Value of Prevention
Preventive medicine may improve overall health and has the potential to reduce health care costs. One of the most dramatic success stories in preventive medicine is the development and widespread use of vaccines. Infectious diseases such as diphtheria, pertussis, tetanus, mumps, measles, rubella, and polio have decreased by more than 99% from their peak number of cases, thanks to the availability of effective and safe vaccines and their widespread use. Furthermore, vaccinations save about $14 in health care costs for every $1 spent.
Preventive medicine also involves screening programs, which have greatly reduced the number of deaths associated with various diseases. For example, cervical cancer, which was once the most common cause of cancer death among American women, has decreased by 75% since 1955 after the implementation of a screening program using the Papanicolaou (Pap) smear. Although most women should have a Pap smear every few years, women at higher risk need to have them more often (see Section 22, Chapter 242).
Efforts on the part of health care professionals to encourage people to adopt healthier lifestyles have not been as successful. The three leading causes of death in the United States--heart disease, cancer, and stroke--are associated with poor lifestyle choices, especially smoking, eating a diet high in fat and cholesterol, and not exercising regularly. Avoiding these risky behaviors could help prevent heart disease, cancer, or stroke from developing. However, the effect that doctors, nurses, and other health care professionals have in getting people to stop or never start these risky behaviors is relatively small. A doctor or other health care professional can explain a person's risk and encourage better behaviors, but only the individual person can do what it takes to change his or her lifestyle.
Although prevention can offer great benefits, it does carry risks of its own. While rare, even such a test as a sigmoidoscopy can cause serious problems, such as a perforated colon. Indirect risks stem from such things as the anxiety and financial burden of having to undergo additional tests to follow up on a test result that incorrectly indicated a person might have a particular disease. Sometimes screening reveals abnormalities that cannot or need not be treated. In such cases, this knowledge may cause anxiety without improving health. Thus, health care professionals aim for balance in providing preventive services, with the focus on selecting people most likely to benefit from intervention.
 See the table Strategies for Preventing Major Health Problems.
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