To: Interested Parties,

The American Recovery and Reinvestment Act (ARRA) provides needed economic stimulus while laying the groundwork for many investments important to our nation’s future. The House of Representatives has passed its version, HR-1. The Senate is now debating its own bill.

We, the undersigned group of 500 practitioners, analysts, and scholars come from virtually every state. We reflect many disciplines within public health, medical care, and policy research. We hold diverse political views, and have diverse ideas about how best to enact healthcare reform. We are united, however, in the belief that the public health provisions included in HR-1 provide a feasible, timely, and cost-effective approach to improving America’s health.

We are thus disturbed by reports of deep proposed cuts to prevention and wellness programs (as well as by proposed cuts to in other areas such as education and disability assistance) rumored to be under consideration.

Evolving press reports indicate that the current Senate bill would cut or eliminate several billion dollars in health prevention funds allocated in the House bill. Areas of proposed cuts apparently include comparative medical research, smoking cessation, HIV prevention and testing, diabetes screening and detection, pandemic flu preparedness, health information technology, and other key public health items. Whether one evaluates these expenditures as short-term economic stimulus or in broader public health terms, each of these proposed expenditures represents sound public policy.

During 2008 campaign, Democrats and Republicans supported increased investment in comparative medical research to improve the quality and cost-effectiveness of American medical care. As Dr. Ezekiel Emanuel noted in his book Healthcare, Guaranteed: “The United States spends over $2 trillion on healthcare, about $200 billion on prescription drugs, and nearly $100 billion on medical research and development, but only a paltry $1 billion to evaluate the comparative costs and effectiveness of medical interventions and their influence on health outcomes.”

The agencies that support this research employ rigorous scientific peer-review to allocate available funds. Many high-quality projects are ready for immediate implementation in hospitals, medical practices, and universities across the United States.

Health information technology is equally central. Electronic medical record systems improve continuity of care and can improve cost-effectiveness by reducing medical errors and by preventing duplicative diagnostic procedures and tests.

The broader array of prevention and wellness measures are equally essential to health and well-being. By some measures, diabetes is America’s most costly and prevalent major chronic illness. Prevalence is increasing due to increased prevalence of adult-onset disorders. Modest proposed expenditures for diabetes screening and management are therefore especially valuable.

HR-1 also includes funds for the prevention of HIV, sexually-transmitted infection, and tuberculosis. Federal expenditures in these critical areas has lagged in recent years. A variety of evidence-based interventions could be quickly implemented to address these public health challenges within the range appropriated in the House bill.

We are especially surprised by proposals to eliminate funds for smoking cessation services. Smoking remains America’s most prevalent and avoidable cause of premature illness and death. Smoking cessation services rank among the most cost-effective interventions in all of medicine and public health. The proposed $75 million would create roughly 1,500 jobs. Moreover, it would help roughly 45,000 people quit smoking, preventing many thousands of smoking-related deaths and serious illnesses.

In the 2008 campaign, candidates across the political spectrum demanded that our health system place greater weight on prevention to reduce avoidable deaths, injury, and illness, and to improve cost-effectiveness. Unfortunately, many prevention measures are politically vulnerable because they improve health among diffuse, disorganized, sometimes politically marginal constituencies.

The hope for such measures often rests with leaders who set aside momentary political pressures to ask what is really needed to promote a healthier America. If the Senate does this, it will retain the modest but crucial public health expenditures contained in the House bill.

Samuel A Bozzette, MD, PhD
UCSD
Fellow: American College of Physicians, Infectious Diseases Society of America
Member: Association of American Physicians, Society for Clinical Investigation

Jacob S. Hacker, Ph.D.
University of California Berkeley

Mark A. Peterson, Ph.D.,
UCLA School of Public Affairs
Member, National Academy of Social Insurance

Dean Ornish, M.D.
Founder & President, Preventive Medicine Research Institute
UCSF

Howard Markel, MD, Ph.D
University of Michigan
Member, Institute of Medicine

Kevin Grumbach, MD
UCSF
Member Institute of Medicine

Gilbert S. Omenn, M.D., Ph.D.
University of Michigan
Member, Institute of Medicine,
Former President and chairman, American Association for the Advancement of Science

Diane Fagelman Birk, MD
University of Texas Southwestern Medical Center
Distinguished Life Fellow, APA

David L. Katz, MD, MPH, FACPM, FACP
Director, Prevention Research Center
Yale University School of Medicine

Marilyn J. Telen, M.D.
Chief, Division of Hematology
Director, Duke Comprehensive Sickle Cell Center
Duke University Medical Center
Fellow, AAAS

Judith R. Lave, Ph.D.
University of Pittsburgh
Member, Institute of Medicine, Distinguished Fellow, Academy Health

Frank E. Speizer, MD
Harvard Medical School
Member, Institute of Medicine

Michael F. Jacobson, Ph.D.
Center for Science in the Public Interest

Merrill Goozner
Center for Science in the Public Interest

E. Richard Brown, Ph.D.
UCLA School of Public Health
UCLA Center for Health Policy Research

Robert S. Lawrence, MD, MACP, FACPM
Johns Hopkins Bloomberg School of Public Health
Member, Institute of Medicine

Claire Broome, MD
Emory University
Member, Institute of Medicine

Clifford E. Douglas, J.D.
Executive Director
University of Michigan Tobacco Research Network

Harry P. Selker, MD, MSPH
Tufts University Clinical and Translational Science Institute
Tufts Medical Center Institute for Clinical Research & Health Policy Studies

Barry Zuckerman MD
Boston University School of Medicine/Boston Medical Center

Georges C. Benjamin, MD
Executive Director
American Public Health Association

Peter D. Jacobson, JD, MPH
Center for Law, Ethics, and Health
University of Michigan School of Public Health

La Tanya Hines, M.D.,F.A.C.O.G.
President Association Black Women Physicians. 2008

Victor Goldin, MD
Life Fellow NY Academy of Medicine
Distinguished Life Fellow APA

Kathleen B. Schwarz, M.D.
Director, Pediatric Liver Center
Johns Hopkins University School of Medicine

Lonnie Zeltzer, MD
President, IASP Special Interest Group on Pain in Childhood
Director, Pediatric Pain Program, UCLA Mattel Children's Hospital
Associate Director, Patients and Survivors Program, UCLA Jonsson Cancer Center

Rupa Redding-Lallinger, MD
UNC Comprehensive Sickle Cell Program
Departments of Pediatrics and Internal Medicine
University of North Carolina
Fellow in the American Academy of Pediatrics

Gregory D. Curfman, M.D.
Executive Editor, New England Journal of Medicine

Walter Tsou, MD MPH
Past President, American Public Health Association

Sidney Starkman, M.D.
Director, Emergency Neurology Program, Co-Director, UCLA Stroke Center
UCLA Emergency Medicine Center

Veronica T Mallett, M.D.
U T Medical Group Chair of Excellence
Dept. Obstetrics and Gynecology
University of Tennessee Health Science Center

Margaret B. Griffin, MD
Fellow American College of OB/Gyn
Maine General Medical Center

Felix L. Nunez, MD, MPH
Community Clinic Association of Los Angeles County, Los Angeles, CA

Jaya Aysola, MD, DTM&H, FAAP
Medical Director, New Orleans Children's Health Project
Chief, Section of Community Pediatrics and Global Health
Department of Pediatrics, Tulane School of Medicine

Charles Homer, MD, MPH
CEO, National Initiative for Children's Healthcare Quality

Paula M. Lantz, Ph.D.
S.J. Axelrod Collegiate Professor of Health Management and Policy
University of Michigan School of Public Health

Organizers
Alexander Blum, MD
UCLA - Olive View

Alice T. Chen, MD
UCLA School of Medicine, Department of Medicine

Mandy Krauthamer, MD, MPH
Department of Veterans Affairs

Vivek Murthy, MD, MBA
Brigham and Women's Hospital, Harvard Medical School
Co-Chair, Doctors for Obama

Arun R. Patel, MD, JD
Fellow, American Academy of Pediatrics

Harold Pollack, MPP PhD
Faculty Chair, Center for Health Administration Studies
University of Chicago School of Social Service Administration

Nina Vasan, MD-MBA Candidate
Harvard Medical School and Harvard Business School

Milan De Vries, PhD
Massachusetts Institute of Technology

Nikhil Wagle, MD
Dana-Farber Cancer Institute / Partners CancerCare
Co-Chair, Doctors for Obama

(The full list and proper titles of more than 500 researchers and practitioners will be posted shortly.)

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