Jul 29, 2009

Actually, preventative healthcare has been a spectacular success

Simon Chapman responds to Bernard Keane's contention yesterday that prevention is not always the best cure when it comes to health reform.

Bernard Keane got a bit excited yesterday, thinking he was onto a major myth-bust: that prevention may not be better than cure. Citing a New England Journal of Medicine review of prevention’s ability to cost save, he faithfully reported the finding that “Although some preventive measures do save money, the vast majority reviewed in the health economics literature do not.”


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5 thoughts on “Actually, preventative healthcare has been a spectacular success

  1. stephen henry

    Bernard Keane is a good thinker and writer, but I disagreed with the idea that cure is cheaper or better than prevention.
    Simons last two paragraphs sum up the counter argument very well.

  2. bakerboy

    Good article, Professor. Being a mere left leaning journo, Bernard just doesn’t want to understand the facts sometimes. Of course prevention works and is worthwhile for most people. Smoking is the best example – my younger brother smoked 2 packs a day for 30 years and used to claim that there was no proven connection between smoking and lung cancer. Then at age 50, we had to watch him slowly die from cancer and emphysemia. The time will arrive when people who abuse their bodies will be given lower priority for treatment and have to pay more for it. Alex

  3. Roslyn Pike

    Professor, Sir,
    Thank you very much indeed, for a really good news story.
    All the best,

  4. Liz45

    A most informative article. Sadly, the growing incidence of violence against women and children from Domestic Violence didn’t rate a mention. According to PM Kevin Rudd, the anticipated cost to the country in the next financial year is $13 BILLION. He announced an injection of over $40 million next year to try and stop this shameful and damaging situation. The biggest threat to the healthy lives of women between the age of 19-45 is domestic violence. I’m not even sure that the $13 billion mentioned by Kevin Rudd covers all aspects of these horrific crimes – health, judiciary, police involvement, setting up a new home, time off school and work, psychological and or psychiatric care, womens’ refuges and associated costs. Not to mention the physical and psychological injuries that rate from mild to severe or life threatening.
    In Australia, 1 in 4 women are abused in their homes. It’s anticipated, that 1 in 3 women will be abused in their life time. Most of the homicides of this nature occur, after the woman has left the home. 75 women, that’s 1 every 10 days is murdered by a male person who purports to love her.

    This shameful situation is totally preventable, we just need to change the attitudes of those men who think it’s acceptable to abuse women and kids. This change in attitude must take place prior to the child being born – it’s the ingrained sexist views of the ‘treatment’ or ‘rights’ of boys and men that places women’s lives in jeopardy in their lives. Too many women experience their first act of violence during pregnancy. Any child who even hears violence in the home is a victim of child abuse. Too many victims of child abuse grow up to be perpetrators or victims.

    The first thing that must happen, is for the community to engage in discussion. For too long, the incidence of domestic violence has been treated as ‘secret and shameful family business’ – this must cease. For too long, women have been made to feel shame and guilt for being abused – this must cease. Crimes of sexual and physical abuse are the only ones where the victim is made to feel guilty. Too often, people are given more sympathy over their car being stolen, than a woman whose daily life is threatened by physical and or psychological abuse.
    Ridding our country of this scourge will add billions of dollars free, to be spent on other areas of health. Rather than ignore it or speak in hushed tones, only adds to an already costly and shameful reality for too many women and their children.

  5. Luke S

    very well argued. I normally agree with most of what Bernard has to say but I didn’t on this. It’s important to begin by saying that health isn’t the absence of disease. A salutogenic approach to this topic hinted at by the author in the last para is the pivotal point of distinction.

    Trouble is that ‘well-being’ is hard to measure if it extends beyond reduced contact with the health care system. I’m a health economist and can say that the profession (or at least a significant branch of it) is locked in a rigid, orthodox mindset when it comes to evaluating interventions. These reductionist methods (rg CBA or CUA) are dodgy enough when trying to evaluate the ‘net benefit’ of a certain medicine. Holding all possible factors and variables steady (the ceteris paribus assumption) becomes close to impossible when trying to measure the economic effect of ‘preventive interventions’. My univesity professor used to say ‘it’s better to be vaguely right than precisely wrong’. The studies cited by Bernard are definitely in the latter.

    The other issue here is that ‘preventive intervention’ is an oxymoron. If it’s an intervention it’s not prevention. It makes me laugh reading that cholesterol controlling medication is classed as prevention. It’s a treatment! True prevention in this case would be empowering individuals or groups to lead lifestyles and foster dietary habits that maintain safe cholesterol levels, perhaps with some medical advice. Some may still need cholesterol meds – that isn’t prevention, though. I suspect pharmaceutical companies like to label most of their products as preventive – it’s great for sales.

    We need to move beyond this mindset and accept that true prevention or, preferably, health promotion strategies lie in the very fundamentals of how societies are structured and organised. This goes beyond sanitation adn clean water (at least in developed countries) and reaches straight into the realm culture, social structure – the political economy. There is more and more evidence emerging that a certain type of economies produce happier and healthier people. That’s where the real action is at.

    For starters, however, it would be good if we could eradicate terms like ‘preventive health’ from the medical lexicon…..

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