New Resolution from the AMA

www.ama-assn.org/system/files/2020-10/nov20-handbook-addendum.pdf


Whereas, SARS-CoV-2 is the novel coronavirus that causes COVID-19; and



Whereas, Three distinct stages of COVID-19 infection have been observed in some people who

test positive for the disease and have variable degrees of symptoms as noted (1); and



Whereas, During the early infection phase (Stage 1), the virus multiplies inside the body and is

likely to cause mild symptoms that may be confused with a common cold or flu; and

Whereas, The second phase is the pulmonary phase (Stage 2), when the Immune

System becomes strongly affected by infection and leads to primarily respiratory symptoms

such as persistent cough, shortness of breath and low oxygen levels. Problems with blood

clotting--especially with the formation of blood clots--may be predominant in Stage 2; and



Resolution: 509 (November 2020)





Whereas, The third hyperinflammatory phase (Stage 3), occurs when a hyperactivated immune

system may cause injury to the heart, kidneys, and other organs. A "cytokine storm"--where the

body attacks its own tissues--may occur in this phase; and



Whereas, There is no current Federal Drug Administration (FDA) indication for the treatment of

Early Coronavirus infection, but early emergency use authorization (EUA) originally approved

the use of hydroxychloroquine and then rescinded it (2); and



Whereas, The FDA limited use of convalescence plasma but now has rescinded that

limitation (3); and



Whereas, Hydroxychloroquine and Chloroquine are FDA approved medications for over

50 years, and these medications are safely prescribed long-term for other indications (2); and



Whereas, AMA President, Patrice A. Harris, MD, issued the following statement: “The AMA

is calling for a stop to any inappropriate prescribing and ordering of medications, including

chloroquine or hydroxychloroquine, and appealing to physicians and all health care

professionals to follow the highest standards of professionalism and ethics” (4); and



Whereas, The AMA, American Pharmacists Association, and American Society of Health

System Pharmacists issued a joint statement on March 25, 2020 on inappropriate ordering,

prescribing, or dispensing of medications to treat COVID-19 (4); and



Whereas, Some states, pharmacy boards and institutions have forbidden the use of these

medications for COVID-19 infection (4, 5); and



Whereas, A proposed regimen to treat COVID-19 for Stage 1, includes 10 days of

hydroxychloroquine, Azithromycin, zinc, and on occasion Vitamin D (6); and



Whereas, This regimen is not being advocated for Stage 2 and Stage 3 COVID therapy; and



Whereas, The original studies published in The Lancet and The New England Journal of

Medicine (NEJM) initially citing harm due to hydroxychloroquine and chloroquine use were

retracted by said journals due to dubious research methodology and incorrect conclusions



(7, 8, 9); and



Whereas, AMA policy H-120.988, “Patient Access to Treatments Prescribed by Their

Physicians,” supports a physician’s autonomy to prescribe medications the physician believes to

be in the patient’s best interest, where the benefits outweigh risk and the patient consents; and



Whereas, Physicians have used off label medications for years and this use is supported by

existing policy; and



Whereas, Data regarding harm have been limited due to poorly designed studies or studies

usually in Stage 2 or later, or stopped without harm but no effect in phase 2 and hypothesis

(7, 8, 9, 10, 11, 12); and



Whereas, There are many studies that indicate that the use of Hydroxychloroquine,

Azithromycin is effective and front-line physicians are using the therapy where permissible



(13, 14, 15); and





Resolution: 509 (November 2020)

Whereas, The COVID-19 pandemic is a serious medical issue, people are dying, and

physicians must be able to perform as sagacious prescribers; therefore be it



RESOLVED, That our American Medical Association rescind its statement calling for physicians

to stop prescribing hydroxychloroquine and chloroquine until sufficient evidence becomes

available to conclusively illustrate that the harm associated with use outweighs benefit early in

the disease course. Implying that such treatment is inappropriate contradicts AMA Policy

H-120.988, “Patient Access to Treatments Prescribed by Their Physicians,” that addresses off

label prescriptions as appropriate in the judgement of the prescribing physician (Directive to

Take Action); and be it further





RESOLVED, That our AMA rescind its joint statement with the American Pharmacists

Association and American Society of Health System Pharmacists, and update it with a joint

statement notifying patients that further studies are ongoing to clarify any potential benefit of

hydroxychloroquine and combination therapies for the treatment of COVID-19 (Directive to Take

Action); and be it further





RESOLVED, That our AMA reassure the patients whose physicians are prescribing

hydroxychloroquine and combination therapies for their early-stage COVID-19 diagnosis by

issuing an updated statement clarifying our support for a physician’s ability to prescribe an FDA21 approved medication for off label use, if it is in her/his best clinical judgement, with specific

reference to the use of hydroxychloroquine and combination therapies for the treatment of the

earliest stage of COVID-19 (Directive to Take Action); and be it further





RESOLVED, That our AMA take the actions necessary to require local pharmacies to fill valid

prescriptions that are issued by physicians and consistent with AMA principles articulated in

AMA Policy H-120.988, “Patient Access to Treatments Prescribed by Their Physicians,” including working with the American Pharmacists Association and American Society of Health

System Pharmacists. (Directive to Take Action)