Art as Therapy

Tuesday, April 15, 2008

David Brown's story "In the Balance" [April 8], exploring how the cost of preventive care, contrary to public perception, often exceeds that of treating disease, prompted lots of reader response. Here is a sampling:

The story and the studies it cites seem to ignore some important considerations:

1. Death isn't the only endpoint. Morbidity comes earlier to patients who receive less preventive care. Sick patients cost a lot of money. Preventive care can delay illness even when it doesn't delay death. The costs related to early morbidity are enormous.

2. Real prevention begins with lifestyle change and early education. Any costs of lifestyle change are incurred by individual patients and not the government. Likewise, early education can be incorporated into existing curricula and will not cost the federal government much, if anything.

Charles diPierro, MD

Charlottesville

You use only one side of the economist's balance pan: Yes, to live longer, you cost society more. But you contribute more in exchange, by being with grandchildren, volunteering, spending down a pension into the economy, growing a garden, etc.

By the extension of your logic, you're saying, "First thing, let's kill all the retirees."

Norbert Hirschhorn, MD

London

Your article changed my thinking on the value of public health initiatives. For over 20 years, I was a public health nutritionist, working with the Women, Infants and Children nutrition program toward such goals as reducing the incidence of low birth weight in babies.

Studies consistently showed that WIC saved over three dollars for every dollar spent on the program and improved the outcome of babies' birth weight and other health issues among the clients we served. Without reviewing the literature, I automatically extrapolated WIC's success to other public and private disease prevention activities. I am embarrassed by my simplistic thinking.

Nancy Hatch

Denver

While it may sometimes be true that prevention costs more than treatment, we should not be reduced to perceiving health benefits only in terms of the cost of investment. Instead we must consider the value of our investments in health to individuals as well as to society.

In considering costs to society, we need only look at the employment sector to see the need for and success of prevention. Promotion of healthy behaviors and preventive services among employees lead to reductions in health risks while increasing worker productivity. That's why employers, who tend to be more careful about spending money than the government, are shifting their employee health care investments upstream.

Clarifying what we mean by prevention is a necessary and useful exercise that helps us demonstrate that prevention increases the overall value of our health investments. The bottom line is, prevention works.

Michael D. Parkinson, MD

President

American College

of Preventive Medicine

Washington

Art as Therapy

"You Gotta Have Art" [April 8], about the use of art in medical treatment, uses the term "evidence" in a way that may create misunderstanding.

Saying there is "no evidence" for the efficacy of art therapy suggests studies have disproved it. What you mean is that existing studies don't yet meet the most rigorous scientific standards.

"Anecdotes" can also be described as "clinical evidence." The article's conclusion describes someone's "faith" in the approach. "Faith" would be the right word only if someone persisted in believing after studies had disproved it.

Elizabeth Wilson

Washington

Assume the Squat Position

In the "Misfits" column ["Exercise Is Nothing to Sneeze At," April 1], you give credence to a pervasive myth about biomechanics when you say: "That's why the cardinal rule of squats is to never let your knees pass in front of your toes."

Notice your knee position relative to your toes the next time you squat down to tie a shoe, pick up something you dropped (especially if it happens in mid-stride while walking) or any number of other movements that are a natural part of life. Our knees can safely travel over our toes, as they were designed to.

If you're squatting 200 pounds on your shoulders, then the knee position becomes more critical and should stay behind the toes. But without an external load (as when dealing with our own body weight), there simply is no concern about the knees going over the toes.

Jonathan Ross

Personal Trainer

Aion Fitness

Bowie