VCU Research Physician’s Commentary Published in Journal of the American Medical Association

By Anne Buckley

The United States invests medical attention and resources in disproportion to the ability of the interventions to do good, leading to greater disease and deaths, a Virginia Commonwealth University physician wrote in today’s issue of the Journal of the American Medical Association.

“Many choices in clinical practice, policy and research end up concentrating resources on interventions that do less for health while shortchanging alternatives that would save more lives,” wrote Steven H. Woolf, M.D., professor and director of research in VCU’s Department of Family Medicine and a member of the National Academy of Sciences’ Institute of Medicine.

In the commentary piece, Woolf outlined four areas of practice and policy in which reordering priorities would be helpful toward maximizing interventions: choosing effective services; delivering care; preventing disease; and fostering social care.

Woolf wrote that the most effective interventions to achieve the main goal of medicine — to help patients live longer in good health — do not always receive commensurate priority in practice. For example, he writes, regularly offering counseling to help patients quit smoking cigarettes would save society an estimated 1.3 million “quality-adjusted life years,” or QALYs, whereas improved breast cancer screening would save an estimated 91,000  QALYs. 

“A health system that ignores these differences and concentrates on mammography screening with little attention to smoking cessation can expect progress in reducing breast cancer, but ultimately more of its patients may die (of smoking-related diseases),” Woolf wrote.

In terms of delivering care, Woolf wrote that improving the fidelity with which health care treatments are delivered would improve outcomes. 

“Society invests heavily in medical advances (e.g., breakthrough drugs and technologies), but such advances hold little promise for improving health if patients cannot receive them,” he wrote.

In addition, Woolf writes that preventing disease is crucial to improving the nation’s health and economy. He points to an aging population, longer life spans in which chronic diseases can progress and increasing costs to care for those illnesses as great motivation for prevention.

“The inevitable outcome — a large population of seniors with costly chronic diseases — threatens the solvency of the Medicare program and the capacity of hospitals and clinicians to provide effective care.”

Four predictors of chronic disease are smoking, poor diet, physical inactivity and alcohol use, Woolf writes. Citing hundreds of thousands of deaths attributable to such behaviors each year, Woolf says that a strong case can be made for prevention, “perhaps more than in treatment, but reverse priorities prevail.”

Finally, Woolf writes that the health of the poor and of minorities is markedly worse than for others, and that “closing so wide a gap has the potential to save more lives that the modest year-to-year reductions achieved incrementally by biomedical advances.”

The commentary in its entirety can be found at http://jama.ama-assn.org/cgi/content/full/297/5/523.