Prevention Matters

The recent revelation of the first U.S. case of an especially drug-resistant form of tuberculosis is the result of a six-month study by the Associated Press of the "soaring global challenge of drug resistance."

"Today, all the leading killer infectious diseases on the planet — TB, malaria and HIV among them — are mutating at an alarming rate, hitchhiking their way in and out of countries," write AP reporters Margie Mason and Martha Mendoza. "The reason: Overuse and misuse of the very drugs that were supposed to save us."

The nation's first-ever "tobacco czar" says his office will be working with tobacco manufacturers to evaluate new products and possibly block them from the marketplace.

"Congress has set a new standard based on the public health and population impact," Lawrence Deyton, Director of the FDA's Center for Tobacco Products, said in an interview with Congressional Quarterly. We have to work with tobacco companies to evaluate the pros and cons of every new product, and a lot of smart people will be working on figuring out how we do that."

After nearly three months and 284 tweets, Partnership for Prevention's Twitter site has attracted its 200th follower. Our Twitter site provides a quick digest of prevention policy news and updates on our activities and initiatives. Hope you'll check us out!

Former CDC Director Julie Gerberding has been hired by Merck to head up its vaccine unit, the Wall Street Journal's Jacob Goldstein reports. Vaccines are a $5 billion business for Merck. Gerberdmg ran the CDC from 2002 until early this year.

USA TODAY's Rita Rubin reports that researchers are investigating whether the same approach used to prevent infectious diseases could treat addictions to such drugs as nicotine.

Nabi Pharmaceuticals has gotten a $10-million grant to study the effectiveness and to monitor the side effects of a smoking-cessation vaccine. Nabi, based in Rockville, Md., expects to begin enrolling patients in the NicVax study by year's end.

The Robert Wood Johnson's Commission to Build a Healthier America was launched in February 2008 to find out why Americans aren’t as healthy as they could be and to suggest ways outside the health care system to improve health for everyone.

The commission is wrapping up its duties and closing its doors after two years in which it has issued two major, held regional field hearings, national events and more than 50 meetings with public and private sector leaders.

"This Commission was not the first time this country has addressed health disparities or the social determinants of health – but it’s the first time in a long time that we have been able to look at these issues squarely in the face and have hope," says RWJF President/CEO Risa Lavizza-Mourey.

"The Commission crystallized for all of us that health is more than health care. Health is where and how we live, learn, work and play," she says. "So, reaching beyond traditional health care communities is essential if we are going to make any headway in improving the health of all Americans."

Lavizza-Mourey further discusses the closing of the commission and the importance of its work in a recent podcast.

The success of a recent Massachusetts program hat provides virtually free access to tobacco cessation treatments has left CDC officials shocked and encouraged lawmakers to look at expanding the approach nationwide.

When the program was launched two years ago, about 38 percent of poor Massachusetts residents smoked. By 2008, the smoking rate for poor residents had dropped to about 28 percent, a decrease of about 30,000 people in two and a half years, or one in six smokers. There are also indications that the drop has lowered rates of hospitalization for heart attacks and emergency room visits for asthma attacks, she said.

Senators Richard J. Durbin of Illinois and Bernard Sanders of Vermont have introduced an amendment that would provide similar new Medicaid coverage for tobacco addiction as nationwide, and the Senate could vote on it by the weekend. If the amendment fails, Senator Tom Harkin of Iowa said he would try another avenue: seeking an expansion through a conference committee that will ultimately reconcile the House and Senate bills.

"We should be able to find an opening," Mr. Harkin said in an interview. "This is one demonstrable way we can actually bend the cost curve and keep people healthy."

Terry F. Pechacek, associate director for science for the CDC's Office on Smoking and Health, told the New York Times that he found the numbers “shocking,” since smoking rates around the nation have barely budged since 2004. He said the U.S. smoking rate has only decreased from 20.9 percent in 2004 to 20.6 percent in 2008, while smoking-related illnesses cost the Medicaid system more than $22 billion a year - or about 11 percent of overall Medicaid expenditures.

Pechacek says if the federal health care overhaul includes smoking-cessation coverage, publicizing it will be as crucial to its success as the cessation tools themselves.

"Even in the some of the states that offer wider coverage,” he said, “there’s been minimal promotion. People have to know about a benefit for it to have an effect.”

The Colorado Supreme Court on Monday refused to exempt theater actors from a statewide smoking ban during their performances. All but one of the justices voted to uphold lower-court decisions barring cigarette use in performances.

The move ends a three-year state fight in which a coalition of state and national theater groups argued in multiple courts that the ban infringed on free-speech rights and interfered with their abilities to accurately produce plays. Six justices found that regardless of whether onstage smoking is a form of expression, the ban on smoking in public places is constitutional because it aims to promote public health rather than stifle free speech.

No other state supreme court has decided a case involving a free-speech opposition to a state smoking ban, according to attorney A. Bruce Jones, who said his theater-company clients have not ruled out seeking a U.S. Supreme Court decision on the topic.

Oklahoma’s new plan to improve the state’s health system has been named  Partnership for Prevention’s “Best Prevention Idea of the Week,” while school lunches that don’t meet the quality or safety standards of many fast-food restaurants was named “Worst Prevention Idea of the Week.”

Oklahoma state officials have unveiled a plan to improve its health system, with an emphasis on improving children's health and reducing obesity and tobacco use. The plan identifies four infrastructure areas in the state's health system that need to be improved: financing of public health programs, the effectiveness of the health care system, work force development and access to public health services.

The federal government is providing the nation's schools with millions of pounds of beef and chicken that wouldn't meet the quality or safety standards of many fast-food restaurants. USA TODAY found that, from late November 2008 through January this year, the US Department of Agriculture bought nearly 500,000 pounds of ground beef with unusually high levels of an indicator bacteria known as "generic E. coli." The government also accepts beef with more than double the limit set by many fast-food chains for total coliform, which is used to assess whether a beef producer is minimizing fecal contamination in its meat.

Suzanne Bohan and Sandy Kleffman write in the Contra Costa Times about  "unprecedented — yet uncontroversial — disease prevention initiatives whose inclusion has been lost in the rancorous debate over health care reform legislation working its way through Congress."

Such initiatives provide federally funded security guards at dangerous neighborhood parks and federal grants to poor neighborhoods to build grocery stores or to keep school gyms open after hours.

"The prevention provisions mark a victory for advocates and federal lawmakers who for years have unsuccessfully sought more federal funding to close the gap in health disparities and life expectancies between richer and poorer Americans," Bohan and Kleffman write.

PBS is airing a special entitled the “Anatomy of a Pandemic” which will explore the science and policy of this year’s swine flu pandemic, from federal vaccination headquarters to big city hospital emergency rooms. Please visit the web site at http://www.pbs.org/newshour/pandemic/ for more information and local listings.

Among those listed who will be interviewed include:
Anthony Fauci

As part of his effort to fight obesity statewide, Delaware Governor Jack Markell has issued an executive order that requires state transportation officials to consider all modes of getting around when planning road improvements. The state also is circulating a handbook that gives municipal officials hands-on advice to create more walkable communities.

The governor is incorporating the state's new five-year strategic plan to make environmental changes that make it easier for people to make healthy choices. At the state Department of Transportation, new road projects won't include just engineering for road design. State officials also look to see if the project can be modified to be more bike- and pedestrian-friendly.

"It sounds so easy," said Jennifer Baldwin, the state pedestrian coordinator-planner. "But historically, departments of transportation ... have focused on motor vehicles."

In Delaware, 36 percent of adults overweight and 28 percent were obese in 2007, while the obesity rate among high school students has climbed from 10.1 percent to 13.2 percent in eight years and 20 percent of those students say they get no physical activity.

The New York City Department of Health and Hygiene raised a lot of eyebrows last summer with a subway advertisement that showed a soda bottle pouring globs of human fat into a drinking glass. The intent was to  shock New Yorkers into choosing low calorie beverages over soda and sweetened juices.

General Mills plans to reduce the sugar content in cereals that it markets to children. The company will reduce the sugar content of 10 of its cereals to 11 grams or less per serving. Previously, General Mills has made efforts to reduce sugar in several of its cereals, some by as much as 20 percent, and now fortifies all of its children's cereals with vitamin D and calcium. All of General Mills cereals also now provide eight grams of whole grains or more per serving.

According to HealthDay, the move is part of an industry-wide response to complaints from consumers, health experts and federal regulators regarding the nutritional content of foods marketed to children.

Kelly Brownell, director of the Rudd Center for Food Policy and Obesity at Yale University, says that "the reduction ... doesn't represent perfection but it represents improvement." He says children "deserve to be marketed products that are healthier to them than what is being marketed now"

From the 12/07 edition of London's The Guardian:

"Health campaigners have warned that attempts to use the London 2012 Olympics to improve public health may be undermined by today's announcement that one in five meals served to fans at the games will come from McDonald's.

"Launching their food strategy, games organisers said that 3m of the 14m meals served during the two-week event will be prepared by the fast food chain. All branded soft drinks will be provided by Coca-Cola and the only other branded food on sale will be Cadbury's chocolate. McDonald's and Coca-Cola both sponsor the International Olympic Committee, which passes several million pounds of those revenues to London's organisers, while Cadbury pays £20m as a direct sponsor of the 2012 games.

"The British Heart Foundation (BHF) and the National Obesity Forum (NOF) said the policy undermined claims from Lord Coe, the chairman of the London organising committee, and Tessa Jowell, the Olympics minister, that one of the main legacies of hosting the Olympics will be improved health across the nation. McDonald's outlets will be erected across the athletes' village, the main Olympic park and in the media centre. 'Health does not seem to be high on their agenda,' said Ruairi O'Connor, head of policy at the BHF."

Despite their receiving record amounts of revenue from tobacco taxes and from the 1998 state tobacco settlement, states have cut funding for tobacco prevention programs by more than 15 percent in the past year, says a new report by the Campaign for Tobacco-Free Kids, American Heart Association, American Cancer Society Cancer Action Network, American Lung Association and Robert Wood Johnson Foundation.

States will collect $25.1 billion in revenue from the tobacco settlement and from tobacco taxes in 2010, and many states will even raise tobacco taxes. But they have cut funding for tobacco prevention by $103.4 million in the past year,and will spend just $567.5 million (2.3 percent of tobacco revenues) on tobacco prevention and cessation programs.

Michigan will become the 38th state to ban smoking in public places on May 1, following passage Thursday of a  prohibition by the House and Senate and a vow from Gov. Jennifer Granholm to sign the bill.  Smoking will be banned in workplaces and food service establishments, including bars, restaurants, food courts at shopping malls, cafeterias and private clubs.  The ban makes exceptions for the gaming floors at the three Detroit casinos, cigar bars, specialty tobacco shops, home offices and motor vehicles, including commercial truck.

The Center for Science in the Public Interest has proposed a revamp of the nutritional information labels that have been required on food packages for nearly two decades.

• Put calorie and serving size information in larger type at the top of the label so it’s immediately clear how much you are eating.
• Make the ingredient list easier to read by printing it in regular type instead of all capital letters. Use bullets to separate ingredients rather than allowing them to all run together.
• List minor ingredients and allergens separately from the main ingredient list. Highlight allergy information in red.
• List similar ingredients together and show the percentage by weight. For instance, sugar, corn syrup, high fructose corn syrup and grape juice concentrate are all forms of sugar and should be listed in parenthesis under the catchall heading “sugars.”
• Use red labeling and the word “high” when a product has more than 20 percent of the daily recommendation for fats, sugars, sodium or cholesterol.
• Make it clear which sugars are added to the product versus those that occur naturally.
• Display prominently the percentage of whole grains contained in a product.
• List caffeine content.

New diagnoses for all types of cancer decreased almost 1% per year on average from 1999 to 2006, while cancer deaths decreased 1.6% per year from 2001 to 2006, according to a new government report.

The improvement is driven largely by declines in the big four cancer killers—lung, colon, prostate, and breast. Specialists attributed the declines to a reduction in the smoking rate, better and earlier detection, and improved treatments, particularly those that can be matched to a patient's specific tumor type. However, experts in the field warn that these successes could be wiped out in coming years by the nation's obesity crisis.

In the wake of the recent controversy over the US Preventive Services Task Force's recommendations on mammograms, the Washington Post has reprinted a piece issued earlier this year by the folks at Consumer Reports where they list several other common screening services it says the task force has deemed unnecessary "for healthy or average-risk people."

The exams listed have been given a D rating by the task force, meaning that they failed to meet the group's standards. "Many of those tests should be limited to people who have symptoms or risk factors for specific conditions," Consumer Reports said.

The Department of Labor recently announced that it is considering whether the Occupational Health and Safety Administration (OSHA)should establish a health standard for airborne infectious agents in health care settings and numerous other worksites. Such a standard would require some  employers to establish a comprehensive infection control program as well as control measures to protect employees from exposures to airborne pathogens that can cause significant disease


"OSHA is concerned about the ability of employees to continue to provide health care and other critical services without unreasonably jeopardizing their health," the department said in a recent regulatory notice. "...Health care workers and workers in related occupations or who are exposed in other high-risk environments are at increased risk of contracting tuberculosis, SARS, and other airborne infectious diseases which are spread through respiratory secretions which are exhaled or expelled though coughing, sneezing, etc. and can be transmitted through a variety of exposure routes."

In addition to health care, the agency listed other worksites where such control measures might be necessary:  emergency responses, correctional facilities, homeless shelters, drug treatment programs,  laboratories which handle materials that may be a source of pathogens, and to pathologists, coroners’ offices, medical examiners, mortuaries.

Changing policies on HIV/AIDS in South Africa and China have been named Partnership for Prevention’s “Best Prevention Idea of the Week,” while a protein-laced vodka that’s being marketed to “health conscious” people was named “Worst Prevention Idea of the Week.”

Billed as "alcohol for the health-conscious" the new, patent-pending Devotion Vodka is being marketed to active, fitness-oriented individuals who also enjoy an active nightlife. But not everybody’s drinking to that. “The health argument this company and its president has latched onto and promoted – that alcohol is good for your health – has been debunked as myth,” says the California-based The Marin Institute: “Yet PR flacks and media outlets continue to push news stories like the introduction of Devotion as another example of the healthy benefits of alcoholic products.”

Billed as "alcohol for the health-conscious" the new, patent-pending Devotion Vodka is being marketed to active, fitness-oriented individuals who also enjoy an active nightlife. But not everybody’s drinking to that. “The health argument this company and its president has latched onto and promoted – that alcohol is good for your health – has been debunked as myth,” says the California-based The Marin Institute: “Yet PR flacks and media outlets continue to push news stories like the introduction of Devotion as another example of the healthy benefits of alcoholic products.”

The CDC has received reports of email phishing scams referencing state sponsored vaccination programs, but the agency says no such program has been implemented requiring registration on CDC.gov. The email tells users they must create a personal H1N1 (swine flu) vaccination profile on the CDC.gov website. The message then says anyone age 18 or older must have his/her personal vaccination profile on CDC.gov. Users that click on the email risk having malicious code installed on their computer.

"The Case for Wellness Programs: From Evidence to Practice," a Dec, 3 meeting in Washington DC sponsored by the U.S. Chamber of Commerce Foundation and Partnership for Prevention, is available for viewing online at http://www.uschamber.com/webcasts/2009/091203_ncf_wellness2009.htm .

As the decade of the "oughts" is ending and the decades of the "teens" is about to begin, the media will no doubt be full of retrospective looks back over the past 10 years. The Daily Beast's Max Read has jumped into the fray, assembling a list of what he deemed to be the decade'[s 21 biggest medical breakthroughs. Prevention accounted for five of them. Those five are as follows:

• HPV Vaccine
• Human Vaccine against Bird Flu
• Discrediting the link between Autism and Childhood Vaccination
• Circumcision Discovered to Help Prevent HIV
• Pentacel - the 5-in-1 Childhood Vaccine

The U.S. Chamber of Commerce and Partnership for Prevention today released a new guidebook - Healthy Workforce 2010 and Beyond - to help employers plan, implement, and evaluate workplace health promotion programs that lower health costs and boost productivity.

“We are committed to improving the health status of American workers,” said Randy Johnson, Senior Vice President of Labor, Immigration, and Employee Benefits for the U.S. Chamber of Commerce. “We can foster employee health by increasing the number of employers that include worksite health promotion and wellness programs in their benefits strategies.”

The book provides both private and public sector employers with information about the benefits of investing in worksite health promotion. It outlines current approaches and tactics that are supported by research findings or “promising practices” that are successful as part of wellness programs.

“Chronic diseases are significant drivers of health care costs, and a majority of American employees have at least one chronic condition,” said Partnership President Robert. J. Gould, PhD. “By practicing health management in the workplace, employers not only help workers live healthier lives, but they also improve employers’ bottom lines through reduced health costs and increased productivity.”

Using a program focused on tobacco, alcohol and drug abuse, physical inactivity, and obesity, the book explains how small, medium, and large organizations can take positive steps to achieve health objectives as part of a comprehensive health promotion program. It also highlights the current health status of American workers, and shows how to design workplace health programs that attain workforce health objectives.

The Senate voted 61-39 Thursday "to safeguard coverage of mammograms and preventive screening tests for women under any health care overhaul legislation." The revision, which was advanced by Sen. Barbara Mikulski, D-Md., Sen. Olympia Snowe, R-Maine, "would allow the Health and Human Services secretary to require insurers to cover preventive health screenings free of charge."

The vote came in the wake of recent controversy over federal task force recommendations that women in their 40s consult with their doctors about the advisability of getting mammograms, rather than considering them a routine procedure. On a 59-41 vote, the Senate rejected an amendment by Sen. Lisa Murkowski, R-Alaska, to ensure the task force recommendations could be ignored.

Zac Bissonnette over at bloggingstocks.com says investors may find a path to profits by looking for companies that have wellness programs for their workers. He cites the 2009/2010 North American Staying@Work Report: The Health and Productivity Advantage from Watson Wyatt Worldwide.

"The study of more than 350 publicly traded U.S. and Canadian companies found that those with strong wellness and motivational programs had a total return to shareholders of 15% between 2004 and 2008," Bisonnette writes. "Shares of companies with the weakest programs lost an average of 10% over that time span. Revenue per employee was also higher at companies with strong wellness programs. Watson Wyatt notes that wellness programs lead to higher productivity and reduced sick days.

WSJ Health Blogger Jacob Goldstein reports that a little-noticed provision in the health reform bill in both the House (p. 1,515) and Senate (p. 1,233) would require vending machines to display calorie counts for the food they dispense.
The requirement, which wouldn’t apply for people who own fewer than 20 vending machines, is part of sections in both bills that would also require chain restaurants to post calorie counts.

Partnership for Prevention and 10 of the nation's leading health and prevention organizations have sent a letter to Congress defending the recent recommendations of the US Preventive Services Task Force regarding breast cancer screening and set the record straight about recent public misstatements regarding the recommendations.

“The U.S. Preventive Services Task Force was established as an independent body to apply rigor and objectivity to the analysis of clinical preventive care – even on issues that arouse passions and political posturing,” the organization leaders said in a letter to Rep. Henry Waxman, D-Calif.., and Rep. Joe Barton, R-Texas. “The misstatements we have noted are evidence of both of these dangers, and the Task Force is our best defense against both.

“Our common goal is for preventive services to improve the health of all Americans,” they continued. “We believe the Task Force is the best way to ensure we’re guided toward that goal by recommendations of experts who are guided by science, and only by science.”

The letter was signed by leaders of the following organizations: American Academy of Family Physicians, American Academy of Nurse Practitioners, American Academy of Physician Assistants, American College of Physicians, American College of Preventive Medicine, American Journal of Preventive Medicine, American Public Health Association, National Association of County and City Health Officials, Partnership for Prevention, Public Health Institute, and Trust for America’s Health.

Waxman and Barton are the chairman and ranking Republican of a House committee that held a Dec. 2 hearing on the USPSTF recommendations.

The letter, a copy of which is available online at http://www.prevent.org/images/mammographyletter.pdf
specifically addressed three misstatements:

• The Task Force recommends that women aged 40 – 49 not receive mammograms. “The Task Force does not recommend that all women in this age group automatically start receiving mammograms at age 40.” the letter states. “Rather, it simply recommends that those women and their health care professionals have a full discussion about the potential pros and cons of screening. This allows the patient to incorporate information about her family history, overall health, and personal values and preferences along with the best scientific information into the decision-making process.

“The result is an empowered patient who is able to make an informed decision about whether or not to be tested. In fact, many women may choose to continue mammography because they value the small chance that they might benefit, but other women may choose to defer beginning mammograms until the balance of benefits and risks is more favorable.”

• The Task Force recommendations were intended to reduce costs. “The Task Force never uses cost as a reason to recommend against a service that has been proven to be effective,” the letter states. “In its review of the evidence about breast cancer screening, the Task Force had a single objective – to determine how to maximize the health of women.”

• Members of the Task Force are not qualified to make scientific recommendations. “Since its inception (in 1984), it has been recognized as the authoritative source for determining the effectiveness of clinical preventive services, and its methods have been adapted by guidelines groups worldwide,” the letter says. “While this small group of distinguished health care professionals and researchers is largely unknown to the general public, its work is well known to clinicians in preventive and primary care practice...The preventive services recommended by the Task Force have prevented hundreds of thousands, if not millions, of premature deaths and averted needless harms.

A couple of women's health experts have turned the tables on some of the critics who accuse the US Preventive Services Task Force of potential conflicts of interest regarding its mammogram recommendations.

Dr. Adriane Fugh-Berman MD of Georgetown University Medical Center, and director of PharmedOut.org and Alicia M. Bell, project manager of PharmedOut and member of the board of directors of the National Women's Health Network, identified specific potential conflicts of interest in some of the critics. Their article in the Hastings Center's Bioethics Forum, entitled "Mammography and the Corporate Breast," is an interesting read.

"The fact is that guidelines for screenings do change (quite frequently) over time based on continuing research. To have some means to continue such deliberation is to recognize the value of evidence-based medicine."

- The New Republic's Suzy Khimm, in an article entitled "Who Will Decide If Women Have to Pay for Mammograms?"

On World AIDS Day. MMWR offers the following statistics to illustrate the scope of the issue:

• An estimated 16.5 million women worldwide were HIV positive at the end of 2008
• Approximately 4 million people in low- and middle-income countries were getting antiretroviral therapy at the end of 2008
• Worldwide, women and girls account for almost 60% of new infections; in the US, HIV infections disproportionately affect blacks, Hispanics, and men who have sex with men
• In the US, an estimated 1.1 million people were HIV positive in 2006

Health and Human Services Secretary Kathleen Sebelius says her department will review its approach to disaster preparedness in the wake of difficulties it has faced in producing vaccine to protect the public against the swine flu epidemic. She says the goal will be streamlined regulations that will speed the approval of new technologies that are promoted through government contracts with private companies.

A Missouri program whose healthy snacks for low-income students has improved their academic performance has been named Partnership for Prevention’s “Best Prevention Idea of the Week,” while a misfire by the gun lobby regarding health reform was named “Worst Prevention Idea of the Week.”

Missouri’s “BackSnack” program, which provides backpacks of food to low-income children so they can avoid going hungry on weekends, is having a positive effect in the classroom. An evaluation of the program by the Midwest Center for Nonprofit Leadership found that the program is helping elementary students improve their academic performance, school attendance and behavior. the BackSnack program has grown in the last two years from providing 650 elementary students with healthy snacks to 10,000 each weekend in the Kansas City area alone.

Gun Owners of America urged the defeat of the Senate health reform bill on the basis of imaginary threats it said prevention measures would pose to the Second Amendment. In an action alert to its membership, GOA alleged that "special 'wellness and prevention' programs (inserted by Section 1001 of the bill as part of a new Section 2717 in the Public Health Services Act) would allow the government to offer lower premiums to employers who bribe their employees to live healthier lifestyles -- and nothing within the bill would prohibit rabidly anti-gun HHS Secretary Kathleen Sebelius from decreeing that 'no guns' is somehow healthier." The White House responded that the bill specifically lists what types of programs would be involved under that section of the legislation, and that there is no mention of guns or changing premiums for gun owners.

The number of Americans with diabetes will nearly double over the next 25 years, while the cost of care will almost triple, as patients live longer and develop more of the disease’s long-term complications, a new analysis said.


The projections, which were published in the December issue of the journal Diabetes Care, estimate that the population will rise to 44.1 million in 2034, from 23.7 million now, with medical spending increasing to $336 billion from $113 billion.

“In 25 years, there’s going to be this convergence of the population getting older but also many people having had diabetes for a long period of time, and that will lead to higher costs,” said Dr. Elbert S. Huang, the lead author of the paper, who is part of a University of Chicago diabetes research team. “Duration of diabetes is as important a predictor of complications as glucose.”

A congressional subcommittee chairman said he called a hearing this week "to get to the bottom" of a recent task force recommendation on mammogram screening for women in their 40s.

"My goal is to get to the bottom of why the task force made these recommendations," Rep. Frank Pallone, D-Va., told the New Jersey Star-Ledger. "Has anything changed in the way we’re looking at testing? And find out about better ways of breast cancer screening to develop in the future, including more efficient blood tests and exams with no radiation impact."

Pallone, who chairs the health subcommittee of the House Energy and Commerce Committee, says the recommendation made it "very confusing for women deciding what to do."  He said he wants insurance companies to continue to allow coverage for those women who want the mammogram at a younger age, and said the flap should not affect the outcome of health reform legislation.

"There’ll always be disagreements about tests and procedures," he said. "Health care reform needs to move forward, as fast as possible. More people lack coverage, insurance premiums and drug prices are going up. We can’t delay it any longer."

A recently published study reports that nearly one in four adolescent girls were found to have had at least one sexually transmitted infection (STI), while the prevalence grew to more than one in three among girls who ackowledged being sexually experienced. "The prevalence of STIs among female adolescents is substantial, and STIs begin to be acquired soon after sexual initiation and with few sex partners," said authors of the study, which was published online in the journal "Pediatrics" on Nov. 23.

Data were analyzed from 838 females who were aged 14 to 19 and participating in the nationally representative National Health and Nutrition Examination Survey 2003–2004. After interview and examination, survey participants provided biological specimens that were tested for five STIs: Neisseria gonorrhoeae, Chlamydia trachomatis, Trichomonas vaginalis, herpes simplex virus type 2, and human papillomavirus (HPV) (any of 23 high-risk types or type 6 or 11).

Among the conclusions :

• Prevalence of any of the 5 STIs was 24.1% among all female adolescents and 37.7% among those deemed "sexually experienced" (gave a "yes” response to the question, “Have you ever had sex?)
• HPV was the most common STI among all female adolescents (18.3%), followed by C trachomatis infection (3.9%).
• Prevalence of any of the STIs was 25.6% among those whose age was the same or 1 year greater than their age at sexual initiation and 19.7% among those who reported only 1 lifetime sex partner.

The LA Times' "Booster Shots" spotlights our "Best and Worst Prevention Ideas of the Week" awards.

Good and bad preventive health ideas ... and where 'drunken cooking' fits in

Posted using ShareThis

A USA TODAY/Gallup Poll of American women indicates that most of them plan to disregard the new recommendations from the U.S. Preventive Services Task Force about mammograms. The poll also shows that most women sharply overestimate their risk of developing the disease.

The task force last week suggested that most women don't need mammograms on a routine basis until age 50. Women under 50 should consult their doctors to see if mammograms are approrpriate for them.

In the survey of 1,136 women, 76% said they disagree or strongly disagree with the recommendations, while 84% of women ages 35 to 49 said they plan to get mammograms before age 50 despite the task force recommendations.

But the poll found that most women have misconceptions about the disease and the panels' motives. Seventy-six percent the panel based its conclusions on cost, even though the task force's report included only scientific studies. Forty percent estimated that a 40-year-old's chance of developing breast cancer over the next decade is 20% to 50%. But the real risk is 1.4%, according to the National Cancer Institute.

A firefighting official’s warning against drunk cooking was named Partnership for Prevention’s “Best Prevention Idea of the Week,” while an organization’s decision to stop rating TV health news stories because of their poor quality was named “Worst Prevention Idea of the Week.”

People should get carryout instead of cooking while drunk, a senior fire officer has warned. It follows an early morning rescue from a house fire of a 24-year-old man in Prestatyn, Denbighshire. North Wales Fire Service said the man had been drinking and not heard the smoke alarm during the fire. Neighbours saw the smoke and dialed 999. The fire service said the man had fallen asleep while cooking. Tom Pye from the brigade said: "Our advice is to never cook after drinking - please prepare a sandwich before you go out or get a takeaway instead."

For more than three years, HealthNewsReview.org editor Gary Schwitzer has been methodically reviewing TV health news claims for accuracy and responsibility. But no more; he told NPR's “On the Media” that he's found the vast majority of TV consumer health reports sickening. For example, he says the morning health news segments on network TV unquestioningly promote new drugs and new technologies; feed the “worried well” by raising unrealistic expectations of unproven technologies that may produce more harm than good; fail to ask tough questions; and make a serious discussion of health care reform even more difficult.

Only about 1 in 4 Americans aged 50–64 regularly take advantage of preventive services such as screenings and immunizations, according to a report from the Centers for Disease Control and Prevention in collaboration with AARP and the American Medical Association (AMA).

The report, “Promoting Preventive Services for Adults 50–64: Community and Clinical Partnerships,” focuses on opportunities to improve the health of the growing number of adults in the 50–64 age bracket to broaden the use of potentially lifesaving preventive services.

The report identifies recommended preventive services such as influenza vaccine, cholesterol screening, breast and cervical cancer screening, as well as preventive screenings for behaviors that could negatively impact health such as binge drinking.

Don't forget the 34th annual Great American Smokeout will take place On November 19. Hosted by the American Cancer Society, this event each year promotes smoking cessation by encouraging smokers to give up smoking for a full day. This year's theme is "creating more birthdays,” since smokers who quit at age 35 gain an additional eight years and those who quit at 55 gain an average of an additional five years.

The Great American Smokeout website, www.cancer.org/greatamericans, provides excellent resources to aid in cessation techniques. They suggest that the first step taken should be to select a specific day to quit, within the next 30 days. The website also offers tip sheets and a “Quit Clock.”

Tobacco use is the single most preventable case of disease and death in the US. Partnership for Prevention and ACTTION Coalition are working to provide greater access to smoking cessation services. Many of these cessation programs include collaboration with the federal government and business employers to provide necessary access to cessation services for their employees. Please visit the Partnership for Prevention at www.prevent.org and the ACTTION Coalition at http://www.acttiontoquit.org/.

The Robert Wood Johnson Foundation and Trust for America’s Health have released a new poll showing that 71 percent of Americans favor an increased investment in disease prevention and that disease prevention is one of the most popular components of health reform.

The poll, conducted by Greenberg Quinlan Rosner Research and Public Opinion Strategies, indicates majority support for disease prevention investments from across the political spectrum (85 percent of Democrats, 59 percent of Republicans, and 68 percent of Independents) and across the country (72 percent in the Northeast, 73 percent in the South, 71 percent in the West, and 69 percent in the Midwest).


According to the survey, 70 percent of people think prevention will save money rather than cost money. Nearly two-thirds of Americans ranked investing in prevention between an 8 and 10 on a scale of 0 to 10, where 0 means not at all an important health care priority and 10 means very important.

A “model” tobacco cessation benefit offered to Massachusetts’ Medicaid participants has produced an astounding 26% drop in smoking rates in only two and a half years, and has already been linked to decreases in heart attacks, hospitalizations for asthma and COPD, and a significant decrease in birth complications.


Researchers from the Massachusetts Tobacco Cessation and Prevention Program (MTCP) found that up to 38% fewer MassHealth cessation benefit users were hospitalized for heart attacks in the first year after using the benefit, and that 18% fewer benefit users visited the emergency room for asthma symptoms in the first year after using the benefit. Researchers also found that there were 12% fewer claims for adverse maternal birth complications since the benefit was implemented.

The Massachusetts Executive Office of Health and Human Services said more than 75,000 people – a full 40% of MassHealth members who smoke – have used the benefit to try to quit smoking. Cost savings are being studied, and all indications suggest they will be significant.

“As the nation debates the future of its health care system, the national significance of this research cannot be understated.” said Robert J. Gould, PhD, President and CEO of Partnership for Prevention. “These findings demonstrate that prudent investments in preventive health today will have a dramatic and positive effect on our health care system tomorrow.”

The 20th Anniversary Edition of America’s Health Rankings notes a worrisome escalation in preventable diseases that will significantly increase costs in an already unaffordable medical care delivery system. Of the $2.4 trillion of annual health care expenditures in the United States, $1.8 trillion is associated with the treatment of chronic disease, such as diabetes, heart disease and cancer.


Obesity has increased nearly 130 percent since the first edition of America’s Health Rankings was issued 20 years ago. Currently, 27 percent of the population is obese. A supplemental analysis to this year’s report shows America now spends $80 billion in direct health care costs associated with obesity. Left unchecked, 43 percent of adults will be obese and obesity will add nearly $344 billion in 2018 alone to the nation’s annual direct health care costs, accounting for more than 21 percent of health care spending.


America’s Health Rankings  is an annual comprehensive assessment of the nation’s health on a state-by-state analysis. It is published jointly by United Health Foundation, the American Public Health Association and Partnership for Prevention. The data in the report comes from validated outside sources, such as the Centers for Disease Control and Prevention (CDC). The report is reviewed and overseen by a Scientific Advisory Committee, with members from leading academic institutions, government agencies and the private sector.

The 2009 Anniversary Edition shows Vermont as the healthiest state this year, while Mississippi is ranked 50th. Over the past 20 years, New York has demonstrated the most improvement in the overall health of its population.

Partnership for Prevention President/CEO Robert J. Gould, Ph.D. today issued the following statement about the revised recommendations of the US Preventive Services Task Force regarding breast cancer screening:


The US Preventive Services Task Force is the nation’s best-equipped institution to make science-based recommendations on the use of clinical preventive services. Accordingly, we accept their recommendations on breast cancer screening.


To help avoid any possible confusion about these new recommendations, we would strongly note three areas where theyhave not changed:

• Mammograms are still recommended for women 40-49 with high risk of breast cancer;

• Mammography has clearly been shown to save lives and is a vital component of our nation’s arsenal to fight breast cancer; and

• All women should talk with their physicians about their individual risks and the value of screening.

Sex education programs that advise students to delay sexual activity while also offering instruction on ways to avoid unintended pregnancies and sexually transmitted infections effectively reduce risky sexual behavior, increase condom use and decrease spread of STIs, according to a Centers for Disease Control and Prevention-commissioned report released on Friday, the Washington Post reports. The report said there is insufficient evidence to determine whether programs that focus on abstinence until marriage reduce the chance adolescents will engage in risky sexual behavior, become pregnant or contract an STI.


The report was authored by a 19-member expert panel assembled by CDC to examine the efficacy of various sex education programs. For the report, the panel reviewed an analysis of 83 studies on sex education programs from 1980 through 2007. The findings come as Congress considers whether to approve President Obama's request to redirect federal funding from abstinence-only sex education to programs that have been validated by scientific research.

CDC's Randy Elder -- who works with the Task Force on Community Preventive Services, an independent 15-member panel that issues public health recommendations -- said the study found "sufficient evidence that comprehensive risk reduction efforts are effective." However, "after a similar look, the task force determined that based on a number of problems with the studies presented to them there was insufficient evidence" to determine the efficacy of abstinence-only programs, Elder said.

The American Lung Association is releasing its second annual "Helping Smokers Quit: State Cessation Coverage" report. The report addresses state coverage of cessation treatments through Medicaid, state employee health plans, private insurance, and quitlines in 2009. It shows that states are not doing enough to help smokers quit, when they could be saving lives and money by doing so.

Currently, only six states provide comprehensive coverage for Medicaid recipients: Indiana, Massachusetts, Minnesota, Nevada, Oregon and Pennsylvania. Just five states provide comprehensive cessation coverage for state employees: Illinois, Maine, Nevada, North Dakota and New Mexico.


The Lung Association recommends that private insurance plans also offer comprehensive cessation coverage and encourages states to require all insurance companies to cover these treatments. Currently, only seven states (Colorado, Maryland, New Jersey, New Mexico, North Dakota, Oregon and Rhode Island) have such requirements.

This lack of comprehensive cessation coverage in most states leaves smokers without clinically-proven treatment options when they want to quit.

The report makes recommendations on how to provide all smokers with access to cessation treatments in health care reform, and urges policymakers to provide this coverage. It also calls on each state to provide all Medicaid recipients and state employees with comprehensive, easily-accessible tobacco cessation medications and counseling. Finally, it recommends that private insurance plans offer comprehensive cessation coverage and encourages states to require all insurance companies to cover these treatments.

You can download the report here, and you can find detailed, state-specific information on cessation coverage through an online State Tobacco Cessation Coverage Database.

The following guest post was written by Sean Barry with Transportation for America - a national coalition seeking to align our national, state, and local transportation policies with an array of issues like economic opportunity, climate change, energy security, health, housing and community development.


In the last few years, health advocates have increasingly urged Americans to walk, bike and exercise more often, noting regular physical activity is paramount to good health. Unfortunately, a new report released this week by Transportation for America and the Surface Transportation Policy Partnership reveals that walking in many of our communities is far more dangerous than it should be.

Dangerous by Design: Solving the Epidemic of Preventable Pedestrian Deaths (and Making Great Neighborhoods) shows that the level of pedestrian fatalities in the U.S. is roughly equivalent to a jumbo jet going down every month. But there is no national sense of urgency about pedestrian safety.

Under current federal transportation law, projects that benefit pedestrians and bicyclists are labeled “enhancements” and attacked by some as luxuries that detract from core road and highway building.

Current transportation policies vastly shortchange people who walk or bike. Less than 1.5 percent of total federal funds are ultimately spent on pedestrian safety, despite walkers comprising 11.8 percent of all traffic deaths and a comparable percentage of all trips. In this decade alone, 43,000 Americans have died preventable deaths while walking or crossing a street in their community. Although members of every demographic group are affected, ethnic minorities are suffering disproportionately, with African-American fatalities 70 percent higher than whites, and Hispanics 62 percent higher.

It should not come as a surprise that our inadequate investment in roads safe for all users adversely affects safety and health. For many Americans, daily physical activity is no longer a part of their daily existence. Seniors, the disabled and low-income Americans who cannot or chose not to drive face limited alternatives. Lower rates of physical activity are linked to rising obesity and pollution from automobiles increases the risks of asthma.

Dangerous by Design ranks America’s major metropolitan areas according to a Pedestrian Danger Index that measures how safe they are for walking. The report also profiles communities across the country that have successfully stepped up and reversed current trends.

In St. Petersburg, FL, for example, a “Vision 2020” planning process resulted in 13 additional miles of sidewalks and 32 rapid-flashing signals at crosswalks, improving driver-yielding compliance by 83 percent. In Charleston, SC, two-thirds of area residents say they are getting more exercise after the launch of a three-mile pedestrian and bike path. And, the installation of 1,600 speed humps in residential Oakland, CA led to a 50 to 60 percent reduction in the odds of injury or death among children walking.

There is growing movement for action in Congress as well. Last year, Sen. Tom Harkin (D-Iowa) and Rep. Doris Matsui (D-CA) introduced the Complete Streets Act. This legislation would ensure that new road projects emphasize safety and accessibility for all users, including pedestrians, bicyclists and transit riders.

Transportation for America is working to arrange a meeting with U.S. Transportation Secretary Ray LaHood, perhaps as soon as next week. At this meeting, we plan to deliver the message from our hundreds of partner organizations and thousands of supporters across the country that safer streets must be a priority.

Sign our petition today and help us send a strong message to the USDOT!

We hope the release of this report will fuel a greater sense of urgency about pedestrian safety and the need for a more balanced transportation policy. With health care remaining in the headlines, let’s convey to our representatives that making our streets safer is no longer just an “enhancement,” but an essential.

The New York Times' Steve Lohr reports that geriatric experts are using "the digital tools of low-cost wireless sensors in carpets, clothing and rooms" to help them learn how to prevent falls among older people. Researchers say the devices provide continuous measurement and greater precision in monitoring an older person’s walking and activity, and that promise to deliver new insights on risk factors and tailored prevention measures.

"For an older person, a fall is often a byproduct of some other health problem: cardiovascular weakness, changes in medication, the beginnings of dementia, gradual muscle degeneration," Lohr writes. "Motion analysis aided by inexpensive sensors and computing, researchers say, may well become a new 'vital sign,' like a blood pressure reading, that can yield all sorts of clues about health."

More than one-third of people ages 65 or older fall each year, with about one fall in 10 resulting in a serious injury. The estimated economic cost of falls ranges widely, up to $75 billion a year in the United States, if fall-related home care and assisted-living costs are added to medical expenses.

The following guest post is from Gloria Linnertz, an advocate in the lung cancer community who hails from Waterloo, Ill.:

We think we know about radon and lung cancer, but do we?

"Why was I so confident in my ignorance?" is the question I ask myself very often. In the months prior to my husband’s diagnosis of lung cancer, he mentioned to me that perhaps we should check our home for radon gas. Of course, I didn’t know anything about radon gas, but thought I did. I said that our home was relatively new—only twenty years old—and we had a tight basement. I was confident in my ignorance! Because radon cannot be detected through our senses, the only way to know if this silent killer is intruding into your home is to test. Recognizing what we can’t see, taste or smell is the problem.

In the year before his diagnosis, my husband Joe also said to me that he might have cancer. My husband had previously had two triple artery bypasses twenty years apart. Again, I said: "You don’t have cancer; you have heart disease." I thought he was just worrying too much. I thought I knew, but I didn’t. My husband Joe was a person to take preventive and safe measures. For 27 years he worked and exercised every day, kept a low fat, low cholesterol diet, and didn’t smoke. We had smoke detectors, carbon monoxide detectors, and fire extinguishers in our home; and we didn’t burn candles. Joe only lived six weeks after his diagnosis of lung cancer that had spread to his liver and bones. We had been living with a radon level of 17.6 picocuries per liter of air in our home for 18 years.

Knowing the word radon and that it is a gas does not constitute knowledge of the element and its danger. You’ve heard the saying “A little knowledge can be dangerous.” I would change that to “A little knowledge can be deadly.” We, the general public, don’t know the facts. We must replace our limited knowledge with a full base of all the facts on radon.

Dr. Bill Field, an American Academic Scholar and Professor in the Department of Occupational and Environmental Health and Department of Epidemiology within the College of Public Health at the University of Iowa, who has recently been appointed to the Advisory Board on Radiation and Worker Health by President Obama, stated that protracted radon progeny exposure is the seventh leading cause of cancer mortality in the United States and the leading environmental cause of cancer mortality. It is the leading cause of lung cancer deaths among non-smokers.

Large and recent studies confirm that radon in homes increases lung cancer risks. Throughout our world up to 18% of the lung cancers can be attributed to indoor radon according to Professor Bill Angell, Chair of the Prevention and Mitigation Working Group of the World Health Organization’s International Radon Project. . Radioactive particles from radon gas are inhaled and attach to the air sacs in the lungs. These particles change the characteristic of the cells to cancer, and those mutated cells divide and multiply.

Radon is a radioactive gas that emanates from rocks and soils and tends to concentrate in enclosed spaces like houses. Soil gas infiltration is the most important source of residential radon and is present in every home (except ones on stilts) because of the way our homes are built and designed.

The analysis from recent studies in Europe, North America, and Asia indicates that lung cancer risk increases proportionally with increasing radon exposure according to the World Health Organization (WHO). There is no known threshold concentration below which radon is safe. On September 21, 2009 WHO, in view of the latest scientific data, released a reference level of 2.7 picocuries per liter of air (pCi/L) as a minimum level to minimize health hazards due to indoor radon exposure.

Radon is easy to measure. Every home needs to be tested for radon because each home has its own individual footprint on the earth. The homeowner cannot rely on the results of surrounding houses in the neighborhood. A short term (3-7 days) and/or long term (3-12 months) test kit can be used. Radon professionals can also perform the test with electronic devices. Test kits can be obtained from the radon hotline at (785) 532-6026 or email at Radon@ksu.edu or Web site: www.sosradon.org. Radon test kits can also be purchased at the local hardware stores.

It is easy to protect from radon gas. Addressing radon is important in new construction as well as existing buildings. Radon prevention strategies focus on sealing radon entry routes and using soil depressurization techniques to prevent the gas from entering the home. The cost is very reasonable. “How little it can cost to save a life!” is what I would say to someone who complained about the expense of a radon mitigation system installed by a licensed radon professional.

I write this in memory of my husband Joe --who was so very dear to me—my friend, my partner, my companion, my love. I ask you to test your home for radon during this month of November—National Lung Cancer Awareness Month. If your level is above 2.7, spend that little extra money to help save a life. That life may be someone you love.