E-News

Please send items of interest for the E-News -- and any other feedback -- to E-News editor Dave Cundiff, MD, MPH. Thanks!

The Washington Convention Center is at 801 Mount Vernon Place NW, Washington DC 20001, adjacent to the Mount Vernon Square Metro stop. Directions to the Washington Convention Center, including shuttles and public transportation, are on the Web at http://dcconvention.com/directions.aspx# . The Washington Convention Center can be reached at (800) 368-9000 or (202) 249-3000.

Business meetings will precede an educational session by AAPHP Past President and PSTK Principal Investigator JOEL L. NITZKIN, MD, MPH, DPA, speaking on "Disarray in State and Local Public Health Agencies: One Possible Root Cause, and Suggestions for an Action Plan" at 3:15 pm. A reactor panel, and group discussion, will complete the afternoon meeting.

A detailed agenda, subject to change, has been published. Remember to set your timepieces BACK to Standard Time the night before the meeting!

AAPHP General Membership Meeting
Room 147-A, Washington Convention Center, Washington DC
Sunday, November 4, 2007 (all times EST)

9:30 Registration and Networking
10:00 Welcome and Introductions
10:15 Approval of General Meeting Minutes 2007-06-23
10:20 Treasurer's Report
10:30 Dues for 2008 and 2009
      Member Services and Recruitment
      AAPHP Bulletin
10:45 Awards and Recognition
10:50 IOM Related Activities
10:55 Preventive Services ToolKit (PSTK) Report
11:00 AMA Reports: House of Delegates resolutions
      from 2007 Annual Meeting & for 2007 Interim Meeting
11:30 Adjourn Business Meeting until 2:30 pm

12:00-2:00 APHA Opening Plenary Session

2:30 AAPHP Resumes General Membership Meeting:
      Officers' Reports
3:00 Old Business
3:15 Educational Session: Joel L. Nitzkin, MD, MPH, MBA,
      "Disarray in State and Local Public Health Agencies:
      One Possible Root Cause, and
      Suggestions for an Action Plan"
4:00 Reactor Panel
4:15 Group Discussion
5:00 New Business and Closing Remarks
5:15 Adjourn

All AAPHP members, and guests interested in AAPHP's mission, are welcome to attend.

Minutes of the June 23, 2007 AAPHP Annual General Meeting are posted, along with a copy of the agenda above, at http://www.aaphp.org/Meetings/dcmeetingfall07.html .

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2) Clusters of Naegleria Meningoencephalitis (PAM):

Orange County, Florida experienced a cluster of Primary Amoebic Meningoencephalitis (PAM) caused by Naegleria fowlerii this summer. This organism grows in natural water sources, especially warm lakes and warm groundwater. When it adheres to human nasal membranes, it can cause fatal meningoencephalitis.

On the basis of two lake-associated fatal cases of PAM in young people in 2007, Cable News Network (CNN) briefly called for all of Orange County's lakes to be closed to all recreational use.

AAPHP President-Elect and Orange County Health Department Director KEVIN M. SHERIN, MD, MPH, Director of the Orange County Health Department in Orlando, Florida, has another idea: education, exposure reduction, and wearing of nose plugs.

An informal poll of current and former Health Officers in AAPHP leadership showed general agreement with Dr. Sherin. Members noted the rarity of the infection, the difficulty of identifying the organism's presence or absence in lakes, and the health benefits of water recreation.

We learned that there is no reporting requirement for PAM in most states. Based on this lack of reporting, we aren't sure how many cases are occurring, or what control measures would provide net public health benefits.

AAPHP member and Florida State Epidemiologist JOHN P. MIDDAUGH, MD has been spearheading efforts in the Conference of State and Territorial Epidemiologists (CSTE) to increase awareness and strengthen reporting about this disease. AAPHP Past President JONATHAN B. WEISBUCH, MD, MPH has shared his experiences with a similar cluster of cases (associated with a small community water system) in Arizona early in this decade.

For more information on this news story, visit http://www.cnn.com/2007/HEALTH/09/18/zarrella.killerlakes/index.html or http://www.cnn.com/2007/HEALTH/10/04/amoeba.lake/. (In response to the first story, Dr. Sherin notes that MRI cannot diagnose "exposure" to Naegleria; he believes the reporter misunderstood his comments.)

For more information on Naegleria and PAM, visit http://www.cdc.gov/ncidod/dpd/parasites/naegleria/default.htm .

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3) Resolutions for AMA Interim Meeting:

AAPHP's AMA Delegate ARVIND K. GOYAL, MD, MPH and Alternate Delegate JOSEPH L. MURPHY, MD have introduced two resolutions for the AMA Interim Meeting this month:

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UNIVERSAL REPORTING OF NAEGLERIA FOWLERII
MENINGO-ENCEPHALITIS (also called PAM)

Whereas, PAM is a highly lethal rare illness caused by a ubiquitous waterborne amoebic infection which enters through the nose in warm standing waters (lakes, hot springs and inadequately maintained swimming pools), and spreads to the brain, often resulting in the unexpected death of children, and

Whereas, according to published reports it was responsible for 23 cases of death in the United States between 1995 to 2004, six cases have been known to occur just this year, 3 in Florida, 2 in Texas and 1 in Arizona, usually within 2 weeks of exposure, and

Whereas, PAM illness and deaths may be preventable given professional and community awareness and use of properly fitted nose plugs when swimming in at risk lakes and other water reservoirs, there is currently no uniform reporting requirement (as currently in place for some other types of encephalitis) which would allow for adequate epidemiological investigation and development of appropriate preventive or treatment strategies against this potentially fatal illness, be it therefore

Resolved, that the AMA, in partnership with the CDC and various state public health departments, call for universal required reporting of PAM throughout the United States.

***

OPPOSE SALE OF TOBACCO WHERE PATIENTS RECEIVE HEALTH CARE

Whereas, the health hazards associated with tobacco use are well known to various professionals involved in delivery of health care and tobacco use continues to remain our #1 preventable public health challenge, and

Whereas it is undesirable for professionals and organizations who promote themselves as guardians of public health and pride themselves in caring for the patients, to benefit from sale of cigarettes and other tobacco products, be it therefore,

Resolved, that the AMA oppose the sale of tobacco at any facility where health care is delivered or where prescriptions are filled.

***

Comments may be directed to aaphp@reachone.com or to the AMA.

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4) Report from AMA Annual Meeting:

AAPHP's AMA Delegate ARVIND K. GOYAL, MD, MPH submitted the following report:

I and JOE MURPHY, as your Delegate and Alternate, were delighted and honored once again to represent you at the recently concluded AMA Annual meeting in Chicago.

Several of our Officers, Board members and other AAPHP members (and families) also attended all or part of the meeting and contributed substantially to the testimony in the reference committees, lobbying on various public health issues, campaigning on behalf of our candidate, and recruiting new members. We had a greater AAPHP presence compared to some of the much larger groups and associations at this meeting. Our President, Dr. RAUSA did a great job leading us.

Here is the report of the meeting in 4 pertinent parts:
I.    Campaign/ Election
II.   AAPHP Resolutions
III. Reports on AAPHP Resolutions previously referred
IV.   AAPHP Member is AMA's New President

I. CAMPAIGN/ELECTION:

I was honored to be nominated by you and endorsed by 7 additional groups/organizations to run for the position of AMA Vice Speaker. There were 4 candidates in the race for that one position. Dr. GURMAN from Pennsylvania was the winner. We did not win, in spite of a convincing and a well organized campaign: we had a diverse team; many of you actively campaigned, called and wrote to those you knew; the write-ups in the election manual and elsewhere were genuine; the mailer, the handouts and stickers were original and entertaining; our AAPHP Pizza Reception brought in over 200 AMA attendees; and our 24 interviews went exceptionally well. We probably did not dance well at those late night events! I was pleased and humbled with the quality of our campaign and the efforts of our team, which could not have played better.

I had entered the contest less than 3 months prior to election while others had announced a year or more in advance. That may have been a handicap, because some people admitted they had made commitments long before they became aware of our campaign. Further, I may have been unsuccessful in differentiating myself so clearly from other candidates. The success, in a race like this, requires others to fail --which did not happen! Thank you, again, for your encouragement and trust in my abilities.

II. SIX AAPHP RESOLUTIONS:

1. Resolution 318, "Maintaining Medical Specialty Board Certification Standard" (authored by AAPHP),

AS INTRODUCED:

"RESOLVED, that our AMA oppose any action, regardless of intent, that appears likely to confuse the public about the unique credentials of Board Certified physicians in any medical specialty, or take advantage of the prestige of any medical specialty for purposes contrary to the public good and safety, and be it further,

"RESOLVED, that our AMA communicate its concerns about the diminished use of the term 'Board Certification' by NBPHE and others to the Specialty and Service Societies in the Federation (SSS), the Association of the Schools of Public Health, the ABMS, the ACGME, the NBME and the Institute of Medicine."

THE OUTCOME:

Both our original resolves were adopted without opposition. The word "diminished" in the first resolve was changed by the reference committee to "misleading." In addition, the reference committee added, with our approval, an additional resolve at the request of multiple other specialty societies:

"Resolved that our AMA continue to work with other medical organizations to educate the profession and the public about the board certification process. When the equivalency of board certification must be determined, accepted standards, such as those adopted by state medical boards or the essentials for Approval of Examining boards in medical specialties be utilized for that determination."

***

2. Resolution 440, "Proper FDA Authority to Regulate Tobacco" (authored by AAPHP):

AS INTRODUCED:

"RESOLVED, that our AMA reiterate its support, in principle, for effective federal regulation of tobacco products, and, further

"RESOLVED, that our AMA condition their support of SB 625/HR 1108 on adoption of amendments needed to extend the FDA, the same unabridged authority currently granted for regulation of Food, Cosmetics and Drugs, that would effectively reduce or eliminate tobacco related illness and death in the American Society and tobacco use by our youth."

THE OUTCOME:

The testimony on this resolution was divided with the incoming AMA President, the Tobacco Caucus Chair, and the Pharmaceutical Physicians Delegate who previously represented the FDA on one side and everybody else including the SSS [Specialty and Service Society - ed.] on the other side. The AMA Board succeeded in preserving its previously announced support of the FDA tobacco Bill. The following SUBSTITUTE resolve recommended by the Reference Committee was adopted by the AMA House in spite of our passionate commentary and a failed amendment:

AS APPROVED:

"Resolved, That the AMA continue to support federal legislation that would give the FDA strong regulatory authority over tobacco products."

[Editor's note: A section-by-section analysis of S.625/H.R.1108, detailing how the bill serves Philip Morris' interests and why it cannot provide any significant public health benefit, is posted on AAPHP's Web site -- along with other arguments for and against the bill -- at http://www.aaphp.org/Feb07tobaccbill.html . Unfortunately, this analysis was not published until July 12, 2007, three weeks after the AMA Annual Meeting.]

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3. Resolution 135, "Funding for Prenatal Care to all Pregnant Women" (authored by AAPHP):

AS INTRODUCED:

"RESOLVED, that our AMA urge the Centers for Medicare and Medicaid Services to require all states to provide basic prenatal care to all pregnant women, regardless of their citizenship or immigration status, as a condition of participation in the Medicaid program, and further

"RESOLVED, that our AMA encourage the State Medical Associations to write to their respective Governors and Legislative leaders to explore various public and private funding options to ensure the provision of prenatal care to all pregnant women, and implement in their respective states, the concept of Presumptive Eligibility for Pregnant Women (PEPW), whereby all pregnant women coming in for prenatal care within the first three months of pregnancy are assured immediate access to the Medicaid system, and further

"RESOLVED, that our AMA support a nationwide campaign to educate women and families about the benefits of early and immediate prenatal care."

THE OUTCOME:

This resolution was placed on the reaffirmation calendar, meaning the already existing AMA policies support our resolves. Cited were AMA Policies # H-420.978, H-420.972, H-420.975, H-420.976 and H-290.986. We were advised to review those policies again and then to reintroduce those parts of our resolution not addressed by the existing policies.

***

4. Resolution 530, "Collaboration between Human and Veterinary Medicine" (authored by AAPHP Member LAURA H. KAHN, MD, MPH, MPP and co-sponsored by AAPHP):

AS INTRODUCED:

"RESOLVED, That our American Medical Association support an initiative designed to promote collaboration between human and veterinary medicine (Directive to Take Action); and be it further

"RESOLVED, That our AMA support joint educational efforts between human medical and veterinary medical schools (Directive to Take Action); and be it further

"RESOLVED, That our AMA encourage joint efforts in clinical care through the assessment, treatment, and prevention of cross-species disease transmission (Directive to Take Action); and be it further

"RESOLVED, That our AMA support cross-species disease surveillance and control efforts in public health (Directive to Take Action); and be it further

"RESOLVED, That our AMA support joint efforts in the development and evaluation of new diagnostic methods, medicines, and vaccines for the prevention and control of diseases across species (Directive to Take Action); and be it further

"RESOLVED, That our AMA engage in a dialogue with the American Veterinary Medical Association to discuss strategies for enhancing collaboration between the medical and veterinary medical professions in medical education, clinical care, public health, and biomedical research (Directive to Take Action)."

THE OUTCOME:

Resolution 530 was adopted with a minor editorial change in the sixth resolve: from the words, "the medical" to "human."

***

5. Resolution 136, "Principles for Health System Reform at State Level" (co-sponsored by AAPHP):

AS INTRODUCED:

"RESOLVED that our American Medical Association adopt the following set of principles against which state level health system reform proposals may be measured:

1. Coverage - Health care coverage for state residents should be universal, continuous, portable and mandatory.

2. Benefits - An essential benefits package should be uniform and include behavioral health; with the option to obtain additional benefits.

3. Delivery system - The system must ensure choice of physician and preserve patient/physician relationships. The system must focus on providing care that is safe, timely, efficient, effective, patient-centered and equitable.

4. Administration and governance - The system must be simple, transparent, accountable, and efficient and effective in order to reduce administrative costs and maximize funding for patient care. The system should be overseen by a governing body that includes regulatory agencies, payers, consumers, and care givers and is accountable to the citizens.

5. Financing - Health care coverage should be equitable, affordable and sustainable. The financing strategy should strive for simplicity, transparency and efficiency. It should emphasize personal responsibility as well as societal obligations, due to the limited nature of resources available for health care."

THE OUTCOME:

This resolution was referred to the Board/Council on Medical Services as intended.

***

6. Resolution 211, "Ending Support for Pay for Performance and Public Reporting Programs" (co-sponsored by AAPHP):

AS INTRODUCED:

"RESOLVED, That our AMA finds that Pay-For-Performance and Public Reporting Programs pose more risks to patients than benefits and calls for an immediate cessation of such programs by private and public Third Party Payers; and be it further

"RESOLVED, That our AMA Chair and Board of Trustees advise the Secretary of Health and Human Services and the Ambulatory Care Quality Alliance (AQA) that the AMA will no longer participate in the creation, development or implementation of the Secretary's "Transparency Initiative" or other Pay-For-Performance Programs; and be it further

"RESOLVED, That our AMA Board of Trustees (a) mount a properly resourced public relations and media campaign by November, 2007, to educate Americans on the risks and benefits of the Pay-For-Performance and Public Reporting Programs and other elements of the DHHS “Health Care Transparency Initiative” being promoted by Medicare and Private Insurance Companies and (b) present a progress report at each of the HOD meetings over the next 3 years, as called for in I-05 (Sub. Res. 902 'Protecting Patients Rights')."

THE OUTCOME:

This resolution was cosponsored by 5 state or specialty societies including us and there were 5 other pay-for-performance (P4P) related resolutions as also a Board report. All these items were lumped together and extensively debated both at the reference committee and then at the House. This item took up approximately a third of the House time at this meeting and got extensive coverage in the media. The Board of Trustees report was extensively amended, not entirely to the liking of the Board. The new policy requires the AMA to actively oppose any P4P program that does not meet all the principles set forth in the previous AMA House approved policy. Also the AMA will advocate for physicians to have an opportunity to review and correct inaccuracies in their patient specific data well in advance of any public release, decreased payments and forfeiture of opportunity for additional compensation.

III. REPORTS ON AAPHP RESOLUTIONS PREVIOUSLY REFERRED:

1. AAPHP Resolution 803/I-05/ Development of Federal Public Health Disaster Intervention Team:

Board of Trustees Report 3 was approved with an amendment to read:

"That our AMA, through its Center for Public Health Preparedness and Disaster Response, work with the DHSS, PHSCC, DHS, and other relevant government agencies to provide comprehensive disaster education and training for all federal medical and public health employees and volunteers through the National Disaster Life Support and other appropriate programs. Such training should address the medical and mental health needs of all populations, including children, the elderly, and other vulnerable groups."

2. AAPHP Resolution 103/A-06/Maximum Allowable Cost of Prescription Medications:

The Council of Medical Services Report 2 was adopted. It recommended that the AMA oppose the use of price controls but continue to promote market based strategies to achieve access to and affordability of health care goods and services.

IV. AAPHP Member is AMA's New President:

Dr. RONALD M. DAVIS, an AAPHP member, was installed as the AMA President on June 26. Public Health is expected to do very well under Dr. DAVIS' leadership. Dr. DAVIS honored the six Public Health and Preventive Medicine related organizations in the AMA House by inviting their leaders to join him on the dais when he took the oath of the office. AAPHP was honored to be among those represented on stage with Dr. DAVIS at his inauguration.

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5) SCHIP Bill:

On October 16, 2007, AAPHP President Rausa sent an Action Alert to AAPHP members and friends, in support of the SCHIP bill vetoed by President Bush. An excerpt from Dr. Rausa's alert:

"In addition to its benefits for children in need of medical care, this bill includes a 65 cent tax per pack of cigarettes. This tax increase is projected to depress adult smoking rates about 10% and adolescent smoking rates about 20%. Some observers believe that the major reason Presidentn Bush vetoed this bill was because of pressure from the tobacco companies who objected to the cigarette tax. The combination of the health benefit for children in need of health services and the tobacco tax increase makes this one of the most important pieces of public health legislation to come before the Congress in recent years."

***

Your Editor received a number of positive comments for this Action Alert. We also received this response from physician and U.S. Representative Tom Price (R-GA):

"[The Heritage Foundation, http://www.heritage.org] has some very clear information on the bill and why it should be structured differently.

"Our own Congressional Budget Office estimates that between 1.6 and 2 million children currently on private, personal insurance will be forced into this government program - clearly not something that would be wise."

***

A scan of the Heritage web site notes an analysis, posted 2007-11-02, of the quality of SCHIP care (http://www.heritage.org/Research/HealthCare/wm1687.cfm). The author notes the instability of governmental health coverage, spotty primary care availability to Medicaid and SCHIP patients, high emergency room utilization rates, and a paucity of outcomes data for the SCHIP program. He proposes tighter SCHIP eligibility criteria than those proposed by Congress; tax relief for "middle class" families purchasing private insurance; and incentives for state insurance outreach efforts. The fiscal impact of these alternatives is discussed separately in a 2007-10-01 analysis at http://www.heritage.org/Research/HealthCare/wm1652.cfm.

Meanwhile, what was inferred at the time of our Action Alert is now explicit: President Bush has been widely quoted as saying he would veto any SCHIP bill that increases tobacco taxes.

[Your Editor has reviewed many tobacco-economics analyses over the years. While many other factors impact the relationship between tobacco price and tobacco consumption, economists agree that increased tobacco taxes lead to decreased consumption. AAPHP stands by its support for tobacco tax increases as part of the SCHIP bill.]

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6) Jobs Update:

AAPHP's Job Market Initiative has fewer jobs to report, but current openings include Missouri's search for a State Epidemiologist and Santa Clara County's search for a TB controller and Deputy Health Officer.

To see current job listings, please visit http://www.aaphp.org/JobMarket/job_opportunities.htm. To suggest jobs for listing, please E-mail AAPHP's Job Market Initiative chair JOEL L. NITZKIN, MD, MPH, DPA. Dr. Nitzkin's E-mail is jln@jln-md.com.

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7) Dues Update:

It's not too late to pay 2007 AAPHP dues. It's not too early to prepay 2008 AAPHP dues at the 2007 rates.

If you haven't done so already, please download AAPHP's 2007 Membership Form right away at http://www.aaphp.org/Membership/2007MembForm.pdf and send it to us by fax or postal mail. Please make your 2007 membership as generous as you can. Consider "Supporting" or "Sustaining" membership for 2007 and 2008 if you are able to do so.

AAPHP is a 501(c)(6) professional membership organization that informs and represents Public Health Physicians. AAPHP dues may be deductible as an "ordinary and necessary" business expense under the Internal Revenue Code. Details may differ based on your individual situation.

AAPHP dues can be paid by credit card -- either by faxing the membership form to (847) 255-0559 or by calling the AAPHP Secretary's secure mobile/voicemail at (360) 870-2483.

Please also tell your friends and colleagues about AAPHP's representation of Public Health Physicians. E-News subscriptions are still free, on request, to any interested physician or medical student. We welcome new subscribers and members.

Thanks for your support!

Dave Cundiff, MD, MPH (cundiff@reachone.com)
AAPHP Secretary and E-News Editor

************ About AAPHP E-News ************

This message is an electronic update from the American Association of Public Health Physicians (AAPHP) to public health physicians.
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