Prevention vs. Treatment

Christine Gorman at the Global Health Report blog asked several bloggers who write about global health to take on the subject of treatment vs. prevention. I write about health as a layperson from personal  experience and public policy. Other bloggers writing today on the subject offer professional expertise and a variety of viewpoints.

The news that the malaria parasite has developed resistance to the best new drug formulated to treat it is cause for significant concern. According to reports, malaria along the Cambodia Thailand border shows signs of resisting artemisinin, an extraction from a plant used in traditional medicine.

One of the greatest fears in the malaria community is the resurgence of the disease, something veterans have witnessed before in the not-so-distant past. Malaria was significantly reduced globally in the 1950s only to come back aggressively and with greater resistance when abatement efforts slowed. The failure to contain it through consistent, on-going effort led to an even more virulent and widespread global outbreak.

We are at a key moment in the fight against this disease. It could be the first warning of a drug resistant strain that has the potential to explode into an even greater threat to world health. How will political and  health leaders respond?

They face a key issue, one that has been discussed and debated for a number of years–prevention vs. treatment. The debate isn’t only about malaria, of course, it cuts across the spectrum of health concerns. It’s about an underlying philosophy of funds allocation. Should time, talent and resources be channeled to research, prevention or direct service?

I became involved in the debate more than thirty years ago around another set of issues. The issue I confronted (as a citizen member of a board of directors for a genetic research program) was to support a policy to put more funds into preventive research which, if enacted, would have the effect of redirecting funds away from direct treatment for children with genetic conditions.

It was an agonizing forced choice, one that I’ve since come to believe is short-sighted and even morally indefensible. It posits that funding research, treatment and prevention is not possible.

It’s based on the morally repugnant premise that health care can be reduced to an economic argument. Obviously, research for prevention must be funded. Prevention in the form of immunizations, innoculations, education for lifestyle changes and medications must be funded, and so, too, must treatment. It’s short-sighted to juxtapose these as if they are competitive, or worse, to act as if funding them is a zero sum game. It isn’t.

It’s also worth noting that the drug resistant parasite in Asia can migrate to other regions, and the mosquito carrying it is no respecter of nationality. Thus, threats in one part of the world threaten people across the world.

A few years ago, I wrote of the proposal by Gary Gunderson and Larry Pray to  focus on the leading causes of life. They make the point that focusing on deficits frames the discussion so that it leads to competition for finite resources when we could see the whole constellation of health in a holistic and positive view. Calling this a search for the “leading causes of life,” Gunderson and Pray write we must move forward on all fronts and not try to capture our piece of the pie for one area of work.

The debate about treatment vs. prevention is the wrong debate. The larger issue is about funding those efforts that lead to a healthy, productive future globally, or choosing other paths.

The United States chose the path of profligate spending on war that destroys human life and leaves us less secure in virtually every way–emotionally, financially and physically.

The same politicians who are resisting health care funding are the ones who drove us into the economic ditch that is collapsing on us now. They went along with an off-budget war that will cost 3 trillion dollars while cutting taxes to pay for it and now tell us we can’t devote our precious limited resources to constructive uses. Bob Herbert asks why anyone is listening to them today. Indeed, why?

To debate treatment vs. prevention is to become diverted from the crucial issue–how shall we move forward humanitarian, progressive policies and programs that contribute to global well-being?

Through global partnerships we can carry out research to prevent and treat malaria, and do much more to combat other diseases and health concerns as well. But this will require sustained support for a change in priorities, a change that has begun but will need continuing reinforcement and updating.

With regard to malaria, it’s urgent to continue preventive measures including bednets, training, environmental cleanup, water management and indoor spraying in addition to sustained spending on research and treatment.

Prevention vs. treatment? That’s the wrong debate.

One Response to “Prevention vs. Treatment”

  1. naman January 30, 2009 at 11:40 am #

    thanks for the post – and highlighting the choice as a false dichotomy

    more comments on the ACT resistance news here:
    http://topnaman.com/drug-resistance/containing-artemisinin-resistant-malaria/

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