Tag Archives: prevention

New Opportunities in the Changing Landscape of Prevention

Excerpt of article by Derek Yach, MBChB, MPH, The Vitality Institute, The Vitality Group, LLC, New York, New York and Chris Calitz, MPP, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland published in The Journal of the American Medical Association (JAMA).

The focus of medical research has historically been on curative medicine, yielding better drugs, medical devices, and clinical procedures. Prevention science—the systematic application of scientific methods to the causes and prevention of diseases in populations—has yet to receive the necessary investment and support required to reduce the growing burden of largely preventable noncommunicable diseases (NCDs).

Human and Economic Burdens of Disease

Recent assessments of the burden of risk and disease found that morbidity and chronic disability account for nearly half of the US health burden.Despite the largest per capita health expenditure of all industrialized nations, the United States has fallen behind peer countries in terms of improvements in population health. Americans reach age 50 with a less favorable cardiovascular risk profile, lung disease is more prevalent and associated with higher mortality, and the death rate from heart disease is the second highest among peer countries. Leading NCD risk factors are unhealthy diets, tobacco smoking, high body mass index, high blood pressure, high fasting plasma glucose levels, physical inactivity, and alcohol use.Many of these risks are amenable to preventive interventions based on behavior change, yet comprehensive action by development sectors across the economy to disseminate evidence-based interventions targeting these modifiable risks is inadequate. Furthermore, knowledge about effective prevention interventions for mental illness and musculoskeletal diseases is limited even as their contribution to chronic disability increases.

Noncommunicable diseases have been cited as major contributors to rising health care costs, which the Congressional Budget Office (CBO) projects will be the primary driver of national debt over the next 4 decades. The greatest increase in health care spending between 2000 and 2011 was attributable to drugs, medical devices, and hospital care, with the cost of treating NCDs estimated to exceed 80% of annual health care expenditure, whereas 3% was spent on public health and disease prevention programs.The National Institutes of Health estimates that 20% of its $30 billion annual budget is allocated to prevention; however, less than 10% is spent on human behavioral interventions that target the major modifiable risk factors.More investment in prevention science could lead to greater health gains at lower cost.

Read the full article here.

Research!America’s response to the Yach and Calitz article in JAMA:

The commentary by Derek Yach and Chris Calitz should be required reading for every federal policy maker.  Preventing disease is the best case scenario, not only for patients, but for taxpayers and the economy.  That’s because reducing the incidence of disease is more than a one-time cost-saving strategy; it actually bends the cost curve and helps individuals lead long, productive lives.  Yet the Prevention and Public Health Fund, which allocates grants to states to reduce the prevalence of NCDs,  has been a perennial target of lawmakers who seek every opportunity to defund it and prevention science as a whole continues to be a low national priority. That’s where advocates come in.  Prevention science is not going to flourish until Washington comprehends the return on investment.  Fighting for prevention science is not just right, it is essential.

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Investments in Research Reduces Injury and Violence

By Frederick Rivara, MD, MPH. Rivara is President of Society for Advancement of Violence and Injury Research (SAVIR). Dr. Rivara holds the Children’s Guild Association Endowed Chair in Pediatrics, and is a University of Washington professor of pediatrics and an adjunct professor of epidemiology. He  is also Editor of JAMA Pediatrics.

Frederick Rivara, MD, MPH

Frederick Rivara, MD, MPH

More than 400 public health researchers and practitioners participated in the 2013 National Meeting of the Society for Advancement of Violence and Injury Research (SAVIR) and Safe States Alliance. Hosted in Baltimore by the Johns Hopkins Center for Injury Research and Policy, this event focused on how research and practice have contributed to reducing injury and violence in this country over the last twenty years while at the same time calling attention to the pressing needs of today and tomorrow.

Speakers provided compelling examples of how investments in the science of injury prevention and control have paid off in lives saved. For instance, the tools of epidemiology were instrumental in establishing the heightened risk of death among infants in the years before car seats were mandatory – in fact, epidemiologists, physicians, and advocates working together used that science to change laws and educate parents so that today using infant car seats is almost universal in the United States. Continue reading →

U.S. Surgeon General Regina Benjamin Stepping Down in July

    left to right: Mary Woolley, president and CEO, Research!America; Jack T. Watters, MD, Research!America Board member and VP for External Medical Affairs, Pfizer Inc.; and U.S. Surgeon General Regina Benjamin, MD, at Research!America’s 2012 Advocacy Awards Dinner

left to right: Mary Woolley, president and CEO, Research!America; Jack T. Watters, MD, Research!America Board member and VP for External Medical Affairs, Pfizer Inc.; and U.S. Surgeon General Regina Benjamin, MD, at Research!America’s 2012 Advocacy Awards Dinner

Surgeon General Regina Benjamin, MD, recently announced her resignation as the nation’s top doctor after four years in the post.

Dr. Benjamin, the 18th surgeon general, has been an active advocate for public health with a special interest in disease prevention, smoking cessation and healthy lifestyles.

“She has been a remarkable advocate in promoting the value of prevention as a national health priority. She forged the way as leader of the National Prevention Council, created under the Affordable Care Act, to help transform our nation’s health system from one that focuses on treating disease to one that focuses on prevention and staying well,” said Research!America Board member and American Public Health Association Executive Director Georges Benjamin, MD, in a press release.

Deputy Surgeon General Boris Lushniak, MD, MPH, will serve as acting Surgeon General in July while a permanent replacement is sought.

Statement from Research!America President and CEO Mary Woolley on Passing of Dr. C. Everett Koop

February 26, 2013

The Board of Directors of Research!America joins me in extending our deepest condolences to Dr. C. Everett Koop’s family, friends and colleagues as we mourn the passing of a visionary leader and champion of medical research. Dr. Koop was well-respected and revered by scientists, the public health community and the public at large, thanks to his unceasing commitment to strengthening government support for research to address health threats. As U.S. Surgeon General, he was known as “America’s Family Doctor.” Notably, by promoting fitness and raising awareness of disease prevention and immunization, he encouraged individuals to take an active role in their health. Koop’s innovative thinking saved lives and improved quality of life for many Americans as he sounded the alarm on the deadly health effects of smoking and the most challenging health issues of our time, making an extraordinary commitment to raising awareness about, and determination to combat, HIV/AIDS. After serving two terms as Surgeon General, Dr. Koop was named honorary director of Research!America. In 1994, he partnered with us to create a widely viewed national public service campaign in support of medical research. Nearly 20 years later, the campaign is still recognized for its impactful message that “insufficient medical research can be hazardous to your health.” His leadership served to elevate the importance of research and public health in our national conversation with unparalleled success. His legacy is second to none.

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Thank your local public health professional today and every day

It started in Tennessee: one patient with an unusual recurrence of meningitis. An infectious disease specialist at Vanderbilt University worked the case like a detective, tracking down a lead. When the detective work led to an unusual suspect – a possible contamination – the Tennessee Department of Health was promptly notified. And when Tennessee public health specialists feared the contamination might be widespread, they contacted the Centers for Disease Control and Prevention (CDC). In short order, a second federal agency, the Food and Drug Administration (FDA), and most states in the eastern half of the country were working to solve a puzzling fungal meningitis outbreak that affected thousands of people.

Although the outbreak continues, much has been accomplished thus far to protect the public’s health. The contaminated medicines have been recalled, the company that produced them has been closed down, and nearly all of the people who may have been infected have been contacted. The incident serves as a front-page reminder of the critical role that public health professionals play every day.

According to ABC News, the initial diagnosis came from April Pettit, MD, an infectious disease specialist at Vanderbilt University. A patient she treated for bacterial meningitis was readmitted to her hospital. Pettit ordered more exhaustive testing, which led to a rare diagnosis: aspergillus meningitis, which is caused by a type of fungus. Pettit talked with the patient’s family members to try to discover how such an infection could have taken place.

Soon, she found a possible answer. The patient had received a steroid shot four weeks earlier to relieve back pain. Sensing there could be a connection, Pettit contacted the Tennessee Department of Health.

That contact led to Marion Kainer, MD, MPH, who is in charge of the state’s health care-associated infections prevention efforts. She confirmed the details of Pettit’s patient just as other cases in the Nashville area were popping up. Three days after Pettit’s initial contact with Kainer, the state alerted its health care network about the potential outbreak. As CDC began to accelerate its role – it had been consulted since the beginning – the FDA also became actively involved in the investigation.

On September 27, the CDC – after putting out a nationwide alert – received a report of fungal meningitis from North Carolina. As the picture became clearer, more states became involved and CDC devoted more of its personnel to the investigation.

“In terms of ratcheting up the [CDC’s] response, several things became apparent fairly early on,” J. Todd Weber, MD, the CDC’s incident manager for the response, told Research!America. “One was that this was a true outbreak, not a unique patient experience. Among the possible sources of exposure were several products that had national or near-national distribution. Our investigation made it apparent that there were many thousands of doses of what turned out to be the implicated drug. As we learned more about the outbreak with each passing day, more and more people became involved as part of their daily work here at CDC.”

Because of the urgency of the situation and the large number of people at CDC focusing on the outbreak, the agency decided early on to activate its Emergency Operations Center (EOC). While some people may think such a facility is primarily for natural disasters, Weber said the outbreak certainly qualified as a man made disaster. Indeed, the EOC had a crucial role in CDC’s response during the H1N1 pandemic and, had it existed in 2001, would’ve been used for responding to the anthrax attacks, Weber said.

The EOC diverts CDC personnel from their normal duties, so Weber said the decision to activate it is not made lightly. But because of the demands of the outbreak – such as helping states with outreach to thousands of people, pulling together needed CDC experts into a centralized location – activating the EOC early in the fungal meningitis response made sense.

“At the time we activated it, there were over 10,000 people who had been potentially exposed to this infection,” Weber said. “And there was nothing we knew at that point that didn’t suggest that all 10,000 of those people might have become ill.”

Weber noted that one of CDC’s objectives was to support the states during the response, and he believes that mission has been achieved. As an example, CDC has facilitated daily conference calls with all of the 23 states that received shipments of the contaminated steroids, resulting in discussions and exchange of current information among state officials. And CDC supported the states’ efforts to reach hospitals, clinics, professionals and patients who were affected.

The reality is that such large-scale outbreaks are thankfully rare. But CDC collaborates with health departments from across the country on a daily basis. At points during the outbreak, agency officials were in contact with all 50 states to keep them up to date on developments.

There’s still more to be done. Because fungal meningitis was so rarely seen prior to the outbreak, Weber likened it to a new disease; there is virtually no historic clinical information to rely on. CDC continues to focus on learning more about the fungal meningitis and other illnesses linked to this outbreak, and providing interim guidance on how to treat those who have been affected.

“It was all the different parts of public health that really worked here,” Weber said. “It was the front line clinicians; it was the local and state health departments who recognized what was going on; it was them having a federal resource that could reach out across states to share information and coordinate activities in a really flexible manner that made such a difference.”

“We brought together many groups at CDC, including the division responsible for healthcare-associated infections and the division with experts in fungal infections. Our fungal infections laboratory – the mycotics laboratory – [is] normally not at the center of public health attention,” he added. “But if we had not had this specialized laboratory as a resource, our response would have not been as good as it was.”

On Public Health Thank You Day, the fungal meningitis outbreak reminds us of the invaluable contributions of those professionals working behind the scenes to ensure that Americans stay safe. Even if you’ve never heard the term “mycotics,” or “healthcare-associated infections”, it’s good to know that there are people who are experts in these infectious disease threats, and that they’re looking out for us every day.

Every year we celebrate Public Health Thank You Day the Monday before Thanksgiving day. Be sure and thank your local public health professional today and every day.

Learn more here: http://www.researchamerica.org/ph_thank_you

A Weekly Advocacy Message from Mary Woolley: A likely topic of discussion over the next few days; how research relates

Dear Research Advocate,

Today, the Supreme Court surprised many in upholding most aspects of the Affordable Care Act. As the pundits and the blogosphere stoke continuing debate, candidates will stake out positions and policy makers will consider next steps. And everyone will have a point of view. As you express yours, I urge you to use a communication “bridge” to talk about the future of health and health care not only as an outcome of a court or legislative action, but as an outcome of research. Because of research, we live longer lives, death rates from heart disease have declined by 65% over the past 30 years, we don’t consider childhood cancer or HIV/AIDS a death sentence, and we confidently aspire to such challenges as defeating Alzheimer’s and autism, preventing strokes, and putting diabetes in the history books. We must stress that the end goals of health reform and health research are the same – to enable longer, healthier, more productive lives in a nation that efficiently and affordably discovers and delivers safe and effective health care and prevention of disease and disability.

Earlier this week the House and Senate cleared the FDA Safety and Innovation Act, formerly known as “PDUFA,” which the president is expected to sign shortly. As FDA Commissioner Peggy Hamburg noted at a Brookings Institution forum, the FDA is committed to regulatory flexibility. For instance, in response to advances in personalized medicine, FDA is open to approving a drug that works for a clearly identifiable subset of patients with a given disease, even if that drug is not effective for all patients.  Hamburg called the passage of the law “a landmark moment.” Read our press statement on this critical piece of legislation, passed in a bipartisan manner – an accomplishment in itself and an indication that more bipartisan agreement can take place.

Another way to think about the safe and effective use of drugs and devices involves the concept of “repurposing,” such as when a molecule/compound or drug itself has been put aside as ineffective for its stated target. Through innovative public-private partnerships including those initiated by NIH’s new National Center for Advancing Translational Sciences (NCATS), there is a push to look at more of those previously shelved products to examine new uses. History tells us that this has happened before, and science tells us it can happen again. Everyone, worldwide, can benefit from such American ingenuity. We have launched a series of print and Washington, D.C., Metro station ads that highlight examples of repurposing and other unanticipated benefits of investing in research to improve health. Check out our “Nice Save” ads.

In view of the holiday week ahead, I am keeping this letter short. Count on us in early July to hone in on what you can do as an advocate to make the case for research to the voting public (we have great examples to call out), to stop sequestration, and to make it clear that patients and all of us who are stakeholders in research for health are not satisfied with the status quo. We all aspire to better health and well-being, and we are all committed to research as an essential pathway toward achieving that goal.

Have a safe and happy Fourth of July.

Mary Woolley