What if we could stop disease from ever occurring in the first place? There is no reason to do screenings for diabetes if not as many people get it or display risk factors for it, just as there is very little reason to provide a prophylactic dose of statins to someone with low blood cholesterol. By making significant society-wide pushes to get people active, eating right, and PREVENTING disease from even manifesting itself, we can incur a significant cost-savings down the road.

Now HOW to do this is a different issue – it’s a Herculean task. But the basic premise is still sound. I realize that prevention takes money out of physicians’ pockets, but perhaps it is the physicians who need to take a look at themselves. Does a healthy population undermine the spirit/status of their profession?

Additionally, increased life expectancy doesn’t mean that one experiences mental decline or decline in physical abilities later. Their problem-solving ability, ability to learn, memory is still declining which makes competing with younger people for jobs difficult. Same about physical strength.

But most people still die between 60 and 80. Those who survive into their 80s and 90s are mostly those with “good genes” – those whose parents also lived into 80s and 90s. Most 70-year-olds are still unable to work. Even if they are able to work, most companies don’t want to hire them. Even if they are still smart or strong (depending on type of job they do), most employers still don’t want them. Try getting a job at the age of 60, then talk about how retirement age shall be indexed to life expectancy.

The normal retirement age must also be indexed to life expectancy and quality of life. Otherwise the financing won’t be there to support the system.

Last time I checked “it is well known” wasn’t exactly a scientific argument. How many things exactly that were “well known” at one time or another before they were proven to be untrue?

OK, let’s take statins as an example, since you mentioned LDL. Yes, treating one high-risk person with statins is cheaper than treating the heart attack in that person (unless the heart attack is immediately fatal). What about treating 50 people for 10 years to prevent a heart attack in one person? 100 people? Based on randomized trials, how many people do you need to treat with statins and for how many years (for PRIMARY PREVENTION) to prevent one heart attack? What about primary prevention in women? What exactly randomized studies say about that?

Or maybe we should do math on some of the screening tests? Ever heard about NNS? False positives? Overdiagnosis?

Can you multiply? E.g. the cost of preventive tests/treatment multiplied by the number of people by years vs the cost of one heart attack or one advanced vs early cancer? Add to it, treating side effects, if any. Or, in case of tests, evaluating false positives and, because of overdiagnosis, treating more people.

Talking about randomized studies, can you show me a randomized study that says that annual checkups in otherwise healthy symptomless individuals save money?

Now you want to impose interventions? Just because you BELIEVE that it’ll save money even if you have no evidence that it will. NO, randomized studies of any of these interventions didn’t include cost saving computations. As to saving lives, while this is a valid argument for recommending an intervention, since when this is a valid argument for imposing it on adults? What if tomorrow new evidence comes out that the particular intervention did more harm than good? Or do you think this never happen? There are no biases in randomized studies, all potentially lethal side effects are known? They never later shown to be wrong?

You talk about science and randomized studies, yet in the same sentence you say that you don’t need to know epidemiology. Tell me, how can you read and understand the studies results if you feel you don’t need to know epidemiology? Especially since you clearly don’t understand either NNT or NNS? Do you understand the difference between relative risk and absolute risk? How about cost-effectiveness and cost-savings?

Pray, somebody tell me that this guy is an exception, and that doctors today actually do learn some epidemiology….

No reason to think these plans are any different.

Hence, it is important to talk about cost savings as these misguided claims can lead to policies that interfere into the decisions that should be between a doctor and a patient.

Prevention makes you live longer (on average). Prevention costs more than non-prevention because (1) you rack up greater incidental health costs as you live, and (2) when you finally get that incurable terminal condition–and you will–your care will still be expensive (barring sudden death of course).

What really matters is whether prevention extends your productive working life (good for the economy and potentially cost-saving) or your less-productive retirement years (bad for the economy and definitely not cost-saving). It's like smoking cessation…the ultimate preventive health service. If patients quit smoking, it's great for employers because there will be fewer sick days among employees <65 years old. But it's bad for the U.S. economy since you now have retirees with longer lifespans _after_ age 65. From a strict economic growth point of view, you want workers who drop dead the day they retire. They pay into national savings and investment and then never make a withdrawal. Smoking comes close to accomplishing this.

Not happy with smoking? Then you probably agree that cost-savings isn't the point. A better goal is probably buying life years when the price is good (i.e,. consuming cost-effective care).