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.