NOV/DEC 2006
Volume 12 - No. 4
SRNT Newsletter
November/December 2006, Volume 12, Number 4
Q & A with Ron Davis, M.D., AMA President Elect
|
A while back, a request was posted on the SRNT listserv, soliciting questions we might pose to Dr. Davis, who answers those questions for us now, below:
Can the AMA help influence the Senate to ratify the Framework Convention on Tobacco Control (FCTC)?
The AMA wrote a letter to President Bush on April 22, 2004, urging him to sign the treaty and to send it to the Senate for ratification. The letter concluded with the following statement:
"WHO has warned that tobacco now kills some five million people each year and, absent the measures included in the new international treaty, this figure could climb to 10 million deaths a year, with 70% of them occurring in the developing world. It would be tragic if your new AIDS relief program helped to prevent millions of deaths from AIDS in developing nations but our country did not do all that it could do to prevent a horrible escalation in tobacco-related deaths in the developing world. United States ratification of the FCTC would be a giant leap forward in that effort."
Then-Secretary of Health and Human Services Tommy Thompson signed the FCTC on behalf of the United States on May 10, 2004. Regrettably, the President has not sent the treaty to the Senate for ratification. The AMA was one of 37 organizations that signed a letter sent to President Bush on October 19, 2005, urging him to submit the FCTC to the Senate for ratification.
In an editorial in the Annals of Internal Medicine (2006; 144: 444-446), I wrote that "Physicians and other health advocates should make the United States' failure to ratify the FCTC a cause célèbre."
In a one-hour meeting that the AMA Board of Trustees had with current HHS Secretary Michael Leavitt on September 11, 2006, I used my opportunity to ask a question to advise the Secretary that if he is able to convince the President to send the FCTC to the Senate for ratification, the physicians of America would be profoundly grateful.
Unfortunately, the FCTC seems to have dropped off the radar in political circles and political discourse. All of us, as individuals and through the organizations with which we are affiliated, need to raise the "noise level" regarding the treaty. The election seasons in 2006 and 2007 would be a good time to do that.
What is the AMA doing to work with the World Medical Association (WMA) and WHO regarding the global impact of tobacco on health?
The AMA is an active member of the WMA, which is a consortium of about 80 national medical associations (listed at http://www.wma.net/e/). The WMA has adopted a strong statement on tobacco (http://www.wma.net/e/policy/h4.htm ), which needs to be updated, and has adopted a resolution in support of the FCTC (http://www.wma.net/e/policy/cr_4.htm ).
The WMA, which is headquartered in Ferney-Voltaire, France (near Geneva), has a small staff and a modest budget, so it is not yet equipped to devote huge resources to the tobacco problem.
However, I hope that it will find ways to increase its visibility and activity in international tobacco control. For example, I am now representing the WMA on the International Liaison Group on Tobacco or Health, which has two main functions: a) to select the venue of the World Conferences on Tobacco or Health; and b) to follow-up on the previous conference, especially by tracking the status of the Resolutions of the previous conference.
I have had recent discussions with Dr. Carolyn Dresler, head of the Tobacco and Cancer Group at the International Agency for Research on Cancer, about ways in which IARC and the WMA might work together in international tobacco control and tobacco research. IARC is also located near Geneva (in Lyon, France). Clearly the WMA has great potential to contribute to international tobacco control through its 80 organizational members. As one of the AMA's three delegates to the WMA, I am looking for ways to help the WMA increase its efforts in this area. I would welcome ideas from members of SRNT on how to accomplish that.
The AMA does not work on a regular basis with the WHO, but has the following policy: "The AMA: (1) continues to support the World Health Organization as an institution; (2) advocates full funding as understood by the United States Government for the World Health Organization; (3) will participate in coalitions with other interested organizations to lend its support and expertise to assist the World Health Organization; and (4) encourages the World Medical Association to develop a cooperative work plan with the World Health Organization as expeditiously as possible" (policy H-250.992).
What is the AMA doing to ensure that tobacco prevention, cessation, and the basics of evidence-based Guidelines are taught in medical school curricula as required topics?
The AMA has extensive policy pertaining to tobacco prevention and cessation, most of which can be found in a 2004 report available online (http://www.ama-assn.org/ama/pub/category /13635.html). A section of that report, under the heading "Physician Responsibilities for Tobacco Cessation," addresses the need to train physicians and medical students to enable them to help their patients quit smoking.
The AMA and the Association of American Medical Colleges are the joint sponsors of the Liaison Committee on Medical Education (LCME), which is the nationally recognized accrediting authority for medical education programs leading to the M.D. degree in U.S. and Canadian medical schools. The LCME's accreditation standards state that "Clinical instruction must cover all organ systems, and include the important aspects of preventive, acute, chronic, continuing, rehabilitative, and end-of-life care" (http://www.lcme.org/functionslist.htm ). The standards do not spell out details of the required clinical instruction in "preventive care," but clearly the treatment of tobacco use and dependence should be an important part of that instruction.
Studies have shown that there is substantial room for improvement in medical school teaching regarding tobacco use and its impact on health, and tobacco prevention and cessation interventions (Ferry, Grissino, & Runofola, 1999; Richmmond, Debono, Larcos, & Kehoe, 1998). All of us who have affiliations with medical schools should work to ensure that each medical student graduating from those schools has achieved proficiency in tobacco control competencies (Geller et al., 2005).
Richmond, R.L., Debono, D.S., Larcos, D & Kehoe, L. (1998). Worldwide survey of education on tobacco in medical schools. Tob Control, 7, 247-252.
Ferry, L.H, Grissino, L.M., & Runofola, P.S. (1999). Tobacco dependence curricula in US undergraduate medical education. JAMA, 282, 825-829.
Geller, A.C., et al. (2005). Tobacco control competencies for US medical students. Am J Public Health, 95, 950-955.
What will the AMA Board do with the resolution introduced by Dr. Steve Hanson about including the assessment of tobacco use in all clinical trials (from trial registration through follow-up)?
In response to that resolution, the AMA Board of Trustees will submit BOT Report 9 to the AMA House of Delegates at its meeting on November 11-14, 2006. The report will recommend adoption of the following statement: "That our American Medical Association urge clinical investigators to carefully consider the need to include an assessment of smoking status, smoking history, and exposure to secondhand smoke in the design of clinical trial protocols and analysis of patient outcomes."
How did you become President of AMA? When will you be President? Is it a full-time paid job?
I have been active in the AMA for 27 years, since becoming involved in AMA activities as a second-year medical student. Various leadership positions I have held in the organization, including membership on the AMA Board of Trustees in 1984-87 (as the resident physician trustee) and in 2001-2006, enabled me to run successfully for election as president-elect in June 2006. I will serve as president-elect for a year, until my inauguration as president on June 26, 2007. I will then serve as president for a year, followed by a year as immediate past president. Presidential responsibilities are shared among the three "presidents," although the middle year is the busiest.
The AMA pays honoraria to its officers and trustees to compensate them (or their employers) for time lost from their medical practice during their AMA activities. Some AMA presidents are able to work full-time in their AMA role, often because they have retired from medical practice. During my tenure, I am going to keep my "day job" at the Henry Ford Health System in Detroit, where I run a Center for Health Promotion and Disease Prevention and oversee a smoking cessation program. So my AMA presidency will not be a full-time job, but will probably account for at least half of my professional work (of course we're not talking about a 40-hour work week here).
Please describe what the President of the AMA does?
The AMA Bylaws indicate that the president shall "serve as the principal spokesperson in enunciating and advocating the official policies and positions of the Association." The president-elect and immediate past president serve as "a principal spokesperson...." This involves giving a lot of speeches, doing interviews with the media, meeting with high-level policy-makers in government and the private sector, testifying in Congress, and serving in other representational roles. The three presidents are members of the AMA Board of Trustees and comprise the AMA's delegation to the WMA, serving on its 16-member Council (the WMA's governing body) and in its General Assembly.
Do you have any special projects you want the AMA to pursue?
The AMA has a focused health care advocacy agenda, which includes six priority areas (discussed at http://www.ama-assn.org/ama/pub/category/12842.html ). One of those priority areas is "improving the health of the public," and it gives specific mention to healthy lifestyles (especially around tobacco, alcohol, and obesity), reducing health disparities, and disaster preparedness. During my presidency I will work on all of the items in the AMA's health care advocacy agenda; but as a preventive medicine physician, I will be particularly vocal and energetic covering our public health priorities.
Are there any tobacco or research-related activities that you wish the AMA to especially focus on?
As mentioned above, the AMA has extensive policy on tobacco. Also, we have been very active in tobacco control through the SmokeLess States program (which the AMA administered from 1994 to 2004, with funding from the Robert Wood Johnson Foundation), by signing onto amicus (friend-of-the-court) briefs in tobacco litigation, and by supporting tobacco control legislation (e.g., the smoke-free ordinance adopted by the city of Chicago). We partnered with Partnership for Prevention and the Campaign for Tobacco-Free Kids in petitioning the Centers for Medicare and Medicaid Services to cover tobacco cessation counseling through the Medicare program. AMA Board of Trustees Report 8, to be introduced to the AMA House of Delegates at its meeting on November 11-14, 2006, will recommend that the AMA work with other medical societies "to seek replacement of the Medicare G-codes for tobacco cessation counseling with CPT codes, as well as their appropriate valuation through the RUC process," so that Medicare will pay a more reasonable fee for tobacco cessation counseling. (The average payment now is $18.19 for "intermediate" counseling [3-10 minutes] and $27.29 for "intensive" counseling [> 10 minutes].)
A new and important opportunity for the AMA and others to build tobacco cessation treatment
into mainstream health care is the incorporation of tobacco measures into performance
measurement and pay-for-reporting and pay-for-performance programs in health care. I reviewed tobacco
measures developed for managed health care plans, hospitals, and physicians in the editorial I
wrote for the Annals of Internal Medicine (cited above). Similarly, we need to ensure that
electronic health records capture data on patients' tobacco use and health care providers' advice
and treatment regarding tobacco use.
How can SRNT help you with the above projects?
Collaboration on any of the ideas and activities mentioned above would be welcome. Effective partnerships are essential in meeting today's challenges. As Henry Ford once said: "Coming together is a beginning; keeping together is progress; working together is success."
In addition, I urge physician members of SRNT who are based in the United States to join the AMA if they aren't already members. As our new motto states, "Together we are stronger." Physicians can join online at https://membership.ama-assn.org/JoinRenew/ , and dues can be paid in monthly installments using a credit card.
Can we still call you Ron at meetings?
"Ron" will work just fine. If you use "Ronnie," I'll think you're a member of my family, because they often use my childhood nickname. If you use "Ronald," I'll think I'm in trouble, because that's what my mother called me during my youth when I was in hot water. Ronald is the Scottish form of Ragnvald, a name introduced to Scotland by Scandinavian settlers and invaders. So you can call me Ragnvald as long as you use a good Scandinavian accent. No need to call me "Mr. President," unless Madam President or Mr. President becomes customary for the president of SRNT.