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An Ounce of Prevention: The best cure for disease is not getting sick in the first place.

Brey, Robin L. M.D.

doi: 10.1097/
Department: From the Editor


It is infinitely cheaper to prevent a problem or disease than to treat it. This concept is true in many parts of our lives, which is why many of us with cars change the oil regularly. How much cheaper are regular oil changes compared to replacing an engine? The concept is not difficult to understand in relation to cars, so why is it so difficult when it comes to our health?

When you really dig into it, the costs of ill health can be staggering. Considering only cardiovascular disease and stroke, the estimated cost in the United States for 2009 is $475.3 billion, according to the American Heart Association (AHA). These analyses are divided into direct and indirect costs. Direct costs include professional fees, medications, and hospital, nursing home, and home health care. Indirect costs include lost productivity due to disability, and lost societal contributions due to premature death. The National Heart, Lung and Blood Institute broke down these estimated costs (direct and indirect) as follows: coronary heart disease: $165.4 billion; ischemic and hemorrhagic stroke: $68.9 billion; hypertension: $73.4 billion; and heart failure: $37.2 billion.



The AHA estimates that about 80 percent of ischemic strokes (which account for approximately 85 percent of all strokes) can be prevented. Ischemic stroke is the third leading cause of death and the leading cause of disability in the United States. Nearly $46.9 billion could be saved in 2009 if we were universally successful in using all of the preventative measures that are available to us. Perhaps more importantly, 80 percent of expected death and disability due to stroke in 2009 could be prevented.

Some of these strokes could be prevented using medications to treat high blood pressure (hypertension), high blood cholesterol (hypercholesterolemia), diabetes, and abnormal heart rhythm (atrial fibrillation), or through surgery for narrowing of the carotid arteries (carotid stenosis). The costs of these treatments would need to be factored in to our economic analysis. But all of these conditions except atrial fibrillation are preventable—with proper management of certain risk factors for stroke.

The good news is that stopping smoking, eating a healthy diet, getting regular exercise, and limiting excess alcohol all lower the risk for developing heart disease as well, leading to even more bang for your preventative buck! As we report in the story on page 18, there is a relationship between these stroke and heart-disease risk factors and the development of Alzheimer's disease as well. This makes adopting these healthy habits even more sensible.

If you look up “disease prevention,” either online or by going to your local library, you'll see that many diseases are preventable—by cultivating healthy habits, getting vaccinated against infectious diseases, getting regular health screenings, and finding and treating diseases while they can still be cured. As we report in Penny Wise on page 32, many insurance plans provide coverage for preventative care. Many employers have preventative health programs, such as screening for hypertension and hypercholesteremia and access to physical fitness facilities. Take advantage of all of these.

Would you knowingly allow your car to burn up its engine? Probably not. Are you allowing your body to burn up its heart, brain, and kidneys? Well, maybe. Know your disease risks and do everything you can to live a long, healthy, disease-free life.

Tell us what your “ounce of prevention” is and why you started on the road to better health. Did you stop smoking after a doctor visit? Did you start exercising after reading an article in a magazine? Send your story to

My very best,



Robin L. Brey, M.D.


Copyright © 2009, AAN Enterprises, Inc.