AAFP Commission on Resident and Student Issues because the new structure did not have such a panel. The delegates considered the amendment this week.

However, in the new structure, the 22-member Commission on Education includes eight residents and students, several of whom told the reference committee they appreciated being part of the commission. In addition, last December, the Board created the commission’s subcommittees on resident and student issues.

“We found we were listened to,” student delegate Anandam Hilde of Portland, Ore., said. “The new structure has done its job, and we’re in favor of it.”

“We went into the Commission on Education wondering how we would feel in a room full of ‘big docs,’” resident delegate Elizabeth Powers, M.D., of Portland, Ore., told the reference committee. “The Board has responded to our needs (through the subcommittee structure). The resident and student listservs are full of recommendations not to adopt the amendment.”

The delegates rejected the amendment.

A proposed resolution would have added to AAFP’s policy “Reproductive Decisions” a statement saying “safe, legal abortion must remain available in order to prevent the maternal morbidity and mortality associated with illegal abortion.”

Instead, delegates adopted wording that had been proposed by the 2006 National Congress of Family Medicine Residents. The revised policy says a physician should supply to a pregnant patient one or more types of information that may include “the availability of safe, legal abortion services (as illegal abortions are known to be associated with significant maternal morbidity and mortality) should she choose not to continue the pregnancy.” Only the parenthetical expression is new.