PUBLIC POLICY COUNCIL

May 10, 1999

1998-99 Activities Report

The following report, covering programmatic activities of the Public Policy Council from May 1, 1998 to April 30, 1999 is modified from a report provided to the joint APS/SPR Councils on May 1, during the annual meeting of the Pediatric Academic Societies in San Francisco. A condensed version of this report was provided at the business meetings of the American Pediatric Society on May 2 and the Society for Pediatric Research on May 3, respectively. This activities report supplements the legislative report prepared by the Public Policy Council=s Washington-based staff. Queries or comments should be directed to the Public Policy Council Chairman, myron.genel@yale.edu.

The Public Policy Council, formed almost fifteen years ago, includes two representatives from each of the three constituent societies, the American Pediatric Society (APS), the Association of Medical School Pediatric Department Chairmen (AMSPDC) and the Society for Pediatric Research (SPR). Members serve simultaneously as representatives to the AAMC Council of Academic Societies and as liaison and alternative representatives to the AAP Committee on Federal Government Affairs (COFGA).

The Public Policy Forum is a loosely knit assembly of designated representatives at each major academic institution represented in AMSPDC; it serves as a communication network with the membership of the three societies and with academic pediatrics in general. Materials are distributed regularly to the Forum, including periodic legislative updates as well as relevant items on time-specific issues. These are supplemented by the Public Policy Council=s home page on the APS/SPR web site which also provides E-mail access to our Washington coordinator and to myself. The Forum also serves as a vehicle for the annual legislative briefing at the annual meeting. This year=s legislative conference, the thirteenth, held early Monday morning, May 3, examined the impact of mergers and new organizational structures on academic pediatrics using as a case study the newly unified UCSF-Stanford health system.

Representatives to the council during the past year have remained Russ Chesney and Jon Abramson, for AMSPDC; Jimmy Simon and myself for APS; and for SPR, Ora Pescovitz and Sam Hawgood, SPR=s vice president and current president respectively. Karen Hendricks continues to serve most effectively as the Public Policy Council's Washington Coordinator, assisted by Jennifer Stevens. They are responsible for maintaining an in-Washington presence for the Public Policy Council and the constituent societies, working from the AAP=s well respected Department of Federal Affairs or, more colloquially, the Academy=s AWashington Office.@ Ms. Hendricks is a well-regarded, Ainside@ player within the health-research advocacy community and Washington policy circles. Ms. Hendricks continues as president of the Coalition of Health Funding, a broad consortium of voluntary health organizations, professional societies and advocacy groups. She has served on the Steering Committee of the Ad Hoc Group for Medical Research Funding for the past six years, is the past chairperson of Research!America=s Public Affairs Committee and is a central figure in a number of issue-specific coalitions. The effectiveness of the Public Policy Council and our continued visibility in Washington remains a reflection of Ms. Hendricks= standing and efforts on our behalf.

Members of the Public Policy Council have been active on a variety of issues during the past year, including a number of interactions with Congressional members and their legislative staff as well as with the relevant federal agencies. While the Public Policy Council did not provide formal testimony during the past year, testimony was submitted to the House and Senate Appropriations Committees for inclusion within the record. The Public Policy Council remained active in monitoring those changes in the federal support for graduate medical education, including provision of federal funding for GME in free standing children=s hospitals, an effort advanced by the National Association of Children=s Hospitals and Related Institutions (NACHRI). The Public Policy Council developed a letter to the bipartisan Commission on the Future of Medicare, sent on behalf of the Federation of Pediatric Organizations and which raised concern regarding proposals to transfer direct GME financing from the Medicare trust fund to the annual appropriations process. In addition I and Washington staff have met with legislative staff for Congressman Ben Cardin on development of legislation establishing an all-payer fund for GME.

The Public Policy Council actively participated in coalitions which responded to public concerns on cloning and embryonic stem cell research and with the Ad Hoc Group for Medical Research Funding and Research!America in advocating for a doubling of the NIH budget by fiscal year 2003. The Public Policy Council was also active with the AAMC and other research organizations in response to legislation directing that all research data collected under federal grants be available through the Freedom of Information Act. Under the leadership of Jon Abramson the Public Policy Council, in concert with the Academy, continued to monitor implementation of the FDA reform legislation (the Food and Drug Administration Modernization and Accountability Act of 1997 or FDAMA) and new FDA regulations which provide for appropriate testing in children of drugs with substantial use in pediatric age groups. FDAMA includes a provision providing for a six-month extension of market exclusivity for drugs that have included appropriate pediatric studies. This has been challenged by the generic pharmaceutical industry in federal court. The Public Policy Council has supported Academy efforts in opposition to the generic industry law suit, including filing of an amicus brief. As usual the Public Policy Council has endorsed the recommendation of the Ad Hoc Group for Medical Research Funding for a 15% increase in NIH appropriations for FY 2000 as well as statements calling for substantial increases in the funding of other health and research agencies of the federal government.

The Public Policy Council again conducted one of the PAS educational seminars, AResearch and Child Health Advocacy: From Community to Congress@ on Saturday, May 1 in collaboration with Abe Bergman from Harborview Medical Center in Seattle. As has been our practice, the Public Policy Council maintained a resource table at the PAS registration area, which included an updated version of the legislative report, relevant fact sheets and other materials on current legislative issues. All of these materials remain available through the Public Policy Council=s Washington Coordinator, Karen Hendricks.

AAP Committee on Federal Government Affairs: COFGA is the former AAP Council on Government Affairs, the new designation reflecting restructuring of the Academy=s staff organization and committee structure in line with strategic planning goals. The Washington office of Government Liaison has been re-designated the Department of Federal Affairs and a parallel unit, the Department of Chapter and State Affairs, has been established at the Elk Grove Academy headquarters. Jackie Noyes, who has headed the Academy=s Washington office, now is responsible for oversight of both departments. COFGA includes eight members appointed by the Academy plus liaison representation from the three societies which form the Public Policy Council as well as from the Ambulatory Pediatric Association, the Society for Adolescent Medicine and the Academy=s senior and resident sections. In addition representatives from NACHRI and pediatricians who serve as Congressional fellows commonly attend COFGA meetings. Academy appointments to the committee include John Lewy, a member of all these PPC constituent societies, Rene Jenkins, Toni Eaton and Rick Bucciarelli, all APS members. Rick Bucciarelli assumed chairmanship of the committee at our January meeting.

COFGA has met on two occasions during the past year, June 7-8, 1998 and January 24-25, 1999, both in the Washington area, and briefly during the Academy=s annual meeting in San Francisco. COFGA=s principal activity during the past year has been related to Academy efforts to ensure universal access to health insurance and to health care coverage for all children. The Academy is actively monitoring implementation of the SCHIP program or Title XXI of the Social Security Act, which was part of the Balanced Budget Act of 1997. The legislation provides more than $40 billion in federal funds for states to implement additional programs to cover children who are otherwise ineligible for Medicaid and/or to expand their Medicaid programs. To date, however, enrollment has been slow, with slightly over one million of an estimated 3.2 million eligible children enrolled, according to data from the National Governors Association as of April 13. Recognizing that SCHIP or enhanced Medicaid enrollment will not provide universal access, the Academy, under the leadership of its current president, SPR/APS member Joel Alpert, has established a Work Group on Health, headed by Rick Bucciarelli. The work group is in some respects a subcommittee of COFGA and presented its draft report at the January COFGA meeting, in essence reaffirming the Academy=s commitment to universal health insurance for all children. The Academy has continued to be quite active on tobacco control legislation nationally and within the various states as a principal member of the ENACT coalition; as an advocate, with other professional organizations, for regulation of some of the more egregious policies of managed care organizations under the rubric of APatients= Bill of Rights,@ and has actively promoted the appropriate testing of drugs in children and the inclusion of children in federally sponsored research. Further details are provided in the Public Policy Council Legislative Report.

AAMC Council of Academic Societies: The CAS is one of the three constituent components of the AAMC together with the Council of Deans and the Council of Teaching Hospitals. The CAS includes 87 societies, four of these pediatric C the three which comprise the Public Policy Council as well as the Ambulatory Pediatric Association. The CAS provides unparalleled opportunity for interaction with a variety of other professional societies as well as for input into AAMC policy statements and activities. I previously served a five-year term as a member of the CAS Administrative Board and as the CAS chairman in 1990-91. Paul McCarthy, a member of SPR and APS and also chairman of the Academy=s Committee on Pediatric Research, has been a member of the CAS administrative board for over three years. At the CAS annual meeting in New Orleans, November 1, Paul was elected CAS chair-elect and will assume office at the forthcoming annual meeting this fall.

The Council of Academic Societies met on two occasions during the academic year C October 30-November 4, 1998 in New Orleans, as part of the annual general meetings of the AAMC, and March 25-28, 1999 in Vancouver, British Columbia. After serious introspection, the Council of Academic Societies has been revamped with a revised statement of the CAS mission B Ato help the faculty of medical schools and teaching hospitals pursue their primary responsibilities of research, education, and patient care@ and articulation of eight explicit goals to achieve this mission. The overriding CAS goal is Ato help medical faculty, their institutions and their societies improve the health of all Americans.@ Current chairman of the CAS is George Sheldon, professor and chairman of surgery at the University of North Carolina, Chapel Hill and immediate past-president of the American College of Surgeons. Over the past year the CAS Administrative Board has established several standing committees/task forces to focus on ongoing issues. The Chairs Development Task Force, chaired by Anthony Scarpa, chairman of physiology at Case Western, is developing recommendations for enhanced AAMC/CAS activities to assist department chairmen. The Task Force on Professional Development, led by Terrence Cooper, chairman of microbiology and immunology at the University of Tennessee, is charged with developing ways to assist faculty. The Scholarship Task Force, directed by Dr. Diana Beattie, immediate past chair of the CAS and chairperson of biochemistry at West Virginia, is developing a monograph on scholarship in medical schools and teaching hospitals. Over the years the most substantive meeting of the CAS is held in the spring in a retreat-like setting. This year=s spring meeting was devoted almost entirely to the subject of professionalism in all components of academic medicine from the undergraduate medical curriculum to research and patient care. Additional sessions were devoted to curriculum for graduate medical education and an extensive discussion of the AAMC=s Mission-Based Management Project, which is attempting to determine explicit mission, goals and most critically, financial resources to support the missions of medical schools.

The AAMC has maintained an active interest in clinical research through formation of an AAMC Task on Clinical Research, headed by Ralph Snyderman, vice president and dean of the Duke University School of Medicine. The AAMC and AMA are joint sponsors, in collaboration with Wake Forest University, of an ambitious national Clinical Research Summit process, in which I am involved through my leadership role on the AMA Council on Scientific Affairs. The Clinical Research Summit is lead by Dr. William Danforth, chancellor emeritus of Washington University Medical Center. During the first half of 1998 the Clinical Research Summit convened ten focus groups of distinct stakeholders. A consensus development retreat was held November 20-22, 1998 at the Graylyn Conference Center in Winston-Salem, North Carolina. At the Graylyn conference, agreement was reached on a comprehensive definition of clinical research, a problem list with 29 specific recommendations and a national strategic plan for clinical research with ten goals and 68 specific objectives. Most significant is the proposal for a Clinical Research Roundtable, a national public/private forum which would Aidentify needs, establish priorities and monitor progress in clinical research.@ Current activities are focused on raising the necessary funding and finding a suitable home for this new entity. In addition I was asked to serve on a restructured AAMC Advisory Panel on Research, which met for the first time in February and now constitutes members with expertise in basic biomedical, clinical and health services research.

With its revamped structure and greatly enhanced staff, the CAS is a natural meeting ground with colleagues in other disciplines and is deserving of our active support. The next meeting of the Council of Academic Societies will take place at the AAMC=s general annual meeting, which will be held in Washington October 22-28, 1999. The next CAS spring meeting will be in Savannah, Georgia March 23-26, 2000.

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