WPH Voices from around the World Focus of medical care: Wellness, not illness The time has come to abandon disease as the focus of medical care. The changed spectrum of health, the complex interplay of biological and nonbiological factors, the ageing population, and the interindividual variability in health priorities render medical care that is centered on the diagnosis and treatment of individual diseases at best out of date and at worst harmful. A primary focus on disease may inadvertently lead to undertreatment, overtreatment, or mistreatment. - M.Tinetti and T. Fried, The American Journal of Medicine 2004; 116 : 179 – 185. Screening industry unplugged Simple minded enthusiasm for screening — combined with the industrial opportunity to make fat profits — may mean that soon none of us will be normal. Richard Smith, British Medical Journal 2003; 326. Evidence supporting the high risk approach for preventing cardiovascular disease is disappointing. The strategy has low effectiveness and is associated with high cost, residual risk, medicalisation, and increasing inequalities. Whole population approaches are cheaper and more effective. - Simon Capewell, Will screening individuals at high risk of cardiovascular events deliver large benefits? NO. BMJ 2008;337: a1395. We're part of the non-linear system Linear thinking in a non-linear system will lead to misleading conclusions. Doctors are predicting the unpredictable future of man by studying a few of his phenotypic features that will never come true! - W. J. Firth, Chaos - Predicting the unpredictable. BMJ 1991;303:1565. Prevention is better than cure Slowing the growth of Health Care Costs – Learning from International Experience High health care expenditures and growing number of people without health insurance set the United States apart from all other industrialized countries… The United States has been slow to learn from countries that have systematically adopted policies that curtail spending and enhance value. Policy options and their projected 10-year impact on spending Promoting health and disease prevention Promoting public health: reducing tobacco use (through new taxed invested in prevention programs). - 191-68-35-39-49 Promoting public health: reducing obesity (through new taxed invested in prevention programs) -283-101-52-57-73 Instituting positive incentives for healthy behavior (through federally funded wellness programs -19 2 -12 -4 -5 - Karen Davis, N. Engl. J. Med. 359:17 Oct. 23, 2008, 1751-54. www.nejm.org