October 13, 2008


Campaign Myth: Prevention as Cure-All (H. GILBERT WELCH, M.D, 10/07/08, NY Times)

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. Both candidates appear to have bought into it: Mr. Obama encourages annual checkups and screening, Mr. McCain early testing and screening.

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.

Increasing the amount of testing for an ever-expanding list of problems always identifies many more people as having disease and still more as being “at risk.” Screening for heart disease, problems in major blood vessels and a variety of cancers has led to millions of diagnoses of these diseases in people who would never have become sick.

Likewise, recent expansions in the definitions of diabetes, high cholesterol and osteoporosis defined millions more as suddenly needing therapy. 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. But you can’t assume it is. Early diagnosis may help some, but it undoubtedly leads others to be treated for “diseases” that would never have bothered them. That’s called overdiagnosis.

Rule One for Good Health: Avoid the quacks until you're sick.

Rule Two: If you ignore it you'll likely get better without them anyway.

Rule Three: If you get really sickj there was nothing they could have done. They "heal" healthy people who they overdiagnosed.

Posted by Orrin Judd at October 13, 2008 6:01 PM
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