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December 12, 1986

Is Prevention Better Than Cure?

Author Affiliations

University Hospitals of Cleveland Case Western Reserve University


by Louise B. Russell, 134 pp, $9.95, Washington, DC, Brookings Institute, 1986.

JAMA. 1986;256(22):3161. doi:10.1001/jama.1986.03380220127038

Over the last 30 years, the prevention of illness has received increasing attention. Many Americans exercise more than formerly, have stopped smoking, and have changed their diet. Regarding prevention, former President Jimmy Carter stated that it "can substantially reduce both the suffering of our people and the burden on our expensive system of medical care."

The purpose of this book is to assess the impact of prevention programs on health care costs. Louise B. Russell concludes that, contrary to much popular belief, preventive measures may improve health but "rarely reduce medical expenditures" and "careful evaluation often shows that the full costs are... larger than any savings." While detection of hypertension, for example, uses an inexpensive blood pressure test, the additive costs incurred by the repeated examinations required in screening, by evaluation of cause, and by drug therapy may mount to hundreds of dollars a year per patient.

The message of