Prevention Matters

...antibiotics and STD screening.

This week CDC released its annual sexually transmitted diseases surveillance report, which showed that chlamydia and syphilis rates in the U.S. continued to rise in 2009. However, gonorrhea reached its lowest level in almost 70 years. All three STDs can be easily treated with antibiotics but can have serious consequences, including infertility and organ damage, if left untreated.

According to the report, chlamydia rates increased by 3% last year, with 409 cases per 100,000 people—representing an all-time high for reported chlamydia infections. The rate increased by almost 20% since 2006. On a positive note, CDC believes that the increase is likely attributed to expanded screening, and not an increase in the disease.

Unfortunately, large disparities still exist among racial and ethnic minority groups, with young African Americans baring a large burden of the disease.

STD screening can help detect disease early and, combined with treatment, is an effective way to protect a person’s health and reduce transmission to partners. One of the continuing problems is that less than half of the people who should be screened for STDs, do so. To help improve screening, as well as prevention and treatment of chlamydia, Partnership for Prevention convenes and leads the National Chlamydia Coalition, whose mission is to reduce the rates of Chlamydia and its harmful effects among sexually active adolescent and young adults.

InSPOT, a website to help people who are infected with STDs inform their sex partners about testing and treatment options using playful, serious, and humorous e-cards that link to free and low-cost testing services, is now available throughout the U.S.

In the national effort to lower health care costs by preventing chronic disease and hospitalizations, dentists may be an important part of the solution. A nationwide survey published in the January 2010 issue of the JADA (The Journal of the American Dental Association) reports that dentists would be willing to screen their patients for medical conditions such as cardiovascular disease and other chronic diseases when they come to the office for dental care. More than three-quarters of the 1,945 dentists who responded thought it was important for them to screen for hypertension, cardiovascular disease and diabetes, with a majority indicating they would be willing to check patients also for hepatitis and HIV.

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 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.

Only about 1 in 4 Americans aged 50–64 regularly take advantage of preventive services such as screenings and immunizations, according to a report from the Centers for Disease Control and Prevention in collaboration with AARP and the American Medical Association (AMA).

The report, “Promoting Preventive Services for Adults 50–64: Community and Clinical Partnerships,” focuses on opportunities to improve the health of the growing number of adults in the 50–64 age bracket to broaden the use of potentially lifesaving preventive services.

The report identifies recommended preventive services such as influenza vaccine, cholesterol screening, breast and cervical cancer screening, as well as preventive screenings for behaviors that could negatively impact health such as binge drinking.

Partnership for Prevention President Robert J. Gould today issued the following statement regarding a New York Times article about a report that breast cancer screening may be leading to overtreatment similar to that resulting from prostate cancer screening:

“The US Preventive Services Task Force has never recommended screening for prostate cancer, but it has recommended mammograms and has modified those recommendations as necessary. The proper use of screening remains an invaluable tool in breast cancer detection and treatment and in saving lives. A woman’s personal physician is the expert best equipped to help her decide what procedures should be employed in her individual circumstances. This important public discussion about screening should not discourage anyone from consulting their doctor.”

From the Schwitzer health news blog: This week's edition of the BMJ publishes a study, an analysis and an editorial all showing that there isn't enough evidence to support population-wide prostate screening with the PSA blood test. (Subscription required to access full text of all of these.)

In a column in the Los Angeles Times, former Senate Republican Leader Bill Friest says true health reform has to emphasize behavior-changing wellness programs.

"The major determinants of health are not doctors, hospitals, universal insurance, public plans and expanded health services," says Frist, who is also a heart surgeon. "Much more significant is behavior -- things such as diet, exercise, smoking and drinking -- basic education and socioeconomic status. So if the goal is to make us healthier, to lower the burden and thus the societal costs of disease, policymakers in Washington must actively promote health and wellness. And the way to do that is by providing incentives for the implementation and sustained use of employer-backed wellness programs. "

Frist said prevention has been written off as costly due to reports like one that appeared recently in Health Affairs subtitled: "An Overwhelming Percentage of Preventive Interventions Add More to Medical Costs Than They Save."

"The key word is 'interventions,'" Frist says. "Think about it: Having more people getting more health screenings, mammograms, pap smears and colonoscopies has to cost more money.While we want such services to be widely available, reform that concentrates merely on offering more of those things isn't the way to fix what ails the nation.

"Instead, we need a system that concentrates on keeping us well, so we need less "healthcare" and fewer "preventive interventions" in the first place."

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.

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.

Screening and brief intervention programs can spot addiction and mental health problems among elderly patients that traditional healthcare interactions may miss, findings from a new Florida study indicate.

Reuters reported June 12 that researchers screened more than 3,000 elderly Florida residents during a three-year study, using a tool called BRITE to assess subjects for six risk factors. The study authors found that 10 percent of those screened had problems with alcohol misuse, 26 percent had problems with prescription and over-the-counter (OTC) medication, 64 percent suffered from depression, and 2 percent were at risk for suicide.

The Wall Street Journal's Anna Wilde Mathews reports that coding errors on health care provider bills are increasingly providing an unwelcome surprise to patients who try to take advantage of preventive screening that is covered by their employers' health plans.

The Centers for Disease Control and Prevention recently reported that screening rates for Chlamydia are disturbingly low, even as it has become the nation’s most common reportable sexually transmittable disease. Partnership for Prevention has organized the National Chlamydia Coalition to help increase routine screening for Chlamydia infections. We discuss these concerns with Dr. Yolanda Wimberly, a nationally recognized pediatrician and the medical director for the Center for Excellence in Sexual Health at Morehouse School of Medicine in Atlanta.

From Science Insider:

"Ordinary folk can now try to be masters of their own health, as private companies offer online DNA tests and full-body CT or MRI scans. But these services, which often offer health information without a doctor’s guidance, have stirred up much controversy in the medical community, with claims that the results the companies provide can be inaccurate or misleading to the average layperson. In response to this issue, the U.K.’s Nuffield Council on Bioethics launched a consultation today on the ethical, legal, social, and economic issues behind these commerical health services."

The U.K.’s plan to offer all residents over 40 a free health screening was named Partnership for Prevention’s Best Prevention Idea of the Week, while the U.S. Border Patrol’s plan to widely spray a chemical herbicide near the city of Nuevo Laredo’s water supply was named the 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 IDEA

UK to Launch Ambitious Health Screening Program

The UK is pressing ahead with plans to give all people in England over the age of 40 a free health screening as part of a new, heavier focus on disease prevention to better the health of the nation, tackle health inequalities, and help the National Health Service cope with the increasing demands of an aging population. The idea behind the health check – plans for which were first touted back in 2006 and then confirmed last year - is that patients at risk of developing serious illnesses such as heart disease and diabetes will be picked up on the radar much earlier, allowing for quicker lifestyle or drug-based interventions to either ward off or better treat potentially life-threatening conditions.

Under the plans, from next month everyone in England will be invited to undergo a free health check in order to identify those at risk of developing serious and expensive to manage/treat illnesses such as coronary heart disease, stroke, diabetes and kidney disease, as well as better inform people of these conditions, in a move which the government claims will help to save 650 lives and prevent 1,600 heart attacks every year.

The health check will be centered on questions regarding patients’ general health, lifestyles, family medical history, height and weight measurements, cholesterol and where necessary blood glucose tests, and will be followed up with a personal assessment of disease risk and recommendations on how to best reduce it, at an annual cost of around £330 million.


WORST IDEA

Border Patrol to Spray Chemical Herbicide near City Water Supply

The U.S. Border Patrol intends to employ a chemical herbicide in order to eradicate stands of the Carrizo cane, an invasive plant that grows as tall as 30 feet and provides convenient cover for undocumented border crossers and smugglers. The variety of Carrizo cane that is common in the Laredo-Del Rio borderlands is from the region of Valencia, Spain.

Concerned about risks to public health from possible herbicide spray drift, runoff and leaching, officials from the city government of neighboring Nuevo Laredo are steadfastly opposed to aerial spraying. “I’ve always been respectful of the law and sovereignty,” said Nuevo Laredo Mayor Ramon Garza Barrios. “But herbicides that affect health in both countries can’t be sprayed.”

The zone targeted for spraying is across the Rio Grande from Nuevo Laredo’s Hidalgo neighborhood and only hundreds of yards from the Mexican city’s public water intake system. Carlos Montiel Saeb, general manager for Nuevo Laredo’s water utility, said the Border Patrol advised his office to turn off water pumps a few hours prior to spraying. “If there is no problem, why are they asking us to do this?” Montiel questioned.

Over at Nieman Reports, the Health News Review's Gary Schwitzer notes that his organization's ongoing review of health journalism has detected a troubling trend in reporting about screening tests.

"In many news reports—including some done by major news organizations—a crusading advocacy seems to exist when it comes to promoting screening tests," Schweitzer writes. "And this happens even when such guidance conflicts with the best medical evidence."

Schweitzer, an associate professor at the University of Minnesota School of Journalism & Mass Communication, says such reporting may be well-intentioned, but can do more harm than good.

"These pro-screening crusades often promote costly approaches, such as CT scans of the heart or of the lungs or of the full body, which convince many new “worried well” people to enter the health care system, costing them and all of us dearly," he says.