Prevention, Dollars and Sense?

By Brackenbury, Mark | New Haven Register (New Haven, CT), February 11, 2013 | Go to article overview

Prevention, Dollars and Sense?


Brackenbury, Mark, New Haven Register (New Haven, CT)


SINCE an iron lung costs quite a few dollars, the prevention of polio cannot make sense. Right? If that one has you scratching your head, with a "say what?" dangling from your lip, we are on the same page. Let's populate it accordingly. Of course prevention can save dollars. But that will only be the case when what we refer to as "prevention" really makes sense.

Prevention enthusiasts have long contended that preventive medicine has the potential to add years to life, add life to years, and save a lot of money into the bargain.

Members of the other side -- let's call them the dubious, because no one is really a prevention 'detractor' -- have argued that the former points may be true, but the last is not.

Prevention, especially in the form of clinical preventive services such as cancer screening, costs money. And since part of the preventive medicine imperative is to find and fix disease early, prevention encourages healthy people to undergo medical testing to identify problems no one knew they had. Suddenly there is expense where there would have been none.

This case, and variations on it, has been made many times, including recently in Reuters. The Reuters article cites a report by the Trust for America's Health on transitioning the U.S. system from "sick care" to genuine "health" care, and a paper published in 2010 in the peer-reviewed journal, Health Affairs. The analysis in Health Affairs suggests that widespread use of preventive services could help us all save only 0.2 percent of personal health spending in the U.S.

The iron lung, with which this argument began, is a costly half- measure. It's a form of prevention, yes; it prevents death in the early stages of poliomyelitis. But it's not nearly as good as preventing polio outright, which of course is now the global norm, courtesy of immunization. Once polio is eradicated, assuming we can get there, its prevention becomes permanent and free. …

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