The Paradox of Disease Prevention – Celebrated in Principle, Resisted in Practice
In a Special Communication, Harvey V. Fineberg, M.D., Ph.D., of the Institute of Medicine, Washington, D.C., examines a number of the reasons that disease prevention in clinical medicine and public health is often resisted, and suggests and discusses the following strategies for overcoming these obstacles:
(1) Pay for preventive services. (2) Make prevention financially rewarding for individuals and families. (3) Involve employers to promote health in the workplace and provide incentives to employees to maintain healthy practices. (4) Reengineer products and systems to make prevention simpler, lower in cost, and less dependent on individual action. (5) Use policy to reinforce choices that favor prevention. (6) Use multiple media channels to educate, elicit health-promoting behavior, and strengthen healthy habits.
“The health care community cannot expect an overnight transformation; preventive messages must be repeated across many forms of media and entertainment to become solidified over time as cultural norms. Success will require a sustained effort from individuals and families in their daily lives; from physicians, nurses, pharmacists, and other health professionals; from cultural, entertainment and sports celebrities; from employers and insurers; from political, civic, and business leaders; from public agencies at all levels; and from philanthropies. In the end, prevention is truly worth the investment to make a difficult sell just a little easier and to put everyone on the road to a healthier future,” Dr. Fineberg concludes.
Smoking Cessation, Weight Gain, and Subsequent CHD Risk Among Postmenopausal Women With and Without Diabetes
“Cigarette smoking is an important cause of cardiovascular disease, and smoking cessation reduces the risk. However, weight gain after smoking cessation may increase the risk of diabetes and weaken the benefit of quitting,” write Juhua Luo, Ph.D., of the Indiana University School of Public Health, Bloomington, Ind., and colleagues.
As reported in a Research Letter, the authors used data from the Women’s Health Initiative (WHI) to assess the association between smoking cessation, weight gain, and subsequent coronary heart disease (CHD) risk among postmenopausal women with and without diabetes. In the WHI, 161,808 postmenopausal women 50 through 79 years of age were recruited from 40 sites between 1993 and 1998 and followed up every 6 to 12 months. Women without known cancer or cardiovascular disease at baseline or CHD at year 3 were followed up until CHD diagnosis, date of death, loss to follow-up, or September 30, 2010, whichever occurred first.
Of 104,391 women followed up, 3,381 developed CHD, during an average of 8.8 years. The researchers found that smoking cessation was associated with a lower risk of CHD among postmenopausal women with and without diabetes. Weight gain following smoking cessation weakened this association, especially for women with diabetes who gained 11 lbs. or more, although power was limited in this subgroup due to the small number of cases.
JAMA Gets a New Look!
First Major Print Redesign in Many Years
Readers of the print issues of JAMA will notice something new this week – new design features inside the journal and a revised cover. “Although the redesign will be most evident in print, it will also improve the readability of our content on our digital platforms,” writes Howard Bauchner, M.D., JAMA Editor-in-Chief, and Ronna Henry, M.D., a JAMA Deputy Editor, in an editorial in the July 3 issue.
“The goals of the redesign were to create an inviting, visually lively publication with clear navigation for readers and to ensure harmony across The JAMA Network.” The redesign project includes all 10 medical journals in The JAMA Network which are now organized in a similar manner. “The order of articles, article types, and names of content sections are identical across the network. Readers will find similarly formatted articles regardless of which journal they read.”
“While this redesign is a major milestone, we are not done yet. We will continue to seek out the best content and to use new print, web, and digital developments to enhance the communication of our content,” the editors write. “Over the past 2 years we have reached out to prospective authors around the world, developed new article types, launched a new platform, renamed the Archives journals, introduced an app that allows users access to the entire content of The JAMA Network, and redesigned our entire content.”
(JAMA. 2013; 310(1):39;