Is an ounce of prevention always worth a pound of cure? No: promoting prevention to contain costs is a logical fallacy.

Abstract

Screening large numbers of healthy people to find the few who will develop a particular disease is rarely cost-effective.1 For instance, some policy analysts hesitate to recommend screening for colorectal cancer. Lowering high serum cholesterol concentrations with the use of statins may reduce the incidence of heart attacks by 30% to 35%, but such drug therapy costs more than $1,000 per year per patient, and that is simply not cost-effective. The risk factors for many chronic diseases have now been identified. Heart disease, for example, is attributable to unhealthy diet, elevated blood cholesterol levels, smoking, and physical inactivity. Counseling to change the lifestyles of those at risk would, therefore, seem to be indicated. But studies have shown that this does not save money and, therefore—especially in countries with universal medical care—it should not be recommended. What is medically advisable for individual patients—certainly if they pay for it on their own—and what is cost-effective for the nation are 2 entirely different considerations. The British government has tried but failed to broaden preventive care by revising its National Health System's general practitioner contract. The revisions were intended to increase the incentive for practitioners to do specified preventive procedures. A policy specialist, citing studies questioning the cost-effectiveness of primary prevention, concluded that the inclusion of health promotion in the general practitioner contract reflected a political view that prevention is popular and cheap. An editorial in the BMJ also concluded that, through altering priorities, the emphasis on prevention was severely interfering with the general practitioner's main goal of “helping patients to understand and cope with illness, relieving symptoms, and offering the occasional cure.”2 In any event, the notion of promoting prevention to contain costs is a logical fallacy: even if disease-preventive measures save money in the short run, making people live longer will impose an even greater later expense on any medical care delivery system because there will then be more people to develop expensive chronic geriatric illnesses. Wrongly advocating preventive medicine as a cost-saving method only detracts from its true value—improving longevity and quality of life. If we can agree that each person's well-being and the ability to live as long as possible are important goals of human life, then the use of preventive care would not be to save resources—as so many analysts and planners contend3—but primarily to preserve, and add to, health.