Prevention Matters

The House Energy and Commerce Committee on Friday unanimously approved an amendment to health reform legislation that would prohibit cost-sharing to Medicaid patients for recommended clinical preventive services. The amendment by Rep. Lois Capps, D-Calif., was supported by Partnership for Prevention, the American College of Preventive Medicine, the American Heart Association, and the Trust for America’s Health.

“This amendment will make it easier for some of the poorest and most underserved Americans to obtain services that will help keep them healthy, instead of waiting for expensive treatment once they get sick,” said Partnership for Prevention President Robert J. Gould, PhD. “These services are currently under-utilized, and cost-sharing requirements would put them out of reach for many families.”

Capps’ amendment would eliminate cost-sharing requirements for Medicaid clinical preventive services that have been recommended by the U.S. Preventive Services Task Force (USPSTF). The USPSTF reviews scientific evidence on clinical preventive services and rates them according to their effectiveness.

“Congresswoman Capps’ knowledge of these issues has been honed by her years of service as a public health nurse,” Gould said. “The American people are indeed fortunate to have a leader like her who understands that real health reform starts with prevention, and that prevention saves much more than money.”

USA TODAY's Liz Szabo reports that about 200,000 children go to the emergency room every year because of playground injuries. About 90,000 of those injuries are serious, such as fractures, concussions and amputations. About 15 kids die from playground injuries every year.

The Consumer Product Safety Commission says most injuries occur when children fall from equipment, so playgrounds need to be built properly and maintained in top shape.

Dr. Richard Besser will leave the Centers for Disease Control and Prevention (CDC) in Septemer to join ABC News as its Senior Health and Medical Editor. Dr. Tim Johnson, ABC's 30-year veteran health news reporter, has been promoted to ABC's Chief Medical Editor .

Besser, currently the director of the CDC's Coordinating Office for Terrorism Preparedness and Emergency Response, served as Acting Director for the CDC from January to June 2009. At the time of the swine flu outbreak, he became the public face of the CDC's response to H1N1 .

"He is an incredibly talented physician, and I look forward to him joining our team," Johnson said in a press release."

In a daring experiment in Europe, scientists used mosquitoes as flying needles to deliver a "vaccine" of live malaria parasites through their bites.

The results were astounding: Everyone in the vaccine group acquired immunity to malaria; everyone in a non-vaccinated comparison group did not, and developed malaria when exposed to the parasites later.

Increasing rates of HPV infection, spread through oral sex, is largely driving the rapid rise in oropharyngeal cancers, says Dr. Scott Lippman, who chairs the thoracic department at the University of Texas' M.D. Anderson Cancer Center.

Lippman says studies of oropharyngeal tumor tissue stored 20 years ago show that only around 20% are HPV positive. Today it is estimated that 60% of patients are infected with the virus.

It's been feared that publication of outcomes for adult cardiac patients would make surgeons more defensive about their work, and lead them to avoid taking on higher-risk patients who may damage their statistics. However a new study in the UK, where death rates have been reported since 2001, are so good that experts there are calling for all surgical specialties to publish such data.

An analysis of more than 400,000 operations by the Society for Cardiothoracic Surgery shows outcomes in the UK have improved significantly since publication of that information began. The study also found more elderly and high-risk patients were now being treated, and that fewer patients are being cut open a second time due to complications like infections.

"We are now taking on older, sicker, higher-risk patients, and these patients, rather than doing worse because of their risk, are actually doing better than they did before," said Mr. Graham Venn, a cardiothoracic surgeon at Guy's and St Thomas' Hospital in London.

However, the data also shows that survival rates remain significantly worse for women than men, with the gap between the sexes failing to close.

A non-profit health care system in Utah has instructed its lobbyists to kick the tobacco habit.

Intermountain Healthcare sent letters this month to its contract lobbyists -- including former House Speaker Greg Curtis -- demanding that they sign a conflict-of-interest statement vowing not to lobby on behalf of tobacco companies or Intermountain would terminate their pacts.

Intermountain is the region's largest health-care provider. President Obama has repeatedly cited Intermountain in his health reform discussions as an example of a health care system that offers high quality health care at costs that are well below average.

Partnership for Prevention today urged the House Energy and Commerce Committee to prohibit cost-sharing to Medicaid patients for recommended clinical preventive services.

Partnership President Robert J. Gould praised an amendment offered by Rep. Lois C. Capps, D-Calif., to a historic health reform bill being crafted by the Committee. Her amendment would eliminate cost-sharing requirements for Medicaid clinical preventive services that have been recommended by the U.S. Preventive Services Task Force (USPSTF).

“This amendment delivers one of the eight consumer protections that President Obama recently outlined for health reform legislation,” said Gould.

“Chronic diseases are causing health care costs to spiral upward, and Medicaid patients are already among the most underserved and at-risk populations for these conditions,” Gould said. “At the same time, they are among those who can least afford high out-of-pocket costs. We should be encouraging - not discouraging - the use of preventive services as a way to help keep this vulnerable population healthy. Waiting for people to get sick and need expensive treatment isn’t real health reform. Real health reform starts with prevention.”

The USPSTF reviews scientific evidence on clinical preventive services and rates them according to their effectiveness. A Partnership for Prevention study of USPSTF recommendations found 17 clinical preventive services that either save money or are cost-effective (cost less than $50,000 per quality-adjusted life year, or QALY). Of those 17, it found 10 that cost less than $15,000 per QALY.

Farmers markets are gaining popularity as a way to bring fresh produce to those living in food deserts. Whether farmers markets improve consumption of fruits and vegetables or impact obesity rates has yet to be determined. But such efforts are a step in the right direction to helping people eat a healthier diet. However, simply setting up a farmers market in a food desert without ensuring it is conveniently located, adequately promoted, offers appealing products, or provides education on how to prepare fresh produce will probably not result in many sales.

A recent Chicago Tribune article shows how several African-American churches around Chicago are doing things right. These churches have partnered with local farmers to bring fresh produce to their congregants, many of whom rely on convenience stores for their food. Weekly farmers markets are held in the church parking lots with onsite nutritionists and demonstrations on preparing traditional African American recipes in healthful ways.

A diet rich in fruits and vegetables reduces the risk for a host of diseases, including diabetes and cardiovascular disease. Both of these diseases plague racial and ethnic minority populations at much higher rates than whites. Farmers markets, community gardens, and other efforts to improve access to fresh produce should be continued, as well as finding ways to overcome barriers. One problem that has hurt farmers markets is the inability to use the electronic benefit transfer cards now given through the Supplemental Nutrition Assistance Program (formerly the Food Stamp Program).

Alyson Hazen Kristensen, MPH
Senior Fellow & Program Officer
Partnership for Prevention

Partnership for Prevention today applauded President Obama’s call for a health reform bill that requires no cost-sharing by patients who obtain preventive services.

The preventive services proposal was among eight “core consumer protections” that Obama said would be provided by health reform legislation. He listed the eight protections during a Thursday town hall meeting in Raleigh, N.C. A fact sheet issued by the White House on Thursday said their cost-sharing protections mean that “Insurance companies must fully cover, without charge, regular checkups and tests that help you prevent illness, such as mammograms or eye and foot exams for diabetics.”

“We applaud the president for seeking this type of protection for patients,” Partnership President Robert J. Gould said. “Proven preventive services will help save lives and reduce the incidence of chronic disease that is a leading driver of spiraling health care costs.

“It makes no sense to seek cost-sharing for preventive services,” Gould said. “The main purpose of cost-sharing is to discourage the use of medical services. But clinical preventive services are currently under-utilized.”

Gould said the president’s stance should strengthen support for an amendment that Partnership is helping members of the House Energy and Commerce Committee to craft that would prohibit cost-sharing for preventive services funded under Medicaid.

A study by Partnership for Prevention’s National Commission on Prevention Priorities found that increased utilization of just five clinical preventive services – daily aspirin use, tobacco cessation counseling, adult pneumococcal immunization, and breast and colon cancer screening – would save an additional 100,000 lives a year, while all five services either save money or are cost-effective.

Partnership for Prevention is a non-profit organization of business, health care and government leaders who are trying to make evidence-based disease prevention and health promotion a national priority.

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Most of $1 billion appropriated by Congress for disease prevention as part of the economic stimulus plan will go to a CDC-planned initiative to fight obesity, heart disease and other chronic conditions, says Health and Human Services Secretary Kathleen Sebelius.

"We finally have a plan," Sebelius told attendees at a CDC-sponsored conference on obesity in Washington DC. She said the Obama administration will give states and local governments more money to control obesity, including investing in public transportation.

Partnership President Robert J. Gould, PhD, warned in an interview for NPR's "All Things Considered" that prevention is being undervalued in the current health reform debate on Capitol Hill.

Even when congressional budget scorekeepers do concede that some prevention and wellness programs work as intended, Gould said, "they warn us that living longer would cost the government more money because people would be using additional Social Security and Medicare payments.

"So if the answer to the question is that people living longer and healthier lives is a problem, then you're asking the wrong question," he said.

He citied a study by Partnership's National Commission on Prevention Priorities, which reviewed the 25 clinical preventive services most highly recommended by the U.S. Preventive Services Task Force. It found that five of those services actually save money, while another 12 were still considered cost-effective - costing less than $50,000 per additional year of life they would provide. He said that compares with $900,000 per year for a mechanical device to keep alive a patient with congestive heart failure.

Fort Worth Star-Telegram columnist Steve Jacobs writes that a new law in Texas mandating coverage of widespread coronary screening for older adults is an example of "medical excess" whose implications reach beyond the Texas border.

"The new Texas law is a classic case of marketing and advocacy preceding science," Jacobs writes. "Ideally, medicine should be based on evidence, not belief."

The law was the idea of State Rep. Rene Oliveira, D-Brownsville, who says coronary screening saved his life by revealing severe blockages that resulted in bypass surgery. Beginning Sept. 1, Texas health-benefit plans must pay up to $200 for coronary artery calcium (CAC) scans and carotid ultrasonography for men ages 45-75 and women ages 55-75, as well as anyone regardless of age who has diabetes or is considered at least an intermediate risk for heart disease.

But the U.S. Preventive Services Task Force — the gold standard in unbiased healthcare recommendations — is against routine CAC screening, because there is no scientific basis that this sort of screening improves health outcomes. The American Heart Association, which cautiously recommends its use for selective patients, did not support Oliveira’s bill.

AP's Lauren Neergaard writes: Obesity's not just dangerous, it's expensive. New research shows medical spending averages $1,400 more a year for an obese person than for someone who's normal weight. Overall obesity-related health spending reaches $147 billion, double what it was nearly a decade ago, says the study published Monday by the journal Health Affairs.

The higher expense reflects the costs of treating diabetes, heart disease and other ailments far more common for the overweight, concluded the study by government scientists and the nonprofit research group RTI International.

RTI health economist Eric Finkelstein offers a blunt message for lawmakers trying to revamp the health care system: "Unless you address obesity, you're never going to address rising health care costs."

Democrats will claim that health care reform legislation has benefits and cost savings in areas including prevention that aren't scored by the Congressional Budget Office, The Hill reports.

"Democrats are going to seek to convince skeptics that the healthcare overhaul has other provisions, such as prevention and wellness measures, that will provide benefits and save money, a House leadership aide told The Hill on Sunday."

On Saturday, the CBO and director Doug Elmendorf issued a cost report concluding that if an independent Medicare panel set costs, only $2 billion would be saved over 10 years. White House budget director Peter Orszag on Saturday criticized the CBO and suggested he was puzzled by the methodology the CBO used to estimate cost savings from a proposed Independent Medicare Advisory Council.

Partnership for Prevention Board Member Michael J. Critelli was quoted in a July 26 article in The Washington Post in which he identified prevention as a way to control health care cost drivers.

An Arkansas program that has produced nearly 100,000 fewer smokers over the last seven years was named Partnership for Prevention's "Best Prevention Idea of the Week," while the ethanol industry’s practice of adding antibiotics to their fermentation tanks was named “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

Arkansas Program Spurs Big Drop in Adult Smoking
http://www.areawidenews.com/story/1555203.html

New survey information shows there are nearly 100,000 fewer smokers in Arkansas since the beginning of the Arkansas Department of Health's (ADH) Tobacco Prevention and Cessation Program in 2002. When the program started in 2002, 25.1 percent adults smoked in the state; more current data show that those numbers have decreased to approximately 20.7 percent. The Tobacco Prevention and Cessation Program is funded through the Tobacco Master Settlement Agreement. Through community and school prevention programs, a media and public relations campaign known as Stamp Out Smoking, a statewide quitline and cessation services for tobacco users looking to quit, TPCP continues to see the positive effects of its efforts.


WORST

Antibiotics Used in Ethanol Production
http://www.iatp.org/iatp/publications.cfm?accountID=258&refID=106420

Ethanol producers are adding antibiotics to the fermentation process to keep fermentation tanks free of bacteria, a practice that the Institute for Agriculture and Trade Policy says may be contributing to antibiotic resistance. The nutrient-rich residue from the fermentation tanks, a co-product of ethanol production, is being sold as livestock feed. Recent research has identified several strains of bacteria living in ethanol fermentation tanks that are resistant to penicillin and virginiamycin, the most commonly used antibiotics in ethanol production.

After a decade of wrangling on Capitol Hill, Congress has approved and President Obama has signed into law a bill giving the Food and Drug Administration the authority to regulate tobacco products. This has huge implications for the tobacco industry and for public health policy. Discussing those implications with us in this podcast is Dr. Corinne G. Husten, Partnership for Prevention's Executive Vice President and former Director of the Office of Smoking and Health at the Centers for Disease Control and Prevention. To listen to this podcast, click on the media player below. If you don't see a media player, click here.

A report by Partnership for Prevention's National Commission on Prevention Priorities was cited in a column in the July 23 New York Times as proof of the value of preventive services.

Dr. Pauline W. Chen said the study showed prevention has value beyond cost-efficiency calculations.

"Last fall, the National Commission on Prevention Priorities found that by increasing just five preventive services, clinicians could save more than 100,000 lives per year," Chen wrote. "These services include breast cancer screening in women 40 and older, flu immunizations in adults 50 and over, colorectal cancer screening in adults 50 and over, smoking cessation counseling, and a daily aspirin in high risk cardiovascular patients."

Investment analyst and financial journalist Liz Peek has pointed to Partnership for Prevention and its "Leading by Example" initiative as an example of how corporations can "pitch in with gusto to solve America's big problems."

"... Corporations should start providing answers to our country's healthcare crisis," Peek said in a July 22 column entitled "Memo to Corporate America: Wake Up!"

"Companies like Caterpillar and Deere are part of an initiative called Partnership for Prevention, which works to promote employee wellness," she wrote. "These efforts are smart, produce excellent public relations, strong employee ties and simultaneously support the bottom line."

Partnership for Prevention is urging chairmen of the three congressional committees crafting the House version of a health care reform bill to raise the federal excise tax on alcoholic beverages and apply those revenues to a special fund to finance prevention and wellness initiatives.

“Higher alcohol excise taxes are an important tool in reducing the public health toll of alcohol abuse, while also providing a viable and appropriate source of funding to finance reform of our nation’s health system,” Partnership President Robert J. Gould said in a letter to Reps. Charles B. Rangel (D-NY), Henry A. Waxman (D-CA), and George Miller (D-CA). Rangel, Waxman and Miller are chairmen, respectively, of the House Ways and Means Committee, the House Energy and Commerce Committee and the House Education and Labor Committee.

In his letter, Gould cited a review of scientific studies by the U.S. Task Force on Community Health Services that found increased taxes or prices on alcoholic beverages are consistently related to a reduction in motor vehicle crashes and deaths, alcohol-impaired driving and death from liver cirrhosis as well as deaths from other causes. Higher alcohol taxes were also demonstrated to reduce the incidence of violence, sexually transmitted diseases, and alcohol dependence.

He also noted that federal alcohol excise taxes were last raised in 1991 and have not kept pace with inflation. Meanwhile, the Congressional Budget Office estimates that a 20% tax hike on distilled spirits and equalizing the tax rates on other alcoholic beverages would provide $60 billion in new revenue over a decade.

It's been a topsy-turvy day on the health reform beat. First, the American Medical Association surprised most people and endorsed the House version of the legislation. Then the head of the Congressional Budget Office delivered an assessment that many say could be a death blow for the legislation being crafted by Democrats - that it might actually hurt rather than help the economy.

The AMA sent a letter to House Ways and Means Chairman Charles Rangel, D-NY, endorsing the health reform proposal put forward by three House committees. The New Republic's Jonathan Cohn attributes the decision in part to the approach the House bill takes on the annually scheduled reduction in Medicare payments, known as the Sustainable Growth Rate (SGR) formula

The AMA's letter says the legislation "recognizes that fundamental Medicare reforms, including repeal of the sustainable growth rate formula, are essential to the success of broader health system reforms."

Under questioning by members of the Senate Budget Committee, CBO director Douglas Elmendorf said bills crafted by House leaders and the Senate health committee do not propose "the sort of fundamental changes that would be necessary to reduce the trajectory of federal health spending by a significant amount."

"On the contrary," Elmendorf said, "the legislation significantly expands the federal responsibility for health-care costs."

Workers who quit smoking, lose weight, and eat right could have their health insurance premiums cut by as much as half, possibly saving them thousands of dollars per year, under a measure inserted with little notice this week into the Senate healthcare overhaul bill.

Under existing federal law, companies that offer group health insurance can offer a maximum 20 percent discount to employees who can show they have taken steps to improve their health. The new measure would raise that discount to 30 percent and enable the Obama administration to raise it to 50 percent.

The measure could have the most impact at larger companies that are self-insured or provide insurance through a private company, and would likely have less impact at small businesses or those with limited health plans, analysts said.

The Obama administration wants to ban many routine uses of antibiotics in farm animals in hopes of reducing the spread of dangerous bacteria in humans. Specifically, it wants to ban feeding antibiotics to healthy chickens, pigs and cattle to encourage rapid growth, as well as the use of antibiotics by farmers in animals without the supervision of a veterinarian.

Both practices lead to the development of bacteria that are immune to many treatments. The legislation is supported by the American Medical Association, among other groups, but opposed by farm organizations like the National Pork Producers Council.

The President's Council of Economic Advisers has issued a new jobs report, and it should provide something to think about for those who questioned why funding for health care was included in this year's economic stimulus package.

The report projects the growth of health-related jobs versus all other occupations between 2000 and 2016 . It predicts 12% growth for “other occupations”; 35% growth for “health practitioners”; and 48% growth for “health care support.”

The biggest job growth of any category in the economy will come "not for doctors, nurses, or nursing home workers, but for a broadly defined group called 'other medical services and dentists.'” The report projects that this group, defined as “a broad category including the ever-expanding home health care, outpatient care, and medical and diagnostic laboratories subsectors,” will produce more than 2 million new jobs per year for the group, on average, between 2008 and 2016.

Dr. Regina Benjamin, a MacArthur "genius grant" recipient who founded a clinic to serve the poor along Alabama’s Gulf Coast, was named by President Barack Obama as his choice for U.S. surgeon general. The nomination requires Senate confirmation.

A new report from the Centers for Disease Control and Prevention shows that the rate of obesity in America is higher than ever. Two-thirds of Americans are considered to be overweight or obese, and the proportion of U.S. adults who are obese increased to 26.1 percent in 2008 compared to 25.6 percent in 2007. Adult obesity prevalence was 30 percent or more in six states – Alabama, Mississippi, Oklahoma, South Carolina, Tennessee and West Virginia.

A public insurance option in health reform legislation could lead some companies to drop employer-based insurance coverage and associated wellness plans, Reuters' Ellen Wulfhorst reports.

"Certainly there are employers now that don't offer healthcare benefits, and if there's a public plan in place, undoubtedly that number will go up," said Lewis Maltby, president of the National Workrights Institute, an advocacy group for human rights in the workplace. "Some employers will certainly say, 'I'm out of here. Use the government plan.'"

About two-thirds of large U.S. companies offer some sort of wellness program to lower the health insurance costs, combat absenteeism and boost productivity.

One incentive under consideration would give tax credits to companies for wellness programs. A Senate proposal would also set aside funds for the Centers for Disease Control and Prevention to serve as a resource for companies to help them establish and standardize wellness program practices.

The Wall Street Journal's Anna Wilde Mathews profiles an initiative by AmeriGas Propane, which requires all employees would to get physical exams preventive screenings. Workers and covered spouses have a year to complete the tests, which are covered 100%, or lose their insurance.

"AmeriGas, based in Valley Forge, Pa., is one of just a handful of companies that have mandated health testing, but benefits consultants say it is at the cutting edge of a growing trend," Mathews writes. "In a February survey by consulting firm Towers, Perrin, Forster & Crosby Inc. 45% of companies said they planned to, or were considering, adding penalties for employees who didn’t participate in wellness activities."

Wellness requirements pose legal questions and raise objections from labor officials. But Mathews notes that, prior to its mandatory program, AmeriGas was facing annual health-expense increases of 10% or more, while its workers had high rates of diabetes and heart disease and only 6% of the enrollees in their health plan had gotten recommended cholesterol checks in the previous 18 months and just 20% had their blood sugar tested.

The economic crisis has disrupted HIV prevention and treatment programs, including causing shortages of anti-retroviral drugs, a report by UNAIDS and the World Bank said Monday.

"In 22 countries in Africa, the Caribbean, Europe and central Asia, and Asia and Pacific, disruption of HIV prevention and treatment programs is expected over the course of this year as a result of the global economic crisis," said the report.

Eight countries were already facing shortages of anti-retroviral drugs or other disruptions, added the report, which compiled responses from 71 countries where 3.4 million people receive treatment.

McClatchy's David Lightman cites experts on and off Capitol Hill who say the estimated price tag for health reform legislation is liable to be unreliable.

"In a letter June 16 to senators, Congressional Budget Office Director Douglas Elmendorf said, ''any of the specific changes that might ultimately prove most important cannot be foreseen today, and could be developed only over time through experimentation and learning.'"

The following is a guest post from Partnership for Prevention President Robert J. Gould, PhD, and Executive Vice President Corinne G. Husten, MD, MPH., that appeared on the blog for the Robert Wood Johnson Foundation's Commission to Build a Healthier America.

When the answer is that living longer is a problem, you know you’re asking the wrong question.

The Congressional Budget Office recently issued a memo identifying areas where Congress could save money in a health reform bill. When it came to disease prevention and health promotion, the logic in its response was troubling.Promoting healthier lifestyles may help reduce the prevalence of costly chronic diseases, the CBO said, but the "overall budgetary effect also depends on the cost to the government... by people who live longer." It said such people could cost the government more in terms of health care costs and Social Security payments generated during their additional years of life.

Too often, the notion of investing more in prevention is being summarily dismissed on the grounds that prevention “doesn’t save money.” Such assertions have been repeated of late by articles in CQ (here for subscribers) and The Wall Street Journal. Those critics are asking the wrong question, and the answer to that question turns logic on its head. The proper question should be: what gives us the most bang for the buck?

Here are the facts: some preventive measures save money, while some don’t. Some medical treatments cost more than others. In each case, some are more effective than others in terms of improving health. But those facts should not result in a blanket dismissal of prevention. Even when preventive measures cost money, they offer tremendous benefits at a relatively low cost.

Partnership for Prevention conducted an extensive review of clinical preventive measures – those that can be performed in a doctor’s office. We found five measures that, if used more broadly, could altogether save an additional 100,000 lives a year. Three of those measures – daily aspirin use, tobacco cessation counseling, and colorectal screening – actually save money as well as lives. The other two – flu immunizations for older adults and breast cancer screening – save lives and are still more cost-effective than most medical treatments. Even so, all of those preventive measures remain under-utilized, due partly to lack of public awareness and partly to deductibles, co-pays and lack of coverage that can discourage clinicians from recommending those services and discourage patients from having them performed.

In a separate study, we reviewed the 25 preventive services recommended by the US Preventive Services Task Force. It found that six of them actually saved money, while 12 were highly cost-effective in that they cost less than $50,000 for each year of life saved. That compares with an LVAD device that helps keep alive heart failure patients who can’t get a transplant – which costs $900,000 per each year of life saved.

As for helping people live longer, prevention pleads guilty as charged. But should we really put proponents of prevention in the Orwellian position of apologizing for helping people live longer, healthier lives? Expensive medical treatments for people who are already sick also help people live longer. But isn’t that the whole purpose of our health care system?

Our current system doesn’t provide value, as evidenced by our low ranking in health status among industrialized countries. But prevention can help change that, because prevention provides great value. The investment to cover and pay for preventive services produces tremendous returns, and providing and increasing utilization of these services will create a much more efficient health care system.

Meanwhile, private-sector companies are reporting phenomenal results from implementing science-based wellness and prevention programs in the workplace. Safeway CEO Stephen Burd said in a recent Wall Street Journal op-ed that the wellness program his company started in 2005 has kept its health care expenses flat while those expenses increased by 38 percent nationally. Dow Chemical Company says that its wellness program saved the company more than 9,000 employee absentee days last year alone and had a return on investment that was equal to seven cents a share of company stock. Pitney Bowes estimates that its health promotion initiatives have saved the company $40 million over nine years.

Perhaps that’s why a recent survey of Americans by the Trust for America’s Health and the Robert Wood Johnson Foundation showed that 77 percent of Americans believe prevention will save money. Even more importantly, it showed that 72 percent of Americans favor increased investment in prevention, even if it didn’t save money.

It’s critical that we conduct widespread cost-effectiveness research to find out what delivers the most health at the least cost are critical. Prevention measures should be a part of that research, so that we can find the way in which our health care system can make the most effective and the most efficient use of both prevention and treatment services. In the meantime, we hope Congress will increase the nation’s investment in high-value preventive services that help people live longer, healthier lives.

Is prevention a “panacea for cost savings?” No, but that’s not the question. The real question is: is prevention a proven, cost-effective way to improve our health and our health system. The answer to that question is “yes.”

The American College of Occupational and Environmental Medicine (ACOEM) has joined the chorus of folks complaining about the Congressional Budget Office's dissing of wellness and prevention programs.

In a letter to Senate Budget Committee Chairman Kent Conrad, D-N.D., ACOEM Executive Director Barry S. Eisenberg said workplace wellness has been a "persistent void in the current health care reform debate" and that the CBO "overlooks several key factors."

Eisenberg said an study in the American Journal of Health Promotion found an average return on investment of $3 for every $1 invested in employer health-promotion programs and $2 for every $1 invested in employer disease-management programs.

He also said the CBO "does not sufficiently consider how critical a healthy workforce will be to the long-term viability of our Social Security and Medicare systems" and that its focus on secondary prevention "is minimizing the cost-effective benefits of primary and tertiary prevention as a part of an overall prevention strategy."

The U.S. Food and Drug Administration announced today that it is seeking public input on the implementation of its historic new authority overseeing tobacco products in the United States. In a Federal Register notice, the agency invites the public to provide information and share views on a wide range of topics, from product content to advertising and marketing. All public comments will be posted online.

"We're interested in receiving input from across the country as the FDA begins to implement this important new authority intended to reduce the enormous toll of suffering and death caused by tobacco products in the United States," said Dr. Margaret A. Hamburg, Commissioner of Food and Drugs. "We look forward to the public's response."

The Federal Register notice can be viewed at:
http://www.federalregister.gov/OFRUpload/OFRData/2009-15549_PI.pdf.

For more information about the FDA and tobacco regulation, see:
http://www.fda.gov/NewsEvents/PublicHealthFocus/ucm168412.htm.