Monday, March 7, 2011

Taking a Step Back to Find Prevention's Place

As a spin-off of our recent 7-Minute Abs post, I've spent part of the past week working on a journal article about the evidence and rationale behind our 8 Ways to Stay Healthy and Prevent Cancer (8 Ways link).  And one of the things that the process of reviewing the science and writing the paper reminded me of what just how straightforward the major cancer prevention recommendations are, especially given the huge benefits they can hold.  Things like maintaining a healthy weight, not smoking, and getting regular excercise and screening tests could eliminate half of all cancers and three quarters of some specific ones.

Public health has always had this type of focus, choosing the straightforward, broad-based approach with proven benefits whenever possible.  Yet, as Sean Palfrey writes in a new Perspective piece in the New England Journal of Medicine this approach towards health is becoming more and more endangered in the high-tech era where more medical tests and more health care are generally equated with better health care.

He argues that medical education and medical care in general needs to take a step back and rely more on good clinical decision-making, rather than knee-jerk testing that may result in more test data but not necessarily any better outcomes.  "Our time and attention," he writes, "have been diverted to the the task of sorting out data instead of sorting out what is important to our patients, their families, and the community at large."

An extension of this, which Palfrey hints at but doesn't explicitly state, is to broaden the clinical reach to include whole-hearted efforts at prevention.  This will take a big reordering of priorities, given that prevention is often relegated to a lower rung on the medical education ladder, but it is far from hopeless.  The new health care reform bill has a number of prevention-related provisions that should, if not spotlight prevention, make it an important behind-the-scenes player in the nation's health.

Time will tell where things fall.  But with the science of prevention showing the large health benefits possible with behaviors we can all do, it makes little sense to not take a hard look at the current paradigm and try to get back in touch with the basics of clinical care.  And what could be more basic than a healthy lifetyle?

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