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Why belong to AMA?
WHY BELONG TO AMA?
ACOG CLINICAL REVIEW Volume 8
●
Issue 9
October 2003
WHY BELONG TO AMA? Ralph W. Hale, MD
A
t the June 2003 Annual Meeting of the American Medical Association (AMA), Dr. John Nelson, FACOG, was elected President-elect. We at the American College of Obstetricians and Gynecologists (ACOG) are proud of John. He will represent our specialty and American medicine very well in this time of rapid change and ever-increasing attacks on our profession. Congratulations to John and his dedication to all physicians and their concerns whether they are members of the AMA or not.
It is this last point that I wish to address. AMA membership is continuing to decrease. Next year ACOG will lose three delegates because more than 3000 members who had designated ACOG as their representative did not renew their AMA membership. ACOG was not alone in this loss of members; many other societies lost delegates as well. Among the many reasons for these changes are decreasing reimbursement, increased cost of practice (especially liability premiums), and a perceived lack of value in
CONTENTS OBSTETRICS ● ● ● ● ● ● ● ●
Outcomes of LBW & Preterm Children Preventing Endometritis First-Trimester Miscarriage Pregnancy & Melanoma Anal Sphincter Tears Calcium Channel Blockers Urinary Tract & Vaginal Delivery Identifying Cysts During Pregnancy
2 2 2 3 3 3 4 4
GYNECOLOGY ● ● ● ● ● ● ● ●
Endometrial Ablation Systems Cytology Interpretations BRCA-Associated Ovarian Carcinoma HRT & Breast Cancer Emergency Contraception Stress Incontinence Statins & Postmenopausal Women Genitourinary Infections & Military Deployment
5 5 6 6 7 8 9 9
©2003 by the American College of Obstetricians and Gynecologists Published by Elsevier Inc. 1085-6862/03/$6.00
● ● ● ● ● ●
HRT & Hypercoagulability Paroxetine & Hot Flashes Phytoestrogens Effectiveness Hysterectomy & Well-Being ERT & Thromboembolism SEER & Corpus Malignancy
9 10 10 11 11 11
GENERAL HEALTH ● ● ● ● ● ● ● ● ● ● ● ●
Glucosamine & Chondroitin NSAIDs & Alzheimers Computer Use & Carpal Tunnel Syndrome D-Dimer Assay & DVT Dementia Among Elderly Women Statin Use & Diabetic Adults Major Depressive Disorder Demographics Repeat Sigmoidoscopy Mediterranean Diet & Reduced Mortality Neck Muscle Training Follow-Up of Smoking Cessation Chorella-Derived Supplement
12 12 12 13 13 13 14 14 15 15 15 16
AMA membership. The strength and programs of specialty societies and some state societies has been a factor as well. So why be a member of the AMA? The answer is simple. As physicians we need a unified presence as we face the onslaught of activities designated to reduce our profession to a job and nothing else. There is no specialty or state that can speak for all of medicine and thus no other single voice to oppose the barriers we face. The AMA can be, and is, that voice. However, if membership continues to decline, the AMA will lose collective effectiveness and all of medicine will be affected because there will be no strong voice to oppose onerous and impractical legislation and regulation, no one voice to address Congress or regulatory bodies (opposing where necessary and supporting when appropriate) about the changes that the government and organizations want to make in our profession. At the June meeting, AMA members heard stories of hospital administration and boards eliminating medical staff authority. The medical staff were to be treated as employees. Other instances of proposed regulations to increase paperwork and reduce payments were also presented. Continued on p. 16 From the American College of Obstetricians and Gynecologists, Washington, DC.
October 2003
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ACOG CLINICAL REVIEW
●
1
were similar for both the placebo group and the nicotine patch group. Clearly, this strategy was not worthwhile; other approaches must be found to assist individuals to stop this compelling habit. Patches are marketed heavily, but based on the results of this study, their efficacy is questionable.
Chorella-Derived Dietary Supplement Halperin SA, Smith B, Nolan C, et al. Safety and immunoenhancing effect of a Chorelladerived dietary supplement in healthy adults undergoing influenza vaccination: randomized, double-blind, placebo-controlled trial. CMAJ 2003;169:111–7.
Synopsis: The authors conducted a randomized, double-blind, placebocontrolled, community-based, clinical trial to evaluate the effect of an oral dietary supplement derived from the edible microalgia, Chorella pyrenoidosa, on immune function. Participants were 124 healthy adults at least 50 years of age randomly assigned to receive either 200 mg or 400 mg Chorella-derived dietary supplement or placebo once daily for 28 days. On day 21, they were administered a single dose of a licensed, trivalent, inactivated influenza vaccine. The authors then measured the hemagglutination inhibition titers before, and 7 and 21 days after vaccination. The primary immunologic outcome was the proportion of participants with a fourfold greater increase in antibodies and geometric mean antibody titer after
16
●
ACOG CLINICAL REVIEW
●
vaccination. They also studied the proportion of participants who reported adverse events during therapy. A total of 117 (94%) participants completed all aspects of the study. No differences were found in proportion of participants receiving either dose of the Chorella-derived dietary supplement or placebo with respect to achieving a four-fold increase in antibodies. Reports of adverse events were similar for recipients of the supplement and placebo, except with regard to fatigue that was reported more frequently by recipients of the 200-mg supplement. Participants who received the 400-mg supplement and were between 50 –55 years of age had a significantly higher geometric mean antibody titer against influenza A/New Caledonia strain 21 days after vaccination and against B/Yamanashi 7 days after vaccination. Level I. ● ● ●
Commentary: Although the findings of the study did not demonstrate an overall enhancement of immune function using this dietary supplement, there was some suggestion of enhancement in patients between 50 –55 years of age in some antibodies. Thus the authors suggest that further study would be necessary to prove or disprove a value of this supplement. As the study was not large, it is possible that the authors have noted a beta error and this may have influenced the study in one way or another.
October 2003
EDITORIAL Continued from p. 1 However, proposals from the Board and Councils recommended improvements to benefit practices, reduce unnecessary paperwork, and change confusing and erroneous rules and regulations, and sought changes to some of our most difficult problems. The AMA will shoulder these endeavors. They will not give up our fight to preserve medicine as most of us think it should be practiced. In the battle for liability reform, the AMA has supported ACOG in every instance. Without the AMA we would not be nearly as close to resolution. This example is just one of many to explain how AMA and ACOG working together are more effective than ACOG alone. Those who oppose the efforts of the AMA are happy to see membership recede. Their hope is that in the near future, the current “800-pound gorilla” will be an “80-pound marshmallow,” and fragmented medicine will no longer be a viable opponent. Then our profession will truly become a job; patients will be only customers; and government will determine all aspects of patient and physician interaction. Don’t let that happen. Join the AMA or rejoin if you have let your membership lapse. Dues are $420 per year, which is less than the cost of one lunch per month, and we all know that missing one lunch a month would not hurt any of us much.
©2003 by the American College of Obstetricians and Gynecologists Published by Elsevier Inc. 1085-6862/03/$6.00
ACOG CLINICAL REVIEW Volume 8
●
Issue 9
October 2003
WHY BELONG TO AMA? Ralph W. Hale, MD
A
t the June 2003 Annual Meeting of the American Medical Association (AMA), Dr. John Nelson, FACOG, was elected President-elect. We at the American College of Obstetricians and Gynecologists (ACOG) are proud of John. He will represent our specialty and American medicine very well in this time of rapid change and ever-increasing attacks on our profession. Congratulations to John and his dedication to all physicians and their concerns whether they are members of the AMA or not.
It is this last point that I wish to address. AMA membership is continuing to decrease. Next year ACOG will lose three delegates because more than 3000 members who had designated ACOG as their representative did not renew their AMA membership. ACOG was not alone in this loss of members; many other societies lost delegates as well. Among the many reasons for these changes are decreasing reimbursement, increased cost of practice (especially liability premiums), and a perceived lack of value in
CONTENTS OBSTETRICS ● ● ● ● ● ● ● ●
Outcomes of LBW & Preterm Children Preventing Endometritis First-Trimester Miscarriage Pregnancy & Melanoma Anal Sphincter Tears Calcium Channel Blockers Urinary Tract & Vaginal Delivery Identifying Cysts During Pregnancy
2 2 2 3 3 3 4 4
GYNECOLOGY ● ● ● ● ● ● ● ●
Endometrial Ablation Systems Cytology Interpretations BRCA-Associated Ovarian Carcinoma HRT & Breast Cancer Emergency Contraception Stress Incontinence Statins & Postmenopausal Women Genitourinary Infections & Military Deployment
5 5 6 6 7 8 9 9
©2003 by the American College of Obstetricians and Gynecologists Published by Elsevier Inc. 1085-6862/03/$6.00
● ● ● ● ● ●
HRT & Hypercoagulability Paroxetine & Hot Flashes Phytoestrogens Effectiveness Hysterectomy & Well-Being ERT & Thromboembolism SEER & Corpus Malignancy
9 10 10 11 11 11
GENERAL HEALTH ● ● ● ● ● ● ● ● ● ● ● ●
Glucosamine & Chondroitin NSAIDs & Alzheimers Computer Use & Carpal Tunnel Syndrome D-Dimer Assay & DVT Dementia Among Elderly Women Statin Use & Diabetic Adults Major Depressive Disorder Demographics Repeat Sigmoidoscopy Mediterranean Diet & Reduced Mortality Neck Muscle Training Follow-Up of Smoking Cessation Chorella-Derived Supplement
12 12 12 13 13 13 14 14 15 15 15 16
AMA membership. The strength and programs of specialty societies and some state societies has been a factor as well. So why be a member of the AMA? The answer is simple. As physicians we need a unified presence as we face the onslaught of activities designated to reduce our profession to a job and nothing else. There is no specialty or state that can speak for all of medicine and thus no other single voice to oppose the barriers we face. The AMA can be, and is, that voice. However, if membership continues to decline, the AMA will lose collective effectiveness and all of medicine will be affected because there will be no strong voice to oppose onerous and impractical legislation and regulation, no one voice to address Congress or regulatory bodies (opposing where necessary and supporting when appropriate) about the changes that the government and organizations want to make in our profession. At the June meeting, AMA members heard stories of hospital administration and boards eliminating medical staff authority. The medical staff were to be treated as employees. Other instances of proposed regulations to increase paperwork and reduce payments were also presented. Continued on p. 16 From the American College of Obstetricians and Gynecologists, Washington, DC.
October 2003
●
ACOG CLINICAL REVIEW
●
1
were similar for both the placebo group and the nicotine patch group. Clearly, this strategy was not worthwhile; other approaches must be found to assist individuals to stop this compelling habit. Patches are marketed heavily, but based on the results of this study, their efficacy is questionable.
Chorella-Derived Dietary Supplement Halperin SA, Smith B, Nolan C, et al. Safety and immunoenhancing effect of a Chorelladerived dietary supplement in healthy adults undergoing influenza vaccination: randomized, double-blind, placebo-controlled trial. CMAJ 2003;169:111–7.
Synopsis: The authors conducted a randomized, double-blind, placebocontrolled, community-based, clinical trial to evaluate the effect of an oral dietary supplement derived from the edible microalgia, Chorella pyrenoidosa, on immune function. Participants were 124 healthy adults at least 50 years of age randomly assigned to receive either 200 mg or 400 mg Chorella-derived dietary supplement or placebo once daily for 28 days. On day 21, they were administered a single dose of a licensed, trivalent, inactivated influenza vaccine. The authors then measured the hemagglutination inhibition titers before, and 7 and 21 days after vaccination. The primary immunologic outcome was the proportion of participants with a fourfold greater increase in antibodies and geometric mean antibody titer after
16
●
ACOG CLINICAL REVIEW
●
vaccination. They also studied the proportion of participants who reported adverse events during therapy. A total of 117 (94%) participants completed all aspects of the study. No differences were found in proportion of participants receiving either dose of the Chorella-derived dietary supplement or placebo with respect to achieving a four-fold increase in antibodies. Reports of adverse events were similar for recipients of the supplement and placebo, except with regard to fatigue that was reported more frequently by recipients of the 200-mg supplement. Participants who received the 400-mg supplement and were between 50 –55 years of age had a significantly higher geometric mean antibody titer against influenza A/New Caledonia strain 21 days after vaccination and against B/Yamanashi 7 days after vaccination. Level I. ● ● ●
Commentary: Although the findings of the study did not demonstrate an overall enhancement of immune function using this dietary supplement, there was some suggestion of enhancement in patients between 50 –55 years of age in some antibodies. Thus the authors suggest that further study would be necessary to prove or disprove a value of this supplement. As the study was not large, it is possible that the authors have noted a beta error and this may have influenced the study in one way or another.
October 2003
EDITORIAL Continued from p. 1 However, proposals from the Board and Councils recommended improvements to benefit practices, reduce unnecessary paperwork, and change confusing and erroneous rules and regulations, and sought changes to some of our most difficult problems. The AMA will shoulder these endeavors. They will not give up our fight to preserve medicine as most of us think it should be practiced. In the battle for liability reform, the AMA has supported ACOG in every instance. Without the AMA we would not be nearly as close to resolution. This example is just one of many to explain how AMA and ACOG working together are more effective than ACOG alone. Those who oppose the efforts of the AMA are happy to see membership recede. Their hope is that in the near future, the current “800-pound gorilla” will be an “80-pound marshmallow,” and fragmented medicine will no longer be a viable opponent. Then our profession will truly become a job; patients will be only customers; and government will determine all aspects of patient and physician interaction. Don’t let that happen. Join the AMA or rejoin if you have let your membership lapse. Dues are $420 per year, which is less than the cost of one lunch per month, and we all know that missing one lunch a month would not hurt any of us much.
©2003 by the American College of Obstetricians and Gynecologists Published by Elsevier Inc. 1085-6862/03/$6.00