عربي

Preventive medicine is widely applicable, relatively easy, and much more affordable than individual treatments, which tend to be complicated, often unaffordable, and frequently limited to the privileged few.  The vernacular wisdom that a bit of prevention is worth a lot of treatment is even truer today because industrialization and population growth are relentlessly polluting our tiny planet.

Sanitation (clean water and sewage control) is the most essential form of prevention but, unfortunately, it is currently lacking for the majority of earth’s population.  Preventable infectious diseases such as Malaria, Tuberculosis, Bilharzia, Aids, Diarrhea, etc. kill more per year than all our wars combined.  Malnutrition is still a major threat to population health and so is illiteracy and, although both are preventable, they continue to be widely prevalent in spite of technological progress.

As for enlightened individuals living in more affluent microcosms, there are other preventable diseases that are commonly neglected even though they are readily detectable with annual physical examinations:

1- High Blood Pressure is a silent killer because it causes no symptoms.  When untreated, it is the commonest cause of strokes and heart failure; moreover, it increases the incidence of heart attacks, ruptured aneurisms, and renal failure.  It can only be detected by measurement and the best measurements are those performed at home by the individual because they avoid the common pitfalls of White Coat (i.e. doctor’s office) hypertension.  If the average of many home-blood-pressure measurements is >130/80, this is considered pre-hypertension and requires treatment before it gets worse and more difficult to control.  Home blood-pressure monitors are widely available and quite reliable.  Declining treatment because the individual feels well is the commonest argument used by those who are not medically enlightened.  Reducing salt intake and walking an hour a day may be all that is needed when pre-hypertension (BP>130/80 and <140/90) is first diagnosed.  Beyond that point, medications are usually required.

2-Obesity and overweight have reached epidemic proportions especially in affluent societies.  Although treatments abound, there are no long-term effective medications that have stood the test of time and science.  Overweight causes a progressive increase in many diseases such as cancer, diabetes, high blood pressure, high cholesterol, high triglycerides, sleep apnea, heart failure, back, knee, and hip arthritis, frequent falls, poor surgical outcomes, and slower recovery from myriad illnesses and infections.  Prevention rests on Cognitive Behavioral Therapy, which teaches the individual to exercise daily and to think and prepare his mind before engaging in any form of eating.  Unfortunately, success depends on the individual’s abilities to learn new, life-changing ways.

3-Diabetes (fasting blood sugar >125mg/dl) begins as pre-diabetes (fasting blood sugar 100-125mg/dl).  During this early stage, it is entirely preventable with exercise and weight loss.  If the individual will just walk one hour a day and reduce his weight, his pre-diabetes may never progress to diabetes.  Exercise and weight reduction reverse insulin resistance, which is the most important metabolic derangement in early diabetes.  Preventing diabetes also prevents all its well-known complications such as blindness, gangrene of digits, and renal failure.

4-Hyperlipidemias (high cholesterol & triglycerides) are major causes of heart attacks, strokes, and poor blood supply to the vital organs and extremities.  They, like high blood pressure, cause no symptoms and are not detectable without blood tests.  Cholesterol lowering medications are safe and very effective in preventing the many types of vascular obstructions caused by hyperlipidemia.  Resistance to treatment is based on irrational fears of medicines.  There is clear scientific evidence that medical treatment saves, prolongs, and improves the quality of life and has no long-term side effects.  In spite of that, medical therapy is often resisted by those who can easily afford it.  Such fears of medicines are major obstacles against disease prevention.

5- Prostate cancer becomes common after age 50.  Most cases are detectable at an early stage by physical examination of the prostate and the PSA (Prostate Specific Antigen) blood test. The science of prostate cancer is still in evolution and, consequently, it is not yet known which form of treatment gives the best results.  Moreover, prostate microscopy (pathology) is not yet capable of reliably telling us which cancers will be aggressive and which will be passive. This presents another therapeutic problem because the passive cancers may be compatible with a normal life span and do not require treatment.  It is well known that as men age, more and more of them will harbor small prostate cancers that may not affect the longevity or quality of their lives.  Until more scientific studies are completed, opinion will remain divided about what constitutes the best treatment approach.

6- Colon cancer, a major killer after age 50, is 90% preventable with colonoscopy.  It tends to begin in polyps and it takes an individual polyp 5-10 years to become cancerous.  Colonoscopy at age 50, if it finds polyps, classifies the individual as a polyp maker, excises the polyps, and places the individual under appropriate surveillance.  Smokers, individuals with family history of colon cancers, obese individuals, and sedentary individuals are at an increased risk of developing colon cancers.  All those who can afford a colonoscopy should have it done when they turn fifty.

2008 - ISSUE 72