Welcome to Center for Advancing Health

Whose expertise can we rely on these days, anyway?  On questions ranging from the value of real estate to foreign threats to safe havens for our investments, Americans have recently been stung by flawed advice. 
 
So it is all too easy to generalize our wariness to new evidence about the effectiveness of different aspects of health care.  I was reminded of this by a new study suggesting that colonoscopies are nowhere near as effective as claimed in catching cancer before it becomes unstoppable.

We have a real stake in these debates.  People over 50 can reduce the risk significantly by having a colonoscopy but many do not do so.  Too many people die painful deaths from colon cancer that is caught too late.  So assuming that I can significantly reduce my own risk of colon cancer by having this test, how can I maximize the odds in my favor?
           
The tentative answers are (1) go to an expert who has a good track record and has done at least a thousand such procedures – if I can figure out what a good track record is and how practitioners should spend their time reaching that threshold – and (2) be really certain my innards are thoroughly flushed out prior to the test (a topic that doesn’t lend itself to discussion in public service announcements or family newspapers).
           
My hypothesis is that the recent reports of evidence about how to improvethe effectiveness of colonoscopies for individuals will have the opposite effect and instead reduce the number of people who seek them. It seems all too likely that those who are impatient with the provisional nature of all evidence and are reluctant to subject themselves to the test will justify their qualms by concluding that it requires too much work on their part to get a test that isn’t really all that effective. 
           
Unfortunately, the dilemma posed by new evidence about a test or intervention that can end up discouraging its use by individuals isn’t unique.  It also applies to mammograms and the use of drugs to reduce cholesterol levels, as well as some asthma and diabetes medications.  On the one hand, there’s evidence suggesting more people should do these things.  On the other, there’s research contending that their effectiveness is oversold and may in fact confer risks.
           
Experts will undoubtedly debate these trade-offs in the upcoming efforts to reform health care as the political and policy communities are challenged to come up with a menu of medical services that should be available to everyone.
           
Complexity is an interesting challenge to insiders – researchers, policy-makers and some clinicians.  But it can constitute a real problem for the rest of us as we try to figure out what care is safe, effective, affordable and worth our time.  Coming up with some simple rules that people can rely on deserves a higher priority.

The Health Behavior News Service regularly distributes stories summarizing new research on health behavior issues. These stories can be found online at http://www.cfah.org/hbns/news/index.cfm.

Here are some stories released in December:

Goal-Setting Drills Make for More Active Coworkers
Workplace programs that encourage employees to set exercise goals pay off, finds a new study that looked at physical activity levels of Home Depot employees. The proportion of employees who regularly participated in either moderate or vigorous physical activity rose from about 30 percent at the start of the study to about 50 percent by study's end.

Home Visits Reduce Risk of Low Birth Weight Babies
Socially disadvantaged mothers who receive home visits from trained community visitors are less likely to deliver low birth weight babies than other mothers in similar circumstances, a new study finds. The earlier that visits occur in a women's pregnancy, the greater the reduction.

For Kids, More Screen Time Means Lower Fitness Scores
If videogames like "Madden NFL '09" didn't exist, 12-year-old Tom might go outside and toss around a real football - and he'd have a better chance of sprinting for a touchdown without getting winded. Too much small-screen recreation could undermine physical fitness, Australian researchers have found, in a new study that looks at how e-mailing and texting, TV and net surfing affect aerobic endurance in adolescents.

Computer-Aided Mammography Finds More Cancer, More False Positives
Computer programs designed to help radiologists could identify more cases of breast cancer, but they might also increase the number of false positive results, which can lead to biopsies in healthy women, according to a recent systematic review from ECRI Institute.

Teens Girls Smoke Now, Pay Later With Larger Waistlines as Adults
Remember the cool girls, huddled together in high school restrooms, puffing their cigarettes? Well, here’s consolation for the nerds in the crowd: Those teen smokers are more likely to experience obesity as adults, according to a new study from Finland.

Exercise Is Healthy Option for Kids With Developmental Disabilities
Group exercise programs, treadmill training and horseback riding can be healthy choices for children with developmental disabilities, a new review of studies concludes.  With these kinds of activities, children with disorders such as autism, mental retardation and cerebral palsy can improve their coordination and aerobic fitness.