AMA adopts new public health policies to improve health of nation

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 second day of voting at the AMA Annual Meeting include supporting "food is medicine" interventions to improve health outcomes, protecting the public and firefighters from wildfire toxins, opposing flavored vaping products to protect youth, advocating for restoring EPA's Endangerment Finding on Greenhouse Gas Emission Standards, and improving public awareness of lung cancer screening. The policies include:

Integrating "Food is Medicine" interventions into healthcare delivery to improve health outcomes, address food insecurity

Building on efforts to promote health through improved nutrition and diet, the AMA adopted policy aimed at recognizing "food is medicine" interventions to improve health outcomes, reduce diet-related chronic disease, and address food insecurity. "Food is medicine" is an approach that aims to integrate healthy food into medical care and includes interventions such as medically tailored meals, medically tailored groceries, and produce-prescription programs. The AMA will support federal efforts to integrate nutrition services into health care delivery as well as funding for "food is medicine" initiatives through the yearly Labor-HHS appropriations process.

"Good nutrition is one of the most powerful tools we have to improve health and prevent disease," said AMA Immediate Past President Bobby Mukkamala, MD. "What we eat and drink directly affects our risk for many chronic conditions, making nutrition a critical component of both prevention and long-term health. Embracing the principle that food is medicine can help individuals live healthier lives and strengthen the health of our communities."

The AMA also supports research, education and implementation efforts to advance "food is medicine" interventions in clinical practice, with emphasis on improving cardiovascular outcomes, reducing health disparities and lowering health care costs.

Protecting communities and firefighters from toxic wildfire exposure

With wildfires in the United States increasing in frequency and intensity - the annual acreage burned has doubled in recent decades - the AMA adopted policy aimed at protecting the public and wildland firefighters from the harmful impacts of wildfire smoke.

Specifically, the AMA's new policy supports the development, dissemination, and implementation of voluntary post-wildfire screening protocols for individuals and communities exposed to wildfire smoke. These screenings should cover heavy metals, polycyclic aromatic hydrocarbons (PAHs), and other dangerous air pollutants and toxic substances. The AMA will also support federal and state efforts, in partnership with public health and environmental agencies, to ensure access to environmental monitoring, mobile health services, medical follow-up, and treatment for individuals exposed to toxic substances during or after wildfire events, with particular focus on frontline, vulnerable, and disproportionately impacted communities.

"Being exposed to wildfire can cause adverse, long-term health complications for people who live in areas impacted by wildfires and the brave firefighters, first responders, cleanup workers, and utility crews that are exposed to harmful smoke during and after fires. We must do everything we can to advocate for their safety and well-being," said Dr. Mukkamala.

Additionally, the AMA will advocate for evidence-based respiratory protection standards for wildland firefighters as well as easy access to National Institute of Occupational Safety and Health (NIOSH)-approved respiratory protective devices and other exposure mitigation technologies appropriate for wildland firefighting operations. These protocols should balance respiratory protection with heat stress, physiological burden, communication, visibility, and exertional demands while maximizing incorporation of the performance objectives and protective elements as described in the National Fire Protection Association's standards on comprehensive requirements for respiratory protection for wildland fire fighting personnel (NFPA 1984).

Opposing flavored ENDS products

The AMA adopted new policy opposing the Food and Drug Administration's (FDA) decision to authorize electronic nicotine delivery system (ENDS) products with fruit characterizing flavors. Expanding on its longtime efforts to efforts to protect Americans, and particularly young people, from the harmful effects of tobacco and nicotine use, the AMA also adopted the following policies that will:

• Continue to oppose the authorization of any ENDS products with characterizing flavors, including but not limited to fruit, candy, dessert, mint, and menthol flavors, that may enhance the appeal of such products to youth
• Advocate to FDA and others that the sponsor of any ENDS product considered for FDA authorization be required to share the data used to prove the effectiveness and durability of age-verification used
• Advocate that the FDA Committee on Tobacco Products require and implement effective post market surveillance data collection to measure the effectiveness and durability of any ENDS age-verification systems
• Urge FDA to take immediate action to remove authorized ENDS products from the market should age-verification technology prove to be insufficient to prevent youth initiation
• Advocate that the FDA establish and maintain a high proof of effectiveness and durability threshold for age-verification systems for ENDS products that aim to prevent youth access
• Advocate for prohibiting flavored cannabis vaping products in regulated cannabis dispensaries, hemp product retailers, and other outlets, and to pursue legislative changes supporting a nationwide ban

"The AMA will continue to support policies and initiatives to keep tobacco and other vape products out of the hands of our nation's youth and work to address this leading cause of preventable disease and death. There is no public health justification for flavoring e-cigarette and vape products in ways that make them more attractive to children and teens," said Dr. Mukkamala.

Advocacy for restoring the EPA's endangerment finding on greenhouse gas emission standards

Following the EPA's decision earlier this year to repeal the 2009 Endangerment Finding and greenhouse gas emission standards for motor vehicles, the AMA adopted policy advocating against its repeal and calling for its restoration.

"The EPA's decision to roll back the 2009 Endangerment Finding and greenhouse gas emission standards for motor vehicles will damage the health of the American public," said AMA President-elect Sandra Adamson Fryhofer, MD. "As physicians, we see the health consequences of greenhouse gas emissions and air pollution in patients every day-asthma caused by poor air quality, heat-related illness, the spread of vector-borne diseases, cardiovascular disease, cancer, and neurological disorders to name a few. Stronger emission standards help protect patient health and prevent premature death. The decision to repeal the endangerment finding moved us in the wrong direction."

Improving public awareness of lung cancer screening

Lung cancer is the second most common cancer and the leading cause of cancer deaths in the U.S., however screening rates remain low. The AMA adopted policy to promote physician education on and awareness of the value of low-dose Computed Tomography (CT) in detecting lung cancer. Under the new policy, the AMA will also encourage education, technological innovation, and continued research around the detection of coronary artery calcification on low-dose CT performed as a part of a lung cancer screening program. Additionally, the AMA will support efforts by key stakeholders in cardiology, pulmonology, oncology, and imaging specialties to research interventions to improve access to and use of lung cancer screening with low-dose CT scans in high-risk patients.

"We know that lung cancer has significant health and economic impacts in the U.S. It is also typically diagnosed at late stages, and as a result often comes with a poor prognosis. Fortunately, evidence shows that targeted screening with low-dose CT can result in earlier diagnosis and better health outcomes like reduced lung cancer-specific mortality," said Dr. Fryhofer.