Ad Hoc Committee on Endorsement of Outside Documents-F922E05D
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President-Elect Ad Hoc Committee on Endorsement of Outside Documents
Final Report of the Committee
August, 2003
Members:
Peter J. Biggs, Chair
Julie Dawson
D. Jay Freedman
Chris Marshall
H. Mower
J. Williamson
M. Yester
Charge to the committee:
R. Gould, AAPM past president, set up this ad hoc committee to address the issue of the society responding to a multitude of requests seeking some kind of endorsement of a position statement from outside entities or organizations. M. Weinhous, the current president, continued the charge to this committee. These endorsements may involve scientific issues, such as the use of whole body CT scans for asymptomatic patients, or some professional issue. A related problem is the issue of endorsing or co-sponsoring of task group reports prepared, wholly or in part, by an outside society. The current process of dealing with these problems is a multi-step process. The requests initially come before EXCOM who refer them to the appropriate council or committee. The designated committee reviews the document, makes a recommendation to their council who, in tum, refer it to the board for approval. The purpose of this ad hoc committee is to draw up a set of guidelines by which the society may act on such requests in future.
The specific charge of this committee is to develop and recommend guidelines for the AAPM to use in evaluating scientific and professional documents or position statements that come to the AAPM from outside entities seeking AAPM endorsement. The committee must consider a variety of factors:
- mechanism(s) by which the AAPM can react quickly to those requests needing a rapid response (which is often the case) - commercial content of the statement or document - coordination within the AAPM to prevent conflicting or contradictory statements
Summary:
The committee has studied the procedures adopted by other scientific societies and organizations to handle the problem of endorsement of a position statement from outside entities or organizations. In consideration of the approaches taken by these societies, the committee recommends the setting up of a standing committee to address this issue. Specific recommendations for the responsibilities of this committee are detailed in the body of this report.
Background:
In debating this issue, the committee naturally asked how other societies respond under similar circumstances. It was felt that societies such as ASTRO or Health Physics, as well as the AIP, must certainly face the same types of requests for endorsements as the AAPM. The presidents of ASTRO and Health Physics were subsequently contacted to learn of their policies in this area. These are shown as attachments to this report. C. Marshall received an e? mail from Richard Jones at the AIP with regard to their 'Rapid Response Procedure.' which the AAPM has previously endorsed as a member society of the Institute and this is also provided as an attachment. It is interesting to note that these three examples illuminate different aspects of our problem.
ASTRO is reactive in developing position statements related to clinical use or misuse of radiation and, very importantly, professional issues that strongly overlap the interests of the AAPM. ASTRO has not formalized its approach, but is considering this step. However, at last year's board of directors meeting, they planned on reviewing all historical documents and previous ASTRO policies relating to this issue, with the ultimate goal of establishing a formal policy. Thus ASTRO, at this time, has little to offer the AAPM in terms of a committee structure to handle these problems.
The Health Physics society is proactive in developing position statements related to the general effects of radiation on the public and has a formalized approach to developing position statements. The focal point for all questions that fall under this rubric is the president of the society. If the HPS already has a policy statement on a particular issue, the president responds directly to the issue. However, if the topic has not previously been addressed by the society, the president will advise the executive committee of the request. The HPS has set up a standing committee, the scientific and public issues committee that is charged with the responsibility for preparing impartial scientific and technical statements. This committee consists of the immediate past-president, the president, the president-elect and the next two most immediate past-presidents. In terms of rapid response of the HPS to time-critical requests, the president acts in conjunction with the congressional liaison, the executive secretary, the public education committee and any other relevant standing committee. The response is drafted by one or more of these persons or committees in collaboration, reviewed by the president who, in turn, submits it to the scientific and public issues committee for final review and approval. In terms of how rapid this response can be, the president notes that this process is not always very efficient but hopes that this will improve with more effective use of e-mail.
The AIP, which is an umbrella organization, attempts to develop or coordinate statements that represent a consensus view, both within its member societies and through liaisons with other umbrella organizations both on a proactive and reactive basis. It has a formalized approach that covers the mechanical aspects of dealing with multiple entities, and agreements with its member societies covering the conditions under which it may speak for the "community," but which allow each society to abstain, support, or disagree with a given statement on its own behalf.
The AIP has had in place a rapid response procedure for time-sensitive policy matters since 1995. The policy is as follows. Each member society designates an individual to serve as a 'primary rapid response contact' (there may be more than one). A roster of all such contacts is provided by AIP to the executive director of each society. When an AIP rapid response is indicated to a time-sensitive policy issue of concern to the physics community, AIP's executive director will advise the AIP governing board, society executive officers, the committee on public policy and the primary rapid response contacts by giving them background information and AIP's proposed response. The executive director will coordinate the response of the governing board, which consists of representatives of the member societies. Upon agreement of 60% of all members of the governing board and (2/3) of those voting, the AIP executive director will respond in an appropriate manner as an AIP response.
Discussion:
At its inaugural meeting, the committee held an open discussion on some of the issues that are typically submitted to EXCOM from outside sources and what methods of response would be most appropriate. There was also discussion as to whether the society should restrict its endorsements to specific areas, principally those involving physics issues. Gradually, the committee turned its attention to the structure needed to provide a timely response to a request for an endorsement by an outside body. This brings us to the policies of the Health Physics Society and the AIP (ASTRO, as noted above, has currently no policy in place). In much of what follows, the emphasis is on developing a time-limited response, but the charge to the committee also implies responding to situations where a rapid response is not required. This is discussed below.
It is clear from the above discussion that the approach that AIP uses, involves, of necessity, since it is an umbrella organization for many societies, many layers. However, in that context, the structure that AIP has developed for a rapid response is very efficient. They are able to provide the relevant information and get member society responses in very few steps. There are perhaps some instructive lessons in this arrangement for the AAPM since the society frequently develops joint position statements with ASTRO, ACR and ACMP.
The Health Physics Society approach might seem more appropriate for consideration since it also is a single organization. However, by effectively creating an ad hoc committee to review the proposal and draft a response which is then passed on to the standing committee, an unnecessary layer has been added to the decision making process. Moreover, this ad hoc committee also consists of other committees - public education and 'any other relevant standing committee.' Thus this substantially reduces the speed of the response. In his letter, the former president notes that the response using this approach is not as rapid as it should be. Also, one of the candidates for president-elect last year, Dr. Brian Dodd, said in his statement of goals "A continuing dilemma that the society must address is how to respond quickly to radiological issues that come to the attention of the public, usually via the media." He further states that he "will attempt to decrease comment response time to less than 24 hours." Note, however, that the Health Physics Society acts primarily on its own behalf and not in concert with other societies, whereas the AAPM frequently acts together with other societies to determine a joint response.
It was agreed that the AAPM should create a standing committee to provide the rapid response. The president, once he/she has received such a request, passes this directly on to this committee, which will provide an appropriate timely response. This committee would consist of the chairs of the Professional and Educational Councils, Radiation Therapy, Diagnostic Radiology, Nuclear Medicine and Radiation Protection committees, the executive director, the AAPM secretary and the government affairs manager. Thus this committee has direct ties to the entire major AAPM standing committees, EXCOM and A.IP. It would also coordinate activities with several of our potential partners, such as the ACR, ASTRO and ACMP. Note that review of endorsements and other outside documents would only be part of its permanent charge. One further advantage of setting up such a standing committee would be that all discussions and decisions arrived at would be suitably archived.
This committee would also serve the society well in the area of inter-society relations, particularly in working on scientific and technical reports in conjunction with other societies. Two recent examples that point to the need to develop a clearer inter-society policy and strengthen the role of the AAPM in their dealings with other societies are (i) the rewrite of NCRP #49 for diagnostic and therapeutic facilities and (ii) the inter-society brachytherapy guidelines. In the first instance, the issue of report approval, the method of publication and whether or not the AAPM logo would be used became a contentious issue. In the second instance, AAPM members expended considerable effort before the board elected not to endorse the report. Thus, had some ground rules been set up before the joint efforts were undertaken, the AAPM could have negotiated a better position in the first case and save its members much wasted effort in the second case. The new committee would therefore undertake the task, in future, of setting up a joint agreement before any action is taken by the AAPM. This agreement should address the mechanism by which the report charge and the completed report are to be approved within the AAPM, the AAPM entity responsible for monitoring its progress, the means of coordinating critiques from different sponsoring organizations and the publication venue, e.g, a jointly sponsored task group. Any financial issues should also be spelled out. Ideally, these negotiations should take place before the task is initiated to allow the reviewing AAPM committee a chance to review and, if necessary, edit the report charge. It is expected that the AAPM review and approval process would be similar to that of task groups.
As long as it is understood by outside parties that the AAPM welcomes alliances and coalitions, the best interests of the society will be served by adopting this approach. The committee would therefore act as the negotiating tool for the society. Similarly, since the committee involves Council and Committee heads, the AAPM secretary and headquarters, they are in a position to assess the implications of the commercial content of any request and act accordingly. In effect, the committee will act as a clearinghouse by deciding how each request for endorsement by the AAPM is to be handled.
In light of the above considerations, the new committee should seek to define the meaning of commonly used terms in this report such as endorsement, where essentially the AAPM approves a document without direct involvement in its preparation, sponsorship, which implies financial and logistical support from the AAPM and joint statement or report, where the AAPM agrees to collaborate with another organization to developing a position paper or report.
Another sensitive area of concern for the society is the avoidance of conflict of interest with regard to commercial content of documents, that it does not endorse the product of a particular manufacturer. For outside documents, this would be one more item for the committee to review. For AAPM-generated documents, report-writing committees would be required to indicate whether or not there is any commercial content in the report. If so, the report is passed on to this committee after approval by science council and before it goes to publications.
Specific recommendations:
If the AAPM is to be effective in making position statements that will have impact, it needs a mechanism to develop such statements, to coordinate its statements with those of other organizations with an alliance of interests, and to make sure that it does so consistently by maintaining an accessible record of past statements and their rationale. Such responsibilities need to be assigned to a single standing committee with staff support.
The committee recommends that a new standing administrative committee be formed to address the issue of developing and endorsing position statements, both proactively and reactively. This committee should consist of the chairs of both councils, all the scientific committees, the executive director, the AAPM secretary (this is important to maintain an historical record of all the committee's deliberations) and government affairs manager.
Scope for the new committee:
- This new Committee should review all position statements that are referred to the AAPM for endorsement or that arise from within the AAPM as the result of actions of Committees or other entities. This review should consider the consistency of such statements with pre? existing positions of the AAPM, including those related to commercial endorsement, and the general objectives and interests of the AAPM.
- This new Committee should be responsible for developing working relationships with other societies, coalitions and organizations with the objective of working collaboratively, and with clear understanding of the terms of collaboration, on developing and endorsing statements, which fit with the general objectives and interests of the AAPM.
- This new committee should be sensitive to the political, as well as scientific, implications of endorsing a document or report.
-This new Committee should recommend actions to the Board on issue that are not time sensitive, or to EXCOM where full Board approval is prohibited by time constraints.
In matters of extreme urgency, and where the normal consultative processes are impossible to exercise, the President may act for the AAPM in endorsing positions, provided that such endorsements are consistent with preexisting policies or positions and are promptly reviewed by EXCOM and the new Committee.
- This new committee will direct incoming requests to the appropriate committee for review.
- This new committee will set up guidelines for reviewing outside documents or proposals for collaboration so that it is clear what the nature of the request entails. This might take the form of a questionnaire with a broad range of questions. This would ensure that the appropriate questions were asked up front.
- The President of the AAPM should sign or otherwise signify approval of all AAPM position statements.
- All position statements made on behalf of the AAPM should be promptly communicated to the Board, and ultimately endorsed by the Board
Final Report of the Committee
August, 2003
Members:
Peter J. Biggs, Chair
Julie Dawson
D. Jay Freedman
Chris Marshall
H. Mower
J. Williamson
M. Yester
Charge to the committee:
R. Gould, AAPM past president, set up this ad hoc committee to address the issue of the society responding to a multitude of requests seeking some kind of endorsement of a position statement from outside entities or organizations. M. Weinhous, the current president, continued the charge to this committee. These endorsements may involve scientific issues, such as the use of whole body CT scans for asymptomatic patients, or some professional issue. A related problem is the issue of endorsing or co-sponsoring of task group reports prepared, wholly or in part, by an outside society. The current process of dealing with these problems is a multi-step process. The requests initially come before EXCOM who refer them to the appropriate council or committee. The designated committee reviews the document, makes a recommendation to their council who, in tum, refer it to the board for approval. The purpose of this ad hoc committee is to draw up a set of guidelines by which the society may act on such requests in future.
The specific charge of this committee is to develop and recommend guidelines for the AAPM to use in evaluating scientific and professional documents or position statements that come to the AAPM from outside entities seeking AAPM endorsement. The committee must consider a variety of factors:
- mechanism(s) by which the AAPM can react quickly to those requests needing a rapid response (which is often the case) - commercial content of the statement or document - coordination within the AAPM to prevent conflicting or contradictory statements
Summary:
The committee has studied the procedures adopted by other scientific societies and organizations to handle the problem of endorsement of a position statement from outside entities or organizations. In consideration of the approaches taken by these societies, the committee recommends the setting up of a standing committee to address this issue. Specific recommendations for the responsibilities of this committee are detailed in the body of this report.
Background:
In debating this issue, the committee naturally asked how other societies respond under similar circumstances. It was felt that societies such as ASTRO or Health Physics, as well as the AIP, must certainly face the same types of requests for endorsements as the AAPM. The presidents of ASTRO and Health Physics were subsequently contacted to learn of their policies in this area. These are shown as attachments to this report. C. Marshall received an e? mail from Richard Jones at the AIP with regard to their 'Rapid Response Procedure.' which the AAPM has previously endorsed as a member society of the Institute and this is also provided as an attachment. It is interesting to note that these three examples illuminate different aspects of our problem.
ASTRO is reactive in developing position statements related to clinical use or misuse of radiation and, very importantly, professional issues that strongly overlap the interests of the AAPM. ASTRO has not formalized its approach, but is considering this step. However, at last year's board of directors meeting, they planned on reviewing all historical documents and previous ASTRO policies relating to this issue, with the ultimate goal of establishing a formal policy. Thus ASTRO, at this time, has little to offer the AAPM in terms of a committee structure to handle these problems.
The Health Physics society is proactive in developing position statements related to the general effects of radiation on the public and has a formalized approach to developing position statements. The focal point for all questions that fall under this rubric is the president of the society. If the HPS already has a policy statement on a particular issue, the president responds directly to the issue. However, if the topic has not previously been addressed by the society, the president will advise the executive committee of the request. The HPS has set up a standing committee, the scientific and public issues committee that is charged with the responsibility for preparing impartial scientific and technical statements. This committee consists of the immediate past-president, the president, the president-elect and the next two most immediate past-presidents. In terms of rapid response of the HPS to time-critical requests, the president acts in conjunction with the congressional liaison, the executive secretary, the public education committee and any other relevant standing committee. The response is drafted by one or more of these persons or committees in collaboration, reviewed by the president who, in turn, submits it to the scientific and public issues committee for final review and approval. In terms of how rapid this response can be, the president notes that this process is not always very efficient but hopes that this will improve with more effective use of e-mail.
The AIP, which is an umbrella organization, attempts to develop or coordinate statements that represent a consensus view, both within its member societies and through liaisons with other umbrella organizations both on a proactive and reactive basis. It has a formalized approach that covers the mechanical aspects of dealing with multiple entities, and agreements with its member societies covering the conditions under which it may speak for the "community," but which allow each society to abstain, support, or disagree with a given statement on its own behalf.
The AIP has had in place a rapid response procedure for time-sensitive policy matters since 1995. The policy is as follows. Each member society designates an individual to serve as a 'primary rapid response contact' (there may be more than one). A roster of all such contacts is provided by AIP to the executive director of each society. When an AIP rapid response is indicated to a time-sensitive policy issue of concern to the physics community, AIP's executive director will advise the AIP governing board, society executive officers, the committee on public policy and the primary rapid response contacts by giving them background information and AIP's proposed response. The executive director will coordinate the response of the governing board, which consists of representatives of the member societies. Upon agreement of 60% of all members of the governing board and (2/3) of those voting, the AIP executive director will respond in an appropriate manner as an AIP response.
Discussion:
At its inaugural meeting, the committee held an open discussion on some of the issues that are typically submitted to EXCOM from outside sources and what methods of response would be most appropriate. There was also discussion as to whether the society should restrict its endorsements to specific areas, principally those involving physics issues. Gradually, the committee turned its attention to the structure needed to provide a timely response to a request for an endorsement by an outside body. This brings us to the policies of the Health Physics Society and the AIP (ASTRO, as noted above, has currently no policy in place). In much of what follows, the emphasis is on developing a time-limited response, but the charge to the committee also implies responding to situations where a rapid response is not required. This is discussed below.
It is clear from the above discussion that the approach that AIP uses, involves, of necessity, since it is an umbrella organization for many societies, many layers. However, in that context, the structure that AIP has developed for a rapid response is very efficient. They are able to provide the relevant information and get member society responses in very few steps. There are perhaps some instructive lessons in this arrangement for the AAPM since the society frequently develops joint position statements with ASTRO, ACR and ACMP.
The Health Physics Society approach might seem more appropriate for consideration since it also is a single organization. However, by effectively creating an ad hoc committee to review the proposal and draft a response which is then passed on to the standing committee, an unnecessary layer has been added to the decision making process. Moreover, this ad hoc committee also consists of other committees - public education and 'any other relevant standing committee.' Thus this substantially reduces the speed of the response. In his letter, the former president notes that the response using this approach is not as rapid as it should be. Also, one of the candidates for president-elect last year, Dr. Brian Dodd, said in his statement of goals "A continuing dilemma that the society must address is how to respond quickly to radiological issues that come to the attention of the public, usually via the media." He further states that he "will attempt to decrease comment response time to less than 24 hours." Note, however, that the Health Physics Society acts primarily on its own behalf and not in concert with other societies, whereas the AAPM frequently acts together with other societies to determine a joint response.
It was agreed that the AAPM should create a standing committee to provide the rapid response. The president, once he/she has received such a request, passes this directly on to this committee, which will provide an appropriate timely response. This committee would consist of the chairs of the Professional and Educational Councils, Radiation Therapy, Diagnostic Radiology, Nuclear Medicine and Radiation Protection committees, the executive director, the AAPM secretary and the government affairs manager. Thus this committee has direct ties to the entire major AAPM standing committees, EXCOM and A.IP. It would also coordinate activities with several of our potential partners, such as the ACR, ASTRO and ACMP. Note that review of endorsements and other outside documents would only be part of its permanent charge. One further advantage of setting up such a standing committee would be that all discussions and decisions arrived at would be suitably archived.
This committee would also serve the society well in the area of inter-society relations, particularly in working on scientific and technical reports in conjunction with other societies. Two recent examples that point to the need to develop a clearer inter-society policy and strengthen the role of the AAPM in their dealings with other societies are (i) the rewrite of NCRP #49 for diagnostic and therapeutic facilities and (ii) the inter-society brachytherapy guidelines. In the first instance, the issue of report approval, the method of publication and whether or not the AAPM logo would be used became a contentious issue. In the second instance, AAPM members expended considerable effort before the board elected not to endorse the report. Thus, had some ground rules been set up before the joint efforts were undertaken, the AAPM could have negotiated a better position in the first case and save its members much wasted effort in the second case. The new committee would therefore undertake the task, in future, of setting up a joint agreement before any action is taken by the AAPM. This agreement should address the mechanism by which the report charge and the completed report are to be approved within the AAPM, the AAPM entity responsible for monitoring its progress, the means of coordinating critiques from different sponsoring organizations and the publication venue, e.g, a jointly sponsored task group. Any financial issues should also be spelled out. Ideally, these negotiations should take place before the task is initiated to allow the reviewing AAPM committee a chance to review and, if necessary, edit the report charge. It is expected that the AAPM review and approval process would be similar to that of task groups.
As long as it is understood by outside parties that the AAPM welcomes alliances and coalitions, the best interests of the society will be served by adopting this approach. The committee would therefore act as the negotiating tool for the society. Similarly, since the committee involves Council and Committee heads, the AAPM secretary and headquarters, they are in a position to assess the implications of the commercial content of any request and act accordingly. In effect, the committee will act as a clearinghouse by deciding how each request for endorsement by the AAPM is to be handled.
In light of the above considerations, the new committee should seek to define the meaning of commonly used terms in this report such as endorsement, where essentially the AAPM approves a document without direct involvement in its preparation, sponsorship, which implies financial and logistical support from the AAPM and joint statement or report, where the AAPM agrees to collaborate with another organization to developing a position paper or report.
Another sensitive area of concern for the society is the avoidance of conflict of interest with regard to commercial content of documents, that it does not endorse the product of a particular manufacturer. For outside documents, this would be one more item for the committee to review. For AAPM-generated documents, report-writing committees would be required to indicate whether or not there is any commercial content in the report. If so, the report is passed on to this committee after approval by science council and before it goes to publications.
Specific recommendations:
If the AAPM is to be effective in making position statements that will have impact, it needs a mechanism to develop such statements, to coordinate its statements with those of other organizations with an alliance of interests, and to make sure that it does so consistently by maintaining an accessible record of past statements and their rationale. Such responsibilities need to be assigned to a single standing committee with staff support.
The committee recommends that a new standing administrative committee be formed to address the issue of developing and endorsing position statements, both proactively and reactively. This committee should consist of the chairs of both councils, all the scientific committees, the executive director, the AAPM secretary (this is important to maintain an historical record of all the committee's deliberations) and government affairs manager.
Scope for the new committee:
- This new Committee should review all position statements that are referred to the AAPM for endorsement or that arise from within the AAPM as the result of actions of Committees or other entities. This review should consider the consistency of such statements with pre? existing positions of the AAPM, including those related to commercial endorsement, and the general objectives and interests of the AAPM.
- This new Committee should be responsible for developing working relationships with other societies, coalitions and organizations with the objective of working collaboratively, and with clear understanding of the terms of collaboration, on developing and endorsing statements, which fit with the general objectives and interests of the AAPM.
- This new committee should be sensitive to the political, as well as scientific, implications of endorsing a document or report.
-This new Committee should recommend actions to the Board on issue that are not time sensitive, or to EXCOM where full Board approval is prohibited by time constraints.
In matters of extreme urgency, and where the normal consultative processes are impossible to exercise, the President may act for the AAPM in endorsing positions, provided that such endorsements are consistent with preexisting policies or positions and are promptly reviewed by EXCOM and the new Committee.
- This new committee will direct incoming requests to the appropriate committee for review.
- This new committee will set up guidelines for reviewing outside documents or proposals for collaboration so that it is clear what the nature of the request entails. This might take the form of a questionnaire with a broad range of questions. This would ensure that the appropriate questions were asked up front.
- The President of the AAPM should sign or otherwise signify approval of all AAPM position statements.
- All position statements made on behalf of the AAPM should be promptly communicated to the Board, and ultimately endorsed by the Board