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    Friday, September 4, 2009

    Preventative Medicine - not always a cost saver

    Jason Fodeman writes in National Review Online about the costs of preventative medicine and why it's not always a cost-effective means of treating disease.

    Fodeman writes:

    "At first blush, prevention seems great. Preventing and detecting disease early to save lives and money — sign me up. But, as new research in this week’s Journal of the National Cancer Institute highlights, prevention unfortunately is not as simple as President Obama would like to depict. Two Dartmouth physicians studied prostate cancer diagnosis-and-treatment statistics, starting with the introduction of prostate-specific antigen (PSA) screening."

    This has some meaning to me, since both my grandfather and father had prostrate cancer (both ended up being treated surgically), putting me in a high-risk group for the disease. Because of that, my prostrate screening, including the PSA test, started at age 40, vice 50 as recommended for most men.

    The study concludes that since the PSA test came online in 1987, "an additional 1,305,600 men have been diagnosed with prostate cancer, of whom 1,004,800 have been treated for the disease."

    But, this wonderful preventative measure has an (un?)intended consequence. "Many of these patients were over-diagnosed and over-treated. They were treated unnecessarily for symptoms they did not have and never would have had. Even when employing the most optimistic benefit assumptions, [the study concludes] 'the vast majority of these additional 1 million men did not benefit from early detection.'"

    The point is, while prevention is a wonderful thing, an attempt to sell health care reform by extrapolating savings from "prevention" ignores the additional costs borne by the system from measures such as these.

    As we are seeing, science is enabling us to determine likelihoods of having particular pathologies based on these kinds of tests and even genetic factors. What happens, when we take health care decisions completely out of the hands of doctors and patients and place it in the hands of a single payer government system and its series of boards and councils (who are empowered to control costs, since government will necessarily have to operate within some cost constraints, since Obama won't be president forever), when they have this knowledge?

    You think "death panels" are ludicrous...


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