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Beyond Observations

Arch Intern Med. 2006;166:486.

	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

A stitch in time saves nine. The proverb's meaning is obvious: catch something early and you save lots of trouble and expense down the road. This thinking has often been applied to various preventive measures, including screening programs that detect disease in a preclinical state. It seems obvious that such efforts would, indeed, save trouble and costly treatments down the road, but the evidence that preventive medicine is efficacious and cost-effective is not as strong as most people might think. Prevention has an intuitive appeal that seems self-evident, and thereby often escapes the scrutiny of evidence-based medicine.

The arguments of "believers" of prevention are based on (1) the principles of presumed cost saving associated with prevention (much of which is unknown or already known to be incorrect—except for vaccination and sanitation programs, prevention is mostly an expensive endeavor); (2) the potential role of prevention in breaching the quality chasm and . . . [Full Text of this Article]

AUTHOR INFORMATION
Patrick G. O’Malley, MD, MPH, Deputy Editor; Philip Greenland, MD, Editor

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