The February 14, 2008 issue of the New England Journal of Medicine ran an article with the astonishing title "Does preventive care save money?" (1). That analysis was prompted, according to the authors, by the health care campaign promises made by various U.S. presidential candidates.

The very question - whether preventive care saves money - seems astonishing enough. But prevention surely isn't just about money. I'd rather not get sick in the first place, even if "curing" me wouldn't cost any more than preventing my disease. Medical treatment is one of the leading causes of death, and I'll take my chances with prevention.

The authors do concede that prevention might just do some good:

"Indeed, some evidence does suggest that there are opportunities to save money and improve health through prevention."

But then they go on to say:

"Although some preventive measures do save money, the vast majority reviewed in the health economics literature do not."

What on earth are these authors talking about? When one reads further one discovers that they aren't discussing what you or I would consider prevention at all. The article is primarily about early diagnosis to detect malignancies in their most treatable stages. In other words, the authors' interest is restricted to medical interventions. Only one sentence in the article pays lip service to genuine disease prevention, and then it's back to medicine:

"Preventable causes of death, such as tobacco smoking, poor diet and physical inactivity, and misuse of alcohol have been estimated to be responsible for 900,000 deaths annually - nearly 40% of total yearly mortality in the United States."

It turns out that the cost of preventive medical interventions actually isn't all that different from the cost of treating diseases. The reason for this, the authors point out, is that too many unnecessary diagnostic tests are performed. For screening to be cost-effective, it should only target populations at high risk for a given disease. The authors' prescription for achieving better health results:

"Conduct careful analysis to identify evidence-based opportunities for more efficient delivery of health care - whether prevention or treatment - and then restructure the system to create incentives that encourage the appropriate delivery of efficient intervention."

I can't help thinking that the authors of this paper are as naive as the presidential candidates with their proposed solutions to the "health" care crisis. What kinds of incentive can you create for service providers by cutting back on spending?

Why is U.S. "health" care so expensive? Because providing it is so lucrative. The more "services" can be provided, even if they are totally ineffective, the more enormous the profits for the service providers. Vested interests will fight any expenditure reductions on preventive interventions tooth and nail.

In fact, an enormous amount of money is spent by the "health" care industry on preventing prevention. Big Pharma has no intention of giving up their customers without a fight. They are spending huge sums of money to influence legislators, regulatory agencies, and medical professionals. Supplement manufacturers cannot make perfectly well-supported health claims, and compounding pharmacies are prevented from supplying bio-identical hormones, to give just two examples of the nefarious influence of the pharmaceutical industry. I would think that the providers of diagnostic services will also fight any cost-effectiveness measures, i.e. any reductions in their profits.

The solution to the "health" care crisis won't come from the medical establishment or from Big Pharma. Our best hope to be healthy is to be informed and proactive. We do need medical care for certain problems, but our health is our own responsibility.

Sources

1. Cohen JT, Neumann PJ, Weinstein MC. Does preventive care save money? Health econmics and the presidential candidates. N Engl J Med 2008;358(7):661-663. [Full Text]