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CHICAGO -- Airlines need to do more to help patients in wheelchairs use them on the plane, members of the American Medical Association's (AMA) House of Delegates said here Sunday, but they were divided on how to make that happen.

Delegates attending a Sunday morning reference committee meeting were debating a resolution from two specialty societies -- the American Academy of Physical Medicine & Rehabilitation (AAPM&R) and the American Association of Neuromuscular & Electrodiagnostic Medicine -- that urged the AMA to encourage Congress and the Federal Aviation Administration (FAA) to require commercial airlines to let passengers stay in their personal wheelchairs during flight.

"If you have a custom wheelchair, because of whatever your diagnoses are, it's an extension of who you are," said Stuart Glassman, MD, of Concord, New Hampshire, an AAPM&R delegate who was speaking for the Physical Medicine and Rehabilitation Section Council and the Mobility Caucus. "And if you have ever tried to fly anywhere, the minute that custom wheelchair was taken away from you and put in the bottom of the plane, part of you was not with you right at that moment."

"Last week in Germany at the Aircraft Interiors Expo, Delta Airlines unveiled a seating system that would allow wheelchairs to fit in the exact dimensions that the [regular] chairs are in right now," Glassman said. "So this is a really important issue, and the technology is there." In addition, by senators Tammy Duckworth (D-Ill.) and John Thune (R-S.D.) would require the FAA to come up with a roadmap for researching the feasibility of allowing wheelchairs in the main airplane cabin, he said. "There is a request from Congress to actually look at this, and we should advocate for our patients to do the same."

But others argued this might not be the best approach. "Most airlines turn over airplanes in a matter of minutes," said Scott Karlan, MD, of Hollywood, California, a California alternate delegate who was speaking for himself. "We're all envisioning a situation when the airline needs a space open for a wheelchair. But, as [the resolution is] written, the airlines will be forced to accommodate 10 people who suddenly need wheelchair access. Are they going to remove 10 seats in the 15 minutes they have to turn over a plane?" Instead of passing the resolution, "The AMA should be studying this in concert with other airlines and the FAA and look for a solution, before we step forward and say, 'We advocate this,'" he said.

Howard Chodash, MD, of Springfield, Illinois, an Illinois delegate who was speaking for himself, said that he didn't go to the AMA interim meeting in Hawaii "because I just recently started using [a] wheelchair about a year ago and flying there would not be easy, or would not be possible," especially since his wheelchair is custom-made and taller than most wheelchairs. He noted that the customized van he drives has a mechanism to lock his wheelchair securely in place, "so issues of securing it are not a problem, and seats can be taken out of airplanes easily ... The turnover is quick. It shouldn't be a problem."

Another item on Sunday's agenda was a resolution from the Gay and Lesbian Medical Association (GLMA) asking the AMA to support either rescheduling or descheduling testosterone; the drug is currently classified at Schedule III by the Drug Enforcement Administration (DEA). "Recent research has found that nearly 3 million American adults are receiving testosterone therapy for a variety of indications, over half of which are actually prescribed by primary care doctors such as myself," said Carl Streed, MD, of Boston, Massachusetts, the GLMA alternate delegate. "A significant portion of this also includes transgender and gender-diverse individuals using testosterone to essentially allow themselves to identify and to align their gender identity and their physical well-being."

However, "right now the DEA still considers testosterone a substance of potential abuse," he continued. "The U.S. is the only country that treats testosterone in such a way. Testosterone can be quite onerous for patients and physicians to be able to access. There are many issues around criminalization, discrimination, and stigma around being able to access testosterone where appropriate."

But Ross Goldberg, MD, of Phoenix, who spoke on behalf of the Council on Legislation, objected. "Rescheduling or descheduling a drug is a process best left to the FDA and its rigorous scientific approach," he said. "Our AMA should not be asking the FDA to take steps regarding the approval, rejection, or scheduling of a medication without unbiased scientific review ... Rather than tell the FDA what to do, the Council on Legislation recommends that we ask the FDA to review the scientific evidence and, if warranted, update us [on] recommendations to the DEA on the abuse potential of testosterone."

Jason Jameson, MD, of Phoenix, an alternate delegate to the American Urological Association who was speaking for his delegation, offered a substitute resolution that asked the AMA to advocate to "decrease federal, state, and health insurer regulatory requirements for testosterone prescribing" -- including delivery limitations, telehealth limitations, and limitations imposed by state prescription drug monitoring programs (PDMPs).

"All of these barriers should be removed, but this can be done without rescheduling," said Jameson. "Even if testosterone was rescheduled, this would not guarantee that states and private insurance would remove these barriers, since they're not always tied directly to drug scheduling."

The committee will consider the delegates' comments and then issue a report with its own recommendations, which the entire House of Delegates will vote on during its general session starting on Monday.

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