Incoming AAAAI president outlines agenda for his administration

Increasing access to care will be a priority for Jonathan A. Bernstein, MD, FAAAAI, when he takes the reins as president of the American Academy of Allergy, Asthma & Immunology at the organization’s annual meeting in February.

“We really can help patients in terms of improving their quality of life and addressing complex problems,” Bernstein told Healio.

Strategies will include a greater emphasis on volunteering, continuing to advocate for better care with policymakers, supporting young investigators in their research, and ensuring that clinicians and patients collaborate for the best outcomes.

Generational commitment

An allergist and immunologist, Bernstein is an adjunct professor of medicine at the University of Cincinnati College of Medicine, where he treats patients, conducts research and teaches the next generation of clinicians. He also is a partner at the Bernstein Allergy Group and Bernstein Clinical Research Center.

“I am the PI for a number of clinical trials both at our facility outside the university and within the university,” Bernstein said.

Bernstein joined the AAAAI in 1988 when he was a fellow at Northwestern University. He has served the organization as a member of various committees, its board of directors as secretary-treasurer and currently president-elect, the AAAAI Foundation and the joint task force, among other roles.

“I have significant organizational experience, as well as a lot of practical experience,” he said.

Also, Bernstein is following in some familial footsteps.

“My father was president of the academy in 1982,” Bernstein said, noting that he and his father, I. Leonard Bernstein, MD, FAAAAI, are the first father-son pair to both serve as president.

“I’ve grown up with allergy,” Bernstein said. “My first job was working in an allergy laboratory at the university.”

Bernstein also works with his brother, David I. Bernstein, MD, FAAAAI, FACAAI, FACP, at their allergy group and clinical research center. His son is now finishing up a fellowship at National Jewish Health in Denver as well.

“I come from a family of allergists,” Bernstein said. “It was a blessing to have a father who was an allergist-immunologist because he was a very good mentor and, of course, my brother has been a good mentor as well. It has been a very good experience.”

Volunteer initiatives

Bernstein acknowledged that many patients simply do not have access to care, but he added that clinicians can donate their time and services to help.

“My initiatives are going to be focused on developing a mechanism for volunteering in communities to address environmental disparities in underserved populations,” he said. “We hope to be able to not just talk about these problems, but actually help fix some of these problems in our local communities.”

Although Bernstein called his plans to launch a volunteer branch of the AAAAI ambitious, he said that many members already do volunteer in many capacities.

“We want to try to channel some of this energy and resources through allergy and immunology so we can have a direct impact through our specialty, especially on the underserved populations that are dealing with a variety of environmental disparities,” Bernstein said.

Inequalities in housing, food insecurity resulting in obesity, indoor-outdoor air quality, noise and green spaces all impact allergy and asthma care, he said.

“We hope to be addressing many of these issues through different channels by providing grants to individuals or groups regionally that are proposing ways of impacting their community directly,” he said.

“We want this to be something that will eventually be very scalable and sustainable over time with measurable outcomes so that it will ultimately have a big impact, not just on educating the population that we serve, but by directly helping the communities we are part of,” Bernstein continued.

Capitol Hill

Bernstein said he also will continue the AAAAI’s efforts in connecting with policymakers through Hart Health Strategies lobbying group, which identifies legislation that is important to the academy’s membership and to the specialty.

“We spent a lot of time this past year addressing the prior authorization process, which has led to barriers in limiting patient access to appropriate evidence-based therapies,” Bernstein said. “This has led to significant delays in patients getting needed treatments, resulting in suboptimal care.”

Although legislation addressing these issues did not get through Congress for various reasons this past year, Bernstein said, the AAAAI will continue these efforts in 2023 and beyond.

Medicare physician payments represent another area that the AAAAI will address.

“We face several cuts in 2023, including a reduction in the Medicare physician fee schedule conversion factor. This is due to budget neutrality,” Bernstein said.

Bernstein also noted the 4% cut that resulted from an across-the-board sequester in the American Rescue Plan impacting all federal funding.

“It’s an important area, and we are very active in voicing dissent. We’re trying to make sure that these changes do not go into effect,” Bernstein said.

The AAAAI will also continue to advocate for its members and patients in other areas. He cited the organization’s success in supporting asthma treatment for children in school, including working with school nurses and administrators to improve asthma awareness and preparedness in schools, among other issues.

“There are many legislative bills addressing environmental disparities and health equity that we will be supporting as well,” he said.

In the clinic

Even with these efforts, patients still may have trouble connecting with the best treatment available.

“Another big obstacle is allowing Medicare patients to receive the medications or the services that are necessary to give them optimal quality care,” Bernstein said.

“For example, asthma inhalers are not covered by most Medicare plans. Often, our patients don’t fill their prescription, or they use their inhalers less than prescribed, resulting in worsening of their asthma. Unlike privately insured patients, Medicare patients are not able to benefit from rebates or discounts provided by the pharmaceutical company, so they have to pay top dollar,” he continued. “There needs to be a mechanism where asthma inhalers can be made affordable for our patients over 65.”

Once patients have the care they need, ensuring that they stick to their treatment plan is another challenge.

“We have to recognize that there are better ways of improving adherence to medication. Many patients start on biologics before they actually have been demonstrated to be adherent to their existing medical regimen,” Bernstein said.

New technologies can improve these shortcomings, he continued.

“For example, there are now many smart devices or apps that can track patients’ utilization of their asthma inhalers and clinical symptoms so you can see if they are controlled and adherent prior to prematurely putting them on therapies that may or may not be useful or necessary,” Bernstein said.

New research

Looking ahead, Bernstein also emphasized the importance of the AAAAI Foundation and how it funds research focused on preventing and curing asthma and allergic and immunologic diseases.

In particular, the foundation supports young researchers and their studies as they evolve from junior faculty into independent investigators by awarding $240,000 grants distributed over 3-year periods.

Since 1993, the foundation has provided more than $9 million in major awards. Following this initial support, recipients have received nearly $102 million in federal grants. Also, 41 of the 42 recipients have continued in their academic careers in allergy and immunology.

The recipients of the 2022 awards are now investigating inhibitory pathways in asthma, responses to COVID-19 vaccines among patients with humoral immunodeficiencies, inflammatory responses to microbial translocation in primary antibody deficiencies, and the role of temperature on the skin barrier and atopic development.

“This is the fundraising branch of our organization, which focuses on providing gap funding for the next generation of young investigative researchers who will hopefully be successful in getting NIH funding,” he said. “This is important for strengthening our specialty by having impactful basic, translational and clinical research investigators.”

Next steps

Bernstein will be inducted as president of the AAAAI during its annual meeting in San Antonio, Feb. 24 to 27. He is excited about the speakers who will be attending the meeting and the broad range of research that will be presented.

“It’s going to be an excellent meeting. The program is extensive. There’s always so much more than one can absorb, but that’s what makes the academy meeting so worthwhile. It provides something for everybody, and that’s what we’re all about: inclusivity” he said.

Hopefully, he said, attendees will be able to increase the scope of their practices with what they learn at the meeting and start managing conditions that they ordinarily would not have been comfortable addressing.

“It’s critical,” he said, “that allergists see different types of patients and help expand the message to our communities as to what we do as a specialty.”

That engagement with his patients and connection to healthcare in general has driven Bernstein’s commitment for decades in practice, education and research, and he aims to encourage and support this dedication among the AAAAI’s membership.

“Being an allergist/immunologist has been a very gratifying career for me,” he said.

References:

• 2022 Award Recipients. https://www.aaaaifoundation.org/what-we-do/award-recipients. Accessed Jan. 25, 2023.
• Grant Impact Study. https://www.aaaaifoundation.org/research/award-program-impact. Accessed Jan. 25, 2023.
• What We Do. https://www.aaaaifoundation.org/what-we-do. Accessed Jan. 25, 2023.