September 16, 2016

ORLANDO, Florida — Delegates will gather here next week to vote on an ambitious resolution that calls on the American Academy of Family Physicians (AAFP) to address the public health implications of climate change, a fitting topic in a state that has been dealing with coastal flooding triggered by the earth's warming atmosphere.

The resolution on climate change directs the AAFP to endorse efforts in the United States to implement the Paris Agreement of 2015, designed to limit the rise in global average temperature to less than 2°C.

The resolution would call on the medical society to make educational materials on the adverse health outcomes associated with climate change available to members and patients; recommend that medical education include the effects of climate change on health; educate members on how to make their workplaces more environmentally sustainable, by becoming more energy efficient, for example; and support research to shape evidence-based policies on climate change as it relates to healthcare and treatment.

Family physicians take an interest in public health policies, "and global warming is clearly part of that," said AAFP President Wanda Filer, MD, in an interview with Medscape Medical News. Climate change is a suspected factor, for example, in changing patterns of infectious disease. "We're seeing the rise in vector-borne illnesses," said Dr Filer, who finishes her term of office next week.

Another hot-button resolution on the agenda, particularly for residents of Orlando, directs the AAFP to urge US Surgeon General Vivek Murthy, MD, to issue a report on gun violence as comprehensive and as pivotal as the 1964 report on smoking. The report should detail "the urgency of action to prevent firearm suicides and homicides in the US using a public health, harm-reduction approach," according to the resolution.

The worst mass shooting by a single gunman in the United States occurred in Orlando in June, when 29-year-old Omar Mateen killed 49 people and injured 53 others at a gay nightclub.

Dr Filer brushed off any concern that approving the resolution might incur the wrath of the National Rifle Association (NRA), which has criticized other medical societies for stepping into the debate on gun violence. The NRA has told them to stick to medicine.

"I'm more interested in representing my members, and my members are worried about community health," she said. "That is where our focus is. It's a very laudable goal to protect patients and communities."

Drug Prices and Drug Overdoses

The high price of prescription drugs has been debated in public health circles, in Congress, and during this year's presidential campaign. AAFP delegates will add their voices when they consider a resolution supporting legislation that would allow Medicare to negotiate drug prices.

The resolution would also have the society advocate for laws to allow Medicare to manage formularies, restore drug rebates for low-income beneficiaries, and permit the importation and reimportation of drugs from Canada.

Dr Filer said that high drug prices force some patients to choose between their medications and food.

"Everywhere I go, I hear from physicians that the high cost of drugs is endangering the health of patients," said Dr Filer. If drug prices don't come under control, "we're not going to see improvements in disease management or lower death rates."

A family of drugs — pain killers, particularly opioids — at the heart of an overdose epidemic will be addressed in a resolution that calls on the AAFP to lobby everyone from lawmakers and health plans to the US Food and Drug Administration and the Joint Commission to eliminate a patient's pain score, often called the fifth vital sign, as a determinant of care. Many employed physicians feel pressured to overprescribe pain killers by hospitals interested in improving patient satisfaction scores, Dr Filer explained.

"They've been pulled aside by hospital administrators and told, 'You need to be do a better job on pain-score numbers. Prescribe more'," she said. "I've had physicians tell me it impacted salary negotiations and their take-home pay because they refused to go down that path."

Will the AAFP Opt for Neutrality on Physician-Assisted Suicide?

Another resolution will ask the AAFP to refrain from taking a position on a burning issue of the day: physician-assisted suicide, also called aid-in-dying or assisted dying. Laws allowing a physician to prescribe a lethal drug to a terminally ill patient — defined as someone with less than 6 months to live — who requests it have been enacted in California, Oregon, Vermont, and Washington. Certain prerequisites must be met, however, such as counseling on palliative and hospice care and a determination that the patient is competent and making an independent decision. Physician-assisted suicide is legal in Montana by virtue of a state supreme court ruling.

Historically, physician-assisted suicide has been opposed on the grounds that it violates the Hippocratic imperative to do no harm. The Massachusetts Medical Society, for example, fought against a ballot proposition in 2012 that would have legalized the practice. Voters narrowly rejected it. The Maine Medical Association played the same contrarian role in 2013, when the state legislature defeated a physician-assisted suicide bill.

California is a different story. In 2015, the state medical society changed its stance from "opposed" to "neutral" as voters there made physician-assisted suicide legal.

The resolution before AAFP delegates also seeks neutral ground. It notes that "aid in dying is an entirely patient-directed medical practice from beginning to end, permitting only self-administration of the medication, and does not constitute euthanasia."

The views of AAFP members on the subject of physician-assisted suicide differ widely, said Dr Filer. "I think you will hear informed and passionate perspectives from every angle at next week's meeting."

"I don't know whether the resolution will pass or not," she said. "What we're hearing from members is a willingness to have the conversation. We can never be afraid to have that conversation."

Medscape Medical News will report on the fate of all these resolutions next week.

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