The costs of prevention

Not necessarily better than cure

To many doctors it seems fundamentally wrong to let people become ill before intervening when it would be possible to take effective action at an earlier stage—for example, by screening. Delayed intervention results in avoidable suffering and possibly a much poorer prognosis. People are also willing to believe that screening is a good investment, whereby costs are incurred now to avoid greater costs in the future. This faith in early action is part of folk wisdom, captured in aphorisms such as “a stitch in time saves nine.” In short, there is a widely held view that prevention is better than cure.

If women aged 65-69 are not routinely screened for breast cancer, or are screened every three years rather than every two years, some will not receive care that would benefit them. However, the view that it is wrong not to benefit a …