Miriam E. Tucker

October 23, 2014

WASHINGTON, DC — Abortion and firearms were among the more controversial topics addressed in resolutions here at the American Academy of Family Physicians (AAFP) 2014 Congress of Delegates.

The hot-button issues were among nine advocacy-related topics discussed during a session of the Reference Committee on Advocacy — one of five reference committees at the congress — and then brought to the entire congress for a vote.

Delegates and other members deliberated on dozens of issues affecting the practice of family medicine at the congress. Other topics addressed by the advocacy reference committee included e-cigarettes, rapid diagnostic testing in community pharmacies, and the e-prescribing of narcotics.

"We definitely had some of the more controversial issues at the congress," said advocacy reference committee chair Arnold Pallay, MD, a family physician in Montville, New Jersey.

Abortion

The AAFP is officially neutral on the issue of abortion, but the congress adopted a resolution that "supports a woman's access to reproductive health services and opposes nonevidence-based restrictions on medical care and on the provision of abortion services."

"The law of the land currently is that under certain circumstances, women are permitted to have abortions," Dr Pallay told Medscape Medical News. "The academy is not for or against abortion, but throwing in obstacles that are not evidence-based is a problem."

A resolution to urge the AAFP to support legislation such as the Women's Health Protection Act (Senate 1696/HR 3471) was sponsored by the New York chapter of the AAFP. The act aims to undo state legislation around the country "restricting physicians' speech and compelling physicians to give medically inaccurate information to patients, particularly regarding abortion services," explained chapter president and long-time reproductive rights spokesperson Linda Prine, MD.

Examples, she said, include state requirements for out-of-date and less-effective medication regimens that are still approved by the US Food and Drug Administration for medical abortions, and rules requiring a physician to tell patients that abortion causes breast cancer. "Most of these measures are intended to delay women from getting timely abortions, which pushes them into later trimesters, where it becomes more dangerous or impossible."

The majority of speakers testified in support of the resolution, but a few who spoke in opposition said they feared that the AAFP's support of the legislation could be interpreted to mean that the AAFP is in favor of abortion.

"I'm a Christian and I believe that life begins at conception. Abortion is akin to murder to me," said Michigan delegate Robert Reneker Jr., MD. "I do not want my academy supporting that procedure. I'm happy with a neutral stance. I can live with that. I don't expect everybody to agree with me on this issue.... We have so many other fish to fry regarding how we want to advance healthcare for our nation. To get mixed up in this debate...serves no purpose in furthering some of our other goals."

In the end, the congress voted to adopt a revised version of the proposed resolution, which was amended to remove all language that mentions AAFP support for legislation on the issue.

Firearms

With respect to firearms, the resolution that was adopted requests that the AAFP advocate for regulations to promote safe firearm storage, children's firearm access prevention laws, and firearm safety training programs.

Overall, the resolution was aimed at aligning AAFP's gun policy more closely with those of other national medical organizations — the American Academy of Pediatrics (AAP), in particular — that have come out strongly in favor of legislating gun safety as a public health measure.

Dr Reneker, speaking on behalf of the sponsoring Michigan delegation, noted that "our current policy is quite brief, actually, compared with AAP's, which is seven pages long."

But the AAFP's new stance the is still more moderate than the AAP's, Dr Pallay told Medscape Medical News. "We're closely aligned. The AAP is perhaps a little more left wing. We have a very wide variety of constituents from many parts of the country, with more rural members, so we probably have a little less of a liberal bias. We need to cover people on both sides."

Nonetheless, he continued, "we took a moderately strong stance, especially in terms of disseminating information to our members about firearm control and education."

Keisha Harvey, MD, from Louisiana, representing the AAFP resident and student caucus, voiced support. "Hundreds of children die each year from the unintentional use of firearms. As family physicians, we care for the pediatric population, and as part of their care, we have to ensure they're in a safe home environment. If we know there are guns in the home, especially guns that aren't secure, it's our job to educate family members how to secure the guns to protect the children."

The original resolution called for advocating a repeal of the section of the Affordable Care Act that bans insurance companies in the health exchanges from collecting data on firearms in homes. However, several delegates expressed concern about allowing insurance companies to collect those data, and the language was removed in the version adopted by the congress.

Other Hot-Button Issues Considered

The congress voted to refer to the board, for further consideration, a resolution that would have opposed rapid diagnostic testing in community pharmacies, on the basis that pharmacists are using such tests — for strep throat or flu, for example — and stepping beyond their scope of practice in diagnosing and treating the illness.

"Pharmacists are strong members of our team who we support diligently, but for them to perhaps do a rapid strep test and recommend treatment, without a full clinical exam, which is not part of their training.... We feel strongly that has to be resolved," Dr Pallay told Medscape Medical News.

Other adopted advocacy resolutions include one that would have the AAFP lobby for e-cigarettes to be regulated the same way tobacco products are, and one that calls for the AAFP to work with appropriate drug enforcement agencies to change the current rule to facilitate electronic prescribing of controlled substances, which is still done primarily on paper.

"It's very bizarre," Dr Pallay told Medscape Medical News. "It's not really prevented by EHR systems or legislation, it's just that there are kinks in the process.... We really feel strongly that it's kind of backward. People should take their amoxicillin prescription to the pharmacy if need be, but should have an e-prescription for their narcotic medications."

Dr Pallay has disclosed no relevant financial relationships.

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