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July 21, 1993

Preventive Medicine: What Does It Prevent?

JAMA. 1993;270(3):320. doi:10.1001/jama.1993.03510030043020

To the Editor.  —Dr Leaf's1 goal of a better quality of life through preventive medicine can hardly be contested. Current opinion holds that limiting smoking and obesity alone would prevent several hundred thousand premature deaths yearly. But I question his supposition that we can save money, under American tradition, by preventing premature deaths.The present costs to the health care system are negligible for the 300 000 Americans he notes who die annually of myocardial infarction before they reach a hospital. If these unfortunates were to live a normal life span, one can assume that they would suffer the normal incidence of colon cancer, breast cancer, lymphoma, cataract, hearing loss, degenerative arthritis, and other expensive afflictions of the elderly. Leaf proposes that "medical care will be freely provided for those conditions for which careful studies establish the likelihood of favorable prognoses." It seems almost axiomatic that the more old