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Prevention: Not a Panacea for National Health Budgets
R. Edward Dodge, MD, MPH
Citrus Memorial Hosptial Inverness, Fla
Arch Fam Med. 1993;2(10):1021.
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I agree with much of what Gellert1 had to say in his thoughtful and interesting article in the May issue of the ARCHIVES. However, the assumption that, "Success achieved in primary prevention... will produce sustained cost savings of a magnitude to ensure future excellence in treatment and rehabilitation,"1 is both unproven and dubious. The examples he cites (prenatal care and measles vaccine) as supporting evidence for the economy of prevention over treatment are undoubtedly accurate, but they do not truly address the enormous problem of chronic late-stage disease that consumes disparate amounts of health care resources. He slides around this difficult and complicated problem by noting that behavioral and lifestyle factors contribute to the origin of major chronic diseases and by stating that beginning prevention to modify behavior has no advance costs.
In actuality, work on behavioral modification is one of the most difficult, time-consuming, and treatment-resistant approaches in
. . . [Full Text PDF of this Article]
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