To the Editor.
—Dr Eddy1 has written yet another excellent article. To be complete, the following principle should be inserted (probably as No. 3) on his list:Because illness-related productivity losses have the same economic impact on society as direct health care expenditures, it is also valid and appropriate to consider the productivity-related costs of providing or withholding treatment.An optimally healthy workforce bestows a tremendous competitive advantage. This has been recognized by armies since antiquity (disease-related losses exceeded battlefield losses in most wars), by nations (the success of the British navy in part through the use of limes to prevent scurvy), and by modern corporations (which invest in the health of the workforce). While this literature is young and the measures of productivity and productive capacity are imperfect, it appears that for many if not most diseases, the lost productivity costs exceed the cost of medical treatment.2
Anstadt GW. The Productivity Costs of Providing or Withholding Treatment. JAMA. 1994;272(20):1578. doi:10.1001/jama.1994.03520200034029