Prevention Matters

The five minute flexi-scope colon cancer test that could reduce the number of deaths from the disease by about 40 percent was named the “Best Prevention Idea of the Week,” while a report showing that six in 10 Americans live in areas with unclean air was named the “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

Colon cancer test could save thousands in Britain

A five-minute colon cancer test could reduce the number of deaths from the disease by about 40 percent, a new study says. British researchers followed more than 170,000 people for about 11 years. Of those, more than 40,000 had a "flexi-scope" test, an exam that removes polyps, small growths that could become cancerous. Researchers compared those results to more than 113,000 people who were not screened. They found the flexi-scope test reduced peoples' chances of getting colon cancer by one third. It also cut their chances of dying by 43 percent. Researchers said the test needed to be done just once in a person's lifetime.

WORST

Report: Most Americans still live in unclean air


Six in 10 Americans - about 175 million people - are living in places where air pollution often reaches dangerous levels, despite progress in reducing particle pollution, the American Lung Association said in a report released last Wednesday. The Los Angeles area had the nation's worst ozone pollution.

The report examined fine particulate matter over 24-hour periods and as a year-round average. Bakersfield, Calif., had the worst short-term particle pollution, and the Phoenix-Mesa-Scottsdale area of Arizona had the worst year-round particle pollution.

The U.S. cities with the cleanest air were Fargo, N.D., Wahpeton, N.D., and Lincoln, Neb.

The Centers for Disease Control and Prevention (CDC) will award grants to help 22 states and four Indian tribes establish colorectal screening programs for the uninsured.

The grants, which range from $300,000 to $1.1 million, will be used to establish programs aimed at screening low-income patients between the ages of 50 and 64. States would have the option of selecting one of three common procedures for the screening program but also could use the funds for outreach, follow-up care or data collection, according to the CDC.

Medicare officials have decided not to pay for "virtual" colonoscopies, concluding that "the evidence is not sufficient to conclude that screening CT colonography improves health benefits for asymptomatic, average risk Medicare beneficiaries."

Gary Schwitzer calls the decision "a bold move," given the intense industry pressure to approve such payments. In response, he says, the industry is already ratcheting up the rhetoric about socialized medicine and rationing of care.

"I wish news stories and press releases would skip the rhetoric and explain the evidence," Schwitzer says. "Otherwise the rationing rhetoric is bound to continue - without advancing true public understanding of the issues at play. It's another early bellwether of what any true comparative effectiveness research effort will be up against."

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.