Advice, or physician counseling, has been advocated as a low cost tool to mitigate the growing costs of diseases arising from life-style choices: lack of exercise, smoking, risky sex, drug and alcohol abuse. Early trials of advice suggested that counseling may have efficacy. Yet differences between control and treatment groups were modest and short lived. Subsequent trials have failed to demonstrate durable results. Efforts to continue studies of advice-based prevention have been sustained by the concept that even small changes in human behavior could provide large decreases in health care costs, and that prevention based on advice was cheap and harmless. Despite a lack of evidence to support counseling programs, Affordable Care Act funds reimburse providers for counseling patients about life-style behaviors. Questions arise whether these counseling efforts misallocate scarce resources. Several strategies that do not depend on changes in behavior have well documented, robust efficacy for injury control.
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