Idea #267 for November 12th, 2009: Stalled Progress or Making Sure Smoking Rates Continue to Decline

We’ve made a lot of progress in smoking cessation over the last several decades, but over the last five years, the smoking rate has stopped declining in the US. Over the decade ending in 2008, the CDC reports that the percentage of people who smoked dropped from 24.1% to 20.6%. However, in 2007 the rate was 19.8%, so there was a slight rise in the rate of smoking from 2007 to 2008. It’s a trend that we have to focus on changing.

Part of the problem is being traced to insufficient state spending on anti-tobacco programs. In the last decade, states have received over $200 billion in tobacco revenue, yet only 3% of that has gone towards anti-smoking programs. If that amount was bumped up to 15% — still just a fraction of the overall revenue — then anti-smoking programs could be funded at levels the CDC recommends. Additionally, states that have made laws regarding smoke-free restaurants and other areas have seen smoking rates drop. While much has been accomplished over the last few decades as far as smoking cessation, there is still a lot more we could be doing, especially considering how little of our states’ tobacco revenue is going towards anti-smoking causes.

Read more about this here.

 

Idea #265 for November 10th, 2009: Keeping An Eye On It or Blood Transfusion Surveillance Network

There’s a new collaborative project headed by the CDC that will try to improve the safety of blood transfusions by monitoring data from organizations involving blood collection, transfusion, and organ donation. The system, called the US Biovigilance Network, is an internet based surveillance network. It seeks to identify trends in adverse events that occur, and will use the data it gathers to help healthcare organizations make changes to avoid those issues in the future. As of now, the US is one of the only developed nations that does not have a blood transfusion reporting and safety system.

The data that the CDC will collect includes events like giving blood to the wrong patient and any reactions that a patient might have after receiving blood. As of now, errors in transfusion are under-reported, but this system aims to change that. The CDC’s stated goals for the project are improving the safety of both blood donors and recipients, as well as reducing costs in healthcare. We’re overdue for a national system for reporting blood donation errors, so this will be a great step forward in making sure donations are conducted in the safest manner possible.

Read more about this news story here.

 

 

Idea #232 for October 8th, 2009: iFlu or Assessing Flu Symtoms Online

Given the large amount of media attention surrounding a possible H1N1 flu outbreak, public panic is a real possibility in the coming months. In an effort to keep people away from unnecessary emergency room visits, Microsoft has unveiled a website to help people make a quick assessment on whether their symptoms are indicative of H1N1 infection.

Microsoft’s licensed their tool from Emory University, who developed it using risk factors identified by the CDC for H1N1. The site asks users some basic questions about their condition to determine if they have H1N1, and if so, whether a visit to a doctor is in order. It can tell you that you likely have swine flu, but that seeing a doctor is not necessary. Or it may determine your symptoms are severe enough that you do have to go to the emergency room. The questions asked are similar to ones used during the triage process at Emory.

Some might expect a tool like this to be wildly inaccurate and steer gravely ill people away from treatment they need. However, a test of the tool against 2500 patient records in Colorado proved quite successful. Only two people that the tool identified as non-serious flu cases were hospitalized in that study. This flu season, a web tool like this holds great promise, if utilized correctly. It’s a quick way of finding out if you’re symptoms are consistent with swine flu symptoms — without the hassle of getting to an emergency room.

Read more about this from the AP.

Idea #229 for October 5th, 2009: Nutrition 101 or More High Schools Get Passing Grades For Food Options

A survey conducted by the CDC has revealed a promising trend: fewer schools are offering junk food to students. Specifically, secondary schools are now selling less sugary drinks and candy. In fact, 63% of secondary schools reportedly do not offer sugary drinks, which is a big increase over the 38% it was a few years ago. And 64% do not sell candy or salty snacks, up from 46%. Considering the rise of obesity and diabetes in children, it makes perfect sense for schools to do their part in staving off the crisis.

States that have adopted strong nutritional requirements for their schools fared especially well in this survey. For instance, in Mississippi 75% of schools do not sell sugary drinks, but just two years earlier only 22% of their schools met that mark. Similar progress was made in Tennessee as well. While schools cannot change what students eat at home, they can instill healthy eating habits that will hopefully carry over to smarter food choices across the board. Steering teens away from sodas and candy is a great first step.

Read more about this in the CDC press release.

Idea #202 for September 8th, 2009: Riding It Out or Antivirals Unnecessary for Majority of Swine Flu Patients

In the next few months, H1N1 flu is expected to pick up steam in the US. Amid non-stop media attention, there’s the potential the public will overreact or panic about the situation. For that reason, the CDC is urging that two antivirals (Tamiflu and Relenza) be reserved for people either hospitalized with H1N1, or people who are at high risk for complications.

In the majority of cases, swine flu is mild and does not require antiviral medication. For elderly or young patients, and for patients with other health conditions that would make them susceptible to flu, Tamiflu can be used to treat H1N1. But overusing the antivirals can lead to resistance, which would make H1N1 even more difficult to treat. It’s also important that, for patients who do receive antivirals, they begin treatment as soon as possible to effectively treat the flu. But for the majority of us, H1N1 will not have to be treated with antivirals.

Read more about this in the Washington Post.

Idea #189 for August 26th: Anti-Virus Applications or Utilizing Social Networking Sites to Fight Swine Flu

If you want to reach huge numbers of people in an inexpensive way, taking advantage of social networking sites may be the best option. The CDC has realized that, and are utilizing twitter, Youtube, Facebook and other sites to spread message about the H1N1 flu. Their Facebook page has over 20,000 fans and on Twitter, the CDC has over 300,000 followers. Tips for prevention, such as getting vaccinated, hand-washing, and staying home when sick, are offered by the CDC, as well as updates on the number of cases of flu.

Additionally, they are reaching out to “mommy-bloggers” who hold great influence online. The CDC hopes reaching out to the public in this manner will inform people flu prevention, while at the same time trying to deter them from making a lot of unnecessary emergency room visits. Updates can spread virally through twitter, so it’s an ideal way to reach millions of people quickly. One concern with this methodology is that it is reaching out disproportionally to a younger demographic. Elderly people, who are less likely to be online, will not be informed to the same extent. Nonetheless, it’s certainly a smart move on the CDC to take advantage of social networking sites to help contain the H1N1 flu, considering the potential consequences if it spreads unchecked.

For more on this, see an article about it here.

Idea #152 for July 20th, 2009: The Wrong Direction or Teen Pregnancies and STDs On The Rise

After more than a decade of decline, the numbers from 2006 and 2007 show that teen pregnancies are on the rise again. Meanwhile, the number of STD cases is rising, including an almost doubling of the rate of AIDS among teen boys. Syphilis is more prevalent in females than it has been over the last decade. Inadequate sex education is being blamed for these trends.

The CDC data also show that a third of teens had not received birth control information before the age of 18. We need to focus our efforts on STD prevention, and that includes changing the way sex education is handled in schools. Some are already blaming the “abstinence only” approach that was promoted by the previous administration. If a third of teens are left in the dark about birth control, then these kinds of results can be expected. Of course, abstinence is the only way to prevent 100% of STDs and pregnancies, but we need a more realistic approach, since that message doesn’t seem to have gotten through to teens.

Read more about this from ABC News and Healthnews.com

Idea #119 for June 17th, 2009: From the Comfort of Home or LA County’s STD Test Kits

Los Angeles County has seen a rise in the number of chlamydia cases in the last decade, and now make up three-quarters of the county’s STD cases. In fact, the CDC ranked LA County first among counties nationwide in cases of chlamydia. Sixty-three percent of the county’s cases occur in women between 15-24. With this in mind, LA County Public Health has developed and implemented a free chlamydia home test kit for young women.

From the Public Health Department’s website women can order the test kit, learn the results, and receive referral and treatment information. The test itself entails using a swab, sealing it in a provided container, and mailing it back to the lab. A week later, patients can get the results over the phone or online. The site also provides a map of nearby clinics for those who test positive.

This program has the potential to reach young people who may otherwise be reluctant to visit clinics for STD testing. Allowing patients to administer the test from their own home will certainly reduce costs associated with providers and facilities. Clearly, catching and treating chlamydia and other STDs before they spread is vital to public health efforts, and this program could be a great help. It will be fascinating to see if LA County’s high STD rates are reduced as a result, and if it turns out be more cost-effective than traditional office visits.

See the county’s website for this program here, and read about the program in the news here and here.

Idea #110 for June 8th, 2009: Erasing the Stigma or Encouraging More People to Get Tested for HIV

In medicine, stigmas can have deadly results. Take for example HIV: fears about the perceptions of being HIV positive has caused some people to avoid getting tested for the disease. The CDC estimates that 20% of people with HIV are unaware of their condition because they have not been tested.

Early testing leads to early treatment, and in the case of HIV patients, that means better long-term prognoses. Now, a community in North Carolina is trying to fight the stigma with a advertising campaign. The campaign will feature television commercials and print media that will convey the message that HIV positive individuals are deserving of the same respect and human rights as any other members of society.

Additionally, the group will attempt to gather 5,000 signatures from community members as a way of showing AIDS patients that they have the community’s support. It will be interesting to see if the rates of HIV testing go up after the campaign launches. If so, there is a case to be made for this to be replicated in other communities where stigmas hinder testing rates.

In the news, see these two local news stories.

Idea #98 for May 27th, 2009: Nowhere To Go But Up or Change at the FDA

The new leadership at the FDA is promising to change the way the organization operates, along with changing the way success should be defined. In an essay published in the New England Journal of Medicine, new FDA head Margaret Hamburg wrote that “the ultimate measures of the FDA’s success should reflect its fundamental goals and go beyond such intermediate measures as the number of facilities inspected or drugs approved.” The new leadership is making it clear that the primary concern of the FDA should be Americans’ health, not industry (as it seemed to be in the past).

Regarding food safety, Hamburg wants the FDA to focus on prevention of foodborne illness instead of simply reacting after the fact, as they tend to do now. Also, they want to be able to work closer with the USDA on the matter, which has been a source of trouble in the past. Outside of food safety, the FDA now plans to work closer with the CDC on matters such as swine flu. Inter-agency cooperation has been difficult in the past, and getting by that obstacle would certainly make the FDA more effective.

Given their failures in the past, it’s a positive development that the FDA now seems to be learning from debacles like the salmonella outbreak in peanuts last year. The FDA has a long way to go before the public regains confidence in the organization. It’s refreshing to hear that the they are taking a new approach, but whether the promised changes will come to fruition is still up in the air. We’ll see how much of that idealism fades with the realities of bureaucracy and private interests.

In the media, see: the Wall Street Journal, the AP, and the New England Journal of Medicine.