Prevention Matters

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.