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Before COVID-19, the American Medical Association (AMA) meetings in June and November would be chock full of lively debate on 100 items or more.

Its House of Delegates leaders would take the mic to argue yes or no on topics extending far beyond the usual passions of better physician reimbursement and medical decision autonomy, such as feeding the hungry, gun control, opposing racism, improving the nutritional value of vending machine snacks, and the appropriateness of legalized recreational cannabis.

Resolutions would be discussed on subjects even if just a few doctors would be affected. For example, one proposal asked the AMA to support policies enabling physicians taking their licensing exams to have access to breast pump accommodations if they are nursing a newborn at the time.

Global issues affecting health, like climate change, have been among those that saw the AMA adopt policy. In 2019, the House of Delegates "the Earth is undergoing adverse global climate change and that anthropogenic contributions are significant. These climate changes will create conditions that affect public health, with disproportionate impacts on vulnerable populations, including children, the elderly, and the poor."

Two more assertive climate change resolutions were due to come up at the meeting this month, but to several members' extreme disappointment and frustration, they got cut, due to COVID-related changes to the meetings in 2020 and 2021 and virtual meetings' limitations, such as technical issues with Zoom.

For the recent meeting, just 39 of the 166 proposed resolutions made the cut, with the remaining postponed.

This provoked some bitter feelings and caustic remarks, especially regarding , which would have raised the AMA's visibility and proactive involvement in global warming policy change.

In 608, advocates asked the AMA to "establish a climate crisis campaign that will distribute evidence-based information on the relationship between climate change and human health." If approved, it eventually could result in a comprehensive global warming advocacy plan or center, with an estimated cost of $2 million.

Trusted Messengers

As uniquely trusted messengers, physicians leading such a campaign would be "in the newspaper or on TV. It would be the nation's doctors -- even though we don't represent everybody -- the largest group of physicians in the country taking a stance on this issue," Raymond Lorenzoni, MD, a pediatric cardiologist from the Bronx, New York, told 名媛直播.

The campaign's main purpose would be to counteract messages from the fossil fuel industry.

"The strategy, tactics, infrastructure, and rhetorical arguments and techniques used by fossil fuel interests to challenge the scientific evidence of climate change -- including cherry picking, fake experts, and conspiracy theories -- come straight out of the Tobacco Industry's playbook for delaying tobacco control," the resolution stated.

Lorenzoni, who leads the AMA's Resident and Fellows Section, which introduced resolution 608, said he thought the proposal had a chance because the AMA has moved "more into the public health sphere, addressing population health and how we can improve medicine on a broader scale" in the last decade, even though some long-standing members don't approve of that approach.

Resolution 608, he said, would put the AMA squarely behind international climate negotiations, and would help carry the message that "hundreds of thousands of people are hospitalized each year because of illnesses including asthma, COPD, emphysema, and certain types of cancer linked to use of fossil fuels, especially in urban areas."

A Public Health Emergency

With resolution 609, the AMA was encouraged to act more aggressively to support and influence laws and policies that recognize climate change as an "urgent public health emergency that threatens the health and well-being of all individuals" and that support clean air and power plant emissions reductions, with an estimated cost between $5,000 and $10,000.

But neither resolution passed the priority threshold set by an anonymous 31-member resolutions committee, for which a score exceeding 2.72 meant the resolution was deemed important enough to merit discussion and a vote in a reference committee, while a score of 2.72 or below meant the issue was dropped. Resolution 609 received 2.34 points, and 608 received 2.32 points.

Proponents were not happy.

"I have many examples of children I treat who live near the Port of Los Angeles, and how that adversely impacts their disease states, including asthma and their performance in schools," Jerry Abraham, MD, of Kedren Health in South Los Angeles and a member of the California delegation that introduced 609, told 名媛直播.

"We see a direct link between what is happening with wildfires in California, hurricanes, and how that directly impacts our patients and the practice of medicine, actually closing a hospital and disrupting the care we provide," he said.

"It's a no-brainer that when we talk about emergent and emerging issues, this should have met the threshold. Why now this does not meet that criteria is extremely frustrating, especially given the breadth of other resolutions that have been accepted as business of this special meeting," he added.

True, the AMA has passed other climate resolutions, acknowledged Ashley McClure, MD, of Kaiser Permanente in Oakland, California, a fierce advocate of 609 who was not speaking on behalf of Kaiser. But those actions were lukewarm, and lacked the urgency and the seriousness of the issues.

Using Abraham's example of children living near the port, McClure said she understands the AMA "can't move people away from the port, or away from freeways," where diesel and gasoline pollution and particulate matter can contribute to all-cause mortality. "But we can transition our transportation fleets, and our businesses away from dirty fossil fuels."

Perhaps rerouting non-electric vehicles from certain sections of freeways adjacent to high-density residential areas would be one concept the AMA might study or even advocate, Abraham and McClure suggested.

The noted that it cut 609 because the AMA "has myriad policies related to climate change and is actively engaged in " and is involved in the and the .

"Existing AMA policy also supports federal legislation and regulations that meaningfully reduce major power plant emissions: as well as efforts to improve the efficiency of power plants and continued development, promotion, and widespread implementation of alternative renewable energy sources in lieu of carbon-based fossil fuels," the report stated.

More Important Than a 'Virtual Water Cooler'

Far less important resolutions did pass muster, like one that proposed that the AMA launch a "virtual water cooler," encouraging "collegial communication" outside of official meetings, McClure pointed out.

Unfortunately, some senior AMA members advised her that climate change isn't really in the AMA's wheelhouse. "One said, 'We're doctors, we should leave that to the experts. We have more pressing issues like reimbursement and COVID,'" she noted.

Others said they just felt it's not "in their lane because it's so much bigger than any individual, than any in our profession," she added.

Some doctors told McClure that they aren't convinced that climate change is even real, or that the degree of its impact is exaggerated, she said. "What we're trying to do is educate our colleagues on the health implications of this global threat caused by fossil fuels; we're not on the same page yet."

In some ways, it's a disconnect between early career physician members and more senior members, Abraham noted. Early career members want the AMA to use its power to take a more proactive stance on many global health equity issues. But many senior members say "that medical service and practice should remain the absolute priority," he said.

Those doctors need to understand that "this is very much in our lane; they should care. It does impact their practices and their patients," he added.

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