Prevention Versus Cure (4/7/14)
Treatment, or Prevention?
In a perfect world, prevention would not prove necessary. There would be cures for everything.
In the American media world, this landscape seems to exist – or is promised soon. Suffering from schizophrenia? There’s a pill. High blood pressure? Multiple pills. Together they’ll surely work. Depression? Check. Where “personal will” no longer works, a pill will succeed.
The tobacco auction list of side effects at the ends of television ads may give a few people pause – particularly satirists, who notice that the same pills that cure may kill. But what happens when pills fail?
There are procedures and devices. Got heart disease? Why take a fistful of daily pills when there are stents, balloons and bypasses? Back pain afflicts the majority of older adults. But fortunately for them, there are braces, injections, lasers and microsurgeries so small that virtually nothing is taken out at all!
Yes, improvements are coming. Yet the sad truth is medical care is far more effective on screen than in life. The human body is not endlessly regenerative – though it can work far better with just a little help.
By why worry about something so far off?
The Defining Moment
Many people remember well the moment their life went from healthy to ill.
It can come from a tiny spot on a lung. It can happen when the chest tightens. The change from carefree to fear may take seconds.
Frequently, however, it takes quite a while. A fine fictional version of denial occurs in the film “The Dallas Buyers’ Club.” Told by a doctor that he should get his affairs in order, for he has AIDS and will probably die within 30 days, roughneck rogue Ron Woodroff stalks defiantly out of the hospital. A healthy, heterosexual male, Woodroff finds it inconceivable that he can suffer from the “gay plague.” Only in the library, scanning through spool after spool of newspaper stories and research studies, does he read how unprotected sex, especially among drug abusers, can lead to AIDS.
Then he sees it. It’s the sexual event that he thinks changed his life forever. We watch the shock of recognition..
Matthew McConaghey won the Oscar for portraying Woodroff. Sadly, most of us won’t win an Oscar for sympathetic imagination.
We usually don’t see the bad stuff happening until it does.
The Teachings of Early Illness
Most people get their first experiences of illness from infectious disease. And those experiences tell many of us that we will get through everything – in part, because medicine works remarkably well.
Kids got loads of viral illnesses. They will get through almost all of them physically unscathed. Yet antibiotics are often given the credit for the “rapid recovery” rather than their own immune systems.
Antibiotics are remarkable. They have been the most effective drugs in the medical armamentarium for a long time.
The public remains powerfully unaware. They know little about the tens of thousands of deaths caused by antibiotic resistance, some of it fueled by profligate use in animals (80% of antibiotics in the US are for animals – they might possibly also affect human obesity.) They are unaware how many millions of children survive infections because of vaccinations. Effective vaccination is now under threat by groups who believe faked studies – and others who invoke God for their cause, including the murderers of polio workers in Afghanistan and Pakistan. Most of the public are thoroughly unaware that most of the eradication of infectious disease, and the precipitous declines in infective deaths, arrived before antibiotics were even developed.
Sanitation, nutrition, education made the difference. They are unsexy. They are common goods. They don’t necessarily make Big Pharma, device and diagnostic manufactuers and hospitals large profits.
They just let you survive and thrive.
About thirty percent of Americans will suffer a depressive episode in their lifetimes. Most of the rest of the population will experience the accompanying hell: pain and misery; economic and social failure; loss of jobs; family turmoil that wrecks marriages and harms children.
Yet watch television or comb the net and you will read of drug after drug that will treat depression “effectively.” Insurance companies privilege drug treatment. There’s a pill out there for everyone.
Few know how well the large pharmaceutical companies hid their data on antidepressants. Few know that the drugs are far more effective as anti-anxiety agents, or that in too many circumstances their effectiveness is just a shade better than placebo.
And far too many don’t know of the many other effective treatments, ranging from cognitive-behavioral psychotherapy to physical activity to light therapy social engagement. That for many a walk every morning may do as well or better than combinations of drugs.
What should be recognized is that there are ways of preventing depression – in populations. People with stronger and more numerous social ties get less depressed; as do those who exercise; or get sufficient rest.
It’s harder for medical care businesses to make money on those kinds of things, too.
Business and Health
The business of the nation is business, said Calvin Coolidge. And a fifth of national business right now is medical care.
Much of that medical care can be witnessed in the form of giant hospital towers, skyscraping stock prices of Big Pharma and Biotech companies, towering multimillion dollar pay packages to hospital administrators.
Where’s health in all this? The answer – mostly left out. For medical care is not health – which is the physical, mental, social and spiritual well-being of people.
In the Kungsholmen study in Sweden, life style can add 7 years to the life of middle aged individuals, 4 years even at age 85 – when medical care adds pretty much zero.
The United States is now spending about 18% of its GDP on health care. European states spend about half.
Their health statistics are better than our own.
Why? Yes, it’s true they usually have rationally, nationally organized medical care. More importantly, it’s in their national interest to advance the national health – as cheaply and efficiently as they can.
So what if we did as Europe and most of the developed world does. What could we do with an extra trillion or two every year we ineffectively spend on American medical care? Could we make cities more walkable? Get all growing kids fresh food? Clean up the water supply? Or just reduce our government budget deficits down to nothing?
Prevention is often better than cure. Not getting a lung cancer is an immense personal and public bounty that doesn’t fully show up in cost benefit analyses.
But saving money is a worthy goal. Adopting public health goals can do more than save lives.
It can save lots of money. It can help a struggling economy.
For a healthy population is a more productive population – in pretty much every way.
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