### The AAPA-AMA Scope Creep Discourse and the Wider Prescription Framework

The persistent contention between the **American Academy of Physician Associates (AAPA)** and the **American Medical Association (AMA)** regarding scope of practice frequently centers around patient safety and clinical results. Nonetheless, a more significant issue looms within these conversations: the increasing dependence of our medical framework on prescription drugs as the fundamental approach to managing chronic illnesses. This concern is especially relevant with the introduction of new medications like GLP-1 receptor agonists (GLP-1RAs) for obesity, which poses growing challenges for both clinical practices and the overall health of the public.

#### Chronic Medication as the New Standard

In examining GLP-1RAs, a specialist in obesity medicine pointed out the necessity of viewing obesity as a chronic condition that demands lifelong pharmaceutical management. Recent statistics from the **Agency for Healthcare Research and Quality (AHRQ)** and the **Centers for Disease Control and Prevention (CDC)** indicate that a considerable portion of American lives is already spent using prescription drugs—40% for men and 60% for women. The rise of GLP-1RAs may exacerbate this trend, promoting continued treatment typically without adequate focus on tackling the root causes of illnesses.

Instead of questioning the appropriateness of the medication-first approach for all scenarios, public health discussions often emphasize minimizing disparities in medication access among different demographic groups. For instance, when research indicated that non-Hispanic Black men had lower statin usage rates than other demographics, the response was to advocate for broader statin utilization instead of investigating alternative preventive methods. A similar pattern is surfacing with GLP-1RAs, as efforts are directed towards making these expensive medications more accessible, often neglecting the long-term health outcomes.

#### Drawbacks of Prescription-First Healthcare

The prevailing model for managing chronic illnesses typically emphasizes indicators such as LDL cholesterol, blood pressure, A1C levels, and weight reduction, measuring success through prescription-related metrics rather than holistic health outcomes. While these interventions provide measurable advantages, the results can often be disappointing when assessed by absolute risk reduction.

For instance:
– **Statins**: Research indicates a reduction of LDL cholesterol by 30–50%, yet achieves only a **1% absolute risk reduction** in negative cardiac outcomes.
– **Hypertension Trials**: Large-scale studies like **SPRINT**, **ACCOMPLISH**, and **ACCORD** show slight reductions in absolute risk despite effectively controlling blood pressure.
– **GLP-1RAs**: While these medications significantly enhance weight and metabolic parameters, they provide **less than 1% absolute reduction** in cardiovascular risk, with long-term health effects still being evaluated.

These figures, along with the “numbers needed to treat” (NNT) frequently surpassing 200 in preventing events such as myocardial infarctions, illustrate a concerning reality. The dependency on prescriptions often conceals underlying physiological issues—like gut microbiome disruptions, chronic inflammation, and metabolic dysfunctions—that frequently remain unaddressed.

#### The Greater Discourse in the AAPA vs. AMA Context

In the discourse surrounding scope of practice, the **AAPA** advocates for empowering physician associates (PAs) with greater independence, referencing studies demonstrating similar outcomes between PAs and physicians in areas such as prescribing and managing chronic conditions. Conversely, the **AMA** argues that these results support the necessity for physician-led teams. However, this exchange overlooks the core issue: irrespective of who prescribes medications, **an excessive dependence on prescriptions has fundamentally influenced how success is defined in health care**.

As clinical practice guidelines increasingly rely on numerical metrics for chronic disease management, this trend results in a conveyor-belt model that marginalizes individualized care. This framework undervalues the comprehensive educational background of both PAs and physicians, transforming healthcare into a function of prescription alignment instead of a holistic, patient-oriented approach.

#### The Price of “Blindfold Healthcare”

While prescriptions are often lauded for their quick effects, they frequently serve as blindfolds that conceal the intricate pathophysiology of chronic diseases. Reflect on the systemic challenges that medications typically fail to address:
– **Gut Dysbiosis**: Disruptions in the gut microbiome are pivotal in the development of obesity, cardiovascular disease, and diabetes.
– **Endothelial Dysfunction**: Essential for cardiovascular well-being, issues related to inflammation and damage to the endothelial lining often remain unexamined.
– **Hyperinsulinemia**: High insulin levels initiate a series of metabolic dysfunctions that rarely improve with medication alone.
– **Sleep Disruptions**: Inadequate REM sleep profoundly affects both metabolic health and cardiovascular risks.
– **Lifestyle Factors**: Elements such as stress, lack of physical activity, and dietary choices are fundamental contributors that prescriptions usually only address superficially.

By prioritizing prescriptions as the ultimate solution, the existing healthcare system inadvertently diminishes its capacity to probe and rectify these vital underlying factors of chronic disease.

#### The Necessity