In Days 2 and 3 of policymaking at the 2016 AMA Annual Meeting, delegates adopted a variety of policies on important issues affecting the health of patients across the country. Issues range from controlled LED lighting to safe provision of dry needling procedures to better training for hemorrhage control.
Attorney ads on drug side-effects
Late-night television is rampant with attorney ads that seek plaintiffs regarding complications from new medications. Potential complications are spoken about in an alarming way, and often, it is the first time the public learns about those potential complications and side effects.
These ads describe only the lethal side effects and not the benefits of the medications that many patients have experienced—but this is not explained to the viewers.
To protect the health of the public, physicians Tuesday adopted policy to advocate for a requirement that attorney commercials which may cause patients to stop using necessary medications to have appropriate and conspicuous warnings that patients should not discontinue medications without seeking the advice of their physician.
“The onslaught of attorney ads has the potential to frighten patients and place fear between them and their doctor,” AMA Board Member Russell W. H. Kridel, MD, said in a news release. “By emphasizing side effects while ignoring the benefits or the fact that the medication is FDA approved, these ads jeopardize patient care. For many patients, stopping a prescribed medication is far more dangerous, and we need to be looking out for them.”
Standards of practice for dry needling
Ensuring patient safety is paramount for physicians. To that end, delegates adopted new policy that recognizes the procedure of dry needling as invasive.
Physical therapists are increasingly incorporating dry needling into their practice. Dry needling is indistinguishable from acupuncture, yet physical therapists are using this invasive procedure with as little as 12 hours of training, while the industry standard minimum for physicians to practice acupuncture is 300 hours of training.
Delegates agreed that the practice of dry needling by physical therapists and other non-physician groups should include—at a minimum—the benchmarking of training and standards to already existing standards of training, certification and continuing education that exist for the practice of acupuncture.
The policy also maintains that dry needling as an invasive procedure should only be performed by practitioners with standard training and familiarity with routine use of needles in their practice, such as licensed medical physicians and licensed acupuncturists.
“Lax regulation and nonexistent standards surround this invasive practice,” AMA Board Member Russel W.H. Kridel said in a news release. “For patients’ safety, practitioners should meet standards required for acupuncturists and physicians.”
Physicians suggest controlled LED lighting
Strong arguments exist for overhauling the lighting systems on roadways with light emitting diode (LED), but conversions to improper LED technology can have adverse consequences.
In response, physicians adopted guidance for communities on selecting LED lighting options to minimize potential harmful human and environmental effects. The guidance was based on a report from the AMA Council on Science and Public Health.
Converting conventional street light to energy-efficient LED lighting leads to cost and energy savings, and a lower reliance on fossil-based fuels. Approximately 10 percent of existing U.S. street lighting has been converted to solid state LED technology, with many efforts underway to accelerate this conversion.
“Despite the energy efficiency benefits, some LED lights are harmful when used as street lighting,” AMA Board Member Maya A. Babu, MD, said in a news release. “The new AMA guidance encourages proper attention to optimal design and engineering features that minimize detrimental health and environmental effects.”
High-intensity LED lighting designs emit a large amount of blue light that appears white to the naked eye and create worse nighttime glare than conventional lighting. The intense, blue-rich LED lighting can decrease visual acuity, resulting in safety concerns and road hazards.
The new policy encourages communities to:
- Minimize and control blue-rich environmental lighting by using the lowest emission of blue-light possible
- Properly shield all LED lighting to minimize glare and detrimental human health and environmental effects
- Consider using dimmers on LED lighting for off-peak times
In addition to its impact on drivers, blue-rich LED streetlights operate at a wavelength that adversely suppresses melatonin during the night. It is estimated that white LED lamps have five times greater impact on the body’s natural sleep-wake cycle than conventional street lamps. Recent surveys found that brighter residential nighttime lighting is associated with reduced sleep times, dissatisfaction with sleep quality, excessive sleepiness, impaired daytime functioning and obesity.
Action to address illegal methamphetamine production
Physicians adopted policy that supports the replacement of current pseudophoedrine-containing over-the-counter products with formulations that are resistant to methamphetamine production as well as initiatives that focus on prevention and treatment of methamphetamine abuse.
Additionally, physicians encouraged the widespread and proper use of the national precursor log exchange (NPLEx), a real-time electronic logging system used to track over-the-counter medications that can be used to make methamphetamine.
Increasing training for hemorrhage control
The AMA adopted policy calling for state medical and specialty societies to promote the training of first responders and the lay public in techniques of bleeding control. With increases in active shooter incidents, the need is greater than ever for training in hemorrhage control training, the AMA policy says.
The AMA also called for providing hemorrhage control kits to law enforcement and other first responders. The U.S. military found that uncontrolled hemorrhage due to trauma was the most common cause of preventable death among more than 6,800 military casualties in Iraq and Afghanistan.
“After implementing hemorrhage control training to help victims of trauma, the military saw a significant decrease in the number of deaths caused by uncontrolled bleeding in these patients,” AMA Board Member Jesse M. Ehrenfeld, MD, said in a news release. “We believe that by equipping the public, police and others who are first on the scene of a traumatic event with training and supplies to control bleeding, we will also be able to help save more trauma patients.”
Promoting long-term health and wellness in the juvenile justice system
The U.S. leads the industrialized world in the rate of confinement of young people. African-Americans and Latinos especially suffer from large-scale incarceration.
The AMA adopted a policy calling for reforms of the nation’s juvenile justice system to help protect the long-term health and safety of adolescents during and after confinement. New policy also aims to help prevent youth incarceration when rehabilitation or community-based alternatives are most appropriate and no threat to public safety exists.
The AMA called for other measures to reduce youth incarceration, including replacement of “zero-tolerance” school policies with other discipline policies, raising the upper age limit for juvenile court jurisdiction, research to identify programs that could reduce minority contact with the juvenile justice system and encouraging juvenile justice facilities to prohibit discrimination based on sexual orientation, gender identity and gender expression.
“Most incarcerated youth today suffer from childhood trauma, mental health disorders or substance use disorders and require proper treatment,” Dr. Ehrenfeld said in a news release. “While we have extensive scientific evidence showing significant differences in cognitive function and decision-making between adolescents and adults and the impact trauma has on adolescent brain development, the law has been slow to apply these scientific findings to the juvenile justice system.”
“The AMA is calling on the federal government, states and schools to implement policies and programs that focus on rehabilitating and treating incarcerated youth to promote their long-term health and wellness, and help prevent unnecessary confinement when better alternatives exist,” Dr. Ehrenfeld said.
