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Is prevention better than cure?

A comment from Oscar H. Franco, on behalf of the EACPR Prevention, Epidemiology and Population Science Section

Coronary Mortality Declines in the U.S. Between 1980 and 2000: Quantifying the Contributions from Primary and Secondary Prevention
Fiona Young, MRes, Simon Capewell, MD, Earl S. Ford, MD, Julia A. Critchley, DPhil
Newcastle University, University of Liverpool, United Kingdom and CDC, Atlanta, USA
Read the abstract


"Prevention is better than cure" wrote the great Dutch scholar Desiderius Erasmus during the 15th century. Intuitively, that to avoid and contain is preferable to repair seems very reasonable. Nevertheless, in the current era, medical decisions most be based on evidence and whether prevention is definitively better, more effective, more efficient and more cost-effective deserves careful evaluation.

British and American scientists evaluated the accuracy of the old adage by aiming to quantify the contributions of primary (in asymptomatic individuals) and secondary (coronary heart disease patients) prevention in the reduction on coronary mortality experienced in the U.S. between 1980 and 2000. Young et al, calculated that approximately 316,100 fewer deaths were attributable to risk factor declines (79% and 21% for primary and secondary prevention respectively and equivalent to half of the decline observed) mainly due to reductions in cholesterol, blood pressure and smoking. 

Irrespective of the inherent assumptions used by the authors and the specific geographical and chronological characteristics of the population assessed, this article adds further evidence to the 500 year old axiom and emphasizes the importance of prevention in the process of improving and maintaining adequate levels of health in the population.