Psychiatrist Wins AMA Leadership Post

In his new role as vice speaker of the House of Delegates (HOD), Lazarus will assist the speaker in directing the HOD’s activities and will also sit as a nonvoting member on the AMA Board of Trustees.

The House of Delegates is the AMA’s policymaking body.

Lazarus told Psychiatric News, “This is an important victory for psychiatry because it shows the respect that our AMA colleagues have for our specialty. It also is a reminder of the value of our section council’s long history of working within the AMA to put forth the issues that affect psychiatrists and their patients.”

Lazarus said the AMA has been particularly helpful in supporting efforts to secure parity for mental health in private insurance and the Medicare program and about issues affecting scope of practice.

John McIntyre, M.D., APA’s senior delegate to the AMA, told Psychiatric News, “This is the most important position within the AMA that a psychiatrist has ever held.”

He added, “It was not an easy victory. Dr. Lazarus’s opponent, Dr. John Fagg, a plastic surgeon from North Carolina, has a long and distinguished history within the AMA. Last December he was identified by many delegates as the clear front runner.”

Lazarus’s energy, enthusiasm, progressive message, and history of leadership in psychiatry and medicine were key factors to his success, according to McIntyre.

Alternate APA delegate Jeffrey Akaka, M.D., told Psychiatric News, “The size of the delegation and increased influence of psychiatry within the AMA were important to the victory. Each of us could turn to friends and allies in other section councils and state societies to make the case for Jeremy.”

Delegate Carolyn Robinowitz, M.D., said, “This was an uphill battle that represents politics at its best. Our job was to help give delegates a chance to know Jeremy. He did the rest. His competence is apparent immediately.”

Robinowitz is a member of the AMA Council on Scientific Affairs (CSA).

APA Medical Director James H. Scully Jr., M.D., told Psychiatric News, “Jeremy’s victory was first a recognition by his colleagues of his capability as a leader in medicine and of the respect they have for him. That he is a psychiatrist and a leader in APA reaffirms the role of psychiatry as a medical specialty and shows continued reduction of stigma toward the field.”

Lazarus is chair of APA’s Council on Advocacy and Public Policy and has chaired APA’s Investment Oversight Committee and the Ethics and Managed Care committees. He is a former speaker of APA’s Assembly. In addition, he is president of the Colorado Medical Society and chair of the Colorado AMA delegation.

Lazarus said that being vice speaker of the House of Delegates will enhance his ability to do advocacy work on behalf of APA and the rest of organized medicine. "In turn, I bring experience about managed care, ethics, parity, and scope of practice to the AMA,” he added.

Last January Lazarus was a featured speaker at a roundtable discussion on scope-of-practice legislative initiatives at the AMA State Legislative Conference in Tucson, Ariz.

Members of APA’s delegation and other psychiatrists also gained new influence and visibility. APA Trustee-at-Large Patrice Harris, M.D., recently was appointed to the Council on Legislation and elected co-chair of the AMA’s Women’s Caucus. Emmanuel Cassimatis, M.D., was re-elected to the Council on Medical Education. Dudley Stewart, M.D., was appointed to the Council on Ethical and Judicial Affairs (CEJA).

In another upset, John C. Nelson, M.D., a Salt Lake City obstetrician-gynecologist, became the new president-elect of the AMA’s Board of Trustees. He defeated John Knote, M.D., speaker of the HOD.

Psychiatry Scores in HOD

APA and the American Academy of Child and Adolescent Psychiatry (AACAP) emerged almost totally victorious from the debate and subsequent actions on their proposed resolutions in reference committees and the HOD.

Specialty and state societies submit draft resolutions and testify on their behalf in front of one of eight reference committees. Those committees then recommend action to the HOD. The recommendations are subject to debate on the floor of the HOD. Final disposition of the resolution depends on a vote of the HOD.

A particularly significant victory was passage of a resolution directing the AMA to circulate a letter for state medical societies to sign urging the Senate and House of Representatives to bring parity legislation to a vote during the 108th session of Congress.

McIntyre said, “Support has been growing for issues related to our patients during the decade I’ve been coming to AMA meetings. Now, our colleagues in other specialties speak almost as frequently about the importance of parity as we do.”

A resolution sponsored by AACAP and APA generated a rare burst of applause from delegates and an editorial in the Chicago Tribune titled “Three’s a Crowd in Exam Room.”

AACAP delegate and APA trustee David Fassler, M.D., who introduced the resolution, said that it called into question the practice by pharmaceutical companies of having sales representatives sit in on patient visits with physicians.

The practice, called “shadowing,” is often a required part of the sales job. Former sales representatives confirmed that there was no oath or directive protecting any patient confidences, according to Fassler.

He testified to the committee, “As child and adolescent psychiatrists, we were also particularly concerned when we learned that this kind of shadowing was occurring in situations involving young children since issues of informed consent are even more complex with younger patients.”

Fassler introduced Barbara Felt-Miller, a former drug company salesperson who had been required to engage in shadowing.

“I was never trained to view a human body like a physician does,” she said. “I personally found sitting in on an exam embarrassing.”

Delegates applauded her comments and ultimately passed a resolution saying that the practice of shadowing should be prohibited and that the AMA should cooperate with industry representatives in promulgating guidelines to that effect.

AACAP, with the support of APA, won passage for another resolution related to the pharmaceutical industry.

The resolution called for the AMA’s CSA “to study the impact of funding sources on the outcome, validity, and reliability of pharmaceutical research and to develop guidelines to assist physician researchers in evaluating and preserving the scientific integrity, validity, and reliability of pharmaceutical research, regardless of funding source.”

Fassler testified that recent reports in the Journal of the American Medical Association (January 22) and New England Journal of Medicine (May 18, 2000) raised issues about “subtle bias” in study design and subject selection and about selective reporting and publication of results.

As passed by the HOD, the amended resolution calls for the study to be conducted jointly by the CSA and the CEJA, because the issues have ethical as well as scientific dimensions.

The American Academy of Pediatrics joined APA and AACAP in sponsoring a resolution calling for the CSA to study the reported increase in the incidence of serious neurodevelopmental disorders, including autism, Asperger’s, and other developmental disorders.

Alternate AACAP delegate Louis Kraus, M.D., testified that an increasing number of children have been diagnosed with autism during the past decade. Theories about the increase include improved recognition, changing diagnostic criteria, and possible environmental etiology. The result is confusion among members of the general public.

Pediatrician Eugenia Marcus, M.D., said, “[Parents] are grasping at straws because they don’t know what to believe. They are spending millions of dollars on alternative treatments that are not supported by science.”

Kraus also argued successfully in favor of an amendment to a resolution asking the AMA to evaluate gender-specific rehabilitation programs, mental health services, and educational services in juvenile detention centers.

Kraus’s amendment added community-based programs for delinquent girls to the list of items to be evaluated.

He also offered a second amendment that was adopted asking that the AMA support comprehensive health education for female delinquents, including information on responsible sexual behavior and the prevention of sexually transmitted diseases and HIV/AIDS.

APA and AACAP requested that the AMA state that the Medicaid funding crisis “is a matter of deepest concern to the membership” and that the AMA urge Congress to appropriate “significant increases in federal assistance.”

Kraus also testified that Medicaid reaches 44 million Americans, more than Medicare or any other form of health insurance, and covers Americans who are “among the poorest and most disadvantaged populations” in the country.

Delegates passed a resolution in lieu of the APA-AACAP resolution that supports recommendations of a report calling for federally funded, refundable, and advanceable individual tax credits that would replace Medicaid for those patients in the medical care portion of the Medicaid population. The report is part of an ongoing effort by the AMA’s Council on Medical Services to develop models for financing care for people with low incomes.

The number of delegates for each specialty society in the HOD is determined by the number of AMA members who indicate they want to be represented by that society.

McIntyre urges APA members who are also AMA members to watch their mail and e-mail for instructions on how to designate psychiatry as their specialty.

AMA Considers Reorganization—Again

Delegates put a temporary halt to efforts to restructure the AMA and address issues related to the increasing importance of specialty medical associations and declining membership in the AMA.

The Committee on Organization of Organizations (COO), which represented 137 of the 171 societies in the HOD, completed a yearlong review of AMA products, services, membership models, funding, and governance and reported their findings to the HOD.

APA was represented by McIntyre, Scully, APA President Marcia Goin, M.D., and Saul Levin, M.D., during the two COO meetings.

The critical challenge for the COO at the beginning of the most recent series of meetings was to find ways of compensating for a loss of $50 million in individual membership dues if that form of revenue were eliminated.

During the discussion, tax and legal issues also surfaced. The AMA has a 501(c)(6) tax status, while many of the specialty societies have a 501(c)(3) status. If the AMA became an organization of organizations, the tax status of those societies could be threatened.

In addition, there was a danger that the societies’ political action committees “would all be considered a single committee for purposes of contribution limits.”

The HOD voted to retain the current governance and membership models. ▪