CHICAGO – The American Medical Association (AMA) gathered physician and medical student leaders from all corners of medicine at its Annual Meeting of the House of Delegates to shape guiding policies on emerging health care topics.

The new policies adopted on the final voting day of voting at the AMA Annual Meeting include improving health care of minority communities in rural areas, increasing awareness of high dose biotin interference in lab test results, calling on stores selling tobacco products to post information about anti-smoking hotlines, decreasing youth access to e-cigarettes, regulating nicotine analogue products, and protecting physician practices and patients against cyber security attacks.

Improving health care of minority communities in rural areas

According to the CDC, more than 46 million people, or 15 percent of the population, live in rural areas in the U.S. Research shows that people in rural communities experience disproportionately higher rates of cardiovascular disease, stroke, cancer, diabetes and respiratory illness, and minority communities in rural areas are at even higher risk for poor health outcomes. Aimed at improving health outcomes for minority communities in rural areas, the AMA’s new policy encourages health promotion, access to care, and disease prevention through educational efforts and publications that are specifically tailored to these populations. The policy also encourages enhanced understanding by federal, state and local governments of the unique health and health-related needs, including mental health, of minority communities in rural areas in an effort to improve their quality of life.

Under the new policy, the AMA will encourage the collection of vital statistics and other relevant demographic data of minority communities in rural areas and will support telehealth access for these communities.

“With widening health disparities between rural and urban communities, particularly for minority communities in rural areas, we must continue working to reduce these inequities, ensure greater access to care, and significantly improve the health of people who live in rural parts of our country,” said AMA President Bruce A. Scott, M.D.

A recent AMA viewpoint by Dr. Scott, Improving Health in Rural Areas is Within Our Collective Reach, outlined some of the ways the organization is advocating for policy changes to improve health and access to care, including Medicare reform, telehealth, and reduced administrative burdens for patients and physicians.

Increasing awareness of high dose biotin supplements interfering in laboratory tests

The use of over-the-counter biotin supplements for hair and nail growth has grown exponentially in recent years. The U.S. Food and Drug Administration (FDA) defines the recommended daily allowance of biotin as 30 mcg per day for an adult, yet the majority of biotin supplements on the market have daily dosages in excess of this recommendation—ranging from 600 to 10,000 mcg. While taking high doses of biotin hasn’t been linked to negative side effects, the FDA issued a safety warning in 2017 that high-dosage biotin supplement use may interfere with accuracy of laboratory test results, including falsely low troponin levels that could lead to missed or delayed heart attack diagnoses. To help raise awareness among both patients and physicians of possible lab test interference resulting from biotin megadoses, the AMA adopted policy supporting efforts to include a clear disclaimer on the bottle of over-the-counter biotin supplements that states the possibility of lab test interference.

“With a proliferation of biotin supplements on the market promoting hair and nail growth, it is our duty to ensure all patients, and their physicians, are aware of the potential for these supplements to interfere in a variety of laboratory tests. For example, not recognizing the interaction of biotin with a troponin lab test can have serious health consequences, such as falsely underdetecting an active heart attack,” said AMA Board Member Alexander Ding, M.D., M.S., M.B.A.

AMA says stores selling tobacco should post information about anti-smoking hotlines

Bolstering its robust tobacco cessation policies, the AMA House of Delegates favored a policy requiring stores that sell tobacco or nicotine products to display information about anti-smoking hotlines.

Hotlines, such as one operated by the Centers for Disease Control and Prevention, provide free confidential coaching over the phone to help people stop smoking. Hotlines offer many of the services and similar support to those in smoking-cessation classes and can be a valuable complement to physician care.

“For years, anti-smoking hotlines have helped people stop smoking with trained coaches who offer personalized plans to quit. Requiring stores to post a hotline number is part of the AMA’s longtime work to reduce tobacco-related morbidity and mortality,” said AMA Trustee Ilse R. Levin, D.O., M.P.H. & TM.

Decreasing youth access to e-cigarettes

Building on the AMA’s long-time advocacy and efforts to protect young people from the harmful effects of tobacco and nicotine use, the new policy aims to decrease youth access to e-cigarettes by supporting measures that decrease the geographic density of tobacco stores, including preventing retailers from selling tobacco products in stores located in close proximity to schools. The policy also supports including all forms of e-cigarettes, particularly disposable, refillable cartridge, and tank-based e-cigarettes, in the language and implementation of relevant nicotine-based policies and regulations by the FDA and other regulatory agencies.

“E-cigarette use among our young people continues to be a significant threat to their health and well-being and threatens to get a new generation hooked on nicotine. We will continue to push for more stringent policies to keep e-cigarettes out of the hands of young people to protect their health and well-being,” said AMA Board Member Sandra Adamson Fryhofer, M.D.

The Council on Science and Public Health report that served as the basis for this policy noted that despite the recent decline in e-cigarette use among high school students and ongoing efforts at the national, state, and local levels to implement tobacco control strategies, including FDA regulatory actions, e-cigarette use among adolescents remains unacceptably high. According to the 2023 National Youth Tobacco Survey, more than 2 million students use e-cigarettes, with 4.6 percent of middle school and ten percent of high school students reporting current use.

Urging regulation of all nicotine analogue products

With a rise in electronic cigarette products containing synthetic nicotine analogues, such as 6-methyl nicotine, that are potentially more potent and more toxic than nicotine, the AMA adopted policy opposing the development, production, market and sale of nicotine analogue consumer products. Under the new policy, the AMA also urges the FDA to regulate all nicotine analogue products as drugs.

“We believe that companies using nicotine analogues in their e-cigarette products are using chemicals like 6-methyl nicotine to circumvent existing regulations meant to protect public health. Given concerns that these products are potentially more addictive and cause increased adverse effects, we must not allow them to go unregulated. We urge the FDA to exert its authority to regulate synthetic nicotine products the same as products containing plant-derived nicotine,” said AMA Board Member Toluwalase Ajayi, M.D.

AMA calls for cybersecurity relief fund

To protect the viability of physician practices – and patient access to them -- in the event of a cybersecurity attack, the AMA’s House of Delegates called for a cybersecurity relief fund financed by payors and for the benefit of providers. 

Health insurance companies and other payors would be required to contribute to the relief fund, and the funds could be used for ‘uninterrupted’ payments to all providers in the event of a cyberattack affecting payments. Physicians, especially those in small practices, have reported the cyberattack has resulted in suspended claim payments and the inability to submit claims or verify benefits.

“The recent cyberattack put on display the warnings the AMA has issued for several years about possible security compromises of health record data. The Change cyberattack proved that the repercussions roll downhill to patients and physicians; therefore, it is critical that payors have a contingency plan to support physicians in times like these,” said AMA Immediate Past President Jesse M. Ehrenfeld, M.D., M.P.H.

“This is a patient safety issue. With more health information being moved around electronically, the entire health care ecosystem can be put at risk. We need policies that improve the safety, resilience, and security of the health care industry.”