Each year, millions of people die of preventable deaths. However, diagnosis of these diseases before they fully develop (pre-conditions), allows drugs to be prescribed, which could delay or prevent the onset of the disease.
Preventative healthcare can be divided into two different aspects: maintaining a healthy body and lifestyle throughout life, and finding and treating a pre-condition. There are however, arguments that both support and condemn treatment in this way.
Benefits of preventative healthcare‘Prevention is better than cure’ as the saying goes, hence an advantage of treating a pre-condition as a medical issue, is that it emphasises the seriousness of the changes that are happening within the body.
In prediabetes for example, the concentration of glucose in the blood is already higher than normal, and as with other pre-conditions, there are signs that point towards disease development. Prediabetes usually results in type 2 diabetes and every year around 10% of individuals with prediabetes are diagnosed with type 2 diabetes.
Diagnosing pre-conditions can also contribute to public health by allowing for future predictions and planning. Collecting pre-diagnosis data from doctors has enabled the International Diabetes Federation to predict that by the year 2040, 642 million people will be suffering from diabetes.
Pre-condition diagnosing is also believed to be more cost-effective, given that regular-check ups and even an ongoing prescription is relatively inexpensive when compared with the price of a major treatment, or of long-term home healthcare visits by nurses.
There is also the idea of the collective good: as more and more people take up preventative healthcare, individual demands on the healthcare system are reduced, which helps keep it efficient and affordable.
Medicines are not always the answerCritics of preventative medicine most avidly protest that very often, healthy individuals are treated. They argue that low- or no-benefit measures including annual physicals and certain screenings are mostly redundant.
Several studies over the years have found that annual physicals do not lower the risk of serious illnesses or premature death. The US Preventive Services Task Force is so convinced that screenings for ovarian, testicular and prostate cancer for everyone produce no health benefits that they recommend against their routine use.
Many clinicians see the real problems that need to be addressed: smoking, physical inactivity and poor diet. In fact, the vast majority of cardiovascular diseases worldwide are caused by these three factors.
When healthy people with unhealthy lifestyles are medically treated, the incentive to exercise and eat well is reduced. Treating these conditions ultimately diverts money away from the treatment or prevention of diseases that simply cannot be prevented by lifestyle changes.
The line between profits and best interests of patientThere is also the concern of the commercial interest of pharmaceutical companies in sponsoring studies that define disease in their own way and promote their treatments.
Statins, a class of drugs that help lower blood cholesterol and prevent stroke for example, have been known to cause kidney failure. However, despite numerous clinical trials and decades of use, scientists and doctors still cannot agree on whether the benefits outweigh the risks. Yet, while this disagreement continues, pharmaceutical companies make over £15 billion per year from statin sales alone.
For as many experts that there are who believe preventative healthcare is cost-effective, there are just as many who believe the opposite. “The number needed to screen or to treat in order to prevent one case of illness can be huge," said economist Austin Frakt of Boston University.
For instance, 217 high-risk smokers would have to undergo a CT lung scan for one to be spared death from lung cancer, according to David Newman, an emergency physician at Mount Sinai School of Medicine in New York.
Health executive director of the non-profit, Trust of America’s Jeffery Levi suggests, "some of the most common, chronic and preventable diseases might be best addressed outside the clinical setting,” such as in health education and screening programs at houses of worship and community centres.
Medicalisation of pre-conditions should only be carried out when necessary and the doctors behind it must be given the same attention and pay as those who provide intervention care. To abolish this precautionary measure would have far-reaching consequences on healthcare systems and people’s quality of life. MIMS
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