Prevention Matters

Recently, the Wall Street Journal (WSJ) posted an article, “The Danger of Daily Aspirin,” that questioned the use of aspirin for prevention of cardiovascular disease and stroke, citing the increased risk for gastrointestinal (GI) bleeding. Although the WSJ article is generally balanced in its discussion about aspirin use, the headline and some comments from the piece add to the confusion about the appropriate use of aspirin for primary prevention.

The WSJ article references a meta-analysis published in The Lancet in May 2009 as evidence for its arguments regarding caution when taking aspirin for primary prevention of heart disease and stroke. But the story really begins in April 2009 when the U.S. Preventive Services Task Force (USPSTF) – the quasi-governmental body that rigorously evaluates the effectiveness of clinical preventive services – reported that regular aspirin use can reduce first heart attacks in men and first strokes in women. The findings from the USPSTF apply to men 45 and 79 years of age and to women 55 to 79. The USPSTF found that aspirin should be used when the benefits outweigh the harms for potential GI bleeding. This straightforward recommendation helped resolve the often confusing messages consumers receive about aspirin use.

Or so it appeared. Little more than a month later, The Lancet study offered a seemingly conflicting conclusion, namely, that the long-term use of aspirin in preventing first heart attacks and strokes is of uncertain net benefit since the potential benefits and harms may cancel each other out.

The study from the USPSTF and the study appearing in The Lancet relied on the same meta-analyses in their research but still came to different conclusions. How could this happen? In layman’s terms, the reason for the seemingly conflicting conclusions appears to be that the authors of the second study gave equal weight to incidents of GI bleeding as to heart attacks and strokes. In contrast, the USPSTF appears to conclude that it is more important to prevent heart attacks and strokes than to prevent gastrointestinal bleeding events.

Upon closer examination, though, the findings of the two studies are far more similar than they appear. Both the USPSTF and the authors of The Lancet study underscore the importance of patients and healthcare providers discussing the benefits and harms of regular aspirin use.

Partnership for Prevention’s Aspirin Task Force – an independent panel made up of some of the nation’s leading experts on aspirin use – carefully reviewed the methodology, findings, and conclusions of this study. The Aspirin Task Force recommended no immediate change in the use of aspirin and aspirin counseling. Its assessment of The Lancet study can be found here.

The decision to take aspirin can sometimes be difficult. It does have a proven track record in preventing first heart attacks and strokes in men and women, respectively, but, like all medications it does have risks. Therefore, as reiterated by the Aspirin Task Force, the key step in the decision-making process is an informed discussion between patients and their healthcare providers to ensure the appropriate use of aspirin. That is not confusing at all.

Rebecca Doigan
Research Fellow and Program Associate
Partnership for Prevention

The seemingly sudden onset of the highly infectious H1N1 influenza caught the world by surprise. The government and drug companies were scrambling last spring to create vaccines to ward off the virus and control the onset. Unfortunately, the H1N1 virus raged before the vaccine could become widely available and accessible.

However, is it possible that the vaccine could have been harvested in a plant, specifically a tobacco plant, rather than chicken eggs? The Wall Street Journal explains that “plants have certain advantages over animal parts, which may contain pathogens harmful to humans. The tobacco plant is particularly promising: it has been extensively researched, is cheap to grow and can yield large amounts of vaccine quickly—potentially reducing production time to weeks instead of several months.”

While this system is only in its early stages and not quite ready to be used as the sole vehicle for the productions of vaccines yet, but it is an excellent possibility. Clinical trials are planned to begin in 2011.

(link to original article)

Amy Himmelstein
Tobacco Policy and Program Intern
Partnership for Prevention

The new report card that compares the health of U.S. counties was named the “Best Prevention Idea of the Week,” while a study showing that poorly fitting condoms contribute to improper use was named “Worst Prevention Idea of the Week.”

The “Best/Worst” awards are announced each week in “Prevention Matters,” the blog of Partnership for Prevention. Nominees are submitted by Partnership staff as well as the general public, and are voted on by the staff. Partnership for Prevention is a nonpartisan organization of business, nonprofit and government leaders who are working to make evidence-based disease prevention and health promotion a national priority. More information is available at http://www.prevent.org/.

BEST

New Report Card Compares Health of US Counties

The Institute of Medicine, (IOM) in a study released today, made recommendations to increase progress in hypertension reduction and control. The study titled A Population-Based Policy and Systems Change Approach to Prevent and Control Hypertension, focused on identifying “strategies that can reach large numbers of people and improve the well-being of entire communities.”

The bad news is that hypertension (high blood pressure), affects nearly one in 3 adults – 73 million people and kills one in 6 adults annually. The good news is that it can be diagnosed easily, is preventable and relatively inexpensive to treat. The challenge is to provide more clinical and population-based interventions to more people, particularly those at high risk of cardiovascular disease.

This study makes several recommendations, including two key dietary strategies – reduction of sodium intake and increase in potassium intake. Currently, 87 percent of U.S. adults consume more than the recommended daily 2.3 grams of sodium and only about 2 percent of U.S. adults meet current dietary guidelines for potassium. Clearly many partners – including state and local governments, food industry, and health and education sectors need to join forces to develop and implement effective awareness and behavior change programs.

Posted by:
Diane Canova
Vice President, Policy & Programs, Partnership for Prevention

President Obama today released his proposal for resolving the impasse with Congress over health reform. The proposal is summarized in an 11 page document released this morning by the White House. Initially prevention advocates were shocked to discover that the words “prevention” and “wellness” were not included in the summary draft. Fortunately, these concerns were premature as the release of additional information highlighted the key role that prevention plays in the Administration’s plan for reform.

We have since discovered that the 11 page summary was intended primarily to highlight proposed changes in the Senate passed health reform bill; HR 3590, the “Patient Protection and Affordable Care Act.”

The White House has developed a detailed web site which discusses the President’s proposal in greater detail. Most encouraging to those of us who believe REAL Health Reform Starts with Prevention, the President has made crystal clear his Administration’s continued support for the key prevention, public health and wellness provisions contained in Title IV of the Senate passed health reform bill. By retaining the Senate proposal for the prevention trust fund, the proposal “provides for unprecedented investments in prevention, public health, disease research, and screening. The national investment in preventing disease and finding cures will save lives and money in the long run for American families, small businesses, and the Nation.”

The President’s commitment to prevention is reflected in the following description of the Prevention and Public Health provisions of Title IV.

“If we want to truly reform health care to benefit American families, we need to transition from a system focused primarily on treating the sick to one that helps keep people well throughout their lives…It directs the creation of a national prevention and health promotion strategy that incorporates the most effective and achievable methods to improve the health status of Americans and reduce the incidence of preventable illness and disability in the United States. The Act relies on the innovation of small businesses and state and local governments to find the best ways to improve wellness in the workplace and in our communities. And it strengthens America’s capacity to respond to public health emergencies. The Act empowers families by giving them tools to find the best science-based nutrition information, and it makes prevention and screenings a priority by waiving co-payments for America’s seniors on Medicare. By attacking disease before it hits, the Act helps to improve health, save lives, and avoid more costly complications down the road.”

Additional details about the President’s health reform proposal are summarized on a white house web site that has been developed in preparation for the bipartisan health summit scheduled for February 25. The summit will begin at 10am and will be broadcast live at whitehouse.gov/live.

Posted by:
Ripley Forbes
Director, Government Affairs, Partnership for Prevention

Tobacco giant Philip Morris USA, a division of Altria Group (MO), on Friday asked the U.S. Supreme Court to throw out the landmark ruling saying the cigarette industry misled the public about the dangers of smoking. Hours later, the Obama administration asked the court to allow it access to nearly $300 billion in what it calls ill-gotten profits from the industry. The dueling filings are the latest chapter in an epic legal fight that has gone on for more than a decade.

In its filing, Philip Morris asked the court to overturn a massive racketeering verdict that forced the company to change its practices and increase its warnings about the dangers of smoking. Philip Morris argued that, in addition to letting the U.S. "pervert" the racketeering statute, known as RICO, the courts had violated its First Amendment rights.

Posted by:
David Zauche
Managing Senior Fellow & Senior Program Officer, Partnership for Prevention

An article in the 2-5-10 issue of National Journal by Neil Munro says “The campaign against fat has failed, even backfired. Maybe it’s time to emphasize fitness instead of weight.”

The Journal notes “The XXXL-sized failure by government-funded public health professionals is demonstrated by the federal Healthy People 2010 education program, which in 2000 set a goal of reducing the obesity rate from 30 percent to 15 percent by this year. The rate has since stretched…to 33.8 percent of the adult population...”

Clearly the growth in obesity over the past decade suggests the need for a new approach. The article quotes a number of public health experts advocating that “government policy should shift away from condemning obesity and fatness toward promoting healthy lifestyles for everyone – fat and thin, slim and obese. Evidence is mounting that making people feel bad about their weight can lead to serious medical and lifestyle problems”


The article notes that “Michele Obama’s childhood-obesity campaign envisions government playing a larger role in getting people to live healthier lives.”


The article also highlights CDC’s 2009 recommended community strategies and measurements to prevent obesity. The RECOMMENDATIONS are especially useful in light of Partnership’s growing work to introduce health considerations into transportation policy. Nat’l Journal writes that the CDC recommendations: “…included a call for local government to … promote the rebuilding of neighborhoods and towns that encourage people to walk, bike, or take public transportation rather than drive.”


Ripley Forbes
Director, Government Affairs
Partnership for Prevention
rforbes@prevent.org

Just one day after announced that a ban on smoking in Seattle city parks would take effect April 1, the city's parks superintendent has relaxed that ban. Superintendent Timothy Gallagher said the revised rule will only prohibit "smoking, chewing or other tobacco use" within 25 feet of other park patrons.

The 25-foot rule is what the Board of Park Commissioners had recommended. Gallagher said he's decided that a gradual approach to a smoking ban is more reasonable.

Starting in June, new federal tobacco laws require cigarette companies to stop using words like “light” or “mild” on packages to imply that those cigarettes are safer than others. At the same time, however, they are adopting lighter colors for the packages of such products. Critics say such moves make those same distinctions: light colors for light cigarettes.


Marlboro Lights, the nation’s best-selling brand, will be renamed Marlboro Gold and Marlboro Ultra Lights will change to Marlboro Silver. Meanwhile, R.J. Reynolds has already changed Salem Ultra Lights, which are sold in a silver box, to Silver Box.

“They’re circumventing the law,” said Gregory N. Connolly, a professor at the Harvard School of Public Health, tells The New York Times. “They’re using color coding to perpetuate one of the biggest public health myths into the next century.”

A prominent British economist writes in the Health Cost Monitor that the evidence is "is decidedly mixed" on whether financial incentives to improve health-related behaviors actually work.

"Financial incentives for specific areas of medical compliance appear to show some promise, but there is insufficient good evidence that they work in any sustained way to alter broader lifestyle behaviors," writes Adam Oliver, RCUK Senior Academic Fellow in Health Economics and Policy at the London School of Economics and Political Science. Oliver was also founding coeditor of the journal Health Economics, Policy, and Law.

"If they do not work, then they will clearly fail to reduce health care costs," he says. "The evidence is decidedly mixed."

Whenever an increase in tobacco taxes is debated, opponents inevitably declare the taxes regressive and say such taxes take money from people who can least afford to lose it and in the process takes food of that families table.

A new study turns that argument on its head. Stephen Block and Patrick Webb, professors at Tufts University, have linked tobacco use in developing countries to malnutrition in children. They found it decreases the proportion of income spent on food. The pair published their findings in October’s edition of the journal Economic Development and Cultural Change.

For example, in Indonesia, where 18 percent of the population lives below the poverty line, the smoking rate is approximately 3 percent for women and 60 percent for men. The World Bank estimates that tobacco is the nation’s second-biggest business and the second-largest expenditure among the country’s poor.

The cover story for a recent edition of Business Week was entitled “10 Ways to Cut Health Care Costs Right Now.” The article focused on making improved health a community effort, and it began by talking about the work being done by the Rochester Business Alliance to address obesity and physical activity in Rochester, New York.

We’re going to discuss those efforts today with Paul Speranza, who is Vice Chairman and General Counsel of Rochester-based Wegmans Food Markets, a integral partner in this effort. To listen to the podcast, just click on the media player below. If there is no media player below, click here.

New research suggests that regular aspirin use among breast cancer patients may cut the risk of dying by 50 percent.  The Nurses’ Health Study surveyed 4,000 registered nurses and showed that taking aspirin two to five days a week cut the risk of dying by 71 percent, and reduced the risk of cancer spread by 60 percent.

Survey results were published in the Feb. 16 online edition of the Journal of Clinical Oncology.Researchers suspect that aspirin controls breast cancer by reducing inflammation in the body. However, the authors of the study call for more research to confirm the findings before aspirin is recommended for breast cancer alone.

At present, most women take aspirin for stroke and cardiovascular disease prevention. The breast cancer study demonstrates yet another preventive benefit of aspirin. Aspirin use could be a simple way for women to get protection for multiple health risks and they should be encouraged to take aspirin appropriately.

A year after the enactment of the federal stimulus package, a new study shows that $1.85 billion the federal government gave to clinics under the American Recovery and Reinvestment Act of 2009 has generated $3.2 billion in economic activity.

The research was done by the George Washington University Department of Health Policy along with the RCHN Community Health Foundation and the United Health Foundation. Researchers say the clinics' stimulus funding shows that the clinics are able to quickly turn funding into new services and additional jobs.

A new report card allows you to compare the health status of any county in the country with that of another. "County Health Rankings: Mobilizing Action Toward Community Health," a health report card for almost every one of the nation's more than 3,000 counties, is being released by the Robert Wood Johnson Foundation and the University of Wisconsin's Population Health Institute.

One in every two U.S. children now grapples at some time with a chronic health condition, such as asthma, attention-deficit hyperactivity disorder (ADHD) or obesity, new research suggests. But those chronic illnesses won't persist for most of those children. Just over 7 percent of those who reported a chronic condition at the beginning of the study still had the condition six years later.

"Over time, we found the rates of chronic conditions and obesity in U.S. children increased, but quite a few of these conditions resolved on their own," said study author Dr. Jeanne Van Cleave, a pediatrician at MassGeneral Hospital for Children in Boston.

The findings are published in the Feb. 17 issue of the Journal of the American Medical Association.

The Lancet’s retraction of a 1998 article linking autism to MMR vaccine was named the “Best Prevention Idea of the Week,” while the widespread failure of American adults to get needed immunizations was named “Worst Prevention Idea of the Week.”

The “Best/Worst” awards are announced each week in “Prevention Matters,” the blog of Partnership for Prevention. Nominees are submitted by Partnership staff as well as the general public, and are voted on by the staff. Partnership for Prevention is a nonpartisan organization of business, nonprofit and government leaders who are working to make evidence-based disease prevention and health promotion a national priority. More information is available at www.prevent.org .

BEST

Lancet Finally Retracts Study Linking MMR, Autism
http://preventionmatters.blogspot.com/2010/02/lancet-finally-retracts-study-linking.html

The Lancet has finally retracted its 1998 article that has fueled a worldwide movement against use of MMR vaccine for infants. The article by Dr. Andrew Wakefield claimed there was link between MMR and autism. The retraction comes days after the U.K.'s General Medical Council, a government regulatory agency, ruled that Dr. Andrew Wakefield acted "dishonestly and irresponsibly" in his research.

WORST

Millions of US Adults Behind on Immunizations
http://healthyamericans.org/report/73/adult-immunization-2010

E-cigarette manufacturers and proponents are touting the results of a recent study that suggests e-cigs have better effects on the human heart rate than regular cigarettes. But the study only looked at 16 people, and was conducted by a Virginia Commonwealth University professor with long-standing ties to the tobacco industry.

Two smoking-cessation groups want to make nicotine patches, lozenges and gum available for sale everywhere cigarettes are sold. They're petitioning the Food and Drug Administration to make that possible by relaxing current restrictions on those products.

The Association for the Treatment of Tobacco Use and Dependence and the Society for Research on Nicotine and Tobacco are also asking the FDA to tone down warnings on cessation products that say they shouldn’t be used when people continue to smoke or in those who have heart conditions.


“It sends the message that these products are dangerous and sends the message to the smoker to just continue smoking,” said Ken Wassum, former president of the Association for the Treatment of Tobacco Use and Dependence

Exellent piece in The Huffington Post on the health care system's failure to adequately tap the tobacco cessation resources that have been scientifically proven to be effective.

A new study published online by the Journal Pediatrics (PDF), takes a first-ever look at the prevalence of food brand placements in popular motion pictures and finds a veritable cornucopia. The Dartmouth Medical School analysis of 200 top box office movie hits that appeared in theaters between 1996 to 2005 yielded a bounty of product placements, mostly for "brands that represent energy-dense, nutrient-poor products and/or product lines."

Researchers identified a total of 1,180 brand placements, including 427 food, 425 beverage, and 328 food retail establishment brand placements. Candy/confections (26%) and salty snacks (21%) were the most prevalent food brands, sugar-sweetened beverages (76%) were the most prevalent beverage brands, and fast food comprised two thirds of the food retail establishment brand placements.

A major review of health inequalities in England says the National Health Service must spend much more on preventing illness and focus more attention to giving every child the best start in life.

The Marmot Review calls for NHS spending on preventing illness at a level much higher than the current 4%, with more money going to initiatives such as providing statins and helping people to stop smoking. It says people in England's poorest neighborhoods are likely to die seven years earlier than people in the richest areas - and a greater portion of those shorter lives will be spent unwell. The report estimates up to 202,000 early deaths could be avoided, if everyone in the population enjoyed the same health as university graduates.

The Obama administration has taken its first stab at crafting its own national drug-control budget priorities (PDF). While it would add new funding for addiction treatment and prevention, critics say the change is incremental and does little to close the huge gap between spending on efforts to reduce the drug supply and those working to reduce demand.

The FY2011 National Drug Control Budget released by the Office of National Drug Control Policy (ONDCP) on Feb. 1 includes a 13.4 percent increase in spending on alcohol and other drug prevention programs and a 3.7 percent increase for addiction treatment. ONDCP Director Gil Kerlikowske says the proposal demonstrates the administration's commitment to "a balanced and comprehensive drug strategy."

"I was hoping for large cuts on the supply side, especially after the previous administration allocated at least $1 billion more each to interdiction and source-country programs that accomplished absolutely nothing," says  drug budget and policy expert John Carnevale. "This nation must stop blaming source countries for our problems and face the fact that we can do more to reduce drug use by focusing on treatment, prevention, and diversion programs."

London's aging baby boomers will soon get their own specially designed outdoor playground. The park will offer low-impact exercise equipment to help older people improve their balance and flexibility and tone muscles that may not have been tested for decades.

"We wanted something that would be of long-term benefit to people, so we came up with this idea for an older person's playground," says Madeline Elsdon, whose local residents' association has won funding for the playground, which is planned for London's popular Hyde Park.

Exercise areas aimed at the elderly are popular in Europe and Asia, and there's already a U.K. precedent—an over-60 playground billed as Britain's first opened in Manchester's Dam Head Park two years ago. The equipment there was still seeing use Wednesday—with senior citizens swinging their legs and working their hips on the machines despite temperatures that hovered around freezing.

Drinking as little as two soft drinks a week appears to nearly double the risk of getting pancreatic cancer, according to a new study. ''People who drank two or more soft drinks a week had an 87% increased risk -- or nearly twice the risk -- of pancreatic cancer compared to individuals consuming no soft drinks," says study lead author Noel T. Mueller, MPH, a research associate at the Cancer Control Program at Georgetown University Medical Center, Washington, D.C. The study is published in Cancer Epidemiology, Biomarkers& Prevention, a journal of the American Association for Cancer Research. The beverage industry took strong exception to the study, calling it flawed and pointing to other research that has found no association between soda consumption and pancreatic cancer.

The U.S. Department of Health and Human Services (HHS) has awarded more than $119 million to states and U.S. territories to support public health efforts to reduce obesity, increase physical activity, improve nutrition, and decrease smoking-the four most important actions for combating chronic diseases and promoting health. This money supports the one of several components in the Department's comprehensive prevention and wellness initiative, Communities Putting Prevention to Work, which is funded under the American Recovery and Reinvestment Act of 2009.

Millions of adults living in the U.S. are not up to date on their needed immunizations, leaving them at risk for preventable illnesses and even death, according to a new report released by Trust for America’s Health (TFAH), the Infectious Diseases Society and the Robert Wood Johnson Foundation.

According to the report, key reasons for the low immunization rates include a lack of knowledge about the safety and effectiveness of vaccines, limited access to immunization and limited research and development of new vaccines in the United States.

If there were no advertising of unhealthy food on US television, between one in seven and one in three obese American children might not be obese, according a new study in the European Journal of Public Health.

"Limiting the exposure of children to marketing of energy-dense food could be part of a broader effort to make children’s diets healthier, said the study's authors, who built a mathematical simulation model to estimate the potential effects of reducing the exposure of 6- to 12-year-old US children to TV advertising for food on the prevalence of overweight and obesity.

The model was based on body measurements from NHANES 2003–04, the CDC-2000 cut-offs for weight categories, and scientific literature that relates advertising to consumption levels and consumption to body mass.

Los Angeles County officials have rejected requests that they require performers in pornographic films to use condoms. HIV/AIDS activists had demanded such a requirement, to be enforced by county health officials.

"It is very, very difficult to implement. There are roughly 200 production companies with about . . . 1,200 actors," said Dr. Jonathan Fielding, the county's public health chief. "All you need is a room and a camera and a bed, basically, to do this kind of shoot, and we have no ability to police this."

In 2009, health spending in America as a percentage of Gross Domestic Product (GDP) rose from 16.2% to 17.3%, according to a new paper in Health Affairs. That's the largest one-year increase since such 1960, when such statistics began to be closely tracked. The percentage is still very much higher than that of any industrialized country.

Total health spending in the U.S. amounted $2.472 trillion last year (or, as WSJ's Jacob Goldstein notes, at a rate of $282 million a hour). Health-care prices rose by 3.2% in 2009, significantly above the overall inflation rate, while utiilization of health care rose by 1.5%.

A new study in the American Journal of Preventive Medicine suggests that people respond well to free counseling programs on weight loss or smoking cessation, but participation falls dramatically when services are no longer free. The cost of counseling also appears to make a difference to the doctors or health-care providers who refer patients to the programs, according to the study.

The authors reviewed a program that used an electronic database system to suggest health-care counseling for adults with unhealthy behaviors. For a time, free counseling was provided until funding ran out. Under the free program, 1,860 of 5,679 people who were evaluated were determined to have at least one unhealthy habit, and 407 of them were given referrals for intensive counseling, the study reported.

After the funding ceased, 729 of 2,510 people who were evaluated were determined to have unhealthy habits and just five were referred for counseling -- a 97 percent decrease in the referral rate, according to the study. Even when clinicians did offer a referral, 81 percent fewer patients followed through and got counseling when the counseling was not free.

The Lancet has finally retracted its 1998 article that has fueled a worldwide movement against use of MMR vaccine for infants. The article by Dr. Andrew Wakefield claimed there was link between MMR and autism. The retraction comes days after the U.K.'s General Medical Council, a government regulatory agency, ruled that Dr. Andrew Wakefield acted "dishonestly and irresponsibly" in his research.

Smoking cessation significantly increases cardiac health later in life, says a new study from Tel Aviv University.

The research found that quitting smoking after a heart attack has about the same positive effect as other major interventions such as lipid-lowering agents like statins or more invasive procedures.

"We found that people who quit smoking after their first heart attack had a 37 percent lower risk of dying from another, compared to those who continued to smoke," said Dr. Yariv Gerber of TAU's Sackler School of Medicine.

Twenty-two institutions across the country are participating in a Phase III clinical trial to determine whether a new investigational "nicotine vaccine" is safe, effective and capable of stimulating an immune response. Approximately 1,000 male and female smokers aged 18 to 65 will take part in the 12-month study NicVAX, a vaccine developed by Nabi Biopharmaceuticals.

Nicotine molecules are so small that they can pass through the body's brain/blood barrier without triggering a reaction from the immune system. However, NicVAX stimulates the immune system to produce antibodies that bind to or capture nicotine
molecules in the bloodstream, making them too large to cross the blood-brain barrier. As a result, many of the expected rewards from smoking are blocked, making it easier for the smoker to become and remain abstinent.

“Smokers continue to smoke even when they know it’s harmful because of these ‘brain effects,’” explained David Gonzales, Ph.D., principal investigator and clinical investigator in medicine at the Oregon Health and Science University, one of the 22 test centers. “While a smoking cessation medication such as varenicline prevents nicotine from binding to receptors once it is in the brain, NicVAX is designed to block nicotine before it enters the brain.”

Increasing insurance co-pays is "an ill-advised cost containment strategy" according to a new study in the New England Journal.of Medicine. The study found that, when Medicare plans raise co-payments for outpatient care, older people cut back on doctors’ visits, then wind up needing more expensive hospital care, a new study reports.

The study compared patients whose Medicare plans had almost doubled co-payments to similar plans that kept co-payments steady. The higher co-pay plans saw a slower initial increase in outpatient visits, but  an additional 2.2 additional hospital admissions per year, 13.4 more annual inpatient days and a 0.7 percent increase in the number of enrollees who had been hospitalized.

The New York Times reports that tobacco manufacturer Altria apparently hopes to navigate around indoor smoking ban laws by persuading the Food and Drug and Administration to let them market smokeless tobacco as far less harmful than cigarettes. 

"While public health doctors agree that the smokeless products are far less hazardous to individuals than cigarettes, they still have concerns because all tobacco products contain nicotine and carcinogens," write the Times' Duff Wilson and Julie Creswell.. "They also contend that promoting smokeless products — some in tiny packages in the shape of cigarette packs — would attract new, perhaps younger customers and maintain the addiction for smokers who might otherwise quit. They note that Altria is adding flavorings to its smokeless products that have long been used in candy.Furthermore, critics say, "

The chairman of the Senate Health Committee tells The Hill that negotiators from the White House, Senate and House reached a final deal on healthcare reform days before Scott Brown’s victory in Massachusetts. Sen. Tom Harkin, D-Iowa said negotiators had an agreement in hand on Friday, Jan. 15 - four days before Scott Brown's surprise Senate win in Massachusetts turned the debate on its head.

“We had an agreement, with the House, the White House and the Senate," Harkin said. "We sent it to [the Congressional Budget Office] to get scored and then Tuesday happened and we didn’t get it back.”

Brown’s Jan. 19 victory gave Republicans control of 41 seats in the Senate, enough to sustain a GOP filibuster of the healthcare bill. But Harkin told reporters in a Monday telephone conference that health reform legislation is still "very much alive."

He said he has been advocating in recent days for the House to pass the Senate version of the health care bill along with a package of revisions that would be passed through the reconciliation process, which would only require a simple majority in the Senate. Harkin predicted that Democrats would pursue that course in the coming weeks and most likely finish by early March.

That differs from the assessment of White House Chief of Staff Rahm Emmanuel, who Thursday told the New York Times that Democrats would try to act first on job creation, reducing the deficit and imposing tighter regulation on banks before returning to the health measure.

In the UK, the National Health Service is ramping up its support for people trying to give up smoking in a bid to halve the number of smokers from 21% to 10% of the population by 2020. According to a new government strategy, every smoker will be able to get help from the NHS to suit them if they want to give up, with new types of support available at their convenience. The government is also considering the case for plain packaging and will review legislation to decide whether to extend the smoking ban from enclosed public places and workplaces to areas like entrances to buildings.