AACBNC
Council of Academic Societies Spring Meeting
March 14-17, 2002  ~ Santa Fe, New Mexico


Changing Values - The Evolving Art and Science of
Medicine

Meeting Summary (Draft)
Pre-Meeting Activities

Program Committee: The CAS Program Committee meet to finalize CAS-sponsored
programming at the AAMC Annual Meeting, November 8-13, 2002, in San Francisco.
The CAS will sponsor two plenary sessions on Sunday morning, November 3, hold a
Business Meeting during lunchtime on Monday, November 4 and sponsor another
plenary session that Monday afternoon.

CAS Orientation: Mr. Tony Mazzaschi, AAMC Director of CAS Affairs, gave an
orientation to the Council of Academic Societies for new CAS representatives. The
session discussed the history of the CAS, its role in AAMC governance, recent CAS
initiatives, and some of the challenges and opportunities offered by the CAS.

Plenary I: Genetics and the Evolving Art and Science of Medicine

Francis Collins, M.D., Ph.D.: In a wide-ranging keynote address, Dr. Collins discussed
the goals and status of the human genome project, the future of genomics, and his
views on the impact of the genetics revolution on medicine and medical education.
Dr. Collins defines genetics as the study of hereditary factors affecting virtually
everything. He reviewed the human genome project's timeline and milestones, all in
light of the upcoming 50th anniversary of the publication of Watson and Crick's paper
describing the double helix in Nature.

Dr. Collins reviewed some of the surprising discoveries that have been produced by
the genome project: there are fewer genes than expected, human genes make more
proteins than other organisms, the male mutation rate is twice that of females, and
'junk' DNA contains remnants and raw materials that appears to be active in the
evolutionary process. Dr. Collins reviewed the development of various areas of
genomics, including medical genomics, functional genomics, comparative genomics
and proteomics.

Dr. Collins described the next major goal in genomics; the generation of a new map of
the patterns of genetic variations across populations, a so-called "haplotype map."
Dr. Collins said this new kind of genetic map may have profound consequences for
identifying genetic contributors to common disease. Dr. Collins explained that the
SNP variants do not occur at random, but are correlated in important ways with their
neighbors. By finding the pattern of variation along chromosomes, scientists can
select a much smaller "gold standard" set of SNPs distributed along the
chromosomes that will represent nearly the entire underlying pattern of variation.
Thus, testing for one or two SNPs can reveal information about variation for a large
region surrounding the indicator SNPs. Although it is still in its formative stage, Dr.
Collins said the development of a haplotype map would provide a critical resource for
researchers seeking to identify and understand the genetic basis of common human
diseases.

To utilize the power of genomics, a number of public policy questions must be               
resolved. Some of the questions posed by Dr. Collins included: Can effective                
statutory provisions be enacted to prohibit genetic discrimination? Can                          
providers and the public become education about genetics? Will knowledge of             
human variation reduce prejudice or increase it? Will we arrive at a consensus             
about the limits of genetic technology for trait enhancement?

Dr. Collins made some educated predictions about the future of genomics, which          
focused on when individualized preventive medicine will be mainstreamed and             
when the genomic therapeutic revolution will be in full swing. Dr. Collins                        
concluded by sharing his views on what medical schools and teaching hospitals           
can do to prepare for the coming revolution in genomic medicine:

Invest in the clinical research infrastructure necessary to facilitate genetic                    
epidemiology.

Build strong biomedical informatics programs.

Build laboratory strength in all aspects of genetics.

Revamp curricula for medical students and residents in light of the genetics                  
revolution.

Consider the structure for future delivery of high quality genetic medicine,                    
including referral networks with the recognition that medical schools will remain           
the locus of genetic expertise.

Engage in key policy debates, including genetic non-discrimination,                                 
reimbursement, access, and intellectual property issues.

Breakout Sessions

Three breakfast breakout sessions were held that focused on critical issues facing
medical school disciplines. One group focused on issues in the basic science
disciplines. The discussion included a consideration of the impact of centers and
institutions on basic science departments. Another group focused on education
issues related to clinical science disciplines. The last group focused on clinical
practice issues.

Plenary II: Prediction and Prevention in Medicine

Robert Desnick, M.D., Ph.D.: Dr. Desnick discussed the future of genome-based
medicine, the goal of which is to identify the genes causing rare and common
diseases for improved diagnosis, prevention, and the development of effective
therapies. He reviewed various approaches to disease gene identification, including
functional and positional cloning, the later markedly accelerated by the Human
Genome Project.

The identification of disease-causing and disease susceptibility genes will lead to an
era of preventive medicine. We won't just detect and treat disease, we will predict,
prevent, avoid or delay disease. Dr. Desnick discussed the "prediction-prevention
paradigm" for identifying an individual risk for genetic disorders including the
pre-disposition or susceptibility for various common diseases. He reviewed current
genetic screening programs for various population cohorts, including prenatal,
newborn, presymptomatic, predispositional, and premarital. For example, Tay-Sachs
disease is the prototype for prenatal carrier screening of recessive diseases. Such
screening has had dramatic results in reducing the number of new cases of
Tay-Sachs disease in North America and this program has expanded to other
recessive disorders.

Newborn screening is currently done for a number of treatable conditions, e.g.,
phenylketonuria, maple syrup urine disease, homocystinuria, galactosemia,
congenital hypothyroidism, hemoglobinopathies, and biotinidase deficiency. In the
future, mass spectroscopic analysis for more than 30 metabolic diseases and DNA
analysis for many other conditions may be routine.

Presymptomatic and predispositional genetic screening and counseling is currently
available for breast cancer, colon cancer, Alzheimer's disease, AIDS, and several
other diseases. The benefits of genetic testing include aiding clinical
decision-making, providing relief from anxiety, and increasing the quality of life. Some
of the potential risks of such testing include psychological distress, loss of privacy,
genetic discrimination, adverse effects on family dynamics, false sense of security,
and prediction inaccuracies.

Finally, Dr. Desnick provided an example of premarital screening involving the
Hassidic Jewish community in which marriages are arranged. Confidential carrier
screening provides genetic screening information in order that the parents avoid
matches between two carriers where the risk for an affected child would be 1 in 4.

Dr. Desnick concluded by discussing various genetic testing and screen issues.
These include stigmatization of both groups and individuals; confidentially and
privacy issues; genetic discrimination involving insurance and employment; and the
need for education and genetic counseling.

Richard Weinshilboum, M.D.: Dr. Weinshilboum discussed pharmacogenomics and the
promise of personalized medicine. Pharmacogenetics is the study of the role of
inheritance in individual variation in response to xenobiotics including drugs. The
goal is to individualize drug therapy. Various factors influence the effects of drugs on
patients, including genetics, age, gender, disease, and other drugs. Pharmacogentic
targets include drug absorbtion, drug distribution, drug-receptor interaction, drug
metabolism, and drug excretion.

Pharmacogenomics is the convergence of advances in pharmacogenetics and human
genomics. Dr. Weinshilboum provided a number of case studies on the potential uses
of pharmacogenomics in practice. Dr. Weinshilboum discussed why the incorporation
of pharmacogenetics-pharmacogenomics into clinical practice has been so slow.
Although there are major scientific challenges, other hurdles exist. The ethical-legal
and social issues are serious. It is difficult to develop clinically relevant tests, and
there are multiple gene effects which make controlled trials difficult.

Dr. Weinshilboum concluded by discussing various perspectives on
pharmacogenetics and pharmacogenomics. The pharmaceutic industry is focused on
drug targets, drug development and market segmentation. Academics are focused on
molecular mechanisms, population science and individualization of therapy. The
imperative, however, remains the patient's perspective: the right drug at the right
dose for me.

Alan DeCherney, M.D.: Dr. DeCherney provided an overview of available in vitro
fertilization techniques, areas of new development, and areas of ongoing
controversy. He provided a detailed discussion of the development if in vitro
fertilization procedures. Controversies about sex selection, trait selection, and
posthumous reproduction were discussed in detail.

Areas of controversy about the assisted reproduction field also include the
disposition of abandoned embryos and the use of fetal oocytes. The industry is
largely unregulated and competition is fierce. Success rates are now being
published. Some practitioners are offering "money backed guarantees" which cause
concern since it appears to be paying for good outcomes. Dr. DeCherney concluded
by discussing other areas of controversy including chimeras, stem cell research,
embryo research, and oocyte cyropreservation.

Optional Session: Exploring Los Alamos National Laboratory

A number of the meeting attendees attended a special session at the Los Alamos
National Laboratory. Participants heard an overview presentation about Los Alamos
by Dr. John S. Rhoades, director of the Bradbury Science Museum. Dr. Jill Trewhell
provided an overview of the Bioscience Division. Dr. Thomas Terwilliger presented a
discussion of the Los Alamos Lab's work in the field of structural genomics. Dr. John
Nolan concluded the presentations by discussing the operations of the National Flow
Cytometry Resource.

Breakout Sessions

Three concurrent breakfast discussion sessions were held. One session focused on
issues related to gifts to residents and physicians. A second session focused on the
future of academic societies, which included a discussion of a recent Society of
Academic Emergency Medicine survey of CAS societies. A third session provided a
detailed update on the various CAS chairs initiatives.

Plenary IV: The Changing Art of Medicine: Preserving the Social
Contract and Our Academic Value

Anne Jobe M.D., M.S.N.: Dr. Job discussed the rhetoric and reality of academic values.
She defined academic values as the medical school mission, vision, goals and
objectives, and personal values. She also discussed what is meant by medical
education's social contract. She explored the contrast between the medical
professional's view of the medical profession and the public's view.

Dr. Jobe discussed the medical school community's need to embrace change and to
recommit ourselves to the meaning of medicine, which remains service to patients
and the community. She provided several examples of medical schools reconnecting
with their communities.

David Hunter: Mr. Hunter discussed the Hunter Group's approach to consulting at
academic medical centers. Their process is analytical and largely data driven. They
assess the entire organization from governance to facilities and interview and
involve key constituents. They lay out options, opportunities and recommendations.

Mr. Hunter discussed his observations from working with academic medical centers.
There are many similarities among institutions that have sought their assistance,
including declining reimbursements, missing budget targets, ineffective business
practices, struggles between the school and hospital governance and operations,
losing volume to their own graduates and community hospitals, and poor service.
Among the differences are state laws, reimbursement methodologies,
market/community, leadership and accountability, the degree of interest from local
political leaders, and the relationship between the clinical organization, medical
school and faculty practice plan.

Mr. Hunter said that he believes that education is a mission, not an excuse and that
education programs don't always reflect the needs of the medical school, hospital and
community. He said that DME and IME no longer cover costs and that living with less
must be a joint effort. The faculty must be responsible for their own clinical practice
and that the funds flow between the hospital/ school/ practice plan is often still a
mystery. He recommends that all deals be put on the table and that information be
shared with all involved.

In a lengthy discussion of the academic medical center's social mission, Mr. Hunter
challenged a number of popular assumptions. He said that to afford the social
mission, hospitals must make money to assure faculty support, that unprofitable
services may need to be eliminated and that tough decisions need to be made. He
concluded by discussing the outline of successful academic health centers of the
future. In general, the successful AHC will streamline governance, strengthen
management and accountability, reform faculty governance, develop realistic budgets
and business plans, maximize revenues, reduce expenses to market competitive
levels, improve quality and clinical resource management, appropriately size capacity,
align incentives and restructure school-hospital relationships.

CAS Business Meeting

See the attached draft Business Meeting minutes.

Option Workshop: The Health Insurance Portability & Accountability
Act Regulations and Research - Key Issues

Jennifer Kulynych, J.D., Ph.D., provided a detailed review of the Department of Health
and Human Services (DHHS) final rule entitled "Standards for the Privacy of
Individually Identifiable Health Information." She discussed some of the potential
impacts on research. Key issues discussed included: the de-identification of
protected health information, the criteria for waiver of patient authorization for the
use or disclosure of information for research, the uses and disclosures for research
purposes, accounting for disclosures, public health reports, accreditation and
institutional oversight of research integrity, the definition of "medically necessary,"
and the cost of compliance.

Dinner Address

Dr. Lori Arviso Alvord discussed her life story, including her training as the first
female Navajo surgeon. She discussed walking the path between two worlds and
discussed the Navajo philosophy of a balanced and harmonious life called "Walking in
Beauty."

Special Session on Human Subjects Accreditation:

Marjorie Speers, M.D.: Dr. Speers, Executive Director of the Association for the
Accreditation of Human Research Protection Programs, discussed the goals and
operations of AAHRP.

Dr. Speers said that the founding organizations that created AAHRPP, including AAMC,
sought to ensure that scientific research can continue to grow and flourish under
conditions in which the best interests of research participants will be protected.
Recent federal shutdowns of research programs around the country underscore the
need to ensure greater consistency of high standards for the protection for human
research participants across the many settings in which such research is carried out.
By creating an accreditation organization founded by bioethicists, patient advocates,
medical investigators, and research institutions, AAHRPP represents the full
complement of perspectives needed to encourage continued confidence in scientific
investigation as a means of improving the health and quality of life of all people.

AAHRPP works to protect the rights and welfare of research participants by fostering
and advancing the ethical and professional conduct of persons and organizations
that engage in research with human participants. AAHRPP achieves its mission by
using an accreditation process based on self-assessment, peer review, and
education.

Responding to increased public and political scrutiny, AAHRPP seeks not only to
ensure compliance, but to raise the bar in human research protection by helping
institutions reach performance standards that surpass the threshold of state and
federal requirements. By establishing a "gold seal" signifying adherence to a
rigorous set of human protection standards, accreditation by AAHRPP will help ensure
consistency and uniformity among all institutions conducting biomedical, behavioral
and social sciences research.

Plenary IV: Hot Topics Session

Jennifer Kulynych, J.D., Ph.D.: Dr. Kulynych discussed the first report of the AAMC
Task Force on Financial Conflicts of Interest in Clinical Research, which provides
guidance related to individual financial interests in human subjects research. A
second report forthcoming in 2002 will address institutional financial interests in
human subjects research.

The key focus of the report is the recommendation that academic institutions
presume that a "financially interested individual" - defined in the report as any
researcher holding a significant financial interest in human subject research - may
not conduct the research in question. The researcher may rebut this presumption
only by demonstrating to a reviewing body that he or she has compelling reasons for
doing so. Consequently, the report recognizes that each case of potential financial
conflict of interest in research must be closely examined on its merits. To help
achieve this goal, the task force recommends that academic institutions appoint a
standing Conflicts of Interest committee.

The guidelines underscore the necessity, whenever they are present, of disclosing
financial interests in human subjects research to participants, in publications, and in
presentations of the research findings. Dr. Kulynych emphasized that the new
guidelines respect institutional autonomy and flexibility.

Tony Mazzaschi: Mr. Mazzaschi presented a summary of the current state of legislative
and regulatory activities regarding stem cell research and somatic cell nuclear
transfer or therapeutic cloning.. Most of AAMC's advocacy activity on these issues is
in coordination with the Coalition for the Advancement of Medical Research (CAMR).
CAMR's mission was initially to promote federal funding for human embryonic stem
cell research. It has been revised to include opposition to limitations on somatic cell
nuclear transfer or therapeutic cloning.

Following the President's August 9, 2001 decision to allow the federal funding of stem
cell research on the 68+ lines available at that time, NIH has been moving
expeditiously to implement the President's decision. Supplements are being made
available to existing grantees who with to work in the field, training and infrastructure
program announcements have been issued as have several stem cell request for
applications. NIH is now moving to clarify some facilities and administrative issues for
institutions. Institutions still need to complete agreements with line owners. The
NIH-WiCell agreement is viewed as a model.

Mr. Mazzaschi stressed a critical distinction between the stem cell issue and the
SCNT/therapeutic cloning issues: the stem cell debate was about federal funding, the
cloning debate is about whether to permit the research using either public or private
funds. There is a consensus to prohibit reproductive cloning. The issue is
therapeutic cloning - the use of a donor's unfertilized egg and a patient's own nuclear
material in an effort to develop stem cells that won't be rejected.

Legislation offered by Senator Feinstein (S. 1758), Congressman Greenwood (H.R.
2172), and Harkin (S 1893) would make reproductive cloning illegal and maintain the
legality of therapeutic cloning. Legislation offered by Senator Brownback (S. 790, S.
1899) and a House passed bill (H.R. 2505) would make both therapeutic cloning and
reproductive cloning illegal. The bills would provide criminal penalties for therapeutic
cloning: 10 years in jail, $1 million fine and prohibit the importation of any therapy
derived from research involving therapeutic cloning. A vote on the cloning issue is
expected sometime this spring
Council of Academic Societies

Business Meeting Summary Minutes (Draft)

March 16, 2002
I. Call to Order

N. Lynn Eckhert, M.D., Dr. P.H., called the Council of Academic Societies Business
Meeting to order at 12:40 p.m. on Saturday, March 16. Dr. Eckhert thanked the
AAMC staff for their efforts on behalf of the CAS and in assisting with the meeting.
In welcoming remarks, Dr. Eckhert said she was gratified by the progress made on
the various CAS chair initiatives. She also expressed appreciation to Dr. Cooper for
organizing and summarizing the CAS Professionalism Roundtable. She thanked her
Administrative Board colleagues for their efforts on behalf of the CAS.

II. Consideration of Minutes

ACTION: On motion, seconded and carried, the minutes of the Business Meeting
of November 5, 2001 were approved.

III. President's Report

Dr. Jordan Cohen reviewed the new AAMC Policy Guidance on Graduate Medical
Education. The report's section on resident work hours was discussed at length.
The policy includes, among other, the following provisions:

Institutional sponsors and individual residency programs should have written           
guidelines governing resident duty hours; these guidelines will vary                           
according to specialty, intensity of patient care responsibilities on a given                 
rotation, level of experience, and educational requirements.

In no case should residents be scheduled to be on duty more than 80 hours in          
any week. On typical clinical rotations, residents should not be scheduled to             
be on duty for more than 24 hours consecutively; continuous duty in high                   
intensity settings (e.g., emergency rooms, critical care units) should, in                       
general, be scheduled for no more than12 hours. These guidelines must be               
applied with sufficient flexibility, as noted above, to ensure that thorough                  
exchange of information and proper transfer of patient care responsibilities              
occurs whenever residents who are going off duty sign over the care of                    
patients to other residents or to teaching physicians.

Duty-free intervals between periods on call should be at least 8 hours long.

If moonlighting is authorized, the time spent doing so should be included                   
within the parent program's duty hour limits; unauthorized moonlighting                     
should be prohibited.

Residents should not be required to have overnight, on-call duty more                       
frequently than one night in three, as averaged over 4 weeks.

Residents should have at least 24 consecutive hours free of all assigned duty          
every seven days.

The on-duty time residents spend delivering patient care services of marginal          
or no educational value should be minimized.

Dr. Cohen noted that there are both federal and state legislative proposals on
resident work hours and that the community has a narrow window in which to show
that it can regulate itself before the heavy hand of government regulation likely
imposes more rigid regulations.

Dr. Cohen also discussed the activities of the AAMC Advisory Committee on the
Definition of Underrepresented Minorities. The committee includes
representatives from a wide range of AAMC councils, groups and committees, and
includes Dr. Phillip Liu from the CAS. the panel has been reviewing the
Association's current definition of the term "underrepresented minority." The
committee met recently and reviewed various legal issues that may affect any
change in the definition. The committee is trying to balance the legal risks a
definitional change may pose to our member institutions while at the same time
maintaining the unwavering commitment of the AAMC to ensuring a diverse
medical student population.

IV. Legislative Update

Dr. Richard Knapp discussed the political environment for health and research
issues in Congress. The President's FY 2003 budget proposal provided for large
increases in bioterrorism-related funding. Although the President proposed
completing the five-year doubling of the NIH budget, increases are not uniformly
distributed among the various institutes and centers. The President has proposed
drastic decreases in funding for the health professions. There is also concern
about the 16.2 percent decrease that the President is proposing for the Agency for
Healthcare Quality and Research. Dr. Knapp also discussed the budget situation for
the Veterans Administration, the CDC and the NSF.

Dr. Knapp discussed the impact of the President's budget on Medicare and
Medicaid providers. There were no new major Medicare cuts proposed. However,
a 15 percent IME reduction is assumed in the budget, as is a second round of
negative cuts to the physician payment update. Dr. Knapp discuss the Association's
strategy and tactics in regards to fixing the Medicare physician fee cut and for
keeping the Medicare IME at 6.5. Lastly, Dr. Knapp discussed the leadership
vacancies at various DHHS agencies.

V. Chairs Task Force

Dr. Michener presented the draft report of the CAS Chairs Objectives Project
Panel, which was formed by the CAS Chairs Task Force. A lengthy meeting of the
Panel was held in Dallas in late November. The project attempts to define the
attitudes, skills, knowledge and values of successful department chairs. Dr.
Michener said that the report, when completed, would assist institutional search
committees and help societies and the AAMC consider appropriate chair
development initiatives.

The report will also be included in a new AAMC resource, a manual entitled, "Good
Practice In the Development of the Successful Department Chair." The first module
is nearly complete. It addresses the events triggered by the departure of a
department chair, and defines good practices in the search, selection and
appointment processes, including leadership transition. The second module will
address the definition of department chair responsibilities and expectations, and
identifies good practices for the development of the skill sets required to carry out
those responsibilities effectively. The CAS Chairs Objectives Project will be
included in this module. The final section addresses good practice in evaluation
and performance review of department chairs, rewards, career transition, and
issues related to termination.

VI. Basic Science Chairs Leadership Forum

Dr. William Dantzler reported that the Forum's Steering Committee is actively
engaged in planning the national meeting planned for basic science chairs in
October. The meeting will be held October 11- 13, 2002 in Philadelphia. A keynote
speaker has been invited. The meeting will focus on the evolving role of the basic
science chair.

VII. Membership Committee Report

Dr. Barbara Schuster presented the Membership Committee report. The CAS
membership now stands at 98 member societies. During the past year, eight new
societies were admitted into the CAS. The Association of Directors of Medical
Student Education in Psychiatry recently expressed interest in applying for
membership. Their application may be ready for consideration at the June
Administrative Board meeting. CAS Representatives were encouraged to
recommend additional academic societies that should be encouraged to join the
CAS.

VIII. CAS Professionalism Task Force

Dr. Terry Cooper said that the Professionalism Task Force has focused on efforts to
enhance professionalism in medical schools and teaching hospitals, sensitize
faculty and students as to the nature of professionalism, and to study how it can be
evaluated. Dr. Cooper presented the final draft summary of the Professionalism
Roundtable held last March in San Antonio. The session was organized to define
the roles and responsibilities of faculty in regards to professionalism. The session
was extremely lively and generated much discussion about the meaning of
professionalism. Dr. Cooper synthesized the discussion into a statement entitled,
"Attributes of Professional in Medicine." Dr. Cooper said that the statement was
being shared with Dr. Tom Inui, currently a Petersdorf Scholar in Residence at
AAMC, to assist him in his professionalism-related project.

IX. Service Recognition Award

Dr. Eckhert presented a plaque to Dr. Terry Cooper to recognize his service as CAS
Chair (2000-2001) and for his six years of service on the CAS Administrative Board.

X. Adjournment

With no further new business, the Business Meeting adjourned.