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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…

Twitter / Dr. Staw