The American Medical Student Association (AMSA) is leading a national reform effort in conjunction with federal legislation to address the issues of physician burnout and medical errors. AMSA is encouraging medical students nationwide to call their representatives in Washington, D.C., to support the federal regulation of resident work hours as introduced by the Patients and Physician Safety and Protection Act of 2001 (PPSPA). The legislation was introduced in November 2001 by Rep. John Conyers, Jr., (D-Mich.) and calls for a limit on resident work hours of 80 hours per week and no more than 24 hours per shift. The proposed legislation will also provide for annual surveys of resident-physician working conditions, public disclosure of hospitals that violate the hours limits and the imposition of civil penalties for noncompliant hospitals. This legislation has been endorsed by such organizations as the Committee of Interns and Residents, the Center for Patient Advocacy, the American Medical Women’s Association, Public Citizen, and the Service Employees International Union.

There it was, in an article in black and white, on page 3129 of the June 19, 2002 issue of the Journal of the American Medical Association (JAMA), unequivocally stating: “We recommend that all adults take one multivitamin daily. This practice is justified mainly by the known and suspected benefits of supplemental folate and vitamins … in preventing cardiovascular disease, cancer, and osteoproosis….” The authors of the article even included a nifty little table with an overview on vitamins and their benefits for the attention-deprived reader.

Remember, we are talking about the American Medical Association (AMA) here–doctors from the hallowed halls of mediocrity when it comes to discussing anything to do with dietary supplements. This plainly rings of some sort of endorsement since JAMA is the AMA’s official organ. Could it be someone slipped them some sort of “Sensibility Viagra” which awakened the flaccid brain cells occupying those coveted editorial chairs?

One month later JAMA created another tempest when they revealed, lo and behold, hormone replacement therapy actually carries risks (see accompanying editorial). And this, only a week or two after AMA handwringing in front of the press decrying the cost of malpractice insurance and how it is driving numerous doctors out of business. Although certainly, amputating the wrong foot, as some doctors are wont to do, will always fall under the heading of malpractice. Of course, one or two inadvertent amputations won’t get your license yanked by the “good old boy” network of state medical boards packed with AMA cronies. Bad doctors have more lives than the proverbial cat. Perhaps if that 10 percent of doctors who continually make the major mistakes truly had their licenses revoked, the malpractice insurance rates would go down. But that would be even more of a double standard, since true malpractice exists simply by ignoring what has been in front of you for years; in other words, being so shortsighted you refuse to see the value of vitamin therapy or the danger of hormone replacement. The data is all there, it always has been, it’s just not in JAMA and the other “traditional” journals. Doctors need to actually look for the relevant treatments that will benefit their patients now, not ten years later when they read the watered-down versions. Read something that will be clinically useful…. Hmmm, I can recommend a nice little journal….

Former Surgeon General Dr. David Satcher is the third recipient of the Association of American Medical Colleges’ Herbert W. Nickers, M.D. award. Satcher was honored at the association’s 113th Annual Meeting held last month in San Francisco. Satcher delivered an address on targeting health care disparities by increasing the diversity of medical school applicants at the meeting.

The Herbert W. Nickens, M.D. Award, named for the AAMC’s former vice president of the Division of Community and Minority Programs, is presented to an individual who has made outstanding contributions to promote justice in medical education and health care.

As Surgeon General from 1998 to 2002 and assistant secretary for health, the second person in history to hold both positions simultaneously, Satcher led the federal government’s effort to eliminate racial and ethnic disparities in health care. This initiative was incorporated into one of two major goals of “Healthy People 2010,” the nation’s public health agenda for the next several years.

Satcher is currently director of the National Center for Primary Care at the Morehouse School of Medicine, where he once served as professor and chairman of community medicine and family practice, over two decades ago.

Last year, the Nickens Award was presented to former University of Michigan President Lee Bollinger for his commitment to promoting diversity in higher education. The first recipient of the Nickens Award was Dr. Donald Wilson, dean of the University of Maryland School of Medicine, and founding member of the Association of Academic Minority Physicians.

The Association of American Medical Colleges represents the 125 accredited U.S. medical schools; the 16 accredited Canadian medical schools; some 400 major teaching hospitals, including Veterans Administration medical centers; more than 105,000 faculty in 98 academic and scientific societies; and the nation’s 66,000 medical students and 97,000 residents.

* Subtle, natural course changes are seen as most effective.

* Students are trained to respond to “all events,” not just specific attacks.

* Efforts are under way to enable benchmarking by other institutions.

The bioterrorism training program at the University of Pittsburgh School of Medicine, among the first of its kind in the nation, has been described as a model by the Washington, DC-based Association of American Medical Colleges (AAMC) during its recent annual meeting.

The program integrates level-appropriate content throughout the four-year medical school curriculum, placing the appropriate content into existing courses and evaluations. Students are taught how to identify, triage, and treat patients exposed to biological, chemical, and radiological terrorism, emerging infectious diseases, and environmental pollution. They also are taught about food and water source safety, the impact of pharmaceutical treatments, terrorist hoaxes, and technologic threats to the continuity of public and health services.

Officials from the school currently are working to help foster benchmarking in other medical teaching facilities in an effort to better prepare health care professionals to deal with potential future biodisasters.

“This type of content has always been included in med school curricula,” notes John D. Mahoney, MD, assistant dean for medical education. “But when I learned about it in the `80s, it was as history–anthrax was about sheep handlers, and the military worried about chemical weapons. Military medical school had hundreds of hours of classes, while we had snippets.”

But when Mahoney developed the current curriculum, he brought to the process his background as an emergency physician and toxicologist.

“Disaster response is about getting out there and getting your hands dirty. I was used to thinking about all of the bad things that could happen–and helping our hospital plan for them. As we headed toward Y2K, as the rest of the country was increasingly worried about threats of chemical weapons, I felt we should cover them in our curriculum,” he explains.

An American Medical Association (AMA) report on the effects of alcohol on the brain dispels the myth that youth are more resilient than adults to adverse effects of drinking. Harmful Consequences of Alcohol Use on the Brains of Children, Adolescents, and College Students is a comprehensive compilation of two decades of scientific research on how alcohol alters the developing brain and causes possibly irreversible damage.

On average, youngsters try alcohol for the first time at the age of 12, and nearly 20% of 12- to 20-year-olds report being binge drinkers (having four or five drinks in a row). Citing the alcohol industry’s aggressive marketing to youth as one of this trend’s key drivers, the AMA has called on cable stations and television networks to pledge publicly to stop airing alcohol commercials to young viewers. “After NBC announced their plans [In December, 2001] to run hard-liquor ads, the AMA successfully lobbied the network to reverse this ill-advised decision,” notes J. Edward Hill, chairman of the organization. “One year later, the alcohol industry is just as aggressive in pursuing underage minds through television, and television is all too willing to comply. This is out of step with public health and public opinion.”

A nationwide poll conducted for the Robert Wood Johnson Foundation found that nearly 70% of Americans favor a ban on television liquor ads and 59% support banning beer commercials. The AMA pledge calls on networks and cable TV not to broadcast alcohol ads on programs that air before 10 p.m. or that have 15% or more underage viewers. It also calls on networks and cable TV not to broadcast alcohol commercials depicting mascots, cartoons, or other characters that are targeted to younger viewers.

“It’s time TV executives and the alcohol industry stop profiting at the hands of those most harmed by drinking,” Hill argues. “This report reminds us of how important it is to protect our children during these crucial early years of development instead of filling their growing brains with the misleading notions that drinking is normal and without consequence.”

President Bush got a great deal of media attention when he ended the American Bar Association’s special role in evaluating federal judges- but a few weeks later, the press largely overlooked Bush’s slap at another white-collar professional group, the American Medical Association. Bush gave his first important health-care address to the American College of Cardiologists, even though presidents traditionally reserve this speech for the AMA. The decision was occasioned principally by concern about the AMA’s political tilt, which has diminished the once-revered organization’s influence and damaged its reputation for protecting the interests of doctors and patients.

Many Republicans, including those at the White House, see the AMA leadership as just another Democratic party constituency. Not so long ago, the AMA was a reliable GOP ally: In 1965, the AMA stood with Republicans in denouncing Medicare as “socialized medicine,” and in strongly resisting excessive regulation of health care; after a brief flirtation with President Clinton’s health-care overhaul in 1993, the AMA helped Republicans crush it. But AMA leaders no longer consider the Republican party the vehicle to advance their interests; in fact, these interests now converge with those of the most liberal wing of the Democratic party.

The AMA’s realignment has had consequences: The association now represents just 32 percent of American physicians, down from a peak of nearly three-fourths in the early 1970s. Much of the decline stems from the increasing specialization of medicine, which has forced doctors into specialty groups better equipped to represent them; but another important factor is the AMA’s strange alliance with trial lawyers. The AMA and the American Trial Lawyers Association favor legislation permitting unlimited lawsuits against HMOs. Together, they helped defeat three GOP senators who held a different view. As a crucial member of the “Patient Access Coalition,” the AMA financed television ads against Sens. Slade Gorton (Wash.), Spencer Abraham (Mich.), and John Ashcroft (Mo.), all of whom opposed the AMA on HMO liability. “Tell your senators to stand up for patients and let America’s doctors make your health-care decisions-not HMO bureaucrats,” the ads proclaimed.

The American Medical Directors Association (AMDA) 2002 survey of its members found that more than 433 nursing home medical directors have had to stop working in facilities because they lost their liability coverage. Also, more than 1,450 nursing home physicians responsible for 168,000 residents are reducing resident care hours, not providing certain services, or are referring more complex cases in reaction to medical liability concerns. Many of these physicians report facing annual premium increases averaging 154%, and 5.6% of medical directors say they are unable to get medical malpractice coverage at all because they work in nursing homes.

“The [AMDA] is closely monitoring the medical liability crisis because of its unfortunate impact on long-term care patients,” said AMDA President Jacob Dimant, MD, CMD, reacting to President Bush’s State of the Union call for liability tort reform. “We are seriously concerned that many frail, elderly Americans are losing access to vitally important long-term care services due to the unavailability of medical liability insurance for our members. As nursing home physicians lose their malpractice coverage, they are being forced out of long term care, leaving their patients with fewer options for quality healthcare.”

According to data released by the Association of American Medical Colleges (AAMC), the number of applicants to U.S. medical schools this year increased by 3.4 percent for the first time in six years. Almost 35,000 persons applied to attend medical school in the 2003-2004 school year compared with 33,625 last year. The main reason for the increase was the number of female applicants (17,672) who made up more than one half of medical school applicants for the first time. The number of black applicants overall rose almost 5 percent to 2,736, but the number of blacks who entered medical school declined by 6 percent to 1,056. Black female applicants increased by almost 10 percent to 1,904. Hispanic applicants increased by less than 2 percent to 2,483, while the number who entered medical school declined by almost 4 percent to 1,089. Included in the applicant pool were 26,160 persons who were applying to medical school for the first time. The data also showed that the sharp decline in male applicants, a trend that started in 1997, leveled off this year with a total of 17,113 applicants, which was slightly more than last year. The number of applicants applying to medical school peaked at around 47,000 in 1996 and reached the lowest point last year.

The Emergency Cardiovascular Care Committee of the American Heart Association (AHA) has published a policy statement on medical emergencies in schools. “Response to Cardiac Arrest and Selected Life-Threatening Medical Emergencies: the Medical Emergency Response Plan for Schools” appears in the January 6, 2004 issue of Circulation. The policy statement introduces a public health initiative to help schools prepare to handle life-threatening medical emergencies.

Life-threatening emergencies can occur in any school, at any time. They can be caused by preexisting health problems, violence, injuries, and other unexpected events. They can affect students or the adults who teach and supervise them. At the same time, schools now employ fewer nurses than before, leaving teachers, coaches, and other staff in charge of first aid before the arrival of emergency medical services (EMS) personnel. Yet, in one recent Midwestern survey, one third of teachers had no training in first aid, and almost one half had never completed a course in cardiopulmonary resuscitation (CPR).

The following five key elements are recommended by the AHA for medical emergency response plans in schools:

1. Effective and Efficient Communication Throughout the School Campus. The statement recommends establishing a rapid communication system that links all parts of a school campus, including outdoor facilities and practice fields, to the local EMS system.

2. Coordinated and Practiced Response Plan. Schools are encouraged to develop a response plan applicable to a variety of common medical emergencies. Potential resources for developing a plan include the school nurse, athletic team physicians and trainers, and the local EMS agency. The emergency response plan should be practiced at the beginning of each school year and periodically throughout the year.

3. Risk Reduction. The statement emphasizes injury prevention with appropriate precautions in classrooms and on playgrounds. It suggests identifying students, faculty, and staff members who have medical conditions that might increase their risk of life-threatening emergencies. School personnel should be trained and equipped to respond to the emergency conditions.

It’s already that time of year again–by now you’re wrapping up your training runs for the Boston Marathon and getting mentally prepared to tackle the race course. And once again, the American Medical Athletic Association (AMAA) will be there to support your efforts and provide you with an educational and fun weekend.

The following details outline the AMAA-sponsored events for the Boston Marathon weekend and address questions frequently asked by runners and/or meeting attendees.

The AMAA’s 33rd Annual Sports Medicine Symposium at Boston: The Runner’s Body

The symposium is scheduled for April 17 and 18 and will be held at The Colonnade Hotel (Huntington Ballroom), 120 Huntington Avenue, Boston.  Following that date, call 800-776-2732 to register. Onsite registration begins at 7:00 a.m. on April 17; however, be prepared to pay an additional onsite registration fee.

ACPM Continuing Medical Education

The 33rd Annual Sports Medicine Symposium at Boston has been planned and implemented in accordance with the Essential Areas and Policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American College of Preventive Medicine and the American Medical Athletic Association. ACPM designates the lecture portion of the educational activity for a maximum of 10.6 Category 1 credits. This activity has been approved for American Medical Association Physician’s Recognition Award credit. This activity has been reviewed and is acceptable for up to 10.75 prescribed credits by the American Academy of Family Physicians. 1.1 CEUs will be awarded for athletic trainers through the NATA.