Tuesday, January 13, 2009

Prevention Efforts Must Go Beyond Early Detection

“Whenever you discuss how our health care system needs to change, someone is sure to call for an increased emphasis on prevention. But what does prevention really mean? When I was a graduate student at Stanford University in the early ’90s, one of my teachers was a physician and prominent public health expert who also was assisting then first lady Hilary Clinton as she chaired the president’s health care reform team. One day, when the doctor had just flown back from the White House, he conveyed to the class his frustration with how things were proceeding because prevention was being relegated to merely mean early detection. All the students understood why he was peeved: Mammograms, pap smears, prostate exams, cholesterol laboratory tests and many other diagnostic assessments — though valuable for the data, they afford us — are not primary prevention efforts. Primary prevention does not attempt to detect diseases early so treatment can be effectively given. Primary prevention attempts to prevent diseases from ever occurring. Usually, this involves helping people change their lifestyles. Just a few examples of primary prevention include drug and tobacco cessation classes, fitness training, psychotherapeutic counseling, chiropractic care, nutritional counseling and massage therapy. Apparently, President-elect Obama’s health care policymakers also believe that early detection equates to primary prevention. Although Mr. Obama has yet to be inaugurated, I make this claim after attending a town hall meeting on health care and perusing the literature supplied by Tom Daschle’, who Obama named Department of Health and Human Services. After what I read, I am a little disappointed. The direction we seem to be heading is unfortunate because to get to the bottom of our lifestyle-related problems, we’re going to need a health care system that is principally structured on primary prevention. Under such a system, individuals would be responsible for their own health, but they would be encouraged with economic incentives to achieve significant health and fitness improvements. A team of specialist providers would assist patients in this effort.”


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