October 11, 2009
On The Paucity Of Disease Prevention Measures
Heather Mac Donald thinks the rhetoric promoting the potential for disease prevention by doctors is overblown.
We need to induce doctors to practice preventive, not just reactive, care! is a favored nostrum in the current health care debate. I’ve yet to hear an example of what this means. Prevention lies overwhelmingly within the realm of individual behavior, but our modern reflex of transferring agency from favored victim groups—in this case, millions of artery-clogged, waddling Americans—onto less-favored entities guarantees that we see the problems of Fat America as the failure of doctors to practice the right kind of medicine. Perhaps more doctors could counsel their patients to exercise and avoid over-eating, but my guess is that if they stay silent on these topics, it is from hard-won experience regarding the futility of such suggestions.
This all sounds very true to me. I wish it were otherwise. But the sum total of what can be prevented by doctors is far too short. This is very unfortunate. But there it is.
Sure, there are things you can do with a doctor's help: Go get a bunch of vaccinations. Now what? Weight loss to prevent future disease development? Unless you are up for bariatric surgery medicine has little to offer. You can take statins or blood pressure lowering medicines to prevent assorted cardiovascular diseases. Or a blood sugar lowering medicine if you've got high blood sugar and insulin resistance. Anything else major come to mind? One thought: should guys take dutasteride or finasteride to reduce prostate cancer risk or benign prostate hyperplasia risk?
I want a long list of actionable items for preventing future diseases. My motto: First, don't die.
There are a few things one can do for early cancer detection such as mammograms, PAP smears, PSA tests, and colonoscopy. Note these are not disease prevention measures. These are early detection measures. I'd like to see a good set of lists of things to do at various ages for disease prevention and disease detection. Sort of like a car maintenance schedule.
I've got a practical question for all my readers: What disease prevention measures can doctors do that do not get the attention they deserve?
For example, should fully grown adults go and get vaccinations? I'm thinking seriously about getting influenza vaccination this year. But are there other vaccinations we ought to think seriously about getting as adults?
Pneumonia is the leading cause of vaccine-preventable death -- or so I've heard. Been thinking of getting vaccinated for that. It's something that can and has hilled many otherwise healthy people in their prime ... get a couple bad breaks, an opportunistic infections, and boom, you go from health to dead in a bad weekend.
To clarify, I meant vaccine preventable death for adults in America.
Yes, I recently came across an article discussing pneumonia vaccination.
Ideally I'd like a list of items to take into a doctor's office and say I want this list of vaccinations, this list of tests, perhaps a couple of drugs to take long term to cut disease risks.
Personally, I am trying to drink more booze.
The bulk of prevention measures are not carried out by doctors, but rather by public health organizations which mostly guard the safety of air, water and food and try to limit the spread of infectious disease.
The unfortunate news from this is that we have already realized most of the gains to be had by such measures, but hanging on to them requires constant vigilance. Thus, I think people should pay more attention to this area of health care, which typically only gets 1% of the total budget.
If you want to know what doctors can do to prevent disease, get hip
to Dr. Joel Fuhrman. Heart disease and Type II diabetes are almost
entirely preventable, and usually even reversible, by a truly healthy
lifestyle. Cancer incidence could be significantly reduced, especially
by improving childhood diets.
Cardiologists should be prescribing vegetables, fruits, beans, seeds
and nuts, not cutting people open or ramming hardware here and
there in diseased artery systems.
In the CBO director's recent testimony he said that they couldn't find any ways to cut total costs by increased spending on preventive medicine. In fact from the green eye shade perspective, the big problem is that we spend too much money on preventive medicine.
I think that repeating irrelevant truisms is just too much easier than thinking through an issue. Case in point from your comments:
> Cardiologists should be prescribing vegetables, fruits, beans, seeds
> and nuts, not cutting people open or ramming hardware here and
> there in diseased artery systems.
Yes that's brilliant.
"Help! I'm having a heart attack."
"Sorry, but all of our cardiologists are out picketing local ice cream trucks. Would you care for a celery stick?"
One of the decisions that the government made a long time ago is that our own individual lifestyle decisions should have no effect on what we pay for health care. After all, health care is a right, so how can a right be conditional on behavior?
Self-insured private companies have been able to reduce their costs by charging their employees higher premiums for poor lifestyle choices, but that type of discrimination is generally banned by state legislators when it comes to private insurance.