What is Big Think?  

We are Big Idea Hunters…

We live in a time of information abundance, which far too many of us see as information overload. With the sum total of human knowledge, past and present, at our fingertips, we’re faced with a crisis of attention: which ideas should we engage with, and why? Big Think is an evolving roadmap to the best thinking on the planet — the ideas that can help you think flexibly and act decisively in a multivariate world.

A word about Big Ideas and Themes — The architecture of Big Think

Big ideas are lenses for envisioning the future. Every article and video on bigthink.com and on our learning platforms is based on an emerging “big idea” that is significant, widely relevant, and actionable. We’re sifting the noise for the questions and insights that have the power to change all of our lives, for decades to come. For example, reverse-engineering is a big idea in that the concept is increasingly useful across multiple disciplines, from education to nanotechnology.

Themes are the seven broad umbrellas under which we organize the hundreds of big ideas that populate Big Think. They include New World Order, Earth and Beyond, 21st Century Living, Going Mental, Extreme Biology, Power and Influence, and Inventing the Future.

Big Think Features:

12,000+ Expert Videos


Browse videos featuring experts across a wide range of disciplines, from personal health to business leadership to neuroscience.

Watch videos

World Renowned Bloggers


Big Think’s contributors offer expert analysis of the big ideas behind the news.

Go to blogs

Big Think Edge


Big Think’s Edge learning platform for career mentorship and professional development provides engaging and actionable courses delivered by the people who are shaping our future.

Find out more

The Myth of Prevention

August 28, 2009, 2:05 PM

In the raging debate over healthcare here in the U.S., there is one point on which everybody, from Newt Gingrich to Barack Obama, seems to agree: We should be spending more to prevent expensive diseases from striking in the first place, and thereby save society a great deal of money in the long term.

The most costly diseases to treat are chronic non-communicable diseases -- adult-onset diabetes, heart conditions, kidney failure and the like -- because they require more office visits and costlier drugs, administered over a longer period, than do infectious illnesses. And ``lifestyle'' choices -- what people eat, drink and do with themselves -- have a large effect on anyone's probability of getting a chronic disease. If a nation can get people to quit smoking, snacking and lazing around, then that country will have fewer cases of chronic illness. With fewer chronically ill people in future decades, we will face lower medical costs. Win-win for everyone, right?

In fact, this argument is false. Its success is a nice illustration of what happens when people confuse the individual perspective (which comes naturally to the human mind, I think) with that of society as a whole (which is a harder subject to think about).

The problem is this: While it is true that obese people and smokers have higher medical bills per year, they also have fewer years. Money saved by preventing diabetes, stroke and heart attack in the 2020's will have to be spent in the 2050's on people who wouldn't otherwise have lived. In fact, in the long term, the medical costs of longevity are higher than the costs of obesity and tobacco use. A computer model of future health spending in Holland, for instance, has found that the extra medical costs of smokers and obese people in Holland will be offset entirely by their tendency to die sooner than their fellow citizens. Even though the ``bad'' lifestyles cost society more per year, then, over a lifetime, it's the healthy lifestyles that cost society most. ``Obesity prevention may be an important and cost-effective way of improving public health,'' writes Pieter H. M. van Baal of the Netherlands' National Institute for Public Health and the Environment, who led the study, ``but it is not a cure for increasing health expenditures.''

Another example: As Joshua T. Cohen, Peter J. Neumann and Milton C. Weinstein pointed out last year in the New England Journal of Medicine, the cost-saving value of any particular prevention measure ``depends entirely on the particular intervention and the specific population in question.'' Reviewing cost-benefit literature on 599 preventive health measures, they found that a large majority (among them an intensive anti-tobacco program for junior-high kids and the diabetes-screening program that targetted all 65-year-old men) did not save money.

This is not, of course, an argument against prevention programs. Helping people avoid pain, suffering and death is a worthy goal, in and of itself. Just don't claim that it will save us from medical bankruptcy.


The Myth of Prevention

Newsletter: Share: