SAN DIEGO – The American Academy of Family Physicians will push the federal government to ban on the sale of energy drinks – caffeinated beverages that come in fizzy cans or small twist-cap bottle syrups – to kids under 18 years old, following a vote to do so by its Congress of Delegates.

Pitched largely to kids, "energy drinks are dangerous to youth and can lead to dehydration, particularly when consumed with alcohol," a not uncommon practice among minors. The academy will also work with the Food and Drug Administration to oppose handing out free samples to kids and establish specific definitions of stimulant drinks.

"Energy drinks are dangerous to youth and can lead to dehydration, particularly when consumed with alcohol," say AAFP reps.

Delegates were following the news reports of the harm done by these drinks, which have been associated with thousands of visits by minors to the emergency department, and some deaths, mostly among children who overindulged on energy drinks. The beverages typically contain perhaps 200 mg of caffeine – but sometimes much more – plus herbs and other ingredients added to boost stimulating effects. In comparison, a 16 oz. Starbuck’s coffee comes with a 330 mg caffeine bolus.

The American Academy of Pediatrics has already come out against the drinks, and a few states are considering bans on sales to those under age 18 years.

The problem in New York, though, where AAFP’s resolution originated, is that legislators "believe this is a federal issue, an FDA issue," said Vito Grasso, executive vice-president of the state’s AAFP chapter. Meanwhile, N.Y. doctors are seeing heart issues, hyperactivity, and exacerbations of asthma and other chronic conditions in children because of the drinks, Mr. Grasso said.

AAFP is likely to draft legislation to remind the FDA that it has jurisdiction in the matter and can demand that companies fully disclose what the drinks contain, but AAFP delegates agreed with their N.Y. colleagues that there’s already enough evidence to ban the drinks for kids.

The move was just 1 of more than 50 resolutions tackled by AAFP delegates. None matched the fireworks of 2012’s vote to support gay marriage, but delegates considered some controversial topics.

Gun violence was one of those. Attendees voted to name it "a significant public health problem" that needs "further research."

That wasn’t as light-footed as it sounds. Worried that scientific findings might be used to support firearm limits, gun interests have kept the federal government from funding gun violence studies for almost 20 years, AAFP board chair Dr. Jeffrey Cain explained later.

The de-facto ban was relaxed a bit after a troubled, assault-weapon–wielding 20-year-old killed his mother and murdered 20 kindergarten and first grade students, and six teachers and administrators trying to protect them, at Sandy Hook Elementary School in Newtown, Conn., in December 2012. Delegates decided it’s time to get behind federal dollars to find how to stop gun murder in the United States and generate the data needed to cut through the country’s indecision on gun access.

Delegates voted down, however, calls by delegates from Washington and Oregon for mandatory background checks and tracking of all gun sales and transfers; delegates decided the issues were too "divisive."

Gun violence "is now recognized by our Academy as an issue of public health," just like using seatbelts in cars. Beyond that, though, "our members’ political views span the full spectrum, like the citizens of America," Dr. Cain said.

Delegates also decided that AAFP’s current gun policy addresses the intent of the Northwest measures, including, as it does, opposition to civilian ownership of military assault weapons, backing of doctors’ rights to ask gun owners about firearm safety in their homes, and support of background checks to keep guns out of the hands of criminals and people with mental illness.

Other measures

Guns and energy drinks weren’t the only things on AAFP delegates’ minds.

The group, which decides academy legislative and policy priorities, tackled more than 50 resolutions. Among them, it directed the academy to do the following:

• Push for automated electronic defibrillators in high schools.

• Work to ensure that "relative value unit" compensation models aren’t used to shortchange family doctors’ paychecks.

• Allow family medicine residents to prescribe for Medicaid patients.

• Stop states from adding extra CME requirements beyond what boards require.

• Consider legislative fixes so doctors can keep their license protections when helping sports teams and disaster victims out of state.

Delegates also revisited gay marriage. Oklahoma wanted the academy to take a neutral position on the issue, arguing that, like abortion and gun control, the issue is too divisive for members and goes beyond the medical issues AAFP should focus on.

Delegates didn’t go for it: "To go back on what the Congress of Delegates decided last year would be to make a divisive issue only more contentious. The testimony and research by the American College of Obstetricians and Gynecologists made it clear that marriage is a key to the access to health care. The adoption of the proposed resolution would say that the AAFP no longer believes that civil marriage is a health issue. In the final analysis ... the Congress of Delegates did not adopt the resolution to support civil [same-gender] marriage, but to serve the health of our members, our patients, and our communities," wrote the resolution committee, winning the day.

Medical marijuana came up, too.

New York asked delegates to fight state approval of smoked cannabis, arguing that it’s the business of the FDA to regulate drugs, not state legislators and that smoking pot probably hurts the lungs. AAFP’s N.Y. members are working stop the Empire State from approving medical marijuana, and wanted the academy’s help.

After testimony about marijuana’s benefits for sick people, delegates decided to sidestep the issue and vote instead for AAFP research and "expressing concerns" about the safety of smoking it.

The academy was also directed to take a few steps on women’s health issues.

Among them, it will try to stop the Centers for Medicare & Medicaid Services from requiring abnormal pap smears before paying for HPV screening. The American Society for Colposcopy and Cervical Pathology wants doctors to screen high-risk women over age 29 years for HPV during routine Pap smears, whatever their prior results. Delegates voted that payment guidelines need to match those of experts. Also, AAFP will also now support IUDs as first-line contraceptives for most women, and work to end prior approval for FDA-cleared contraceptive devices. The Affordable Care Act requires their coverage, so requiring prior authorization doesn’t make any sense, California and Texas delegates said in their resolutions.

The academy is going to look into pushing for OTC birth control pills, as well, but delegates didn’t want it to support OTC access without more investigation. Some worried that insurance companies won’t cover OTC birth control, and others that women might "stop visiting their family physicians if they no longer had to rely on them for birth control prescriptions."

Putting the ‘primary’ back into primary care education

Medical schools were the subject of three strong resolutions from New Hampshire delegates tired of hearing about professors who shoot down primary care as a career option.

Delegates didn’t like that either and voted for AAFP to poll new residents about what medical school faculty said regarding family care, and to figure out how many medical school graduates go into primary care each year and how many are still at it 5 years later.

The big hammer, though, was a vote from delegates for the academy to consider a push to link medical school accreditation and CMS education reimbursements to the number of graduates who go into primary care.

A better way for rural EDs

The AAFP endorsed Comprehensive Advanced Life Support (CALS) training as "an appropriate advanced life support course for" rural physicians and will consider it as an alternative to Advanced Trauma Life Support (ATLS) for low-level state trauma designation.

That’s not a trivial decision for rural emergency departments (EDs), where a lone family physician, physician assistant, or nurse practitioner is on the hook to handle anything that comes through the door, without help from specialists.

CALS was designed in Minnesota 20 years ago to help providers in rural EDs do that. "Other ED courses focus on specific emergencies. We compressed them, eliminated the redundancies, and added psychiatric, neurologic, burn, and other emergencies the other courses don’t cover," said Dr. Paul Van Gorp, a family practitioner in Long Prairie, Minn., and CALS board chair.

"It’s been very successful. We’ve presented CALS in nine states and several countries; people who have taken it, many from remote places like Alaska, have wonderful things to say about it, but not every state recognizes CALS as an acceptable route to qualify as a level 3 or 4 trauma center," he said.

In most states, "the only route to trauma level designation is ATLS, but trauma is just a small part of what we see," he said.

AAFP’s recognition will add heft to efforts to get states to recognize CALS as an alternative.

The course has 2 days of scenario-based training, a half-day trauma module that meets requirements for state trauma designation, and a day-long benchmark skills lab. A sheep is killed in the lab, but "we recognize that there’re a lot of people opposed to us using animals in this way, so we developed" an alternative that "entirely uses mannequins as a substitute," Dr. Van Gorp said.

The course comes with an exhaustive electronic reference manual to freshen up when the ambulance calls in. It’s a reassuring resource in places where "you go through an emergency and get pretty comfortable with it, but don’t see it again for 5 years," he said.

aotto@frontlinemedcom.com

AAFP votes to ban energy drink sales to kids