Prevention not always a cure-all

Doctors tout it. So do hospitals and insurers. Politicians, including the president, also are increasingly praising prevention — and not just for good health, but as a way to curb America's massive spending on medical care.

Prevention, however, may not be the savior.

It still has a cost. A month's supply of the popular cholesterol-managing drug Lipitor, for example, can hit as high as $140.

And prevention sometimes is spread so broadly that patients receive treatments and screenings for conditions that would never affect them.

In the end, some researchers say, costs for prevention often offset or surpass the savings of keeping people out of the hospital. The key, they say, is to get pills, screenings and other treatments to those most at risk because of age, family history or other factors.

The role of prevention is just one topic being debated this month as Washington politicians gather public comments before taking up the competing proposals for overhauling U.S. health care.

To be sure, nobody is suggesting prevention isn't worthwhile for your health. It can help people lead longer, more robust lives. One national report suggested that two simple forms of prevention — exercise and eating right — can produce savings in health care costs.

But the growth over the past 30 years in the variety and broad use of health screenings and drugs has reduced the cost effectiveness of prevention, said Dr. Donald Frey, vice president for health sciences at Creighton University. Armed with new forms of prevention, doctors try them on patients, who sometimes demand them.

Spending for prescription drugs hit $217 billion in 2006 — more than five times the amount spent in 1990.

Part of the problem is that no one knows which people with high blood pressure, for instance, will suffer heart attacks or strokes and which won't, said Louise Russell, a research professor in the Institute for Health at Rutgers University.

So some doctors give blood pressure medication to most everybody, whether their blood pressure readings are slightly above normal or way above.

“We can't identify that (victim) in advance,” Russell said. “We only can identify people who are at risk.”

Screenings also raise questions about payoffs. The two screenings that are used for prostate cancer can produce false positives, which might lead to additional costly testing.

An analysis published last year in the New England Journal of Medicine said: “Although some preventive measures do save money, the vast majority reviewed in the health economics literature do not.”

The analysis involved a review of 599 studies on the cost effectiveness of prevention, said Joshua Cohen, a co-author of the analysis and a faculty member at Tufts Medical Center in Boston.

Dr. Steven Woolf, a health services researcher at Virginia Commonwealth University, questioned the results of the analysis. He said it includes obscure preventive steps such as a screening for a rare enzyme disorder in newborns. By including screenings that are not widely used or recommended, the analysis waters down the overall ability of preventive steps to control health care costs.

Woolf said screens such as mammograms and colonoscopies can help slow the growth of health care spending.

Weight loss is among the other preventive steps that can save on health care costs, according to a report last year by Trust for America's Health, a nonprofit group focusing on prevention.

The report suggested that an investment of $10 per person per year in proven nonmedical prevention programs could save the country more than $16 billion in annual health care costs within five years.

The report said that would be a return of $5.60 for every $1 spent on prevention.

The conclusions are based on a review of 84 studies of prevention programs that met three factors: The programs did not require medical treatment; they targeted communities rather than individuals; and they were shown to reduce disease through exercise, better nutrition and prevention of smoking and other tobacco use.

Frey, a family practice physician, said he tries to avoid prescribing drugs and other treatment if he thinks a medical problem could be addressed through weight loss, exercise and similar steps.

Because cholesterol slightly above the recommended level is common, Frey advises weight loss, not taking drugs, if a patient has no other risk factors for heart attack or stroke.

Getting patients to drop some pounds can be tough. He recalled a man who tried to lose weight to reduce his cholesterol but just couldn't shed the pounds.

That changed when the man ended up in the emergency room with chest pains — a great motivation to lose weight.

Frey said some doctors are too quick to prescribe drugs because their large patient load prevents them from providing adequate follow-up and counseling to help with weight loss.

Rosalee Yeaworth of Omaha is trying to lose weight to lower her blood pressure, and it's not easy. “There's not a flavor of ice cream I don't like,'' she said.

She switched to 1 percent milk, eats low-fat yogurt and joined a health club.

She pays about $70 per month out of pocket for medicine to control her high blood pressure. The 80-year-old retired nurse said if she lost about 25 pounds, her blood pressure would probably return to normal and she could skip the medication.

The cost of the drugs takes away funds she'd rather use for travel, including a winter trip to Florida, said Yeaworth, retired dean of the College of Nursing at the University of Nebraska Medical Center.

“I'm sure I could find fun ways to spend the money,'' she said.

Frey said patients and their doctors must work together to find what will be most effective.

“It's very much teamwork.”

Contact the writer: 444-1122, michael.oconnor@owh.com

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