

Is Preventive Medicine Its Own Health Risk? - benbreen
http://aeon.co/magazine/health/is-preventive-medicine-its-own-health-risk

======
akiselev
There's one TEDMED talk about chronic disease [1] in particular that has
really stuck with me over the years. At about 2:40 the speaker pulls up a
graph compiled from WHO Global Burden of Disease data [2] that shows the
occurrence of serious acute (usually communicable) and chronic diseases across
countries with high (United States), middle (India), and low (Kenya) incomes.

As you would suspect, the United States has significantly fewer acute diseases
than India, which in turn has significantly less acute disease than Kenya. BUT
for chronic conditions, the numbers (relative to population size) are pretty
much the same across the board. The distribution of chronic disease is
slightly different depending on wealth (diabetes vs obesity vs malnutrition vs
heart/lung disease like cancer vs liver disease from alcohol, etc) but they
are almost _entirely preventable_ often with "just" some life style changes
(I'm oversimplifying, but the vast majority of the conditions are considered
very preventable). With the United States spending nearly a fifth of its GDP
on medical care we STILL have just as big a problem with chronic disease as
Kenya, a country where the average income is under $10/day.

Preventive medicine is almost definitely its own health risk but when you look
at what we're trying to combat and just how intractable the problem is here in
the US, let alone globally, it starts to look like a very acceptable risk.

[1]
[http://www.tedmed.com/talks/show?id=7333](http://www.tedmed.com/talks/show?id=7333)

[2]
[http://www.who.int/topics/global_burden_of_disease/en/](http://www.who.int/topics/global_burden_of_disease/en/)

~~~
protonfish
So your logic is: The US is spending nearly a fifth of their GDP on medicine,
it has no effect on chronic conditions. Therefore that is a good thing and we
should continue.

I think I am missing something.

~~~
akiselev
The money we spend may not have an effect on chronic condition _occurrence
rates_ but it does have an effect on _people,_ which is the entire point of
healthcare. No amount of money spent on an obese patient will change their
eating habits; only the patient can do that of their own free will. However,
that money will keep them alive longer and drastically increase their quality
of life despite the negative impacts of their behavior.

Are you saying you'd rather be in Kenya, where you have almost zero options
for improving your quality of life, given a disease that is for all intents
and purposes permanent?

------
npsimons
I was afraid this would be one of those pieces that the morbidly obese would
cite to say that "preventive medicine" in the form of exercise or just weight
loss in general is dangerous, but it's actually a fairly good piece. The
statin screening especially hit home for me as I've been threatened with being
put on statins myself. I just love how the screening calculator was most
likely written by the drug companies (no conflict of interest there) and
didn't take into account physical activity level, diet, or even weight! Like
the article's author, I would steadfastly refuse to be put on a medication
that did very little to decrease my susceptibility to a disease, while
hampering more natural ways to prevent the disease (ie, less exercise due to
muscle pain from statins).

~~~
debacle
The statin stuff is just bad science. Statins don't have the effect on
cholesterol that they are purported to have. They are the product of a time
when we still thought that the fat you eat makes you fat. We're beyond that
point, but statins are absolutely huge in terms of money.

~~~
gmarx
Look at the literature and try to find convincing evidence that high
cholesterol causes heart disease. I've never seen it. They keep looking for
new fractions of cholesterol that will finally show significance but they
never question their Bayesian prior assumption. Many drugs lower cholesterol
and show now reduction in mortality. Statins (last I read) were alone in this.
The logical conclusion is that statins do not achieve this effect through
cholesterol reduction.

~~~
IndianAstronaut
This makes me wonder if eggs should be considered a health food instead of a
health hazard. Anecdotal, but if I eat 4 eggs(~300) calories, I am full for
the same period of time as eating ~600-1000 calories of something else.

But considering the saturated fat and cholesterol in eggs, they have been
considered harmful. Are they?

~~~
mindcrime
_But considering the saturated fat and cholesterol in eggs, they have been
considered harmful. Are they?_

Good question. The author of _Living Low Carb_ [1] argues that it's not
"saturated fat" in general that's bad for you, but rather more specifically
"trans-saturated fat", or saturated fat consumed along with simple carbs
(sugar, etc). He also argues that most dietary cholesterol passes through your
system unprocessed, and that serum cholesterol is largely driven by
cholesterol manufactured by your liver.

[1]: [http://www.amazon.com/Living-Low-Carb-Controlled-
Carbohydrat...](http://www.amazon.com/Living-Low-Carb-Controlled-Carbohydrate-
Long-Term/dp/1454903511)

~~~
gmarx
yep. Manufactured by your liver, on purpose. Cholesterol is necessary for
animals to live. It comprises,for example (if memory serves) about 50% of
animal cell membrane.

It's bizarre that people have been convinced this stuff is deadly poison.

Same thing for sodium chloride

------
tokenadult
The article is interesting, and I see that the author is a science writer who
has written a book (which I had not ever heard of before, even though I search
library databases for books on that topic all the time). After reading the
comments previously posted in this thread, I'll link to some broader context.

First of all, it is plain that screening test programs that are not based on
"hard endpoints" (actual reductions in all-cause disease or death) often end
up being discovered to be wastes of time and money and the cause of needless
patient worries. There is a group blog, Science-Based Medicine, with
participation by multiple medical doctors, pharmacists, lawyers, and even
reformed chiropractors, which examines the issue of the usefulness of
screening tests from time to time.[1] An informed patient might well decline
many currently offered screening tests, and might also well decline some
preventive treatments, for example statin drugs.

But the second bit of context to look at is that whatever is being done in
public health and medicine in the developed world appears to be working in
part, as life expectancy at age 40, at age 60, and at even higher ages is
still rising throughout the developed countries of the world.[2] Chances of
surviving to healthy old age from middle age have been increasing steadily in
the United States and in the whole developed world throughout my lifetime, so
I may have to get ready to live as long as some of my aunts and uncles, who
are now well into their nineties and still living independently.

[1] "Recent Developments and Recurring Dilemmas in Cancer Screening: Colon,
Lung, Thyroid" 18 November 2014 [http://www.sciencebasedmedicine.org/recent-
developments-and-...](http://www.sciencebasedmedicine.org/recent-developments-
and-recurring-dilemmas-in-cancer-screening-colon-lung-thyroid/)

"A Skeptical Look at Screening Tests" 23 July 2013 repost
[http://www.sciencebasedmedicine.org/a-skeptical-look-at-
scre...](http://www.sciencebasedmedicine.org/a-skeptical-look-at-screening-
tests/)

"Screening Tests - Cumulative Incidence of False Positives" 30 June 2009
[http://www.sciencebasedmedicine.org/screening-tests-
cumulati...](http://www.sciencebasedmedicine.org/screening-tests-cumulative-
incidence-of-false-positives/)

[2]
[http://www.nature.com/scientificamerican/journal/v307/n3/box...](http://www.nature.com/scientificamerican/journal/v307/n3/box/scientificamerican0912-54_BX1.html)

~~~
mariodiana
> whatever is being done in public health and medicine in the developed world
> appears to be working

"Whatever" is a pretty broad statement. What if we found out that the biggest
factor is nutrition and health care while young: in other words, maybe poor
health and nutrition while young leaves "scars" of a sort that come back to
bite us as we age?

I'm not saying that that's the case. I'm just saying that "whatever" is too
broad a statement. The piece is about the comparatively superfluous effect of
so-called preventative medicine in late middle-age. If we just grant that
point, for the sake of argument, then that's a whole bit of "whatever" that we
could save our money on and do without.

