Optimal Health Newsletter #3 -
Preventive Medicine
A year or so ago I attended a weekend conference dealing with the interpretation of some complex laboratory tests. It was a good meeting and I got a lot of useful, practical information. Most of the tests discussed at this meeting dealt with preventive aspects of health care. As my own career in medicine has progressed, the absence of real preventive medicine modalities has always bothered me. In the early '70s, when I first began medical practice in Santa Barbara, I was one of the original physicians in the Emergency Medical Group at SB cottage Hospital. While it was very interesting and rewarding work, as time went by it became increasingly clear that I was always working at the .wrong end. of the disease process. As I saw person after person come to the Emergency Room with acute problems, it became more and more obvious that something wasn’t being done right from the perspective of illness prevention. This was one of the major reasons (there were others) that I left the Emergency Department to open my own practice. I wanted to actively try to .get in front. of the pathological processes that led to overt problems and the health care calamities that would lead them prematurely to the Emergency Room. To a certain degree, I was probably somewhat successful. In a general medical practice there are some modalities that can, in actuality, be called preventive. Some examples are blood pressure management, blood sugar control, weight and cholesterol reduction, and some immunizations (in certain situations). For the most part, however, typical modalities that are called 'preventive' should more accurately be called 'early detection' because all they do is 'prevent' an already existing disease process from getting worse. An example would be detecting a cancer lesion before it spreads. In this situation, a much more serious health condition is indeed prevented. This is called 'secondary' prevention. Pap smears, mammograms, colonoscopy examinations, and treadmill tests don’t do anything to prevent or retard any pathological processes. At best they may find conditions earlier, when they are more easily and effectively treatable, but nothing is really prevented. I'm not saying that there is anything wrong with this concept or approach; of course it is good to find problems early and deal with them before they become catastrophic. Its just that we should be clear about our terms when we use the word 'prevention'. Personally, I am most interested in what is called 'primary' prevention, i.e., interceding, averting, or reversing the process that leads to the problem in the first place, so that 'secondary' prevention becomes irrelevant
My former associate, Dr. Henry Hoegerman, was one of the real leaders and pioneers in true primary preventive medicine. Since joining him about four years ago I have been able to emphasize and develop a medical practice directed towards my real interests, valid prevention modalities. This is the real focus and emphasis of everything we try to accomplish in our office. When we are talking about disease prevention, we are primarily discussing the retardation of the progression of chronic illness. These conditions develop slowly and silently over many years and eventually culminate and present as an acute problem. The two most significant chronically progressive illnesses are heart disease and cancer. There are many other chronic and progressively disabling conditions, but these two are .where the money is. (as Willie Sutton, the famous bank robber said when asked .why do you rob banks?). In the United States, far more people die prematurely from these two conditions than all other illnesses combined. Again, it is premature illness and disability that we are trying to prevent. No one is going to live forever, but it is entirely reasonable to both want and expect to be able to live a long, robust life without premature disability or serious health problems. These are big topics, and I am not going to go into any detail in this edition.
In the next newsletter I will be talking bout some of the measurable risk factors for heart disease. I will not be talking much about cholesterol, which although it is a risk factor, is not nearly as significant as many others that are not as well known. These risk factors are not only important, but they are modifiable.
I have promised to keep these newsletters 'somewhat' short, so that’s all for now.
Best regards,