Originally posted 16 January 2009
In the ongoing debates about US health care reform, you hear an increasing number of calls for a shift from crisis-based medicine to preventive medicine. (We noted the dental version of it earlier this week in our comment on the recent Lancet editorial on the topic.) The basic idea is that if we can help more people avoid getting sick in the first place, health care costs will go down.
We agree wholeheartedly.
Unfortunately, conventional ideas about preventive medicine tend to still cost a good amount of money and may in some cases do more harm than good in the long run. This is because so much of the emphasis is being put on medical tests and screenings: mammograms, colonoscopies, prostate tests and so on. (Login bypass for the last two links available via BugMeNot.)
Problem, the first: no such screenings can be said to be truly preventive. At best, they allow earlier detection of problems. At worst, they may actually cause harm.
The case with mammograms is particularly telling in this regard, where the number of cases caused early is overshadowed by the numbers of false positives leading to unnecessary surgery and drug treatment, not to mention future problems aggravated by so many regular exposures to radiation, should one agree to get screened every year after the age of 35, as is generally recommended.
As Maggie Mahar recently wrote in an article republished on AlterNet:
Here are the numbers: In order to prevent one cancer death among women over 55, 250 women have to be screened annually, beginning at age 55. But mammograms will also detect two other women with breast cancer who would not have died of the cancer. “In other words” Hadler says, “the screening will lead to the treatment of three women, for two of whom the treatment is unnecessary.”
“This is the best-case scenario for screening postmenopausal women,” Hadler explains. One out of 250 will be saved, and two out of 250 will be exposed to the risk and worry of treatment without deriving any benefit. Hadler sums up the findings: “Early detection [via a mammogram] makes less sense the older the woman, or the more morbidities [potentially fatal diseases] that she suffers. In such a circumstance, breast cancer is but one of the processes vying for the proximate cause of death and not the most likely to win.”
Moreover, there is no “best-case scenario” for screening younger woman, unless they have a family history of early death from breast cancer. This, Hadler notes, is why “the American College of Physicians believes that the risks of unnecessary biopsies far outweighs the likelihood of saving a life, and therefore does not recommend mammography before age 50 and suggests that women do not need to be screened after age 74. Similarly, the U.S. Preventive Services Task Force recommends mammography screening only every one to two years for women age 50-69.
How, exactly, is any of this “medicine” preventive?
Similarly, we can look to industrial dentistry, where – again, in the name of “prevention” – young children are given fluoride treatments and sealants, even as the Journal of the American Dental Association (a big-time fluoride supporter) tells us that there is scant evidence that fluoride supplementation helps prevent cavities in children, and even as sealants have been shown to contain BPA and may contribute to a number of toxic conditions and soft tissue damage in the mouth.
What does a true preventive approach entail?
1. Follow health-promoting habits – not smoking or taking drugs (prescription or otherwise), getting enough exercise, eating a nutrient-rich diet, and so on.
2. Reduce exposure to environmental toxins as much as possible.
3. Keep good oral health and get your teeth cleaned regularly.
4. Work with your doctor, dentist and other health and wellness providers to create and maintain the best plan of action for keeping you healthy and avoiding the need for treatment of chronic conditions.
5. Take a conservative and long-vision approach when problems do arise to minimize trauma to the body via treatment.
While making the lifestyle changes needed to support health and wellness can be difficult, even challenging at times, it can be accomplished…and will save a lot of time and money in the long run. To put it another way, you can do whatever you want now and pay later, or you can learn to be conscientious and up the odds that you’ll not have to pay later. It’s that simple.
Consider the example of one of our clients, now a 40 year old woman. Although she knew the risks and possible consequences, she chose to smoke for more than 15 years. This smoking – along with poor dietary choices, a lack of exercise and a lot of unmanaged stress – led to severe bone loss in her jaw, despite healthy-looking gum tissues noted by the several periodontists she saw. Even after she improved the other lifestyle factors, she continued to smoke – to the point where she was counseled that if nothing changed, she would surely lose a lot of teeth sooner rather than later due to the severity of bone loss. So finally, she quit smoking – at which point, a top periodontist agreed to treat her. After several thousands of dollars worth of laser surgery and tissue grafts, the situation in her mouth has finally begun to settle. Her teeth are becoming more stable, and periodontal pockets that were once up to 9 mm. deep are now only 2 or 3. She’s now determined to keep as many of her natural teeth for as long as she possibly can. Still, this resolve has come at quite a cost – a lot of time, energy and money.
With the economy in the state that it’s in, consider: do you really want to be spending your hard-earned dollars on trying to undo the damage of so many years of not caring?