To the Editor.
—Dr Leaf1 raises some important points in his article concerning the role of preventive medicine. He is right on target when he comments that preventive medicine is grossly underemphasized in both medical education and medical practice. However, I found his argument that prevention will save money unpersuasive.Preventing disease involves risks (which are rarely mentioned) as well as benefits. Even when financial costs of preventive measures look small on a per-person basis, careful evaluation often shows that the full costs in the treated population are larger than any savings. Costs are incurred at each step of detection and treatment. These costs include the cost of the screening test or treatment regimen itself, drugs, visits to physicians, and laboratory tests. It also includes treating any side effects as well as the cost of medical care in the years of life added by successful prevention. The accumulation of