Prevention: A Major Contribution to Good Health

by Edward R. Annis, M.D.

The steadily increasing cost of medical care run parallel with new ideas and the development of new and better ways for doctors to diagnose and treat illness and accidents. In the minds of many there is the belief that so-called preventive medicine and finding medical problems early in their development will save money. Doctors know better because their efforts are not directed by economics, but rather are directed toward better ways to prevent, to detect and to treat the ills of mankind. Because of these efforts by their doctors, more babies survive and more people live longer to develop other problems associated with later years such as diabetes, high blood pressure, arthritis, and many other medical and surgical maladies.

Accidents, a subject which will be dealt with more extensively at a later date, are the second greatest drain on the health care dollar (only treatments for cancer cost more). This is because of the tremendous cost associated with fixing broken bones, replacing blood loss and the often necessity for multiple medical specialist such as neurosurgeons for head injuries, general surgeons for injuries to internal organs, and a multiplicity of laboratory and blood bank personnel. In the so-called "olden days", before such help was available, people died, which, of course, was much less costly than today's many life-saving procedures.

Next to cancer and accidents the third largest expenditure for health care is made for cardiovascular disease found primarily among the over-40 generation. Yet, in terms of population segments, the most important generational fact is that the greatest amount of health care money is spent on the very young and the very old.

Each year of the last twenty years we have lowered infant mortality. When I was a young physician, it was exceedingly rare to save a newborn weighing less than four pounds; today trained physicians specializing in the care of tiny infants save many who used to die, even some weighing as little as one and a half pounds. It is done at great expense since the average cost is around $25,000 per baby saved. Shall we ask the woman who has successive miscarriages, then finally delivers a two-pound baby she wants dearly, how much the child is worth? Doctors ask: If we can continue to lower infant mortality with these greatly increased costs, should we do it?

At the other extreme the elderly over sixty-five constitute 13% population, but they consume more than one third of all money spent on health care in our country. Modern medicine enables them to live better and to live longer, but at steadily increasing costs as the their numbers continue to grow. Therefore, again your doctors ask: If we can further extend enjoyable life but at greater continuing costs, should we do it? Your doctors believe we should.

While continuing efforts to improve quality care and to make it available to all who need it, doctors are directing increased efforts to inform patients what they can do to make their lives more enjoyable and in the process, live longer. As is true in childhood, prevention has the number one priority.

There are two approaches to prevention. One is to concentrate on those actions which can prevent diseases and/or accidents from occurring. The other course is to follow those procedures which have been shown effective in detecting diseases early enough for their control or cure.

Examples of the first approach are many, starting with such immunization procedures as vaccinations against the seven medical diseases of childhood and vaccinations of the elderly against influenza when so advised by their doctors. Other examples are wearing seat belts when driving or riding in a car, dieting to lower excess weight, only moderate use of alcohol, some type of regular exercise and the total elimination of the use of tobacco in any form.

Examples of the second approach vary with age and sex. For women, Pap smears and regular breast examinations by a physician should be accompanied by a continuing program for self examination. After certain ages, doctors, depending on their examination and the age of patients, will recommend mammography as a proven method for early detection of breast diseases.

Already mammography has proven to be of real value as reflected in the steadily increasing record of cures for the second most common cause of cancer deaths for women. Medical examinations and the early detection of high blood pressure, which often has no early symptoms, have proven to be life saving and life prolonging, as reflected in a steady decline in deaths due to heart attacks and strokes.

Around three or four out of every hundred Americans over sixty-five develop glaucoma, the leading cause of blindness in the United States. Glaucoma is not a single disease, but is rather a number of diseases and the most common type can progress to a serious stage without warning.

Only with regular eye checkups, including measurements of pressure within the eye, can the disorder be detected before significant loss of vision occurs. This is one more important reason for checkups by competent ophthalmologists, those doctors who specialize in problems and diseases of the eye.

The relationship between cigarette smoking and alcohol consumption are undoubtedly linked with the development of many kinds of cancer, and their avoidance or discontinuation stand high on the list of preventative measures which individuals can employ successfully.

Diseases of the heart and blood vessels continue to be the number one cause of death. Evidence continues to mount that elevated cholesterol levels, overweight, lack of physical activity and the use of tobacco are definite risk factors which, when controlled, definitely eliminate or at least lessen heart attacks and strokes.

The challenge of prevention is considerable, because many people feel well with no obvious symptoms until disaster strikes. This is one more reason why modification of life styles which are potentially harmful are providing to be the greatest factor in prevention.

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