Prevention Matters

Earlier this week, the research article, “Aspirin for Prevention of Cardiovascular Events in a General Population Screened for a Low Ankle Brachial Index (ABI)”, was published in JAMA. The goal of the study was to determine if daily aspirin reduced the risk of heart attack and stroke in patients with a low ABI, a quick and inexpensive way to establish risk for these events, and no other risk factors. Researchers hoped to show that the ABI could identify asymptomatic higher risk individuals that could benefit from preventive treatments, such as aspirin use.

The researchers found that aspirin was not effective in preventing first heart attack, stroke, or other cardiovascular events for individuals with low ABI and an absence of other risk factors. However, due to the fact that ABI was the only indicator used when determining risk, the study population was ultimately found to be at very low risk for heart attack and stroke. According to current guidelines, this low risk group would not be encouraged to use aspirin. So the study may actually say more about ABI or the range of ABI as a screening tool for cardiovascular risk than aspirin for primary prevention of cardiovascular events.

Other issues with the study include adherence to the therapy and disproportionate number of females in the study. Interestingly, the study showed no statistically significant difference between the aspirin and control groups for bleeding. Recently, aspirin use for primary prevention has been questioned due to a potential increased risk for gastrointestinal and intracranial bleeding; this study shows that bleeding events were similar between aspirin and non-aspirin users.

Ultimately, this study shows that ABI or the ABI threshold measurement used (0.95) is not enough to predict higher risk of heart attack and stroke on a population level. Future studies with more participants, improved compliance rates, a more equitable distribution of males and females, and a lower level of ABI for study inclusion are necessary to shed more light on this issue. An editorial, also published in JAMA, further explains the potential limitations of the study. Although at first glance this article appears to be another critique on aspirin for primary prevention-as many media outlets suggested- the current American Heart Association and United States Preventive Services Task Force guidelines for aspirin use to prevent first heart attacks and strokes should still be followed. And, as they recommend, those considering aspirin should talk to their health care provider to determine if aspirin is right for them.

Posted by:
Rebecca Doigan
Program Associate, Partnership for Prevention

In a wide-ranging interview (“Michelle Obama: No longer a 'caricature”) published today in Politico, the First Lady “addressed a doctors’ report that the president is still smoking, saying he has found it difficult to quit amid the rigors of the presidency.”

“What the president struggles with is what every smoker struggles with, it’s a difficult habit to break. It’s understandable that he struggles with it. Do I want him to stop completely? Absolutely. And I will push him to do so, but it’s a process,” Michelle Obama said.

“I’ve never been a smoker so I can’t relate, but people who’ve smoked say like anything, you have dips and valleys, and to try to quit smoking in one of the most stressful times of the nation’s history is sort of like, you know, OK, he’s going to struggle a little bit. This may be the year he’ll struggle,” she said.

We know that quitting smoking is tough work. It takes persistence. That is why Partnership for Prevention and its ACTTION initiative are working to assure that health reform continues to include coverage and access to comprehensive smoking cessation services. But, no less important to successfully quitting, is having the kind of supportive family and workplace environment that is available to the President. I’m not worried about the President. With Michele in his corner he’ll get there.

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

An important article in Preventive Medicine underscores the important role that urban design can play in promoting healthy communities. The research comes from an Atlanta project and will be a featured presentation at the 18th Annual Congress of the New Urbanism to be held in Atlanta May 19-22 in partnership with the Centers for Disease Control and Prevention.

The theme of this year’s conference is appropriately enough “New Urbanism: Rx for Healthy Places.”

Those of us in the prevention community need to pay more attention to this “New Urbanism.” Their work is very much at the cutting edge of new, community-based initiatives that can help us achieve success in reducing the incidence of chronic disease.

Want to learn more? There is an engaging 3 minute You Tube video introduction to “New Urbanism” called “Built to Last.” The video explains how this innovative approach to community design helps people replace dependency on driving with the freedom to connect with their community on foot, bicycle, or public transit. And there’s more. The correct approach to community design can help reverse the harmful effects of urban sprawl on the environment AND effect, in a good way, our personal and community health. New Urbanism seems like a strong investment in our future.

“When it comes to saving the planet what we build is the greatest threat … or the greatest hope.”

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

The test to cut down on unnecessary use of antibiotics was named the “Best Prevention Idea of the Week,” while cities shortening yellow lights to nab drivers with a ticket 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.or/

BEST

Simple Test Could Cut Excessive Antibiotic Use

German researchers found that testing for a marker of bacterial infection known as procalcitonin (PCT) helped identify patients whose respiratory tract infections would respond to antibiotics, and stopped others being offered unnecessary drugs. Respiratory infections are very common and doctors are taught to prescribe antibiotics on the basis of features like sputum or fever, which suggest there may be bacterial infection. But this judgment is not always easy, the researchers said, and lab tests can help sort bacterial from viral infections. Excessive prescribing of antibiotics adds to healthcare costs and to the worldwide problem of multi-drug resistant bacteria, or "superbugs," like MRSA.

WORST

Cities Shortening Yellow Traffic Lights for Deadly Profit

Some cities have been shortening yellow lights to nab drivers with a ticket. But studies show that they're raking in the bucks at the expense of public safety. "With all of the stories we hear on a daily basis, there is little doubt that the desire for ticket revenue trumps safety concerns," Gary Biller, executive director of the National Motorists Association told AlterNet. "A quick current example is California's governor Arnold Schwarzenegger, who a few weeks ago proposed state budget including a proposal to add speed sensors to 500 existing red-light cameras. The reason? Safety wasn't mentioned, but an expected additional annual revenue of $338 million was."

At the recent health summit in Washington, President Obama repeatedly emphasized his commitment to pass meaningful health reform. Despite strong opposition from Republicans in Congress, President Obama is showing the mettle he demonstrated throughout the 2008 campaign. He isn’t giving up and he won’t back down. His commitment to insurance reform and extending high quality health coverage, including access to vital clinical preventive services to millions of uninsured Americans shows courage and character.

But the issue of smoking is one where we value quitters. According to press reports President Obama’s recent physical revealed that he continues to struggle to quit smoking. Most smokers have trouble quitting tobacco so the President’s situation is not unusual. It is ironic that the President who has done so much to protect children from tobacco, and through health reform, increase the availability of tobacco cessation therapies, would struggle to win his personal cessation campaign. But Obama is human and difficulty quitting tobacco is an all too common experience among the millions of smokers who try to quit each year.

Writing in the March 1st Christian Science Monitor, Ron Scherer notes that “anti-smoking advocates view the president’s cigarette struggles not so much as a setback, but rather as an opportunity to try to get more Americans to quit. And they place more importance on his desire to snuff out his tobacco usage than on his success in those efforts.”

Now that’s something we should all be able to agree with. That the President has struggled to quit smoking underscores why it is so important that insurance plans, employers, friends and family members do all they can to support and encourage smokers seeking to quit what is all too often a lifelong and life threatening addiction.

A CBS TV News Healthwatch segment (“Up in Smoke”) added important commentary from medical correspondent and physician Jennifer Ashton. Dr. Ashton cautioned that most former smokers find success only after trying to quit multiple times. She urged that smokers take advantage of available treatments including counseling, OTC nicotine replacement products and prescription medications. Ashton said the decision to quit smoking is really “a life or death issue and the single most important thing you can do for your health.”

Good advice for the public…and for our President.

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

According to a new study based on a survey of 1,552 parents, one in four U.S. parents believes some vaccines cause autism in healthy children. However, extensive medical research has found no connection between the two. The unfounded fear stems from a flawed 1998 study published in The Lancet that was recently retracted after a council that regulates Britain's doctors ruled the study's author acted dishonestly and unethically. This new study is based on a University of Michigan survey of parents that took place a year ago—before The Lancet study retraction.

There is some good news, though. Many of the parents surveyed that worried about vaccine risks still think their children should be vaccinated.

"Nine out of 10 parents believe that vaccination is a good way to prevent diseases for their children," said lead author Dr. Gary Freed of the University of Michigan. "Luckily their concerns don't outweigh their decision to get vaccines so their children can be protected from life-threatening illnesses."

For more information on additional findings of the study, you can view the Pediatrics article for free here.

Posted by:
Christianne Johnson, Program Manager, Partnership for Prevention

Writer Sarah Wildman suggests that one asset President Obama has yet to use in getting health reform over the goal line would be to enlist help from the First Lady. In an engaging piece of “what if” writing, Wildman argues that Mrs. Obama’s enormous popularity gives her a potentially powerful platform to show Americans that health reform is an “apolitical” problem that affects us all.

Wildman is disappointed that the Mrs. Obama stayed in the family garden focusing her time on the important but “safe” First Lady-like issue of childhood obesity.

“At a moment when an entire year's worth of bickering over health care reform has unraveled into a partisan wrestling match, and the very word "reform" has nearly ceased to be meaningful, tackling obesity is cheerfully unobjectionable. Laudable even. But it's not the most important thing on the agenda right now… As a concept it vaguely brushes up against the health care reform debate but without, in reality, getting anywhere close.”

Wildman argues that the First Lady should use her popularity “to get America to understand how very nonpartisan health care reform might be? … The First Lady could have gathered together a task force comprised of a clutch of women -- moms, mostly -- and presented their stories, simply and without fanfare, to highlight how un-family friendly our current insurance policies are. How anti-woman. How anti-mother."

She might have brought in, say, a widow who lost health insurance after her husband died, therefore leaving the family uninsured. Women, she would have pointed out, are more likely to be on their husband's insurance than vice versa, leaving them vulnerable in the event of divorce, or death, or job loss. She might have invited a young, entrepreneurial would-be mother who desperately sought health insurance to cover a potential future pregnancy, but discovered there was no way to sufficiently cover maternity on the individual insurance market. She might have shown America a mother who owns her own business and discovered, happily, she was pregnant and that, unhappily, she could not find health insurance to cover the prenatal care, labor, and delivery.”

Wildman writes that the First Lady could have told the country that “On the individual market, pregnancy … is a pre-existing condition. Most insurance companies will not allow a woman to purchase insurance once she is already with child. Worrisome, the First Lady would have said, because this woman now has to decide between caring for her fetus and going into debt. Maternity benefits, she would have explained to the cameras, are never a guarantee.”

At the moment health reform appears stuck between a partisan divide. Although many of us are rightfully focused on the important nuances of prevention coverage and policy, the larger context of health reform – coverage, fairness, quality -- is fundamental to our national character. The First Lady can do much to remind us of this even as we are called to become more physically active and less attracted to junk food.

As we enter the final quarter of play lets remember that health reform is a team sport and no one should be left on the bench.

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