Tuesday, June 23, 2009

WSJ - They're Just Not That Into Prevention

Has anybody seen the Wall Street Journal column praising the benefits of prevention? Neither have we, and we're starting to suspect such a column doesn't exist. But we sure have seen their columns that take the opposite tack. In the last dozen or so days, in fact, the WSJ has published two columns and two blog postings dismissing prevention as part of health reform.

Was it something we said?

First, there was a June 12 print piece by Janet Adamy entitled "Prevention Efforts Provide No Panacea on Health Costs." On the same date, WSJ printed a blog post by Shirley S. Wang entitled "Does Preventing Disease Really Save Money?" (Her answer: probably not, and it may not even improve health); and a blog post by Peter Landers entitled "Disease Prevention in Germany Is Mostly Good for Doctors." Then there was Abraham Verghese's June 20 column on entitled "The Myth of Prevention."

C'mon, folks, how do you really feel?

The logic employed in these pieces is simplistic - preventive services aren't worth investing in because not all of them save money. But that's concentrating on the hole, not the doughnut.

The fact is that some preventive services DO save money. We reviewed 25 procedures approved by the US Preventive Services Task Force and found that six of them actually saved money while 12 of them were highly cost-effective. We also found five preventive clinical servces that are currently underused that could save an additional 100,000 lives a year if they were broadly utilized. Three of those services save money, while the other two are highly cost-effective.

Which raises another problem with the logic in the WSJ columns. A preventive service doesn't have to save money to provide value to the health care system. Many of the procedures that don't save money still deliver significant health benefits for the dollars spent.

Using logic like that employed in the WSJ columns, the owners of Major League Baseball teams wouldn't invest in hitters, because even the best of them get a hit less than a third of the time they go to the plate. In reality, of course, those owners look not at the hits the players don't get, but at the hits they DO get - how many homers they hit, how many runs they drive in, how many put people in scoring position - and they invest in the players that give them the most bang for the buck.

Perhaps there's a lesson there for health care... and for the WSJ.

1 Comment:

  1. Danalexa1 said...
    The Adamy piece in the WSJ was rather scattered in its discussion of prevention. First, a distinction was not made between screening for conditions versus a clinician's recommenation to a patient with asthma/hypertension/diabetes to change a negative behavior such as smoking. Second, nothing was said about preventing chronic diseases. It is still early days; however, the evidence is accumulating re: lifestyle changes that can keep hypertension,diabetes, & CVD at bay. Third, the progressive nature of chronic illness was not discussed in terms of how lifestyle changes have been demonstrated to reduce the risk of complications.....where the big bucks are spent.
    All participants in the prevention discussion need to be much more precise about language and the target of a particular preventive measure. Federal legislators are new to the topic of prevention and the evolving nature of the concept. As prevention advocates we need to clarify what prevention can achieve in the short & medium term prior to chronic disease onset and in its earliest stages. Without clarity/simple language on our part, opponents will make a muddle in the minds of decision makers of whatever prevention advocates communicate about a valid health reform strategy.

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