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What is Preventive Medicine and Primary Prevention?

"An ounce of prevention - A pound of cure for an ailing health care system" [1]
 
Over the past decade, interest in anti-aging treatments and interventions aimed at promoting health, vitality and youthfulness over the life course into old age, has risen exponentially. The popularity and rise of anti-aging interventions has been fueled by the aging baby-boomer generation and the great dissatisfaction surrounding the current medical system in the US and many other Western nations. 
 
Are you frustrated with today's big-pharma dictated assembly line medicine with doctors who only spend 7 minutes per visit with their patients? Are you against the routine "have a symptom - take a pill" traditional medical system mantra that is so pervasive in modern medicine? Then preventive medicine, which is a unique medical specialty recognized by the American Board of Medical Specialties (ABMS), and primary prevention is for you…
 

What are the different types of prevention?

 
Primary prevention refers to prevention of disease and disability in the first place, by monitoring and “treating” risk factors, often with nutrition, exercise and lifestyle interventions.[2-4]
 
Secondary prevention refers to delaying the progression of established disease, or postponing disease in all of its guises. For example, preventing cardiac events (like heart attacks) in patients who are already diagnosed with heart disease.[2]
 
Primordial prevention refers to preventing development of risk factors via healthy lifestyle habits.[5-7] It is especially applied to children and adolescents.[5, 8-10]
 
The American Heart Association (AHA), in its goals for 2020 to reduce the prevalence and mortality of heart disease, presented a version of primordial prevention called “ideal cardiovascular health”.[2] The AHA defines ideal cardiovascular health as not only the absence of cardiovascular disease, but also having a healthy lifestyle (i.e. absence of smoking, adequate exercise, defined superior diet score, and body mass index (BMI) <25 kg/m2), and ideal health factors (i.e. untreated normal values of blood cholesterol, blood pressure, and fasting glucose).[2] 
 

Preventive Medicine vs. Traditional Medicine

 
Preventive Medicine, aka lifestyle medicine, differs from traditional medicine.[11]
 
* Traditional medicine focuses on existing illness. It is a “sick care” system that does not deal directly with underlying causes of diseases and disability, but instead is based on secondary prevention. One common characteristic of traditional medicine is “assembly line” medical care aimed at quickly addressing signs and symptoms of illness, rather than uncovering and managing the causes of illness. It operates on a symptom-relief approach.
 
* Preventive medicine focuses on the health of individuals with the goal to promote and maintain health and well-being and to prevent disease, disability. It is a true health care system that deals directly with risk factors that cause development of diseases and disability. A cornerstone in preventive medicine is primary prevention. 
 

Proof that the traditional disease-oriented medical system isn't doing any good

 
* 7 out of 10 deaths among Americans each year are caused by chronic lifestyle-related diseases [12]. 
 By 2020, their contribution is expected to rise to 73% of all deaths globally [12, 13].
 
* Cardiovascular diseases (CVD) remain the leading cause of morbidity and mortality in modern societies, followed by cancer [14, 15]. In 2009, cardiovascular diseases accounted for 32.3% of all deaths, or 1 of every 3 deaths in the United States [15]. The total number of inpatient cardiovascular operations and procedures increased 28% between 2000 and 2010.[15]
 
* In 2005, 133 million Americans had at least one chronic illness [16]. 
 
* 33% of US adults (78 million) over 20 years of age have high blood pressure [15]. Among these, almost 20 % aren't aware of their condition [15].
 
* High blood pressure is a major and most common risk factor for developing cardiovascular disease and mortality [17]. The mortality risk doubles for every 20-mmHg increase in systolic blood pressure above the threshold of 115mmHg and for every 10-mmHg increase above the diastolic blood pressure threshold of 75mmHg [18]. 
 
* In 2010, an estimated 19.7 million Americans had diagnosed diabetes, representing 8.3% of the adult population. An additional 8.2 million had undiagnosed diabetes, and 38.2% had pre-diabetes, with elevated fasting glucose levels [15]. The prevalence of diabetes is increasing dramatically, in parallel with the increases in prevalence of overweight and obesity.
 
* The age-adjusted prevalence of metabolic syndrome, a cluster of major cardiovascular risk factors related to overweight/obesity and insulin resistance, is approximately 34% (35.1% among men and 32.6% among women) [15].
 
* The United States spends significantly more on “sick” care than any other nation. In 2006, our 
medical expenditure was over $7,000 per person [19], more than twice the average of 29 other developed countries [20]. We also have one of the fastest growth rates in sick care spending, tripling our 
expenditures since 1990 [19]. Yet the average life expectancy in the United States is far below many other nations that spend less on health care each year. 
 
* An increasing percentage of health care dollars spent in the U.S. are spent on people with chronic conditions. In 2004, the care given to people with chronic conditions accounted for 85% of all of health care spending [21]. 
 
* The total direct and indirect cost of CVD and stroke in the United States for 2009 was $312.6 billion. By comparison, in 2008, the estimated cost of all cancer and benign neoplasms was $228 billion. 
CVD costs the US sick care system more than any other diagnostic group [15].
 
* In treating patients with chronic conditions, 66% of physicians believe their medical training did not adequately prepare them to provide effective nutritional guidance for their patients.[22]
 
* The largest number of people with chronic conditions is of working age and is privately insured: 
78 million people with chronic conditions have private insurance coverage and their care accounts for about 73% of private insurance spending. Almost all Medicare dollars and about 80% of Medicaid spending is for people with chronic conditions [21].
 

What is at the core of preventive medicine?

 
Preventive Medicine includes all aspects of medical care aimed at preventing development health problems before they get established:
 
- Regular health check-ups with blood testing to detect risk factors at an early stage. 
 
- Emphasis on lower threshold for common diagnoses; e.g. pre-diabetes and pre-hypertension, i.e. borderline elevations of blood glucose and blood pressure.
 
- Proper control of risk factors, such as high blood pressure, elevated blood glucose and triglycerides, low HDL (the “good” cholesterol) by e.g, monitoring, self-management education.
 
- Screening for disease development (e.g. atherosclerosis by imaging, breast cancer by mammography).
 
- Development and maintenance of healthy lifestyle habits by health education: daily exercise, proper nutrition, weight control, avoidance of smoking and drug abuse, moderation of (or abstinence from) alcohol consumption.
 

Challenges facing preventive medicine

 
While suffering patients might be motivated toward action to feel better and prevent worsening of their diagnosis, people who are not suffering often might not. Many consider health and illness to be independent of behavior and, regardless of unhealthy practices, perceive that health can be purchased in a medicine bottle. 
 
Because the rewards of healthy lifestyle habits are often intangible in the short-term and because the consequences of unhealthy lifestyles do not manifest immediately, there is often no instantaneous incentive to adopt healthier habits.
 
Therefore, health education, information and health status monitoring is critical. Studies show that screening for risk factors results in a positive effect on health behaviors [23], likely because it gives an objective measure for people to use as an incentive in their efforts to improve their health status. Blood testing is the most basic and essential form of health screening, and something everybody should do on a regular basis.
 

Preventive Medicine with Dr. Pierce at Ageless Forever

 
In contrast to mainstream doctors who practice traditional “disease-oriented” medicine, Dr. Pierce practices preventive medicine and runs comprehensive blood test panels on all his patients. By doing this, Dr. Pierce can detect abnormalities at an early stage, which, it left unattended, will lead to development of pathological chronic diseases. 
 
Dr. Pierce spends more time with his patient's and listens to your concerns. He takes time to explain your medical issues in a way that you can understand.
 
Take the first step towards controlling your health by scheduling an appointment with Dr. Pierce for a comprehensive health check-up. Call us at 702-838-1194 if you have any questions.
 
 
References:
 

1.            Genuis, S.J., An ounce of prevention: a pound of cure for an ailing health care system. Can Fam Physician, 2007. 53(4): p. 597-9, 605-7.

2.            Lloyd-Jones, D.M., et al., Defining and setting national goals for cardiovascular health promotion and disease reduction: the American Heart Association's strategic Impact Goal through 2020 and beyond. Circulation, 2010. 121(4): p. 586-613.

3.            Sigurdsson, E.L. and G. Thorgeirsson, Primary prevention of cardiovascular diseases. Scand J Prim Health Care, 2003. 21(2): p. 68-74.

4.            Kones, R., Is prevention a fantasy, or the future of medicine? A panoramic view of recent data, status, and direction in cardiovascular prevention. Ther Adv Cardiovasc Dis, 2011. 5(1): p. 61-81.

5.            Bambs, C. and S.E. Reis, Embracing primordial prevention for ideal cardiovascular health. Future Cardiol, 2011. 7(4): p. 447-50.

6.            DeBusk, R.F., The role of the health care system in primordial prevention. Prev Med, 1999. 29(6 Pt 2): p. S59-65.

7.            Berenson, G.S. and S.R. Srinivasan, Cardiovascular risk in young persons: secondary or primordial prevention? Ann Intern Med, 2010. 153(3): p. 202-3.

8.            Daniels, S.R., Diet and primordial prevention of cardiovascular disease in children and adolescents. Circulation, 2007. 116(9): p. 973-4.

9.            Fuster, V., Childhood: a critical focus for 'primordial prevention' research. Nat Clin Pract Cardiovasc Med, 2005. 2(3): p. 113.

10.          Kavey, R.E., et al., American Heart Association guidelines for primary prevention of atherosclerotic cardiovascular disease beginning in childhood. Circulation, 2003. 107(11): p. 1562-6.

11.          Clarke, J.L., Preventive medicine: a ready solution for a health care system in crisis. Popul Health Manag, 2010. 13 Suppl 2: p. S3-11.

12.          Kung, H.C., et al., Deaths: final data for 2005. National Vital Statistics Reports 2005: Available from: http://www.cdc.gov/nchs/data/nvsr/nvsr56/nvsr56_10.pdf.

13.          Mathers, C.D. and D. Loncar, Projections of global mortality and burden of disease from 2002 to 2030. PLoS Med, 2006. 3(11): p. e442.

14.          Murphy, S.L., J.Q. Xu, and K.D. Kochanek Deaths: final data for 2010. 2010.

15.          Go, A.S., et al., Heart disease and stroke statistics--2013 update: a report from the American Heart Association. Circulation, 2013. 127(1): p. e6-e245.

16.          Wu, S.Y. and A. Green, Projection of chronic illness prevalence and cost inflation. 2000, RAND Health; Santa Monica, CA.

17.          Chobanian, A.V., et al., Seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Hypertension, 2003. 42(6): p. 1206-52.

18.          Vasan, R.S., et al., Assessment of frequency of progression to hypertension in non-hypertensive participants in the Framingham Heart Study: a cohort study. Lancet, 2001. 358(9294): p. 1682-6.

19.          Services, C.f.M.a.M., National health expenditures aggregate, per capita amounts, percent distribution, and average annual percent growth, by source of funds: selected calendar years 1960–2007. 2008, Baltimore, MD: Available from: http://www.cms.hhs.gov/NationalHealthExpendData/downloads/tables.pdf.

20.          The Organisation for Economic Co-operation and Development (OECD), Health at a Glance 2011 - OECD indicators. 2011, Organisation for Economic Co-operation and Development, Paris.: http://www.oecd.org/els/health-systems/49105858.pdf.

21.          Anderson, G., Chronic conditions: making the case for ongoing care. . 2007, Baltimore, MD: John Hopkins University.

22.          Ciemnecki, A.B., et al., National Public Engagement Campaign on Chronic Illness - Physician Survey. 2001, Mathematica Policy Research, Inc.

23.          Deutekom, M., et al., The effects of screening on health behaviour: a summary of the results of randomized controlled trials. J Public Health (Oxf), 2011. 33(1): p. 71-9.

Last modified on Monday, 22 September 2014 19:30
Monica Mollica

Medical Writer & Nutritionist

MSc in Nutrition

University of Stockholm & Karolinska Institute, Sweden 

   Baylor University, TX, USA

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