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Fixin' Healthcare

Saturday, June 10, 2006

The Lifestyle Chronicles - Prevention, Where Fore Art Thou?

Tommy Thompson, bless his heart, is still out there advocating preventive medicine, and the National Center for Disease Control reports a decline in risky health behavior among teens from 1991 to 2005. Investigators at Duke University reported evidence that physical activity reverses consequences of prior physical inactivity. So, maybe there is reason to hope for continued and increasing emphasis upon prevention and improvement in health status.

However, there are some dark clouds overhead and on the horizon. Of particular concern is the medicalization of prevention. Medical health professionals are trained to diagnose and treat people with illness and disease. They are by nature aggressive in this endeavor and, generally, this posture is appropriate to the situation. When a medical approach is applied to prevention the risk is unnecessary stress and cost due to inappropriate mind-set (illness and disease) and use of the wrong tools.

Use of statin agents to lower LDL-cholesterol is widespread and the recommendations advocate more aggressive utilization. Statin agents are usually prescribed in conjunction with advice to change lifestyle but the emphasis is clearly upon the drug. One reason may be there is a medical system in place to administer drugs. Another reason might be the absence of established mechanisms to change lifestyle and a lack of confidence that people can change their lifestyle. Among the many problems associated with using drugs for prevention are the cost and side-effects. And, if the truth be told, compliance with long-term drug therapy is not much better than the probability of changing lifestyle.

Another area of concern is expanding the use of technology for early diagnosis of disease before benefit has been confirmed. This is expensive and there are false positive results. The information obtained may lead to therapy that has not yet been demonstrated to be result in beneficial outcomes. The knowledge base about the early stages of disease needs to be developed before any reliable recommendations can be proposed.

It is entirely possible and even likely that prevention will become a different branch of health care separate and related to medical care. Primary care practitioners can be a factor but much will depend on how they are chosen and trained. Much of prevention is based upon inspiration and motivation. These are qualities more often found in coaches and educators.

Cost and universal application are additional issues that will determine the future of prevention. The likely course of development will be a system that is implemented at the community level for populations. This is in contrast to the current medical model that is better suited for the diagnosis and treatment of illness and disease on an individual basis.

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