Prevention vs. Treatment?


A recent post by Ezra Klein of The Washington Post seems to call into question the utility of preventative measures as compared with treatment of advanced disease states.

Klein quotes a book called “Prevention vs. Treatment” edited by Haley Faust and Paul Menzel, specifically a chapter written by Louise Russell who in turn “draws heavily on research” done by Joshua Cohen, who along with three co-authors appears to have rolled up evidence from “hundreds of studies over the past four decades”.

(How many times can one person’s original work be repackaged by others? Good grief!)

The centerpiece of Klein’s post seems to be the following chart, originating from Cohen et al:

The chart specifically states that it shows a distribution of cost-effectiveness ratios of various prevention and treatment strategies for different disease states, presumably “hundreds” of them. It absolutely does not show pairwise comparisons between specific treatment and prevention strategies as substitute goods within the context of particular disease states. Perhaps one of the editor-authors misunderstood the rather obvious symmetry between the prevention and treatment distributions to imply that prevention and treatment are roughly cost-equivalent. Oops.

Full disclosure: I have not read Cohen’s original work, nor any of the derivative works mentioned above. But from what I have inferred about the study design (a meta-analysis of published QALY data from hundreds of different prevention and treatment studies over four decades), it’s simply impossible to use such a study as the rational basis of an argument about the relative merits of treatment vs. prevention in general.

The debate over healthcare policy is complex enough without having to sift through heavily-repackaged summaries of summaries of other people’s research. Didn’t we learn enough about the perils of repackaging from subprime CDOs? My gut tells me this one doesn’t deserve a AAA rating.

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