Prevention Versus Cure: Use of Resources in the National Health Service

One way of addressing this subject would be, like Freymann (1974), to assume that any ‘versus’ between prevention and cure stems from a fundamental discordance between curative medicine and public health, and proceed to analyse, as he did in the USA the reasons for such a discordance. Another approach would be to attempt to weigh the advantages brought by high technology clinical medicine against those that would be gained if the same resources were invested in a preventive programme. I am not properly qualified to attempt this even were suitable data available, and I am reluctant simply to dismiss ‘high tech’ anyway. The only procedure based upon it I have studied at first hand (with colleagues) is cardiac transplantation (Buxton et al. 1985). This operation is only offered to patients who have been considered unsuitable for coronary artery by-pass graft and all other forms of therapy and who are not expected to live for more than six months. Our analysis showed that the expectation of life for 94 per cent of a comparison group of 70 for whom no organ was available, was six months or less as anticipated, but 50 per cent of those receiving a new heart could expect to live for at least five years. Whereas at the time they were put on the waiting list for the operation only 11 per cent were employed, subsequently 57 per cent had jobs and a further 23 per cent were actively seeking them. On the basis of these facts it is reasonable to consider it to be an outstandingly successful operation.