BlaineAnd time is money.

     Each IVD industry success in developing an innovative diagnostic test to help prevent disease or detect it earlier, and every expert panel recommendation on appropriate use of those tests raises the same question: how many people will actually get the best tests we have? Inevitably, the answer is “not enough.” Even tests that are proven to the highest level of our scientific ability to save in upstream human and economic costs remain terribly underutilized.

     We’ve long known some of the major barriers to effective delivery of preventive services. Inadequate insurance reimbursement, patient noncompliance and lack of physician expertise in counseling techniques come as no surprise at the top of the list in a study appearing in the April 2003 issue of the American Journal of Public Health. Also at the head of the list: lack of physician time.

     Contrary to popular perception, physicians are spending more time with each patient in office visits than ever before. But if doctors were to follow all the recommendations of the U.S. Preventive Services Task Force they would, by the most conservative estimates, spend an average of 7.4 hours of each of their working days providing preventive services. Where will this time come from when patients have immediate medical problems physicians must treat?

     Finding an effective answer — not to the science of the test but to our will to make it deliverable — challenges our innovation in a different way. Physicians should not have to give up providing one effective service in order to have time to provide another. It takes a team, not just a doctor, to provide the best medical care for wellness and for illness.

     But can we afford to pay for good tests and good teams? We see what’s happening to health care budgets, even though we are the proudest, wealthiest and most technologically sophisticated democracy on earth. It would cost but a fraction of the money to protect our health that we spend on the greatest threats to it, with a far more representative group of beneficiaries. Perhaps the innovation most needed is in reinvigorating the meaning of prevention. It’s about time.

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Ellen Blaine