FDA tobacco law, late HIV/AIDS testing named "Best, Worst Prevention Ideas fo the Week"

The signing of a law giving the Food and Drug Administration authority to regulate tobacco was named Partnership for Prevention's "Best Prevention Idea of the Week," while the national trend of people waiting too long to be tested for HIV/AIDS was named the "Worst Prevention Idea of the week."The Best/Worst Idea awards are a regular feature of Prevention Matters, the blog of Partnership for Prevention. Each week, Partnership for Prevention's staff will choose the designees based on nominations of items in the previous week's news submitted by members, staff and the public at large. To submit a nomination or for more information, contact Damon Thompson at dthompson@prevent.org.

BEST

Obama Signs Tobacco Regulation Bill into Law http://news.yahoo.com/s/mcclatchy/20090622/pl_mcclatchy/3257729

President Barack Obama , who still struggles with his own addiction to cigarettes, on Monday signed into law the most sweeping federal anti-tobacco legislation to pass Congress in decades.
The law gives the Food and Drug Administration broad authority to regulate the marketing and manufacture of tobacco products. It bans fruit- and spice-flavored cigarettes, slaps expansive new warnings on packages and gets rid of the monikers "light" and "low-tar."

It also allows the FDA to order manufacturers to reduce — though not eliminate — the amount of the addictive chemical nicotine that's in cigarettes.

WORST

HIV testing in U.S. often performed late
http://www.reuters.com/article/healthNews/idUSTRE55O6L420090625?feedType=RSS&feedName=healthNews

An analysis of data from 34 states suggests that many people still do not undergo HIV testing until late into the course of infection, when treatments may have limited effectiveness. In a study of subjects who were diagnosed with HIV from 1996 to 2005, researchers from the Centers for Disease Control and Prevention found that 45 percent had a diagnosis of AIDS within 3 years: 38.3 percent within 1 year of their initial HIV diagnosis and another 6.7 percent in the next 2 years.

CDC Launches LEAN Works! Site to Help Employers Combat Obesity and Reduce Health-Related Costs

The Centers for Disease Control and Prevention recently unveiled LEAN Works! (Leading Employees to Activity and Nutrition), a free web site designed to help businesses address obesity. CDC’s LEAN Works! can help employers calculate the cost of obesity for their organization and develop a tailored approach to help control these costs through nutrition and physical activity interventions.

Garry M. Lindsay, Managing Senior Fellow and Senior Program Officer at Partnership for Prevention, was a member of an Expert Panel on Worksite Obesity Prevention convened by CDC in 2006 and 2007 that provided initial input into the development of the Website.

Silent STD causes infertility

I know that an untreated chlamydia infection can result in infertility, but many young women do not know. In today's Wall Street Journal, consumer health writer, Melinda Beck, addresses the facts about chlamydia infections and the challenges to getting young women screened routinely. In developing the article Melinda interviewed several members of the National Chlamydia Coalition (www.prevent.org/NCC) which is convened and operated by Partnership for Prevention, in conjunction with the Centers for Disease Control and Prevention.

Susan Maloney
Senior Program Manager
Partnership for Prevention




URL to link to

Prevention Named a Priority for Comparative Effectiveness Research.

WASHINGTON - Prevention was one of six priority areas cited by a federal panel in its recommendations as to how the Secretary of Health and Human Services should spend $400 million in stimulus-bill funding for comparative effectiveness research. The Federal Coordinating Council for Comparative Effectiveness Research (CER) issued its findings in a report issued today. Partnership for Prevention testified before the Council at a May 13 field hearing in Chicago and urged that prevention be made a priority in the recommendations.

"Many effective interventions for improving health are likely to involve prevention and community intervention, but these areas are currently understudied," the council concluded. "For example, behavioral change and prevention have the potential to decrease obesity, decrease smoking rates, increase adherence to medical therapies, and improve many other factors that determine health."

The high-priority interventions cited by the council were medical and assistive devices, procedures/surgery, behavioral change, prevention, and delivery systems.

"Due to astonishing achievements in biomedical science, clinicians and patients often have a plethora of choices when making decisions about diagnosis, treatment, and prevention, but it is frequently unclear which therapeutic choice works best for whom, when, and in what circumstances," the council said. It said CER "should identify interventions that yield the most health improvement and represent the best value wherever and however the interventions are delivered."

Partnership for Prevention President Robert J. Gould expressed appreciation to the council for making prevention a priority and for encouraging Partnership's participation in their listening sessions.

"The council's decision is an important step in giving prevention the footing it needs to take its rightful place in the spectrum of health-care decisionmaking," Gould said. "Everyone wins when consumers and health professionals can make informed decision based upon science-based comparisons that show how we can get the most health benefits for the dollars spent."

"We hope HHS Secretary Katherine Sebelius will follow this blueprint when she makes her final decisions on the federal investment in CER," he said.

The council's report was mandated by the American Recovery and Reinvestment Act, is designed to help the HHS Secretary and lawmakers improve the quality of care for patients, and provide patients and doctors the best information possible to make decisions about health care. The report is available at www.hhs.gov/recovery/programs/cer.

Harkin Talks Up Prevention and Wellness

Sen. Tom Harkin, D-Iowa, wrote a column for Yahoo.com in which he made a strong call for the inclusion of prevention and wellness services as part of health reform.

"It’s not enough to talk about how to extend insurance coverage and how to pay for health care – as important as those things are," Harkin said. "It makes no sense just to figure out a better way to pay the bills for a system that is dysfunctional, ineffective, and broken. We also have to change the health care system itself, beginning with a sharp new emphasis on prevention and public health.

"We also have to realize that wellness and prevention must be truly comprehensive. It is not only about what goes on in a doctor’s office. It encompasses workplace wellness programs, community-wide wellness programs, building bike paths and walking trails, getting junk food out of our schools, making school breakfasts and lunches more nutritious, increasing the amount of physical activity our children get, and so much more."

Screening Detects Elderly Addictions Previously Overlooked

Screening and brief intervention programs can spot addiction and mental health problems among elderly patients that traditional healthcare interactions may miss, findings from a new Florida study indicate.

Reuters reported June 12 that researchers screened more than 3,000 elderly Florida residents during a three-year study, using a tool called BRITE to assess subjects for six risk factors. The study authors found that 10 percent of those screened had problems with alcohol misuse, 26 percent had problems with prescription and over-the-counter (OTC) medication, 64 percent suffered from depression, and 2 percent were at risk for suicide.

Many Patients Not Told About Abnormal Test Results

A new study in the Archives of Internal Medicine shows that an average of one out of every 14 patients with clinically significant abnormal results don't get this information from their doctors. Failure to disclose such results can put a patient's health at serious risk.

Doctors' offices without clear procedures for handling test results dropped the ball for as many as one in every four patients; those with standard procedures did so very infrequently or not at all.

The study recommends that patients call for results after a certain period of time if they haven't heard from their doctor. Every responsible physician should get a copy of lab result, sign it, and inform patients directly of the results or ask staff to do so, the authors say. Also, staff should document that a patient has been informed of a test result each time this occurs.

Gawande: Prevention Could Help Reduce Medicare Costs "Overnight"

Atul Gawande, the doctor whose recent New Yorker piece piece comparing the medical systems of El Paso and McAllen, Tex. has caused a major stir in health policy circles, says a greater focus on prevention could help reduce costs in McAllen "overnight."

"...We have not been thinking hard enough about how we control costs and make a better system," in an interview with the Washington Post's Ezra Klein. "I think it's achievable in about 10 to15 years, and maybe even faster. I can tell you three things that will transform McAllen overnight. But CBO doesn't score them."

Gawande said McAllen's average $15,000 annual expenditure per Medicare beneficiary could be reduced to $10,000 through a reduction in home visits, an increase in the use of hospice care vs. ambulance rides, and "work on basic cardiac prevention like getting people statin drugs."

"Most studies have shown you'll lower the cardiovascular disease rate by 25 percent and lower the number of procedures ordered," he said. "This was done in by Kaiser of Northern California, and they became the first community I've ever heard of where heart disease stopped being the leading cause of death."

WSJ - They're Just Not That Into Prevention

Has anybody seen the Wall Street Journal column praising the benefits of prevention? Neither have we, and we're starting to suspect such a column doesn't exist. But we sure have seen their columns that take the opposite tack. In the last dozen or so days, in fact, the WSJ has published two columns and two blog postings dismissing prevention as part of health reform.

Was it something we said?

First, there was a June 12 print piece by Janet Adamy entitled "Prevention Efforts Provide No Panacea on Health Costs." On the same date, WSJ printed a blog post by Shirley S. Wang entitled "Does Preventing Disease Really Save Money?" (Her answer: probably not, and it may not even improve health); and a blog post by Peter Landers entitled "Disease Prevention in Germany Is Mostly Good for Doctors." Then there was Abraham Verghese's June 20 column on entitled "The Myth of Prevention."

C'mon, folks, how do you really feel?

The logic employed in these pieces is simplistic - preventive services aren't worth investing in because not all of them save money. But that's concentrating on the hole, not the doughnut.

The fact is that some preventive services DO save money. We reviewed 25 procedures approved by the US Preventive Services Task Force and found that six of them actually saved money while 12 of them were highly cost-effective. We also found five preventive clinical servces that are currently underused that could save an additional 100,000 lives a year if they were broadly utilized. Three of those services save money, while the other two are highly cost-effective.

Which raises another problem with the logic in the WSJ columns. A preventive service doesn't have to save money to provide value to the health care system. Many of the procedures that don't save money still deliver significant health benefits for the dollars spent.

Using logic like that employed in the WSJ columns, the owners of Major League Baseball teams wouldn't invest in hitters, because even the best of them get a hit less than a third of the time they go to the plate. In reality, of course, those owners look not at the hits the players don't get, but at the hits they DO get - how many homers they hit, how many runs they drive in, how many put people in scoring position - and they invest in the players that give them the most bang for the buck.

Perhaps there's a lesson there for health care... and for the WSJ.

Obama "95% Cured" of Tobacco Addiction

President Obama said today he's "95% cured" of tobacco addiction, but admits to falling off the wagon on occasion.

"I've said before that as a former smoker I constantly struggle with it," the president said at a press conference. "Have I fallen off the wagon sometimes? Yes. Am I a daily smoker, a constant smoker? No." "I would say that I am 95 percent cured, but there are times where, there are times where I mess up," he added.

The president, who this week signed legislation into law giving the Food and Drug Administration the power to regulate tobacco products, said that he does not smoke in front of his kids or the rest of his family, and compared his situation to that of a recovering alcoholic.

"I don't know what to tell you, other than the fact that, you know, like folks who go to A.A., you know, once you've gone down this path, then, you know, it's something you continually struggle with, which is precisely why the legislation we signed was so important, because what we don't want is kids going down that path in the first place," he said.

School-based Prevention Program, Buyer's Lettuce vs. Tobacco Rant Named "Best, Worst Prevention Ideas of the Week"

A school-based prevention program that cut risky behaviors in half was named Partnership for Prevention's "Best Prevention Idea of the Week," while a congressman’s contention that tobacco is no more dangerous than lettuce was named the "Worst Prevention Idea of the week."

The Best/Worst Idea awards are a regular feature of Prevention Matters, the blog of Partnership for Prevention. Each week, Partnership for Prevention's staff will choose the designees based on nominations of items in the previous week's news submitted by members, staff and the public at large. To submit a nomination or for more information, contact Damon Thompson at dthompson@prevent.org.


BEST

School-Based Prevention Program Reduces Problem Behaviors by Half

http://www.nih.gov/news/health/jun2009/nida-18.htm

A study suggests that a school-based prevention program begun in elementary school can significantly reduce problem behaviors in students. Fifth graders who participated in Positive Action (PA), a comprehensive interactive school prevention program, for one to four years were about half as likely to engage in substance abuse, violent behavior, or sexual activity as those who did not take part in the program. The study, supported by the National Institute on Drug Abuse (NIDA), a component of the National Institutes of Health, will appear in the August 2009 print issue of the American Journal of Public Health.



WORST

Congressman: "Smoking lettuce same as cigarettes"

http://briefingroom.thehill.com/2009/06/12/rep-buyer-smoke-some-lettuce/

Rep. Steve Buyer, R-Ind., said smoking lettuce is the same as smoking cigarettes. He says it's not the nicotine that kills, it's the smoke. In a House floor speech opposing a bill allowing the FDA to regulate tobacco Buyer said, “It's not the nicotine that kills. It's the smoke that kills. So it's the inhalation of the smoke. That's what causes and is responsible for the pandemic of cancers, of heart disease, respiratory disease, and other disease. It's the smoke." No word as to whether Buyer thinks that eating lettuce would be as bad as chewing tobacco.

Podcast #15 - Calculating Prevention's ROI

How do you prove the value of disease prevention and health promotion? A research team at Harvard Medical School thinks they may have an answer. They have developed a calculator that allows them to estimate the return on investment of prevention services. Dr. Nancy Oriol, dean of students at Harvard Medical School and a leader of the research team, explains how this new tool operates. She also discusses "The Family Van," a mobile clinic program she has helped to operate in the Boston area that inspired their efforts to develop the calculator. To listen to this podcast, click on the media player below. If you don't see a media player below, click here.

House Releases Discussion Draft of Health Reform Bill

The three committees in the U.S. House of Representatives that are crafting a health reform bill today released a "discussion draft" of the legislation they are about to propose. The 852- page discussion draft is designed to provide “quality affordable health care for all Americans and controls health care cost growth." In brief, provisions in the discussion draft would:

• Expand the capacity of two independent, advisory task forces — the U.S. Preventive Services Task Force (USPSTF) and the Task Force on Community Preventive Services (TFCPS) — to undertake rigorous, systematic reviews of existing science to recommend the adoption of proven and effective services.
• Provide new investments in the science of prevention to further expand the base of information available for evaluation by the task forces.
• Deliver clinical preventive services by including USPSTF‐recommended services in Medicaid and insurance available in the Health Insurance Exchange.
• Eliminate cost‐sharing on recommended preventive services delivered by Medicare, Medicaid, and insurance available in the Health Insurance Exchange.
• Deliver community preventive services by investing in state, territorial, and local public health infrastructure andby providing grants to implement TFCPS‐recommended services.

Meanwhile, here's a more detailed rundown of provisions within Title III, which covers the creation of the Prevention and Wellness Trust Fund and program allocations. The key provisions include:

(Section 2301; page 797) Establishes Prevention and Wellness Trust funded at $2.4 Billion in FY2010 and rising to $3.5 Billion in FY2014. The trust makes funding available for the following areas:

• $30 million in each of FY 2010-2014 to fund the activities of the Clinical and Community Preventive Services Task Force.
• $100 million in FY 2010 for prevention and wellness research and rising to $300 million in FY2014.
• $1.1 billion in FY 2010 for community-based prevention and wellness services and rising to $1.6 billion in FY2014.
• $800 million in FY2010 for core public health infrastructure and activities for state and local health departments rising to $1.3 Billion in FY2014.
• $350 million in each of FY2010-2014 for core public health infrastructure and activities for CDC.

(Section 3121; Page 800) Prevention and Wellness Strategy. A national strategy to improve the Nation’s health through evidenced-based clinical and community-based prevention and wellness activities, including core public health infrastructure improvement activities. Strategy will work to address unmet prevention and wellness needs AND unanswered research questions on prevention and wellness.

(Section 3131, page 802) Task Force on Clinical Preventive Services. Revises and strengthens the Task Force under the authority of the Agency for Healthcare Research and Quality. Authority will include a clinical prevention stakeholders board to advise the Task Force on developing, updating, publishing, and disseminating evidence-based recommendations on the use of clinical preventive services.

(Section 3132, page 807) Task Force on Community Preventive Services. Codifies in Federal statute, under the CDC, a permanent task force to review scientific evidence related to the benefits, effectiveness, appropriateness, and costs of community preventive services for the purpose of developing, updating, publishing, and disseminating evidence-based recommendations on the use of community preventive services. A community prevention stakeholders board is established to advise the Task Force on developing, updating, publishing, and disseminating evidence-based recommendations on the use of community preventive services

Subtitle D – Prevention and Wellness Research

(Section 3141, page 813) Requires that prevention and wellness research undertaken by CDC and NIH be informed by the national prevention strategy and the Task Force (Preventive/Community)recommendations.

(Section 3142, page 813) Authorizes CDC to make prevention and wellness research grants.

(Section 3151, page 814) Authorizes CDC to make community-based prevention and wellness services grants. 50% of funding is reserved for services “whose primary purpose is to achieve a measurable reduction in one or more health disparities.”

(Section 3161, page 818) Authorizes a new program of Core Public Health Infrastructure and activities for State and local health departments.

(Section 3162, page 822) Authorizes a program of Core Public Health Infrastructure and Activities for the CDC.

Partnership Exec VP Attends White House Health Reform Discussion

On June 18, I took part in a discussion at the White House billed as a "Stakeholder Meeting with Physicians.” We discussed health reform, with an emphasis on prevention and health cost savings. The meeting was chaired by Michael Hash, Senior Adviser in the White House Office of Health Reforman and attended by Dr. Zeke Emanuel from the Office of Management and Budget, Dr. Bob Kocher from the National Economic Council, Dr. Kavita Patel from the Office of Public Engagement, and Dr. Dora Hughes from the Department of Health and Human Services.

There is strong commitment by the President to disease prevention and health promotion in health reform, with a good appreciation that this encompasses clinical prevention, community preventive services, and creating healthier communities.

There was widespread consensus among the participants that multiple strategies are needed, including reimbursing for clinical preventive services, creating financial incentives that reward primary care and prevention more and high tech procedures less, expanding the primary care and public health workforce, creating a sufficient and sustained funding source for our public health system and community preventive services, assessing the health impact of our non-health policies (transportation, food), increasing prevention research, and fostering better integration between Federal agencies and between clinicians and community resources.

There was also widespread agreement that there needs to be a focus on reducing tobacco and obesity if we are to reduce chronic disease rates and control future health care costs.

Corinne G. Husten, MD, MPH
Executive Vice President &
Chief Policy & Program Officer
Partnership for Prevention