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The National Committee To Preserve Social Security And Medicare - Protecting The Health And Economic Future Of Older Americans
"As the President himself has said, America does not face an entitlement

Washington Times Examines Proposed Teen Pregnancy Prevention Initiative In Obama Budget Plan
The Washington Times recently included a two-part series examining President Obama"s proposed reallocation of abstinence-only sex education funding in his 2010 budget plan. The proposal would redirect funding toward a new Teen Pregnancy Prevention Initiative that uses comprehensive sex education curriculums. Summaries of the series appear below.~ Part 1: Obama"s budget proposal states that funds for the Teen Pregnancy Prevention Initiative should go to programs that are proven to help delay first sex, increase contraceptive use or reduce teen pregnancy, though a few advocates of comprehensive sex education say such goals are laudable but too narrow, the Times reports. William Smith -- vice president for public policy for the Sexuality Information and Education Council of the United States -- and James Wagoner -- president of Advocates for Youth -- wrote in a June 17 blog entry that preventing unintended pregnancy among teens is "incredibly important" but that it is "not the only sexual and reproductive health issue facing our nation"s youth." They continued that it would be more beneficial to "expand the scope" of the initiative so it can serve "all young people in all communities, including lesbian, gay, bisexual, transgender and questioning youth, whose needs fall wholly outside of the narrow teen-pregnancy-prevention framework." According to the Times, Smith said in an interview that money allotted for the initiative would be best used if it went to programs focused on "good outcomes" for youth, "not these disaster-aversion silos that don"t serve us well." Wagoner said that advocates have been "very clear in giving the president credit for shifting tracks here in a big way" by ending funding for abstinence-only sex education. However, he added that it is "our job to press for the right destination" and to see the changes implemented into law (Wetzstein, Washington Times, 6/28).~ Part 2: Some supporters of Obama"s proposal argue that it is "exactly the right idea, at the right time," as the U.S. teen birth rate has increased in the last two years after 14 years of decline, the Times reports. Sarah Brown, CEO of the National Campaign To Prevent Teen and Unplanned Pregnancy, said that Obama"s proposal is the "first really focused expenditure on effective teen pregnancy prevention programs." Brown noted that the U.S. has the highest rates of teen pregnancy and birth in the industrialized world. She said that the best programs will address one or more of the three goals of the initiative -- delaying first sex, increasing contraceptive use or reducing teen pregnancy. Last month, about 175 organizations sent a letter to Obama and members of Congress calling for an expanded initiative that would include subjects such as sexually transmitted infections and abusive relationships. However, Brown said that many teen pregnancy prevention programs include discussion of STIs and other areas, "[s]o we really don"t see much tension here" (Wetzstein, Washington Times, 7/5).
News of the day
BioVex To Report Phase I/II Clinical Trial Results For The Front Line Treatment Of Head And Neck Cancer
BioVex Inc, a company developing next generation biologics for the treatment and prevention of cancer and infectious disease, announced that the results from a Phase I/II combination study in previously untreated patients with head and neck cancer will be presented at the 2009 American Society of Clinical Oncology (ASCO) Annual Meeting, which will take place May 29, 2009 - June 2, 2009 in Orlando, FL.
Mental Health

New Guideline For Low-Back Pain Interventions, Surgery Issued By The American Pain Society

The American Pain Society (APS) has issued a new clinical practice guideline for low back pain that emphasizes the use of noninvasive treatments over interventional procedures, as well as shared decision making between provider and patient. The findings are published in the current (May 1, 2009) issue of the journal Spine. The new APS guideline, based on an extensive review of existing research, provides clinicians with eight recommendations to help determine the best way to treat patients with low-back pain. It also expands its current and previously published guideline for initial evaluation and management of this chronic condition. "These recommendations are based on an even more complete body of evidence than was available just a few years ago. Consequently, we believe these recommendations will give physicians more confidence when treating patients with persistent back pain," said Roger Chou, M.D., lead author, director of the APS Clinical Practice Guideline Program, and associate professor of medicine (general internal medicine), Oregon Evidence-based Practice Center, Oregon Health & Science University. "Unfortunately, randomized trials for a number of commonly used interventional procedures are still too limited to generate evidence-based recommendations, and our review also highlights the need for more research," Chou added. Low-back pain is the fifth most common reason for doctor"s visits and accounts for more than $26 billion in direct health care costs nationwide each year. While a number of interventional diagnostic tests and therapies, and surgery are available, and their use is increasing, in some cases their usefulness remains uncertain. "We have advocated strongly in many of our recommendations for physicians to use shared decision making because of the relatively close trade-offs between potential benefits relative to harms, as well as costs and burdens of these various treatment options," Chou explained. Shared decision making involves a patient"s full participation in medical choices after receiving comprehensive information about the impact of all options on his or her particular life situation. To develop the guideline, a multidisciplinary APS panel, augmented by experts on interventional therapies, reviewed 3,348 abstracts and analyzed 161 relevant clinical trials. The panel found that the evidence for the use of these interventions was mixed, sparse or not available. Based on the data the panel gathered, the APS now recommends: * Against the use of provocative discography (injection of fluid into the disc in order to determine if it is the of back pain) for patients with chronic nonradicular low-back pain. * The consideration of intensive interdisciplinary rehabilitation with a cognitive/behavioral emphasis for patients with nonradicular low-back pain who do not respond to usual, non-interdisciplinary therapies. * Against facet joint corticosteroid injection, prolotherapy, and intradiscal corticosteroid injections for patients with persistent nonradicular low-back pain, and insufficient evidence to guide use of other interventional therapies. * A discussion of risks and benefits of surgery and the use of shared decision making with reference to rehabilitation as a similarly effective option for patients with nonradicular low-back pain, common degenerative spinal changes, and persistent and disabling symptoms. * Insufficient evidence to guide recommendations for vertebral disc replacement. * A discussion of the risks and benefits of epidural steroid injections and shared decision making, including specific review of evidence of lack of long-term benefit for patients with persistent radiculopathy due to herniated lumbar disc. * A discussion of the risks and benefits of surgery and use of shared decision making that references moderate benefits that decrease over time for patients with persistent and disabling radiculopathy due to herniated lumbar disc or persistent and disabling leg pain. * Discussion of risks and benefits of spinal cord stimulation and shared decision making, including reference to the high rate of complications following stimulator placement for patients with persistent and disabling radicular pain following surgery for herniated disc and no evidence of a persistently compressed nerve root. Chou and his colleagues also reaffirm their previous recommendation that all low-back pain patients stay active and talk honestly with their physicians about self care and other interventions. "In general, noninvasive therapies supported by evidence showing benefits should be tried before considering interventional therapies or surgery," said Chou. Recommendations from the first APS Clinical Practice Guideline on Low-Back Pain are intended for primary care physicians and appeared in the Oct, 2, 2007, issue of the Annals of Internal Medicine. For diagnosis, the first APS low-back pain guideline advises clinicians to minimize routine use of X-rays or other diagnostic tests except for patients known or believed to have underlying neurological or spinal disorders. Tamara Hargens-Bradley Oregon Health & Science University


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