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May 15, 1996

Will Altruism Endanger Prevention?

JAMA. 1996;275(19):1463-1464. doi:10.1001/jama.1996.03530430007003

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IT'S AN IRONIC twist that could jeopardize the future of public health and prevention.

In an era when the bottom line and managed care concepts increasingly drive the provision of medical services, prevention in some quarters still is regarded as a somewhat selfless write-off rather than part of a cohesive business plan.

"The evil word is altruism," said Thomas J. Chapel, MBA, technical director of Macro International Inc, an Atlanta, Gabased evaluation research firm. "I'm in the unfortunate position of saying people are bad for being good."

Chapel's firm, commissioned by the Centers for Disease Control and Prevention, studied 8 health care organizations primarily in the Midwest and Northeast. The project attempted to pinpoint how and why the organizations provide preventive services and, in some instances, privatized public health functions.

"Altruism, 2 to 1, drives what these folks are doing," Chapel said during this year's annual meeting in Dallas, Tex,