Let’s say the US magically turned it’s budget deficit into a surplus, and Congress wanted to use the extra money to reduce the rate of coronary disease in the US, which would in turn reduce overall health care costs.
This money could be spent educating the public on what causes coronary disease, such as smoking and obesity, or it could be spent on R&D in an effort to develop better treatments, or it could be spent providing low-cost (or free) testing of the general population in an effort to find people who either have early signs of coronary disease or who have advanced disease and need immediate treatment to prevent an inevitable heart attack.
Based on current technology is there a non-invasive test that could be performed on men and women, say over 40 years old, that would definitively show if they had signs of cardiovascular disease or not? Any guess what such a test would cost on a per person basis?
Would the country save money avoiding expensive emergency surgical treatments by early diagnosis and recommending non-surgical treatment possibilities like exercise and diet restrictions? Or would people just continue to smoke and overeat until they had their first heart attack?
Human nature being what it is, it doesn’t matter how many times you tell people something is bad for them they will keep doing it. Look at cigarettes. Every pack has a warning as to how harmful it is, but it doesn’t make people quit. There’s only so much education can do. It’s good to tell people that a thing they do is harmful so they can make an informed decision as to their habits, but ultimately they’ll do it anyway.
That said, developing better treatments would be a better use of the money. I don’t know how easy it is to test for cardiovascular problems now so I don’t know if there’s a better way. Of course early treatment is way cheaper than stage 4 cancer or heart attack treatments.
Well, I know this is a hypothetical but you might also want to consider all the other diseases, like diabetes, that would be prevented with the same programs.
Let’s generalize it. According to Ben Franklin, “An ounce of prevention is worth a pound of cure”. In this US this would be difficult since we have private health insurance, but in Canada and in the UK and most of Europe the government is responsible for paying for health care.
Has there ever been a program to test the entire population and handle issues that are discovered as a result of the testing instead of waiting for someone to show up in the emergency room? And if not, why not? Wouldn’t it be cheaper and better for everyone in the long run?
We are using at this time a screening tool for risk assessment. It’s basically a series of questions the patient can answer, along with the results of some basic blood tests. This helps predict those at higher risk for a cardiac event within the next 10 years.
But even then, to catch all those folks who are at increased risk, one has to let slip through into the ‘high risk pool’ a lot more folks who won’t have an event.
It’s not really too helpful to do massive testing even of this whole subselected population, since false positives vastly outnumber true positives. And the tests themselves carry a risk, too. CT gives a non-negligible dose of radiation, as do nuclear stress tests. Running someone on a treadmill carries a small risk of provoking a heart attack or a stroke, or even a stumble which can result in injury. Catheterizations regularly result in hemorrhage, stroke, and heart attack.
Basic emphasis on exercise, decent nutrition, and regular checkups for all is probably still the best way to go at this time.
The US Preventive Services Task Force keeps nice track of those routine screenings which do seem to be of some value, for folks in general, and for those with particular conditions or medical histories.
Fixing cardiovascular disease might raise health care costs. Most people generate most of their health care costs when they are old and require more care and, often, institutionalization. A nice cheap heart attack at 62 saves a lot of money. This same effect was noticed years ago in a study on drinking that also included a study on smoking to verify the methods, which found that smokers had lower health care costs. Smokers tend to die early of less expensive diseases.
I don’t know whether there might be enough expensive treatments to change this, but sparing that I’d expect it.
That’s a good point, Napier, but many healthy 90 year olds who spend most of their health care dollars in their last year are going to be cheaper, over all, than an obese diabetic who keeps losing limbs.
Keep in mind, too, that not all cardiovascular disease can be prevented. Approximately half my relatives on my mother’s side had severe cardiovascular problems due to a genetic problem. My generation and those following are screened for it (you either have it or you don’t, and if you don’t you can’t pass it on 'cause you just don’t have the gene). Those affected are getting treated from childhood on, long before overt symptoms appear, yet they are all getting cardiovascular disease in the end. They’re just having the heart attacks, strokes, and blood clots in their 60’s instead of in their 40’s. There is nothing at present that will cure the problem, only delay the onset of severe damage.
But hey, an extra 20 years of good health IS worth something!
That said, yes, where prevention is straightforward and relatively easy it should be done, but I suspect we’ll always have a pool of cardiac patients no matter what we do prevention wise
It’s a common delusion (and one that affects the current Administration) that throwing a lot of money into preventative medicine will save big bucks in the long run.
I don’t see this happening relative to cardiovascular problems, whether we’re talking about nutritional/exercise counseling, getting more people on anti-cholesterol drugs etc. And it’s not going to save money if we vastly increase cancer screening.
As an example, take the recent study which suggested a significant number of lives can be saved if smokers get regular low-dose CT scans to detect malignancy. I don’t doubt some lives will be saved, but at what cost? Here in the Ohio Valley, for example, most of us probably have either enlarged mediastinal lymph nodes or lung nodules which on CT scan would suggest the possibility of malignancy but likely are signs of old infection with Histoplasma (endemic in the area). Do we biopsy all these lesions when they turn up in smokers? That’ll cost a fortune, not to mention the morbidity and potential mortality of the biopsy procedures. Do all the men with elevated PSAs who get prostate biopsies need them? If cancer is found, do we have the knowledge to determine who requires major surgery or other therapy and who can be left alone because their cancers will be slow growing? We don’t.
Greatly expanding comprehensive preventative care in many instances will save lives and/or avoid long-term debilitating disease. But it is NOT going to be cheap, and it will NOT save money. It’ll cost more, probably a lot more than we’re allocating for health care right now.
Those who claim otherwise either don’t understand the situation or are kidding themselves (or us).
Correct me if I’m wrong (I probably am) but aren’t we talking about *secondary *“prevention” here? Tests that "“identify and treat asymptomatic persons who have already developed risk factors or preclinical disease but in whom the condition is not clinically apparent.”? (The U.S. Preventative Services Task Forces’ Guide to Clinical Preventive Services (2d edition, 1996))
It isn’t prevention, it’s early detection. Sure, it may be “preventing” worsening clinical pictures or symptoms to treat it early, but it’s not really “preventing” cardiovascular disease to catch it in a 29 year old. It may be preventing a heart attack (but most likely only delaying it), but it’s not preventing the underlying disease process.
Primary prevention is what **Qadgop **is talking about with “Basic emphasis on exercise, decent nutrition, and regular checkups for all.” Maybe it’s nitpicky of me, but I think it’s an important distinction. We shouldn’t throw polio vaccination into the same discussion as mammograms for 30 year olds with no family history of breast cancer.
True Primary Prevention is a very important part of health care already. I don’t know if we have a dollar amount on it, but if you took every HealthWatch on the nightly news, every issue of Prevention or Eating Light or similar magazines, every health blog, every news website with a health section, every local vaccine clinic, every Weight Watchers meeting, every assembly on Health in grammar school, every poster in every lunchroom extolling the Food Pyramid, every visit by a nurse to a postpartum mom and baby in the first month of life…well, there’s a heck of a lot of time and money spent on Primary Prevention. Many of them have had a huge impact, some none at all.
Where things get dicey, as already said, is not Primary Prevention, but Secondary Prevention, which isn’t really prevention at all…it’s early detection. And that’s actually going DOWN in popularity, as we see the increased costs not just in cash but in emotional and physical stress, as well as increased mortality and decreased quality of life, that aren’t outweighed by reduced disease outcomes. Witness PSA screening and mammogram recommendations being tightened up so that not so many people are screened, resulting in fewer false positives or treatment of slow growing cancer which is asymptomatic until death.
It suggests treating people who have chest pain with a >90% risk of cardiovascular disease as if they have angina, and doing very limited investigations on people with a risk of less than 10%.