The Weight of an Ounce

An ounce of prevention may seem a heavy load for the already overburdened, costly US health care system. But as health reformers somewhat wishfully argued during the 19th century, the road to wellness, although a lifelong journey, holds benefits along the way for those who seek prevention before they have to seek cure. The present generation has seen evidence of what those earlier reformers could only allege: that positive effects of prevention are sometimes just around the bend. The past two decades have witnessed dramatic declines in death rates for heart disease (51% reduction) and stroke (60% reduction).1,2These vast improvements in the nation's health are attributable to medical advances and nationwide changes in specific risk factors that were identified through epidemiologic research and addressed through population-based interventions.3-5. See also p 1123. Prevention works, then. But in this era of fiscal belt-tightening, the question arises, "At what cost?"