The Hard Truth: There's No Such Thing as Truly Preventive Services

If only there really was such a thing as a "preventive service."

With all this talk about the Affordable Care Act these last few weeks, the inclusion in the law of "free preventive services" has been billed as a big plus.

The problem is that, except for vaccinations, we're not preventing anything.

We're screening for disease, which means we're often catching it sooner, and therefore, hopefully, nipping it in the bud.

Whether you're talking about mammograms, Pap smears, well-baby exams, colon cancer screenings, blood pressure screening, PSA tests or others, a positive result means that you've got a problem and further tests or interventions will be necessary. Getting tested isn't prevention. Getting a negative result isn't prevention. It's getting tested.

Don't get me wrong. There are a handful of screenings that have shown great benefit ad have saved lives. But we shouldn't fool ourselves. None of the screening tests actually prevent disease.

Yes, disease is better stopped earlier than later, without a doubt. But it's not prevention. It's slowing or stopping disease.

If there were a truly preventive service, it would be worth billions of dollars. We don't have anything like that yet.

We tend to lean too much on the concept of having a health system that provides "prevention." And the risk for us all is simple: if we think checking off our screening tests is our best path to preventing disease, we'll miss the ultimate goal.

The only things we know -- by extensive research -- that prevent or delay disease are behaviors that we ourselves must do. No one can do this for us. Maintain a healthy weight. Get exercise. Manage your stress. Eat a healthy diet. Get plenty of sleep.

Yes, there's counseling (for alcoholism, obesity, smoking), but that's not prevention. That's a form of treatment.

The real challenge for medicine and health care starts when screening turns up a "positive" result. That's because the results of the screenings are sometimes hard to define or understand, we're frequently unsure of whether we should treat the findings aggressively or with watchful waiting, and we're often uneasy about the quality of the diagnosis or treatment plan that follows.

We're using the wrong word and putting'  putting too much emphasis'  -- and possibly too much money -- on'  the concept of prevention --'  especially since it isn't prevention at all.

The bottom line: Early detection, yes. (But remember, it isn't actually prevention).' Adopting a lifestyle that has been proven to help prevent disease? Yes.