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June 6, 2007

Priorities to Improve Health Outcomes

Author Affiliations

Letters Section Editor: Robert M. Golub, MD, Senior Editor.

JAMA. 2007;297(21):2346-2347. doi:10.1001/jama.297.21.2346-a

To the Editor: In his Commentary, Dr Woolf1 makes a compelling case for improved distribution of health care resources. However, some of his examples may be overstated. For example, Woolf cites estimates that tobacco use accounts for 430 000 US deaths each year compared with only 17 000 deaths that would be averted by full delivery of some cardiovascular treatments such as β-blockers and warfarin. The problem with this comparison is that it contrasts the effect of completely eliminating a risk factor from the population with the outcome of a specific intervention. The observed outcome of any intervention includes the effect of treatment failures, adverse effects, and nonadherence. The hypothetical elimination of a risk factor accounts for none of these modifiers. Therefore, comparing the total deaths due to a risk factor against the effect of a specific intervention may lead to erroneous conclusions.