The Myth of Preventative Medicine
Politicians of all stripes are talking about preventative medicine. They claim that if we catch medical problems earlier, we can fix them for less. By paying a little more now, we can save a lot more later. The only problem? It doesn't work.
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.
Early screening is like the "check engine" light in your car. It can alert you to problems that need to be fixed, but too often it picks up trivial abnormalities that don't affect performance, like one sensor's recognizing that another sensor isn't sensing.
And if we look hard enough, we'll probably find out that one of your check-engine lights is on.
What's wrong with that? Getting extra -- possibly unneeded -- medical care can't hurt, can it?
It's hard to ignore a "check-engine" light. Some mechanics reset them and see if they come on again, but often they lead you to a repair. And you may have had the unfortunate experience that a repair makes matters worse.
If so, you have some feel for the problem of overdiagnosis. Almost everybody with a diagnosis undergoes treatment. And all of our treatments have some harms. From 1 to 5 percent of patients die after major surgery, and as we are all increasingly aware, prescription medicines carry real risks. Recent experiences with hormone replacement (breast cancer) and Vioxx (heart attacks) are potent reminders that our "best" new treatments may harbor unpleasant surprises.
Oh. Not only is "preventative medicine" more expensive, it's also riskier. Maybe I'll stick to going to the doctor only when I actually feel sick.
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