In defense of Surgeon General Dr. Regina Benjamin — Thank you for your service – National Consumers League

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By Sally Greenberg, NCL Executive Director
Earlier this month, Forbes magazine contributor Henry I. Miller penned a needlessly nasty assessment of Dr. Regina M. Benjamin’s tenure as U.S. Surgeon General. Dr. Benjamin, who on Tuesday stepped down from the office she has held for more than four years, leaves behind a robust record of health advocacy, having tackled some of our country’s most challenging public health issues. In his piece, Miller declaims Dr. Benjamin for being “nowhere to be found since the beginning of President Obama’s first term.”

This could not be further from the truth! In promoting her National Prevention Strategy campaign, Dr. Benjamin regularly traveled to cities across the country, touting the importance of physical activity and wellness in often underserved communities that receive little media attention. Granted, Dr. Benjamin was not a press hound. And unlike her well-known predecessor Dr. C. Everett Koop—famed for flouting the will of politicians who wanted to suppress discussion of the nation’s AIDS epidemic, an extremely controversial and media-grabbing issue in the 1980s—Benjamin preferred to confront some of America’s most pernicious public health challenges without fanfare. Her priority initiatives included: combating the nation’s growing obesity problem (she helped to implement First Lady Michelle Obama’s “Let’s Move” campaign), reducing tobacco use, trumpeting the importance of breastfeeding, and raising awareness of the country’s suicide epidemic, among others.

Dr. Benjamin’s commitment to confronting the greatest public health challenges working-class Americans face may not prompt the kind of controversy that would draw much media attention, but her impact in engaging this community has been unsurpassed. Dr. Jocelyn Elders, Surgeon General under President Clinton, (in)famous for controversial comments regarding sex education, confirmed that Benjamin “hadn’t been out on the firing line getting picked at like some of us in the past.” She added that Benjamin’s efforts have mostly taken place behind the scenes. Indeed, Dr. Benjamin clearly has dedicated herself to serving Americans in those places where she might not elicit a lot of public attention, but where she could make the biggest difference.

As Executive Director of the National Consumers League, I can personally attest to Dr. Benjamin’s commitment to educating Americans. Dr. Benjamin became an early champion for our Script Your Future Campaign to improve medication adherence. Poor adherence – patients not taking their medications as directed – is a $290 billion problem; 3 of 4 patients say they haven’t taken their medication as directed and 125,000 die each year on account of poor adherence. The Surgeon General helped NCL to launch the campaign at the George Washington University School of Public Health.

In early 2011, Dr. Benjamin launched a “Call To Action” in support of breastfeeding aimed at communities of color. If every woman who was able nursed her baby, we would save the health care system billions of dollars. The Surgeon General, who has gotten behind these and many other initiatives (with unprecedented outreach to minority communities), has made all the difference for community organizations dedicated to overcoming America’s most crippling public health challenges. Dr. Benjamin has been everything that Miller portrays her not to be, as the nation’s top public health official HHS Secretary Kathleen Sebelius suggests. Sebelius said that the Surgeon General has “touched the lives of millions of Americans and has had a positive impact on the health of this Nation.” Dr. Georges Benjamin (no relation), President of the American Public Health Association, said that “Regina Benjamin taught America how to walk again … and has been a remarkable advocate in promoting the value of prevention as a national health priority. Instead of lobbing ad hominem insults at Dr. Benjamin (Miller says she is obese, for example, which she is not) for her work as Surgeon General, we should be thanking her for her four years of distinguished service as the nation’s doctor.

The NSA scandal: balancing safety and liberty – National Consumers League

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By Sally Greenberg, NCL Executive Director
On June 6, Edward Snowden leaked classified information about the National Security Agency’s (NSA) collection of massive amounts of data over the last decade. First came the revelation that the secretive agency demanded that telecom providers hand over droves of phone conversation metadata, including the telephone numbers of those making and receiving calls and how long those calls lasted. Later we learned that the NSA also requested online data collected from Google, Facebook, Yahoo, and others. Some have called Snowden a hero, others a traitor.

The U.S. government has charged Snowden with espionage. Snowden, a 29-year-old high school drop-out (he later earned his GED), had been hired by an outsourced government contractor and working with sensitive NSA data since 2009. His release of the classified information has not only raised serious questions about the legality of such data collection and what this means for people living in a free, democratic society such as ours, but also has muddled international relations with China and Russia, both countries in which he has appeared since fleeing. Neither Russia nor Hong Kong were willing  to extradite  him  to the US. Much of the media’s focus over the last few weeks has revolved around Snowden’s whereabouts, but these revelations about NSA’s actions have also started a more sobering discussion about what role the government plays in both protecting the American people from terrorist attacks and preserving civil liberties. Polls taken since the disclosure of NSA’s policies show Americans are divided on this issue.

A PEW poll reported that 56 percent of Americans think the NSA’s tracking of “millions of Americans” phone records is an acceptable way for the government to investigate terrorism. Conversely, in a CBS poll that asked about collecting phone records of “ordinary Americans” only 38 percent of respondents found the practice acceptable. Due to the lack of transparency in the NSA program, Americans are unclear how useful such data collection is to ensuring our safety and security. Both the Obama Administration and Gen. Keith B. Alexander, head of the NSA, claim the programs have thwarted dozens, perhaps as many as 50, terror plots. This number might prove more persuasive if the agency would reveal more details about these terrorist activities, but they’ve instead played the “trust us, we’re here to protect you” card and are reluctant to disclose information about the actual plots or the tools used to stop those plots. That leaves many Americans skeptical about the validity of such statements. Could these terrorist attacks have been stopped by other means? Were these terrorist attacks stopped by other means?

One strategy that both protects security but seeks to preserve our privacy and freedom of association is being pursued by a handful of US Senators. Patrick Leahy (D-VT), chair of the Senate Judiciary Committee, has introduced the FISA Accountability and Privacy Protection Act of 2013. This bipartisan bill aims to bolster existing privacy safeguards and require greater oversight, transparency, and accountability in connection with the government’s expansive domestic surveillance powers. Government plays an important role in all of our lives in acting for the common good; state and local governments were established to do the things communities benefit from: ensure fire and police protection, build and maintain schools, hospitals, water treatment plants and sewer systems. But when our federal government collects billions of pieces of information from the phone records and Internet data of all its citizens with a vague explanation that this is needed for “national security,” that’s a fishing expedition and should raise serious concerns about privacy.

Perhaps most of us don’t feel like we’re living in a police state, but when you stop to think about the ways in which our privacy has been invaded, it’s scary. Many cities, including where I live in Washington DC, have literally hundreds of cameras deployed all across town operating 24/7. GPS tracking devices are ubiquitous. DUI checkpoints are common and the cops can take your blood if they suspect you’ve been drinking, and now, according to the Supreme Court, if you get stopped for a minor infraction your DNA can be loaded into a database. As one USA Today commentator put it, “There must be a balance between legitimate security and overbearing government.” We have indeed seen a steady erosion of privacy since 9/11.

The passage of the Patriot Act was a reaction to the attack on the United States and was just the opening salvo. And what has that gotten us? More protection from terrorists? I’m skeptical. Why did the FBI miss the Boston Marathon bombers when the Russian government warned them about the older Tsarnaev brother, saying he was dangerous? The CIA missed Fort Hood shooter Nidal Hasan’s relationship with terrorist groups. Not to mention that there were many red flags that our intelligence agencies missed before the 9/11 attack, such as young Saudi men living isolated lives but getting flight training, traveling from the United States to Osama Bin Laden’s training camps. In America, there exists a generation of young people who are inured to this loss of liberty, loss of privacy and the difficulty getting these protections back once they’ve been lost. As Benjamin Franklin said “Any people that would give up liberty for a little temporary safety deserves neither liberty nor safety.” Ronald Reagan, 200 years later, echoed the same: “Concentrated power has always been the enemy of liberty.”

Will repackaging medicine prevent suicides? – National Consumers League

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By Sally Greenberg, NCL Executive Director
This week Dr. Ezekiel Emanuel wrote a persuasive column in the New York Times laying out a strategy for reducing suicides. He suggests that by simply changing the way we package medication, as Britain has done, we could sharply reduce the number of people who take fatal doses of medicine. Emanuel, the brother of the Mayor of Chicago and a physician who comments frequently on health policy, notes that every year one million people attempt suicide, more than 38,000 succeed.

It turns out that suicides and poisonings from medication have been steadily climbing since 1999. He says that “a good way to kill yourself is by overdosing on Tylenol and other pills”.  Emanuel argues that if we make it hard to buy pills in bottles of 50 or 100 capsules that can easily be dumped out and swallowed, we can prevent many deaths. If pills were packaged in blister packs of 16 to 25, anyone who wanted to use them to commit suicide would have to work really hard. The fact is that suicides occur all too often when a person is at a particularly low moment. Research shows that if the opportunity to take pills – or use a firearm – is effectively diminished – often the moment passes and the person lives. Emanuel cites very persuasive data from Britain. In 1998, Britain changed packaging for the active ingredient in Tylenol, acetaminophen, requiring blister packaging of 16 pills when sold over the counter in places like convenience stores and for packages of 32 pills in pharmacies.  The result, published in an Oxford University study, showed that over 11 years or so, suicide from Tylenol overdoses declined by 43%. Accidental poisonings declined as well. The number of liver transplants attributable to Tylenol toxicity went down significantly. In fact, in 2011 the makers of Tylenol added protective flow restrictors and dosing syringes to all liquid infant and children’s medicines, to prevent accidental overdose.  There is already a precedent here in the US to modify packaging to prevent adverse events; this isn’t a new concept for industry. Not only can repackaging acetaminophen-containing products reduce incidence of suicide caused by overdosing, but it will also prevent accidental poisoning of children. Manufacturers should work with the FDA to learn from Britain’s example and continue to improve packaging. With a change in packaging, which comes with a cost to manufacturers of course but could be carried out over time, we could potentially save thousands of lives.

Breastfeeding a public health issue – National Consumers League

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A study published recently brings news that breastfeeding could save 900 lives a year and billions of dollars if 90 percent of women breast-fed their babies for the first six months of life. These findings are from the journal Pediatrics, which determined that there are hundreds of deaths and many more illnesses from health problems that breastfeeding could prevent – like asthma, diabetes, ear infections, stomach viruses, or even childhood leukemia.

The analysis studied the prevalence of 10 common childhood illnesses, costs of treating those diseases, including hospitalization, and the level of disease protection other studies have linked with breastfeeding. The $13 billion in estimated losses due to the low breastfeeding rate includes an economist’s calculation partly based on lost potential lifetime wages, at $10.56 million per death.

Breast milk contains antibodies that help babies fight infections; it also can affect insulin levels in the blood, which may make breast-fed babies less likely to develop diabetes and obesity. One or two critical things the study failed to note – breastfeeding is FREE. Check out the prices of infant formula some time – it’s expensive!  And it doesn’t provide nearly the benefits that mother’s milk contains.

Secondly, breastfeeding is a wonderful bonding experience for baby and mom. We need to do so much more to encourage women to nurse their children – like a major education campaign for starters about the benefits of breastfeeding. And marketing baby formula to new moms should be vastly curtailed in hospitals and doctors’ offices. Happily, the new health reform legislation encourages breastfeeding by requiring that employers create a private space for working women to nurse their children. And under a new provision the Joint Commission, a hospital accrediting agency, hospitals may be evaluated on their efforts to ensure that newborns are fed only breast milk before they’re sent home.

“The magnitude of health benefits linked to breast-feeding is vastly underappreciated,” said lead author Dr. Melissa Bartick, an internist and instructor at Harvard Medical School. Bartick calls breastfeeding a public health issue, and I couldn’t agree more. About 43 percent of U.S. mothers do at least some breastfeeding for six months, but only 12 percent follow government guidelines recommending that babies receive only breast milk for six months.

Why do moms either never start or quit breastfeeding early? It’s not always easy to get started – the kid and the mom have to figure it out together, and it can be frustrating when the baby won’t “latch on.” It also can be messy and you have to keep up with it, which means pumping at work if you’re a working mom, which can be a pain. But as this study shows, it’s the best thing for the baby, and we have to do a much better job of communicating the importance of breastfeeding to expectant and new moms. In short, there are ways to address all of these challenges.

The pediatrics academy says babies should be given a chance to start breastfeeding immediately after birth. Bartick said that often doesn’t happen, and at many hospitals newborns are offered formula even when their mothers intend to breast-feed. “Hospital practices need to change to be more in line with evidence-based care,” Bartick said. “We really shouldn’t be blaming mothers for this.” Bartrick’s study is invaluable. No, not every woman can successfully breast-feed and she shouldn’t feel guilty if it doesn’t work for her. But the statistics in this study demonstrate that we need to do all that we can to ensure that women who want to and can nurse their infants are given all the encouragement in the world to succeed.