MMS, AMA Oppose E-cigarettes for Youth, Among Other Policies

WALTHAM — Resolutions on electronic cigarettes, the use of antibiotics in farm animals, physician participation in accountable-care organizations, and physician preparedness for public health and disaster response led the list of the policies adopted by physicians of the Mass. Medical Society (MMS) at its interim meeting held last month.
The interim meeting brings together hundreds of Massachusetts physicians from across the state to consider specific resolutions on public-health policy, healthcare delivery, and organizational administration by the society’s House of Delegates, its policy-making body. Resolutions adopted by the delegates become policies of the organization.
Delegates voted for a resolution stating that the MMS opposes the marketing, sales, and use of e-cigarettes and other nicotine-delivery products among youth, particularly for people under the age of 18, and urging the MMS top keep working with state lawmakers and officials to develop strategies to prevent the marketing, sale, and use of those products for individuals within that age group.
In voting for the policy, MMS noted that the use of electronic cigarettes by U.S. middle- and  high-school students (grades 6-12) more than doubled from 3.3{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} in 2011 to 6.8{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} in 2012, according to the U.S. Centers for Disease Control. The society also expressed concern that the nicotine-containing vapor generated from the battery-powered e-cigarettes is often flavored, which can make them more appealing to young people, and that the use of e-cigarettes has the potential negative impact of nicotine on adolescent brain development and may encourage young non-smokers to become users of conventional cigarettes or other tobacco products.
The statement coincides with the American Medical Society’s similar concern over e-cigarettes. At the recent interim meeting of its own House of Delegates, the AMA adopted policy advocating for the U.S. Food and Drug Administration (FDA) to extend its tobacco regulations to include all non-pharmaceutical tobacco and nicotine products, including e-cigarettes, pipes, cigars, and hookahs. The AMA said FDA oversight of these products is necessary in order to ensure safety and proper labeling, and to deter adulteration and the sale of tobacco products to minors.
The AMA’s existing policy on e-cigarettes from 2010 recommends that they be classified as drug-delivery devices, subject to the same FDA regulations as all other drug-delivery devices, and supports prohibiting the sale of e-cigarettes that are not FDA-approved.
“This policy recommendation for FDA could help ensure that e-cigarettes and other tobacco products have proper oversight and regulation to limit the detrimental health consequences that come from these products,” said AMA board member Dr. Albert Osbahr III. “Very little data exists on the safety of these tobacco and nicotine products, and the FDA has warned that they are potentially addicting and contain harmful toxins.”
Other policies adopted by the Mass. Medical Society include:
• Use of antibiotics. Declaring that the widespread use of antibiotics in animal husbandry presents a threat to personal and public health by increasing the resistance to antibiotics, physicians resolved to educate the public about the antibiotic resistance that arises from excessive use of non-therapeutic doses of antibiotics in farm animals and to advocate for legislation and regulations that prohibit the use of non-therapeutic antibiotics in farm animals in the Commonwealth.
• Accountable-care organizations. With the rapid growth of ACOs as a new model of healthcare delivery, the MMS adopted an extensive policy on physician participation in these organizations to include such considerations as eligibility, use of health-information technology, transparency of information, governance, management and administration, legal and contractual compliance, and standards for quality of care and clinical practice.
• Physician preparedness and disaster response. Stating that emergency preparedness and disaster-response training are essential parts of public health, and with the Boston Marathon bombing still fresh in the memory, delegates voted to engage physicians in preparedness efforts and to support the development of emergency-preparedness and disaster-response resources for physicians.
Other policies adopted by the American Medical Assoc. at its recent interim meeting include:
• Physician satisfaction.
The AMA adopted policy to study current tools and develop metrics to measure physician satisfaction. Findings from a recent RAND Corp. study sponsored by the AMA show that being able to provide high-quality healthcare is a primary driver of job satisfaction among physicians, and obstacles to quality patient care are a source of stress for doctors.
“Physicians too often feel disconnected from what really matters — their patients — yet it’s providing patients with high-quality care that drives a physician’s professional satisfaction,” said AMA President Dr. Ardis Dee Hoven. “A physician’s professional satisfaction is important to both increase the quality of care for patients and better recruit and retain physicians in healthcare today.”
• Modern chemical-controls policy. The AMA adopted new policy calling on Congress to amend the Toxic Substances Control Act (TSCA) of 1976, the only major environmental law that has never been updated since its adoption. The TSCA does not currently require toxicological testing of chemicals before they are used, and many toxic chemicals are in use today.
Dangerous chemicals disproportionately affect vulnerable populations and communities through proximity to industrial production facilities, landfills, and contaminated properties. The AMA will work with relevant stakeholders to modernize the TSCA to require chemical manufacturers to provide adequate safety information on all chemicals and give federal regulatory agencies reasonable authority to regulate hazardous chemicals.
Exposure to toxic chemicals is associated with numerous health issues, including higher rates of cancer, asthma, low birth weight, autoimmune diseases, diabetes, and obesity,” said AMA board member Dr. Stephen Permut. “Ensuring these substances are safe will help better protect public health and patient safety.”
• Stricter OSHA standards for permissible exposure to silica dust.
The AMA adopted policy supporting a proposed rule from the Occupational Safety and Health Administration (OSHA) to establish a stricter permissible exposure limit (PEL) for respirable crystalline silica. Crystalline silica is fine dust that is used as an abrasive blasting agent in industries including mining, sandblasting, and construction. Research has shown that exposure to respirable crystalline silica leads to significant respiratory disease, including a progressive and often fatal lung disease known as silicosis.
“The current level of silica exposure can impact worker health, and lead to many cases of preventable disease,” said AMA board member Dr. Patrice Harris. “Supporting the OSHA proposed rule can save lives and significantly cut down on worker illness.”

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