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AMA Adopts Policies on Circumcision, Gun Safety

MedpageToday

The American Medical Association (AMA) House of Delegates adopted a number of new policies at its interim meeting, including policies on male circumcision, physician discussion of gun safety, and a new medical coding system that will go into effect in 2013.

The AMA, which just wrapped up its interim meeting in New Orleans, adopted a policy officially opposing any attempt to legally prohibit circumcision of infant boys. The resolution was sponsored by the AMA's California delegation and is in response to legislative initiatives recently proposed in California that would ban infant male circumcision and penalize physicians who performed it, according to the AMA.

In July, a judge ruled that a proposed circumcision ban in San Francisco was illegal and could not be put on the city's election ballot.

The California delegation said the medical reasons for circumcision are "compelling enough that many physicians and other health authorities feel the procedure is justified," and that prohibiting the practice would be an "intrusion into legitimate medical practice and the informed choices of patients."

Interest in newborn circumcision has increased in recent years because three large randomized trials in Africa have shown that, in adult men, the procedure reduces the risk of acquiring HIV and other sexually transmitted infections.

Gun Safety

The AMA adopted a policy opposing restrictions on doctors being able to talk to patients about firearm safety, including how to safely store guns so kids won't find them.

In May, the Florida state legislature passed a bill that made it illegal for pediatricians and other physicians to ask patients or their parents whether they have guns in their home. Gun-rights advocates contended that such questions are an invasion of patients' privacy and an infringement of Second Amendment rights.

Pediatric groups have recommended that physicians ask parents whether they keep guns at home, and discuss gun safety with those that do in order to prevent shootings involving children. In 2009, according to the CDC, nearly 400 children younger than 15 were killed by firearms. Under the law, doctors would have faced a $500 fine for inquiring about gun ownership and recording it in a patient's medical record.

In September, a federal judge in Florida declared the law unconstitutional.

The AMA's new resolution, which also was introduced by the California delegation, officially opposes any laws placing restrictions on gun safety discussions from occurring between physicians, patients, and their families, and says that doctors should be free to have firearm safety conversations during office visits.

ICD-10 Opposition

Another policy adopted at the AMA meeting states that the organization will "work vigorously to stop implementation of ICD-10." The ICD-10 is the 10th edition of the International Classification of Diseases and Related Health Problems, which is the manual most commonly used for coding medical diagnoses.

The Centers for Medicare and Medicaid Services has decided that Oct. 1, 2013, is the "firm date" for implementation of the new ICD-10 coding system for medical diagnoses. The ICD-10 has about 69,000 codes and will replace the 14,000 ICD-9 diagnosis codes currently in use.

"The implementation of ICD-10 will create significant burdens on the practice of medicine with no direct benefit to individual patients' care," said Peter W. Carmel, MD, AMA president, in a press release. "At a time when we are working to get the best value possible for our healthcare dollar, this massive and expensive undertaking will add administrative expense and create unnecessary work flow disruptions."

He added that the "timing could not be worse," as physicians are already dealing with implementing electronic records into their practices.

Health Exchanges

The AMA also adopted a policy on the state-based health insurance exchanges that will be created by the Affordable Care Act (ACA) as a place where patients can compare insurance plans and buy coverage.

The AMA policy says that the group is in support of using an "open marketplace model" for exchanges in order to "increase competition and maximize patient choice." The policy asks the AMA to advocate that physicians and patients provide input on the establishment and implementation of the exchanges.

"If they are developed well, health insurance exchanges will provide a new way for millions of Americans to obtain healthcare coverage from private insurers," said AMA Board of Trustees member Barbara McAneny, MD, in a press release. "Physicians and patients should be involved in setting up and governing these bodies to ensure they best meet the healthcare needs of residents in each state."

Drug Shortages

The House of Delegates also addressed the current drug shortage issue and passed a new policy in support of legislation that would require drug manufacturers to notify the FDA of any discontinuation or other change that may result in a shortage of a particular medication.

"Physicians strive to provide the best possible care to their patients, which means being able to obtain the right drugs at the right time," said AMA President-Elect Jeremy A. Lazarus, MD, in a prepared statement. "Drug shortages can delay a patient's treatment and may force physicians to use alternative drugs that aren't optimal, leading to an increased potential for errors and adverse outcomes."

In 2010, the FDA identified 178 shortages of medically necessary drugs, which was triple the number of reported shortages from 2005.

The bulk of the shortages have been for drugs used to treat cancer, including lymphoma, leukemia, and breast cancer. Other drug shortages have involved antibiotics, anesthetics for patients undergoing surgery, and electrolytes for patients on IV feeding tubes. Most of the drugs that have experienced shortages are injectable drugs, which generally are made in smaller batches and are difficult to produce.

The new AMA policy also calls for the organization to advocate that FDA and/or Congress require drugmakers to create a plan for how to continue to provide life-saving and life-sustaining medications and vaccines, in the hopes of averting future shortages.

Virtual Medical IDs

Another policy adopted at the meeting calls for making portable medical identification systems for patients. The virtual medical ID -- which could be attached to patients' keys or carried in a wallet -- would allow emergency medical personnel to quickly access a patient's medical history.

"When patients are unable to communicate for themselves, especially in emergency situations, these identification devices can share vital information and may help save lives," AMA Board of Trustees member Carl Sirio, MD, said in the press release.