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Prevention's Underinvested, Yet Fails to Save $

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Curative, Preventive and Now Precision Medicine Will Consider Individual Variability

Medical research has largely been focused on curative medicine–"medicine yielding better drugs, medical devices, and clinical procedures. [Where as] Prevention science—the systematic application of scientific methods to the causes and prevention of diseases in populations—has yet to receive the necessary investment and support required to reduce the growing burden of largely preventable noncommunicable diseases (NCDs)."[1]

Yach D, Calitz C. "New Opportunities in the Changing Landscape of Prevention." JAMA Network, Viewpoint | July 17, 2014 [Free]

[1] Fineberg  HV.  "The paradox of disease prevention: celebrated in principle, resisted in practice." JAMA. 2013;310(1):85-90.

See also, Vence L. Bonham., Shawneequa L. Callier, and Charmaine D. Royal. "Will Precision Medicine Move Us beyond Race?"  N Engl J Med 2016; 374:2003-2005May 26, 2016DOI: 10.1056/NEJMp1511294  where it says: "Precision medicine is premised on the idea of improving health outcomes by generating and using many sources of personal data to more accurately group and treat patients. If the major challenges can be overcome, precision medicine could lead the way in reducing and ultimately eliminating the use of crude racial and ethnic census categories in drug prescribing.... [But] There are many hurdles to overcome if a precision medicine approach to health care is to replace the use of race in treatment decisions. First, greater inclusion of patients of diverse ancestry in genomic and other biomedical research can improve understanding of intrapopulation and interpopulation diversity....Rising costs present a second major challenge to precise drug prescribing....prospective cohort studies will help establish an evidence base regarding the effectiveness of drugs for individual patients — and thereby advance equitable distribution.....Third, moving the drug-selection process beyond race to more accurate indicators of drug response will depend on the ease and usefulness of implementing a precision medicine approach."


Does Preventive medicine or efforts save money, net?
The notion that there will be savings in health care costs from affording expanded, more accessible, universal health coverage "makes intuitive sense, but it’s not backed up by research." Affording people health insurance can enable them to get preventive care and this form of medicine is less likely to be dis-incentivized by cost-sharing (e.g., co-payments, large deductibles, co-insurance for procedures, etc.). “You might expect health spending to jump initially, then slow in future years as people benefit from new prevention. But research shows that even preventive care rarely ends up saving money”

Trying to justify or support the ‘investment’—‘Numbers Needed To Treat’

“For the individual patient whose heart attack is prevented by a cholesterol screening, to give one example, that blood test is a cost-saver. But to prevent one heart attack, the health care system has to test hundreds of healthy people — and give about a hundred of them cholesterol-lowering drugs for at least five years. Added together, those prevention measures No, Giving More People Health Insurance Doesn’t Save Money" by Margot Sanger-KatzNY Times, August 07, 2015, The Upshot - "Conventional Wisdom Clashes With Data on Health Care Savings"  


Definitions

Primary, secondary, tertiary and quaternary prevention levels: 

Level

Definition

Primary prevention

Primary prevention strategies intend to avoid the development of disease. Most population-based health promotion is primary prevention.

Secondary prevention

Secondary prevention strategies attempt to diagnose and treat an existing disease in its early stages before it results in significant morbidity.

Tertiary prevention

These treatments aim to reduce the negative impact of established disease by restoring function and reducing disease-related complications.

Quaternary prevention

This term describes the set of health activities that mitigate or avoid the consequences of unnecessary or excessive interventions in the health system.

Wiki


In President Barack Obama's, State of the Union Address, January 20, 2015, he "announced a research initiative that aims to accelerate progress toward a new era of precision medicine....

The proposed initiative has two main components: a near-term focus on cancers and a longer-term aim to generate knowledge applicable to the whole range of health and disease. Both components are now within our reach because of advances in basic research, including molecular biology, genomics, and bioinformatics. Furthermore, the initiative taps into converging trends of increased connectivity, through social media and mobile devices, and Americans' growing desire to be active partners in medical research....

Such a varied array of research activities will propel our understanding of diseases — their origins and mechanisms, and opportunities for prevention and treatment — laying a firm, broad foundation for precision medicine. It will also pioneer new models for doing science that emphasize engaged participants and open, responsible data sharing. Moreover, the participants themselves will be able to access their health information and information about research that uses their data."

Collins, S, Varmus H."A New Initiative on Precision Medicine." N Eng J Med  Jan. 30, 2015.

See also,  "Precision Medicine — Personalized, Problematic, and Promising"

"The terms precision, personalized, and individualized medicine are often used interchangeably. Many physicians contend that they have always practiced individualized and personalized medicine. We agree and, for this reason, prefer the term precision medicine to emphasize the new aspects of this field, which is being driven by new diagnostics and therapeutics. We define precision medicine as treatments targeted to the needs of individual patients on the basis of genetic, biomarker, phenotypic, or psychosocial characteristics that distinguish a given patient from other patients with similar clinical presentations. Inherent in this definition is the goal of improving clinical outcomes for individual patients and minimizing unnecessary side effects for those less likely to have a response to a particular treatment."

Jameson JL, Longo DL. "Precision Medicine — Personalized, Problematic, and Promising." N Engl J Med 2015; 372:2229-2234June 4, 2015DOI: 10.1056/NEJMsb1503104