Preventive Medicine

Picture8In the course of human history, Preventive Medicine/Public Health interventions have saved more lives than all medical treatments combined.  This is often forgotten because no wonder drugs, surgery or miracle cures were involved.  Instead measures such as assuring access to clean water and encouraging simple lifestyle behavior changes such as hand washing, putting garbage in a bin and getting recommended vaccines on schedule had the greatest impact.

Until the early 20th century, most people in the US died of preventable infectious diseases.  Antibiotics got the credit for controlling these diseases because few people know that death rates from infectious diseases began falling many years before antibiotics became widely available.  In fact, infectious diseases were controlled mostly by prevention-oriented doctors from many specialties who realized the importance of cleanliness and encouraged the public and their fellow doctors to change their habits.

Change did not always come easily but it did come.  Now, in the 21st century, we are at a crossroads again, the most common causes of death are preventable lifestyle diseases caused by the foods we eat and way that we live.  The standard medical treatments available today like the treatments in past centuries do not cure lifestyle diseases and have potentially dangerous side effects.  Again, prevention-oriented practitioners are urging the public and their colleagues to change their lifestyle habits.  Lifestyle medicine expands the current practice of Preventive Medicine to address the growing epidemic of lifestyle diseases.

Currently Preventive Medicine is practiced on three levels, primary, secondary and tertiary.
Primary prevention aims to avoid disease occurrence and is most commonly associated with Public Health departments that assure health services such as clean water, sanitation, food safety, and communicable disease control.  Lifestyle diseases prevention and control measures are usually limited to ineffective health education and health promotion programs.  Despite the scope of the problem the Centers for Disease Control and Prevention allocates less than 5% of its annual budget for Lifestyle/Chronic Disease prevention.

Secondary prevention aims to avoid disease progression by screening for the early stages of disease when it can be treated and “cured.”  Mammography to detect early breast cancer and blood pressure checks to detect hypertension are examples of secondary prevention. This is the main focus of clinical preventive medicine as it is currently practiced.  There are two fundamental problems with screening for lifestyle diseases.  First, most people who have have the standard American lifestyle have some stage of the standard American lifestyle diseases, heart disease, diabetes or cancer.  Second, there are no cures for lifestyle diseases, current medications treat symptoms and risk factors.  Surgery removes cancer but not the underlying conditions that allowed the cancer to grow.

Picture9As a result, “Preventive” screening most often results in detection of some stage of a lifestyle disease and medications for life or worse surgery, chemotherapy, radiation and medications for life.  Few people are ever told at any stage of the screening and treatment process that their lifestyle disease was preventable or reversible with comprehensive lifestyle changes.  While screening is very important if you have risk factors for certain diseases, the biggest risk factor for any lifestyle disease is an unhealthy lifestyle.  Lifestyle Medicine can advise, guide and coach you to make the lifestyle changes that will prevent disease or reverse the early stages alone or in conjunction with medications depending on the severity of the disease.

Tertiary prevention aims to avoid disability and death from established disease by restoring function and reducing complications.  Cardiac rehabilitation after a heart attack and bypass surgery is one of the most common examples of tertiary prevention for a lifestyle disease.  Most cardiac rehabilitation programs focus on exercise which is extremely beneficial but it does not unclog arteries.  Despite randomized controlled clinical trial evidence to the contrary most cardiac rehabilitation programs continue to advise patients to follow the American Heart Association diet guidelines which also do not unclog arteries or reverse disease progression.

Lifestyle medicine increases the effectiveness of all levels of clinical preventive medicine and of traditional medical treatments and surgery.  Advanced Lifestyle Medicine educates patients about the underlying causes of their diseases.  The focus of treatment is on evidence-based lifestyle behavior changes such as plant-based nutrition, exercise and stress management.  Your decision to make lifestyle changes is supported and your are guided to make these changes in the healthiest way. The only side effects of this approach to care are loss of unhealthy weight, more energy and a healthier, happier more balanced life.

Preventive medicine is not a new concept, In 1895, Joseph Malins wrote a poem entitled, “Ambulance Down in the Valley”, which makes a case for prevention instead of treatment. The following is an excerpt:

Better guide well the young than reclaim them when old,
For the voice of true wisdom is calling.
“To rescue the fallen is good, but ’tis best
To prevent other people from falling.”
Better close up the source of temptation and crime
Than deliver from dungeon or galley;
Better put a strong fence ’round the top of the cliff,

Than an ambulance down in the valley.