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CHICAGO -- Gun violence continued to take its place in the spotlight Monday at the American Medical Association (AMA) House of Delegates meeting, with delegates approving a resolution calling on all candidates for public office to refuse contributions from any organization that opposes public health measures to reduce firearm violence.

'Now Is the Time to Speak Out'

"Columbine, Sandy Hook, Las Vegas, Buffalo. Again, again, and again," said Ryan Englander, a delegate from Connecticut who was speaking for the Medical Student Section, which had introduced the resolution. "Each time, nothing changes. Our nation, a wounded patient, unable to heal and continuing to bleed."

And although people thought nothing would happen after last month's mass shooting of 19 children and two teachers at an elementary school in Uvalde, Texas, this time is different because Senate Republicans and Democrats have reached a tentative deal on gun violence legislation, he noted.

"Now is the time to speak out," Englander continued. "Now is the time to make our position plain. America must treat gun violence like the public health crisis it is and take commonsense measures to combat it. Asking political candidates to refuse political donations from groups that oppose these measures is the next logical step. The AMA must add our voice to the chorus calling for change -- not in 6 months, not in a year, now."

Former AMA president Lonnie Bristow, MD, agreed, calling the resolution "excellent."

"We should back up what we say we are with proper action," he said. "This is the American Medical Association, not the American Hunting Association or the American Gun Owners Association. We deal with the consequences of guns ... Guns kill. The American Medical Association ought to be standing on the side of those things that will protect our patients."

But not everyone liked this strategy. "It's an important basic political principle that you do not burn bridges," said Greg Cooper, MD, a delegate from Kentucky who was speaking for himself. "Politics should not be a place for intolerance and rancor that ends discourse ... Some of those we support may not qualify as saints and they might not check all the boxes in regards to areas of legislative issues we would choose, but if we choose not to support -- or to support -- based on litmus test issues, we're making a big mistake."

Resolution on Removal of BMI

The delegates also voted to ask the board of trustees to study a resolution supporting removal of body mass index (BMI) as a standard measure in medicine; the resolution also asked the AMA to "recognize the significant limitations and potential harms associated with the widespread use of BMI in clinical settings."

Anna Yap, MD, the Resident and Fellow Section Delegate for the American Association of Public Health Physicians, said that standard definitions of overweight and obesity don't work well for Asian Americans, in part because they don't differentiate between different subgroups of Asian Americans.

Luis Seija, MD, who spoke for the Minority Affairs Section in favor of referring the resolution to the board, said that BMI "was created by a group of white mathematicians, not physicians ... [It] promotes race-based medicine, which our AMA is actively working to dismantle." Referring the matter for study will help the association figure out some alternative measures that are not racist in nature, he said.

On the other hand, Rose Berkun, MD, an alternate delegate and anesthesiologist from New York State, said she opposed referral. "BMI is not perfect; however, it's not intended to discriminate," she said. "It's a risk assessment measure. In anesthesia, we use it to determine whether a person qualifies for certain types of anesthesia, and also where to perform a procedure -- for example, above a certain BMI, we will not allow those patients to be operated on in an office-based setting. Until we have a better measure, I'd prefer to keep it."

The delegates also acted on a number of other measures, including:

• Passing a resolution to urge health and life insurers to divest from investments in fossil fuels
• Rejecting a resolution to define physician burnout as a repetitive stress injury subject to oversight by the Occupational Safety and Health Administration
• Passing a resolution to revive the concise hospital discharge summary that used to be given prior to the advent of electronic health records, and to have the AMA develop a model discharge summary "in such a manner as to be concise but informational ... to promote excellent, safe patient care and improve coordinated discharge planning"

Protecting Sexual Assault Victims

One resolution that brought out a lot of emotion asked the AMA to modify its current policy on privacy protection for sexual assault victims, adding a sentence saying that the association "opposes the publication (including posting) or broadcast of videos, images, or recordings of any illicit activity of the assault. The AMA opposes the use of such videos, images, or recordings for financial gain and/or any form of benefit by any entity."

Rodney Alford, MD, who spoke for the Illinois delegation, said his delegation's members "were concerned about the massive increase in uploading of nude or semi-nude images of individuals without their consent. This causes immense emotional and reputational harm to that person and is very, very difficult to remove from the internet ... This proposed change will make it clear the AMA opposes the use of such images and videos for both financial gain and/or any form of benefit to the entity that posts the content."

Nicole Plenty, MD, speaking for the Women Physicians Section, said that a few years ago, she took care of a patient who was sexually assaulted. "She was pregnant, and her video was circulated with over a million hits," Plenty said. "A few weeks after she had her baby, she took her own life ... Her mother said she left a note that said the constant embarrassment was too much to bear."

"Sexual assault victims constantly re-live their assault in their minds daily," she added. "We need to protect them as much as we can by making sure they don't have to literally see the trauma played out on social media or online platforms."

Sean Figy, MD, a delegate for the American Society for Reconstructive Microsurgery who was speaking for himself, said that his mother "was a sexual assault investigator for 32 years; this was standard dinner conversation about what her survivors had to endure and how things affected them ... It's important to improve their experience." The resolution passed, a move that garnered loud applause from the delegates.

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