The largest US physician organization wrestled with the professional risks and rewards of artificial intelligence (AI) at its annual meeting, delaying action even as it adopted new policies on prior authorization and other concerns for clinicians and patients.
Physicians and medical students at the Annual Meeting of the American Medical Association (AMA) House of Delegates in Chicago intensely debated a report and two key resolutions on AI but could not reach consensus, pushing off decision-making until a future meeting in November.
One resolution would establish "augmented intelligence" as the preferred term for AI, reflecting the desired role of these tools in supporting — not making — physicians' decisions. The other resolution focused on insurers' use of AI in determining medical necessity.
(See specific policies adopted at the meeting, held on June 8-12, below.)
A comprehensive AMA trustees' report on AI considered additional issues including requirements for disclosing AI use, liability for harms due to flawed application of AI, data privacy, and cybersecurity.
The AMA intends to "continue to methodically assess these issues and make informed recommendations in proposing new policy," said Bobby Mukkamala, MD, an otolaryngologist from Flint, Michigan, who became the AMA's new president-elect.
AMA members at the meeting largely applauded the aim of these AI proposals, but some objected to parts of the trustees' report.
They raised questions about what, exactly, constitutes an AI-powered service and whether all AI tools need the kind of guardrails the AMA may seek. There also were concerns about calls to make AI use more transparent.
While transparency might be an admirable goal, it might prove too hard to achieve given that AI-powered tools and products are already woven into medical practice in ways that physicians may not know or understand, said Christopher Libby, MD, MPH, a clinical informaticist and emergency physician at Cedars Sinai Medical Center in Los Angeles.
"It's hard for the practicing clinician to know how every piece of technology works in order to describe it to the patient," Libby said at the meeting. "How many people here can identify when algorithms are used in their EHR today?"
He suggested asking for more transparency from the companies that make and sell AI-powered software and tools to insurers and healthcare systems.
Steven H. Kroft, MD, the editor of the American Journal of Clinical Pathology, raised concerns about the unintended harm that unchecked use of AI may pose to scientific research.
He asked the AMA to address "a significant omission in an otherwise comprehensive report" — the need to protect the integrity of study results that can direct patient care.
"While sham science is not a new issue, large language models make it far easier for authors to generate fake papers and far harder for editors, reviewers, and publishers to identify them," Kroft said. "This is a rapidly growing phenomenon that is threatening the integrity of the literature. These papers become embedded in the evidence bases that drive clinical decision-making."
AMA has been working with specialty societies and outside AI experts to refine an effective set of recommendations. The new policies, once finalized, are intended to build on steps AMA already has taken, including last year releasing principles for AI development, deployment, and use.
Congress Mulling
The AMA delegates are far from alone in facing AI policy challenges.
Leaders in Congress also are examining AI guardrails, with influential panels such as the Senate Finance and House Energy and Commerce committees holding hearings.
A key congressional AI effort to watch is the expected implementation of a bipartisan Senate "road map," which Senate Majority Leader Chuck Schumer (D-NY) and colleagues released in May, said Miranda A. Franco, a senior policy advisor at the law firm Holland & Knight.
The product of many months of deliberation, this Senate road map identifies priorities for future legislation, including:
- Creating appropriate guardrails and safety measures to protect patients.
- Making healthcare and biomedical data available for machine learning and data science research while carefully addressing privacy issues.
- Providing transparency for clinicians and the public about the use of AI in medical products and clinical support services, including the data used to train models.
- Examining the Centers for Medicare & Medicaid Services' reimbursement mechanisms as well as guardrails to ensure accountability, appropriate use, and broad application of AI across all populations.
"I think this is all going to be slow and rolling, not big and sweeping," Franco told Medscape Medical News. "I don't think we're going to see an encompassing AI bill."
AMA Policies Adopted on Other Issues
At the June meeting, AMA delegates adopted the following policies aiming to:
- Increase oversight and accountability of health insurers' use of prior authorization controls on patient access to care.
- Encourage policy changes allowing physicians to receive loan forgiveness when they practice in an Indian Health Service, Tribal, or Urban Indian Health Program, similar to physicians practicing in a Veterans Administration facility.
- Advocate for federal policy that limits a patient's out-of-pocket cost to be the same or less than the amount that a patient with traditional Medicare plus a Medigap plan would pay.
- Oppose state or national legislation that could criminalize in vitro fertilization.
- Limit what the AMA calls the "expensive" cost for Medicare Advantage enrollees who need physician-administered drugs or biologics.
- Help physicians address the handling of de-identified patient data in a rapidly changing digital health ecosystem.
- Support efforts to decriminalize the possession of non-prescribed buprenorphine for personal use by individuals who lack access to a physician for the treatment of opioid use disorder.
- Expand access to hearing, vision, and dental care. The new AMA policy advocates working with state medical associations to support coverage of hearing exams, hearing aids, cochlear implants, and vision exams and aids. The revised AMA policy also supports working with the American Dental Association and other national organizations to improve access to dental care for people enrolled in Medicare, Medicaid, and CHIP programs.
- Increase enrollment of more women and sexual and gender minority populations in clinical trials.
Kerry Dooley Young is a freelance journalist based in Washington, DC.