HEALTHCARE
April 16, 2013

Is Health about Treatment or Prevention?

Researchers tend to study treatments far more frequently than prevention. Is this backwards?

As Ben Franklin famously said, an ounce of prevention is worth a pound of cure. Study after study shows that staying trim, exercising regularly, drinking in moderation, and eating a healthy diet can prevent or seriously reduce the risk of most serious diseases.

But when it comes to so many diseases, the emphasis seems to be on “curing” the disease after it occurs, rather than preventing it in the first place.

For example, diabetes studies are heavily tilted toward treatment rather than prevention. A team from Duke University discovered that 75% of the trials on diabetes, one of the country’s fastest rising health epidemics, tested treatments; and only 10% were interested in preventive measures.

People at either end of the age spectrum were rarely included in diabetes trials. Older people were the focus of studies just 1% of the time and were excluded from studies over 30% of the time even though in 2010 more than a quarter of all people 65 and older were estimated to have had diabetes.

Using a registry of the research studies done on diabetes in the U.S. and in 174 other countries across the globe, the investigators analyzed 2,500 clinical trials conducted between 2007-2010.

Not only were studies heavily tilted toward treatment vs. prevention, most treatments (63%) were medications. Only 12% involved preventive, behavioral methods such as diet and exercise. Many studies followed a small number of patients for just two years or less.

"We don't know what the right ratio of these different types of trials should be, but this is a good starting point for discussion," said study author Jennifer Green in a statement.

There were also some peculiarities when it came to who was being studied. People at either end of the age spectrum were rarely included in diabetes trials. Older people were the focus of studies just 1% of the time and were excluded from studies over 30% of the time, even though in 2010 more than a quarter of all people 65 and older were estimated to have had the disease.

Diabetes trials only focused on those 18 or under about 4% of the time.

"It's important that clinical trials enroll patients who are representative of populations affected by diabetes and its complications," said Green. "Our study is just a snapshot in time, but it can serve as a guide for where we need to focus attention and resources." Since the study registry they used (clinicaltrials.gov) is not required to record information about participants’ race or ethnicity, these factors could not be addressed.

Few studies looked at the effects of diabetes treatments themselves. Diabetes drugs can raise the risk of heart attack, stroke, and mortality in general.

Both the International Diabetes Federation (IDF) and the American Diabetes Association (ADA) stress prevention, since its value in delaying diabetes in people who are at high risk has been proven. Now we have a vivid portrait of the degree to which research on preventing at least one disease is shortchanged in favor of treating symptoms.

Research tends to go where the grant money is. It may be that it is far easier to fund studies of existing or prospective medications than those trying to find ways to get people to engage in the sorts of things that improve health and prevent disease.

The Duke study is published in the journal, Diabetologia.

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