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Saturday, August 22, 2009

A new Preventive Medicine blog; who needs it anyway?

Preventive medicine, also called preventive care (my preferred way of calling it), refers to the steps taken to prevent illness or injury. In addition to the public health prevention programs aimed mainly at vaccinations, there are two main aspects of preventive care, primary and secondary.

In primary care, one tries to identify the risks you may have for the development of acute or chronic disease. These risks are assessed from knowledge of your lifestyle, environment and family history, and also on the basis of the physical findings and laboratory tests you may undergo at your physician’s office.

Based on your health risk factors, a program can be developed to help you reduce these risks, so that the likelihood of disease is decreased. A simple, but very important, example is smoking. The risks are well known: heart disease, chronic lung disease, lung cancer, and many other. And the preventive intervention is well known too. Quit, in time. Don’t start. Other risk factors are much more subtle or less well known. Did you know that the presence of the KIF6 protein in blood is associated with an increased risk for heart attacks, and that certain medications can reduce this risk? (If you didn’t, don’t be disappointed, I only learned about it recently…).

Secondary care is the early detection of disease, before symptoms occur or before the disease becomes chronic or otherwise incurable. This is the reason why women get periodic pap smears and mammograms, men have a prostate examination, and both have periodic colonoscopies.

But you probably already know much of this, so why am I stressing prevention here?

Prevention is not only what your doctor can do for you. Much, if not most, of primary prevention relies on things you can do for yourself. This is particularly important in the US today, when the cost of medicine is skyrocketing and healthy lifestyles are frequently taking a back seat, and where the environment is becoming continuously less friendly (yes, that does include some of the bad stuff we’re eating).

It’s been said again and again that “we have the best medical system in the industrial world.” In many respects this is true. We have some of the best physicians here, and more of the sophisticated diagnostic and treatment facilities than anywhere else in the world. People do come to the US for treatment; they don’t usually leave the US for better treatment elsewhere.

But look at longevity. If we’re so good, we should be number one! But number one is not the US. It’s little Andorra with an average life expectancy of almost 85 years. The US is not at the bottom; it shares a very humble 33rd place with Cuba. You draw the conclusions.

In industrialized countries, the main reasons for the differences in longevity are diet, use of tobacco, and access to medical care.

A little more emphasis on prevention, by the medical profession, by every individual and by the government, will go a long way toward increasing health and longevity, and will save trillions along the way.

I’ll cover the obvious and much of the less obvious things that can be achieved with the practice of prevention in subsequent segments.

Health care reform, in one way or another, is coming. I’m not here to fix the blame on any entity (yet…), but this has been brought upon us because the system of which we were so proud is rapidly breaking down. There is no way to know what shape medicine will take in the next few years. Will it become a single payer system, will some form of free market be preserved or will there be serious rationing of care? Will it answer your needs? But of one thing I am certain, that if we don’t push for prevention at full throttle, it would not matter at all, the system will fail.

Please give me your comments, your experiences, your successes and frustrations. We can all learn from each other and do our best to enjoy a longer healthier life…


  1. We will strengthen your hands, after all we are all in the same boat.

  2. No doubt, preventive medicine is the way to go. However, how can we possibly address America's addiction to high fat, simple carbohydrate foods, or even to soda pop. Diet soda is arguably even worse than the 17 teaspoonsful of sugar in every 12 oz can of regular soda.

    Which is to say, where is there a force that can possibly conter the millions in advertising and media control exercised by the big food corporations?

    Oh, and by the way, an interesting book by my next door neighbor just came out: Shock Therapy for the American Health Care System

  3. There's no question that preventive medicine, which includes early detection, is the way to go (please help all of us convince congress and the HMO's...). It not only helps you live a healthier life, but it is the easiest and safest way to decrease the cost of medicine. It will not be easy to curb big business advertising of fatty, sugary food. What can change the behavior of the processed food manufacturers is a change in the way we buy food, concentrating on the healthier products. And this takes a lot of will power and education, both on our part and that of our children.
    To answer the question about sweetened drinks versus diet sodas: I would still take the diet soda over the sugar sweetened (or high fructose sweetened)soda. But remember that the drink of champions does not come in a soda bottle, it's simple H2O.
    I. Staw, MD


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