September 29, 2016


ORLANDO, Florida — The American Academy of Family Physicians (AAFP) 2016 Congress of Delegates has called on the Department of Health and Human Services to issue a comprehensive report on gun violence.

The resolution in support of a study on gun violence is an end-run, of sorts, around the Congressional ban on funding for any study by the Centers for Disease Control and Prevention (CDC) that "may be used to advocate or promote gun control." That language has effectively squelched gun-violence research by the CDC, which is a part of the Department of Health and Human Services. At its House of Delegates meeting this summer, the American Medical Association (AMA) urged Congress to repeal the ban.

The original AAFP resolution directed the academy to petition Surgeon General Vivek Murthy, MD, to conduct a study "detailing the urgency of action to prevent firearm suicides and homicides...using a public-health, harm-reduction approach." An amendment replaced Dr Murthy with the secretary of the Department of Health and Human Services.

One supporter of the resolution, Melissa Hemphill, MD, from Oregon, described herself as a "gun owner and a provider who has lost patients to gun violence."

"From a harm-reduction perspective, managing gun violence is very important," Dr Hemphill said. "We'd like to see the AAFP take a stronger stance on this."

Another threat to patients, according to delegates, is the runaway cost of prescription drugs. The Centers for Medicare & Medicaid Services reports that there was a 12.2% increase in spending on retail prescription drugs in 2014, compared with an increase of 2.4% in 2013.

Negotiating Prescription Drug Costs

To make drugs more accessible to patients, delegates passed a resolution that would enable Medicare to negotiate drug prices in both the Part B and Part D programs. Some physicians pointed out that if Medicare could bargain for lower prices, the need to legalize the importation of less expensive drugs from Canada would be diminished.

A considerable amount of time at the Congress of Delegates was devoted to discussion of the public health implications of various forms of discrimination. A resolution was passed to support the right of transgender people to use public facilities of the gender they identify with — a right they do not enjoy, for example, in North Carolina.

Two other resolutions called on the AAFP to condemn xenophobia directed against new immigrants, and discrimination against gay, lesbian, bisexual, transgender, and queer people. Because the AAFP is already on the record opposing these types of discrimination, delegates passed a substitute resolution that directs the academy to promote its existing policies in a more high-profile fashion.

Delegates rejected a resolution to adopt a neutral stance on the growing practice of physician-assisted death, which is now legal in five states.

Physician-Assisted Death Rejected

Physician-assisted death has divided organized medicine in recent years. The AMA and most other societies oppose it; however, a few, like the American Medical Women's Association, support it, and others, like the California Medical Association, have staked out a neutral position.

Asim Jaffer, MD, from Illinois, said the AAFP should follow the lead of the American Academy of Hospice and Palliative Medicine (AAHPM), which is officially neutral about physician-assisted death. "There are probably good points on both sides," said Dr Jaffer, who also is an AAHPM member.

The blanket endorsement of the AMA Code of Ethics by the AAFP has led to its current position on physician-assisted death. A two-thirds majority would have been required to support the resolution, but instead, two-thirds of the delegates voted it down.

Some resolutions received strong support, only to be referred to the AAFP board of directors for further study. One such resolution would create an Office of Diversity, which would work toward "nondiscrimination in education, training, and practice." Another laid out a complex and ambitious agenda on climate change. Among other things, it proposed teaching medical students and residents about the effects of climate change on human health.

Several delegates testified that coastal flooding and heavy rains related to climate change have spurred the growth of mold and virus-bearing mosquito populations. Walter Weare, MD, from Guam, described how rising sea levels are causing inhabitants of small Pacific islands to migrate.

"The situation will only worsen as climate change progresses," Dr Weare warned.

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