H. Gilbert Welch [op-ed, July 1] says that "even in middle age, many of us who feel well have evidence of diabetes, heart disease, osteoporosis, hepatitis, vascular disease and cancer. Just because we harbor these early forms of disease doesn't mean that they will ever affect our health." This is untrue.

In fact, diabetes, arteriosclerosis, hypertension, breast cancer, cervical cancer, skin cancer, osteoporosis, etc., if unchecked, have serious health consequences that can often be mitigated by early detection and treatment. This is rigorously documented in the Department of Health and Human Services' 933-page Guide to Clinical Preventive Services, which catalogues the diseases in which solid experimental evidence exists for the success of the intervention approach. It is true that the value of early detection of prostate cancer in older individuals is not established, but this is just one disease and does not invalidate all the beneficial findings in other diseases.

Preventive medicine was a favored political issue in the past. But the major role of third-party payers in medical care; the explosion of effective diagnostic, therapeutic and preventive methodologies; and the realization that effective screening uncovers much early disease that is unrecognized or ignored by the patient (placing a large, new burden on the "health care system") has put prevention in an unfavorable light.

Prevention has been dropped by politicians and now is apparently to be stigmatized as undesirable because of purported conflicted interests of test manufacturers, hospital pharmaceutical companies and some doctors. Welch does not address the clear conflict of interest of third-party payers who have a major interest in containing medical care costs. He deplores "the increased expense of so many more to treat," but one of your paper's readers might end up in the "so many more to treat" group whose unrecognized high blood pressure is at risk of a stroke.

Increased medical care costs are primarily the result of the extraordinary success of medical research in the last half of the 20th century. Ways of dealing with the cost associated with this medical bonanza and its technology are an important topic for discussion by society, but playing down the real and documented benefits of preventive care is not an acceptable option.

-- Jack M. Gwaltney Jr.

Charlottesville

The writer is professor emeritus at the Department of Internal Medicine and head emeritus in the Division of Epidemiology and Virology at the University of Virginia School of Medicine.

*

"Dangers in Early Detection" did not give enough credit to the value of life-saving screening technologies and the importance of people taking an active interest in their own health.

My 62-year-old husband recently received a new CT heart scan that turned out to be abnormal. Although he was asymptomatic, the results prompted his doctor to order another procedure called a cardiac catheterization, which found three major blockages in his coronary arteries. In short, my husband was a heart attack waiting to happen.

If my husband's physician had subscribed to the author's line of reasoning, he would have advised my husband to hold off on the screening until he experienced chest pains or shortness of breath. Such advice could have cost my husband his life. Instead, the doctor inserted three stents to keep open my husband's arteries. He returned home the next day and was back at work two days later, resuming his life as a husband, father and businessman with no physical restrictions.

Admittedly, some unnecessary screening tests always will be done. But it is tough to argue that too much information is bad for patients and society. Early detection saves lives and helps reduce health care costs by eliminating the need for many complicated and invasive therapies.

-- Pamela G. Bailey

Washington

The writer is president of the Advanced Medical Technology Association.