Delegates to the 2015 Congress of Delegates here addressed a number of health policy issues, including making medications affordable for patients and conducting more research on marijuana. Other topics tackled included immunization exemptions and student loan repayment.
In a Sept. 28 reference committee hearing at the 2015 Congress of Delegates, Oregon delegate Glenn Rodriguez, M.D., of Milwaukie, speaks in support of a resolution addressing the availability of affordable medication for patients.
During the Reference Committee on Advocacy hearing on Sept. 28, family physicians discussed a pair of closely related resolutions that addressed the availability of affordable pharmaceuticals. The conversation was sparked, in part, by the recent news that Turing Pharmaceuticals had acquired the drug pyrimethamine (Daraprim) and immediately increased its price from $13.50 to $750 per tablet -- a jump of more than 5,000 percent.
Oregon delegate Glenn Rodriguez, M.D., of Milwaukie, testified in support of both resolutions, one of which the Oregon AFP had submitted.
"Our efforts to deliver the triple aim are overwhelmed by some of the other cost drivers in the system, and one of the biggest right now is pharmaceutical prices," he said. "We purposely asked for investigation into this pattern of profiteering -- because that is what this is. I think our voice is really important to speak up against this profiteering."
Rodriguez said that during his recent training on Medicare fraud, waste and abuse, abuse was defined as "anything that results in unnecessary cost that is not consistent with best patient care and professional standards and is priced unfairly."
- Delegates to the 2015 Congress of Delegates addressed, among other topics, making medications affordable for patients and conducting research on the health effects of marijuana.
- After lengthy testimony and debate, delegates adopted a resolution that asked the Academy to advocate for graduated loan repayment programs.
- Delegates also adopted a measure that directed the Academy to support legislation eliminating nonmedical immunization exemptions for those participating in federally funded educational programs, including Head Start.
"So maybe the Academy should initiate a whistleblower suit against some of the generic drug price increases, and when it's settled, we get a cut," he quipped to a round of applause.
General registrant Hugh Taylor, M.D., of South Hamilton, Mass., also spoke in support of the resolution, explaining that in his area of the state, physicians deal with a lot of Lyme disease. It used to be pretty cheap and easy to treat patients with medication, he noted, before the price of doxycycline went up significantly. "So it's been a real problem for our patients," said Taylor.
Noting that he is a member of the Academy's delegation to the AMA House of Delegates, Taylor said the AMA is actively researching what action it can take to help with this issue in accordance with a multipart resolution AMA delegates adopted during their 2015 annual meeting. That measure directed the AMA to, among other things, work with groups such as the Federal Trade Commission and the Generic Pharmaceutical Association to come up with solutions.
Ultimately, AAFP delegates adopted a substitute resolution that called on the Academy to urge Congress and other appropriate federal agencies to investigate current policies that result in pharmaceutical price increases that create barriers to accessing generic medications.
The reference committee also heard testimony on another drug-related pair of resolutions: one resolution introduced by the New York State AFP that sought to legalize marijuana "for personal use" and tax it to support substance abuse treatment, and a second resolution from the Minnesota AFP that called for the reclassification of marijuana to allow research to be conducted on its potential benefits for patients.
General registrant Heather Paladine, M.D., of New York, N.Y., supported both resolutions and contended that using the verbiage "decriminalizing marijuana use" versus "legalizing" its use would make it similar to alcohol -- that is, a substance adults could choose to use or not use.
"Having previously practiced in several states that have legalized medical marijuana, I chose as a physician to let people make their own choices about whether to use marijuana," she said. That approach avoids putting the physician in the awkward position of tacitly giving marijuana use a "stamp of approval," Paladine added.
General registrant Heather Paladine, M.D., of New York, N.Y., testifies in support of a pair of resolutions discussing legalizing marijuana, explaining that decriminalizing marijuana use versus actually legalizing its use would make it similar to alcohol.
Colorado alternate delegate Brian Bacak, M.D., of Denver, weighed in with his concerns, explaining that his state legalized personal use of marijuana in 2012 and medical use of marijuana back in 2000.
"Legalized medical marijuana has not been simple in Colorado," Bacak told committee members. "A common idea is if you legalize marijuana, then the criminal activity will disappear. But that is not what happened" in his state, he added.
"I urge the AAFP to be cautious and careful in seemingly endorsing the public health problems of marijuana," Bacak advised.
Washington alternate delegate Gregg VandeKieft, M.D., of Olympia, also spoke about legalized marijuana in his state, but in support of legalizing its use. He sees outpatient palliative care patients two half-days per week, he said, and the use of medical cannabis has made a dramatic difference in many of their lives.
"It's a misnomer to say there is no evidence -- there is a paucity of evidence -- (on the health benefits of marijuana use), and reclassifying will allow for much better trials," VandeKieft said. "For many of these patients, they can dramatically reduce their opioid use, and we have never had overdose deaths from cannabis, but we have with opioids.
"For these chronic pain and end-of-life patients, oral cannabis preparations and vaporized preparations -- where they aren't smoking it -- could make a dramatic difference in their quality of life."
Minnesota alternate delegate Julie Anderson, M.D., of Saint Cloud, who co-authored the second resolution, testified that reclassifying marijuana as a Schedule II (has a currently accepted medical use despite a high potential for abuse) rather than a Schedule I (has a high abuse potential and no accepted medical use) controlled substance would open up opportunities for federally funded research.
Delegates eventually adopted a substitute measure that called for the Academy to support decriminalizing the possession of marijuana for personal use and to encourage NIH to conduct appropriate research on its health effects.
The other resolution was reaffirmed as current AAFP policy that to better research the drug's benefits, the FDA needs to reclassify it.
After lengthy reference committee testimony and continued debate during the Sept. 29 business session, delegates overruled the reference committee's referral recommendation and adopted a resolution that directed the Academy to advocate for graduated loan repayment programs.
Delegates also adopted a measure that looked to the Academy to support legislation that would eliminate nonmedical immunization exemptions for those participating in federally funded educational programs, including Head Start.
In addition, delegates adopted a number of substitute resolutions on various clinical and public health issues, directing the AAFP to
- support implementation of programs for first-responders and nonmedical personnel to administer naloxone;
- advocate for a federally funded adult immunization program that would include administration of vaccines recommended by the Advisory Committee on Immunization Practices that are given in the primary care office; and
- support the inclusion of U.S. territories and Puerto Rico in all aspects of the Patient Protection and Affordable Care Act, including funding.
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