Prevention, Health, and Politics
An old saying says, "An ounce of prevention is worth a pound of cure." And that is true. NOT drinking alcohol is the surest way to avoid the consequences of drinking. NOT engaging in risky behavior is the surest way to avoid the consequences. Eating a healthy diet is the surest way to avoid the consequences of a diet rich in fats, sugars, and chemicals.
But that is not all there is to it. It is TRUE that preventing a disease obviates having to cure it. But it is NOT true that all good and healthy behaviors will prevent the disease. Nor is it true that spending money on "prevention" will keep all diseases at bay.
The NY Times has an essay on the matter, here.
In a presidential campaign that promises straight talk and no gimmicks, why do both candidates champion one of medical care’s most pervasive myths?
The myth is that like magic, preventive medicine will simultaneously reduce costs and improve health.
...
The term “preventive medicine” no longer means what it used to: keeping people well by promoting healthy habits, like exercising, eating a balanced diet and not smoking. To their credit, both candidates ardently support that approach.
But the medical model for prevention has become less about health promotion and more about early diagnosis. ...
It boils down to encouraging the well to have themselves tested to make sure they are not sick. And that approach doesn’t save money; it costs money.
...
... A new definition of “abnormal bone density,” for example, turned 6.8 million American women into osteoporosis patients literally overnight.
These interventions do prevent advanced illness in some patients, but relatively few. Any savings from preventing those cases is dwarfed by the cost of intervening early in millions of additional patients. No wonder pharmaceutical companies and medical centers see preventive medicine as a great way to turn people into patients - and paying customers.
If preventive medicine were effective in improving the nation’s health, it might warrant these added expenditures. ... Early diagnosis may help some, but ... leads others to be treated for “diseases” that would never have bothered them. That’s called overdiagnosis.
...
Most diseases exist along a similar spectrum. ... most patients with osteoporosis won’t fracture their hip, and most people with diabetes won’t lose a limb.
It’s hard to ignore a “check-engine” light. ... often they lead you to a repair. And you may have had the unfortunate experience that a repair makes matters worse.
If so, you have some feel for the problem of overdiagnosis. Almost everybody with a diagnosis undergoes treatment. And all of our treatments have some harms. From 1 to 5 percent of patients die after major surgery...
For those who are ill, the potential benefits typically overwhelm the potential harms. But the calculus is different for those recruited to consume preventive medicine: those who are well. They are the ones at risk for overdiagnosis - and overdiagnosed patients can’t benefit from prevention, because there is nothing to prevent. Instead, they can only be harmed.
Both presidential candidates need to challenge the conventional wisdom about preventive medicine.
There is so much there; all of it should be read.
Whatever we do with the health care "system" in this country, we must remember the primary rule of medicine: "First, do no harm."
But that is not all there is to it. It is TRUE that preventing a disease obviates having to cure it. But it is NOT true that all good and healthy behaviors will prevent the disease. Nor is it true that spending money on "prevention" will keep all diseases at bay.
The NY Times has an essay on the matter, here.
In a presidential campaign that promises straight talk and no gimmicks, why do both candidates champion one of medical care’s most pervasive myths?
The myth is that like magic, preventive medicine will simultaneously reduce costs and improve health.
...
The term “preventive medicine” no longer means what it used to: keeping people well by promoting healthy habits, like exercising, eating a balanced diet and not smoking. To their credit, both candidates ardently support that approach.
But the medical model for prevention has become less about health promotion and more about early diagnosis. ...
It boils down to encouraging the well to have themselves tested to make sure they are not sick. And that approach doesn’t save money; it costs money.
...
... A new definition of “abnormal bone density,” for example, turned 6.8 million American women into osteoporosis patients literally overnight.
These interventions do prevent advanced illness in some patients, but relatively few. Any savings from preventing those cases is dwarfed by the cost of intervening early in millions of additional patients. No wonder pharmaceutical companies and medical centers see preventive medicine as a great way to turn people into patients - and paying customers.
If preventive medicine were effective in improving the nation’s health, it might warrant these added expenditures. ... Early diagnosis may help some, but ... leads others to be treated for “diseases” that would never have bothered them. That’s called overdiagnosis.
...
Most diseases exist along a similar spectrum. ... most patients with osteoporosis won’t fracture their hip, and most people with diabetes won’t lose a limb.
It’s hard to ignore a “check-engine” light. ... often they lead you to a repair. And you may have had the unfortunate experience that a repair makes matters worse.
If so, you have some feel for the problem of overdiagnosis. Almost everybody with a diagnosis undergoes treatment. And all of our treatments have some harms. From 1 to 5 percent of patients die after major surgery...
For those who are ill, the potential benefits typically overwhelm the potential harms. But the calculus is different for those recruited to consume preventive medicine: those who are well. They are the ones at risk for overdiagnosis - and overdiagnosed patients can’t benefit from prevention, because there is nothing to prevent. Instead, they can only be harmed.
Both presidential candidates need to challenge the conventional wisdom about preventive medicine.
There is so much there; all of it should be read.
Whatever we do with the health care "system" in this country, we must remember the primary rule of medicine: "First, do no harm."