Prevention Matters

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


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

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

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

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

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

Partnership Executive Vice President Corinne G. Husten, MD, MPH, tells the New York Times that some workplace wellness incentive programs that tie an employee's health insurance premiums to targets such as weight have raised concerns among some health and prevention advcocates.

“Actually, achieving a target is not necessarily within someone’s control,” says Husten, noting that genetic predisposition is a factor in many conditions like heart disease and diabetes, and the environment also plays a role. “If you live in a neighborhood with only convenience stores and fast-food, you don’t necessarily have access to the food that will help you to eat healthier,” she adds.

Provisions in health care legislation under consideration in Congress would allow employers and insurers to offer premium discounts of as much as 50 percent to employees in workplace wellness programs who meet specific health targets, such as keeping their weight, cholesterol and blood pressure within healthy ranges. Under current law, discounts for meeting these kinds of health targets can be no greater than 20 percent of the total premium. An amendment passed by the Senate Finance Committee would raise that cap to 30 percent and permit the secretaries of Health and Human Services, Labor and Treasury to increase the cap to 50 percent at their discretion. A similar provision appears in a Senate Health, Education, Labor and Pensions Committee bill.

The New York Times reports that a start-up company led by Adam Bosworth, former head of the Google Health team, plans to become the newest entrant to the online consumer health business. Bosworth and his San Francisco-based company, Keas (pronounced KEE-ahs) Inc. Keas is at the forefront of the effort to combine advanced Web and database technologies so it can personalize health education. Using the Keas system, for example, a person with Type 2 diabetes might receive reminders, advice on diet and exercise, questions and prompts presented on the Web site or delivered by e-mail or text messages — all personalized for the person’s age, gender, weight and other health conditions. Keas' major partners include Google Health and Microsoft HealthVault.

When college-town bars offer special prices on drinks, the result is an increase in drunk college students. That's the conclusion of recent research, and it didn't come from the "Univeristy of DUH!"

Alcohol researchers from the University of Florida and San Diego State University decided to study the relationship between drink specials and the quantity of alcohol consumed. According to the New York Times' Tara Parker-Pope, they were spurred by long-time claims from bar owners that special drink prices attract more people to the bar, but don't result in people drinking more.

The researchers collectied data on 495 men and 309 women leaving seven bars near a university campus. The bar patrons were given breath alcohol concentration tests and also told researchers what they drank and spent during their time at the bar. For every $1.40 hike in drink price, the bar goer was 30 percent less likely to leave the bar legally drunk.

The findings will be published in the November issue of Alcoholism: Clinical and Experimental Research.

The New York Times reports that public health officials are considering the promotion of routine circumcision for all baby boys born in the United States to reduce the spread of H.I.V., the virus that causes AIDS. The topic will be discussed this week at the CDC's National HIV Prevention Conference in Atlanta. A formal draft of the proposed recommendations is due from the CDC by the end of the year.

The question of why prevention doesn't save money continues to dominate media coverage of health reform issues as they relate to disease prevention and health promotion. The most recent example was Michelle Andrews, who wrote a piece entitled "The Problem with Prevention" for The New York Times' online "Prescriptions" page. The "problem" is, of course, is that experts say prevention won't save as money, contrary to claims made by President Obama and others.

Partnership President Rob Gould was interviewed for the piece, and he cautioned that value, not savings, is the proper question for consideration.

"The key is to invest in measures that provide the most bang for the prevention buck — high clinical value at a reasonable cost," Andrews writes. 'The right question to ask is whether it’s a cost-effective use of health dollars,' said Rob Gould, president of the Partnership for Prevention, a nonprofit that promotes preventive health.

"Judged this way, certain preventive services, but not all, may be considered worthwhile, in that while they may not save money, their cost is considered reasonable for the years of sickness and the deaths that they help people avoid," Andrews says. "By those criteria, effective prevention includes colorectal cancer screening for adults ages 50 and older, adult flu shots and screening for high blood pressure in appropriate patients."

But Andrews also notes that even those services may run afoul of the Congressional Budget Office scoring that holds that "the lower mortality rates that result … could increase federal spending for Social Security and Medicare.”

This prompted the following response from one reader: "I’m waiting with bated breath for the stunning argument... that the cheapest way of all is to have NO health care system."

Colorectal cancer patients who took aspirin had a much better chance of surviving than non-users, even after being diagnosed, according to a new study. The study, written by researchers from Harvard Medical School, Massachusetts General Hospital and the Dana-Farber Cancer Institute, is being published in this week’s Journal of the American Medical Association. An abstract is available online.

"The improvements in outcomes were striking," wrote The New York Times' Roni Caryn Rabin. "Patients with colorectal cancer who regularly used aspirin before and after a diagnosis were almost one-third less likely to die of the disease than non-users. Patients who initiated aspirin use only after a diagnosis did even better and had half the risk of dying from the cancer, possibly because of differences in their tumors."

The patients were all being treated for nonmetastatic, or localized, cancers, and were followed for almost 12 years on average.

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."

The New York Times didn't mince words in an editorial over the weekend urging Senate passage of a bill giving the FDA the power to regulate tobacco. It declared tobacco manufacturers "a rogue industry," a judgment it said is borne out by a recent court of appeals ruling against those manufacturers.

"The decision makes it clear that the tobacco companies have engaged in deceitful and harmful behavior for many decades and cannot be trusted to reform on their own," the editorial declared. "Regulatory oversight is the best chance to rein them in."

The New York Times' Robert Pear reported over the weekend that Congress is planning to put language in the health reform bill to give employers "sweeping new authority to reward employees for healthy behavior, including better diet, more exercise, weight loss and smoking cessation."

Senate Finance Committee Chairman Max Baucus, D-MT, and Sen. Tom Harkin, D-IA, are taking the lead in devising such incentives. Harkin recently re-introduced his legislation to provide tax credits or other subsidies to employers who offer wellness programs that meet federal criteria. In addition, Pear reports, "lawmakers said they would make it easier for employers to use financial rewards or penalties to promote healthy behavior among employees."

Encouraging use of medical services – and discouraging use of services without evidence of effectiveness – will be critical to improving the performance of our health system and to controlling healthcare costs. A New York Times editorial rightly gives Medicare credit for proposing not to cover virtual colonoscopies since they are believed to be less effective at discovering small polyps than standard optical colonoscopies.

The quasi-governmental U.S. Preventive Services Task Force and Task Force on Community Preventive Services – the groups charged with evaluating the effectiveness of clinical and community-based preventive services – have been leaders in the movement toward evidence-based medicine. They have carefully identified those preventive services that are proven to be effective. Where there is evidence that preventive services are ineffective, or where there is simply insufficient evidence to even render a judgment, the task forces say so.

Decision-makers across the health system should follow the lead of the Medicare program and provide coverage of proven services while discouraging use of services of uncertain benefit. This is an important first step in moving toward a health system that provides high quality and ensures that our health dollars are spent wisely.