Do the benefits of preventing disease outweigh the costs associated with screening large groups of people?

The answer depends on who you ask. For example, a recent article in Health Affairs by Louise B. Russell reminds us that:

Over the four decades since cost-effectiveness analysis was first applied to health and medicine, hundreds of studies have shown that prevention usually adds to medical costs instead of reducing them. Medications for hypertension and elevated cholesterol, diet and exercise to prevent diabetes, and screening and early treatment for cancer all add more to medical costs than they save.

In response to the above study, John Goodman (not the actor, but the “father of health savings accounts”), writes the following on his blog:

Does preventive care save lives? Of course. Does it save money for some patients? Definitely. But the cost of screening healthy patients outweighs the savings on patients whose diseases are caught in their early stages. Preventive medicine is desirable. But there’s no free lunch.

So if you’re the among the group whose disease is detected early by screening, you’re not only likely to save money but also live longer. Society, however, pays for all those mammograms, colonoscopies, and PSA’s that end up being negative and don’t lead to detecting disease.

So what is the right thing to do?

To screen or not to screen: that is the question.

Whether ’tis nobler in the mind to suffer
The slings and arrows of outrageous fortune,
Or to take arms against a sea of troubles,
And by opposing end them?

If you’d asked Frank Zappa, the genius composer who died in 1993 from advanced prostate cancer at age 52, he may have found it nobler to had been given a chance to fight. By the time they found his cancer, it had metastasized, rendering him defenseless against his outrageous fortune.

Below is Frank Zappa’s last official interview with Today Show. Fast forward to 7:26 to hear him urge the public to get tested and then retested for prostate cancer.

There’s definitely no free lunch… and no one-size-fits-all solutions. Saving lives is becoming an increasingly expensive endeavor.

Filed under: Culture, Health Policy