Prevention

The first article in last week's Journal of the American Medical Association, coauthored by Health Policy Senior Fellow Susan Blumenthal, presents a compelling argument that the SNAP program (formerly food stamps) is contributing to the growing obesity problem, particularly among low-income children. If we want to keep people healthier in the long run--and better control our healthcare spending at the same time--it's worth thinking about ways to help SNAP beneficiaries stay a healthier size.

The problem is pretty simple. Federal food assistance programs have been very successful in reducing the number of Americans who don't get enough calories to live, but SNAP--the largest one--doesn't include any mechanism for targeting spending toward foods that provide high-quality energy and plentiful nutrients, so a lot of the money ends up getting spent on soda and other junk food. Those foods appear to contribute to obesity, which can later lead to diabetes and a host of other medical conditions.

That challenge prompted Blumenthal to lead a group that created a report, SNAP to Health, laying out some policy changes that could help reduce obesity among the SNAP population and improve our health in the future. The report is long, but worth a look--check it out! Also check out the JAMA piece here.

In some respects, America’s market for beer has never looked healthier. Where fewer than a hundred brewers operated a generation ago, we now can count more than 2,000, producing a mind-boggling variety of beers. Yet just below this drinkers’ paradise, we see a market that has never been more closed. Two giant firms — Anheuser-Busch Inbev and MillerCoors — now control some 90 percent of production. At the same time, a few giant retailers — led by Costco — are rolling up control over sales. This concentration is already diminishing real variety in much of the country.

Boston Globe health reporter Chelsea Conaboy has a brief profile of Dr. Bernard Lown in the most recent edition of the Boston Globe Magazine. It covers some of the most important moments in a truly remarkable life, including our conference this April on Avoiding Avoidable Care. Check out the piece here.

If you haven't seen it yet, you can also read more by and about Dr. Lown at his blog.

On Friday August 6th, the New America Foundation will be hosting an advanced screening of "Escape Fire: The Fight to Rescue American Healthcare." The event will take place in New York City from 6:30pm-8:30pm. Watch the trailer here.

Directed by Matthew Heineman, “Escape Fire” is a stirring documentary about the perilous situation of our current healthcare system, and what can be done to fix it. The film, which has been honored at both the Sundance Film Festival and the Full Frame Festival, is being screened nearly two months before it comes out in theaters. More details, as well as a link to RSVP, are available here, at the event's page:  "Escape Fire - Screening Event"

This April the University of Wisconsin hosted a conference called "Science Writing in the Age of Denial." The conference set out to brief science writers on strategies to deal with skepticism toward and denial of evidence based discoveries (think: people hanging on to the fabricated link between vaccines & autism; denial of evidence that some cancer screenings and drugs don't work, and claims that proponents of evidence-based medicine are trying to "kill cancer patients;" vehement denial of climate change).

Gary Schwitzer, creator of HealthNewsReview.org, gave a keynote address entitled: "Cheerleading, Shibboleths and Uncertainty." Here are links to the video of his presentation and his slides.

'Shibboleth’ is a Hebrew term that was referenced in the Bible. In a story from the book of Judges, the word "shibboleth" is used to sort one tribe from another, and from that time the word has been used to mean a signal that members of a group give each other to show membership.

Mr. Schweitzer suggests that for some medical and journalism groups, unlimited advocacy for medical screening is a shibboleth. He describes these “cheerleading” groups as having a "cult-like advocacy for screening tests." His main example was the "media cacophony" that surrounded the release of USPSTF's revised breast cancer screening guidelines.  His presentation contains other examples of screening shibboleths.

Gary's work, and the work of this conference, represents an important step toward evidence based medicine. It will be incredibly hard to get evidence used in medical practice until we get better at acknowledging and counteracting forces that will push back against any threatening or uncomfortable truth. As it stands, 25-40% of all that is done in medicine is not evidence based. If we want care that is safer, more cost effective, and patient centered we need to regularly stop and evaluate ourselves and what we have learned. Then we need to keep what is working, and have the courage to leave behind our shibboleths that don’t hold up anymore.

Host Elizabeth Weingarten talks to Steve LeVine about the environmental downside of the impending oil and natural gas boom, and to Jamie Holmes about whether New York Mayor Michael Bloomberg's soda ban can really change consumer behavior.

In case you missed it, the FDA came out with new rules last week to limit the use of antibiotics in farm animals. While at first glance this might seem unrelated to health issues in humans, it actually matters quite a lot. The connection works like this: the indiscriminate use of antibiotics to produce the food we eat contributes to the creation of antibiotic-resistant disease strains. When humans then get infected with these strains, antibiotics are ineffective at treating the new strains, thus posing a fairly significant public health risk.

This risk is not insubstantial. According to the New York Times, “at least two million people are sickened and an estimated 99,000 die every year from hospital-acquired infections, the majority of which result from such resistant strains.” Further, the use of antibiotics for farm animals is not an isolated occurrence – as Ezra Klein pointed out in the Wonkbook newsletter this week, “70 percent of the antibiotics used in this country – 70 percent! – go into livestock production.” The director general of the WHO, Margaret Chan, has warned that the overuse of antibiotics could “end medicine as we know it.”

So the overuse of antibiotics is bad for humans, bad for public health, and leads to up to $40 billion of avoidable care costs per year. It should be pointed out that many doubt the efficacy of the new rules, but even with these concerns, it’s a welcome first step towards reducing improper antibiotic use in farm animals and reducing avoidable care costs for those humans among us.

Some would argue that $40 billion might not seem much compared to the overall costs of health care, estimated at $2.6 trillion dollars in 2010 alone. That's barely over one percent of medical spending--but one percent matters! (It meets Zeke Emanuel's threshhold, at least.) The fact is, the medical spending problem is enormous, and we need small, common-sense changes in addition to large-scale payment and delivery-system reform if we want to make a difference.

We've been pretty quiet here at New Health Dialogue recently, but rest assured that our blogging will resume apace in the next couple of months. We've been busy working on a few projects, and I want to share one of them with you now. You'll hear more about the others soon...

If you follow our Twitter account (you should!) or Chelsea Conaboy of the Boston Globe, you've heard about the Avoiding Avoidable Care conference that we're hosting with the Lown Cardiovascular Center next month. (Chelsea did a great writeup on the conference over at the Globe's White Coat Notes blog.)

The agenda for the conference is up! We're thrilled to have such a great set of speakers, moderators, and panelists--it's going to be a great conference. While the meeting is by invitation only, we'd love to hear your comments on the agenda--post them here, and look for more in late April when we tell you about what the meeting covered.

In her latest column at TIME Ideas, Shannon Brownlee takes on the controversy over the Obama administration's birth control rule, and links it to some of the other purportedly moral debates over the extent of health insurance coverage. The core point is that, while each person is entitled to his own opinion, we're not entitled to our own facts. In cases where the facts line up solidly against a treatment, as with some kinds of back surgery, PSA testing for prostate cancer, and other elective procedures, it makes sense to limit the extent to which taxpayers and other members of insurance pools have to subsidize care. In cases where moral beliefs are at issue, though, we have to be careful to respect differences:

...the medical issues that are now sparking debate have relatively little to do with the pure numbers or effectiveness. The controversy arises because people have different moral beliefs. In a pluralistic society, we should try to respect and even celebrate that. When it comes to decisions that are rooted in values, I don’t want anyone—be it the government, my employer, or somebody else’s religious leader—coming between me and my doctor.

Apologies for our extended hiatus--we've been hard at work on an extended report, and it hasn't left a lot of time for blogging lately. But we're back, and hopefully we'll be blogging more often in the coming weeks.

Now, without further ado: this week's Health Wonk Review is up! Check it out.

Many thanks to Joe Padua at Managed Care Matters for hosting!

Join us again on March 14th, for the next exciting edition of Health Wonk Review!