Preventive medicine, as the American College of Preventive
Medicine defines it, aims “to protect, promote, and maintain
health and well-being and to prevent disease, disability, and
death.” These may be lofty goals, yet they have been well and truly
realised by some of medical science’s greatest achievements:
John Snow’s linking of a cholera outbreak to a water pump in
London; Edward Jenner’s smallpox vaccine; Louis Pasteur’s
development of pasteurisation; and Joseph Lister’s pioneering
of antiseptic surgery. Such examples demonstrate the concept
known as primary prevention: the aim of preventing disease or
injury before it ever occurs. The impact that just these few
examples have had on the astonishing post-Industrial Age
increase in human life expectancy is truly remarkable.
Modern medicine also engages in what is termed “secondary
prevention”. Here, the aim is to reduce the impact of a disease or
injury that has already occurred by detecting and treating it as
soon as possible in order to stop or slow its progress. Common
examples include cancer screening, blood pressure monitoring
and hepatitis C case-finding in intravenous drug users. Such
screening is usually undertaken at the level of individual
doctor–patient encounters or via public health screening programs.
Tertiary prevention then seeks to enhance quality of life by
softening the impact of an ongoing illness or injury on the patient.
An example is cardiac rehabilitation following a heart attack.
It’s important to note, however, that the primary preven-
tion breakthroughs cited above all share one thing in common:
they were formulated by a tertiary-educated scientists judi-
ciously applying what is arguably humankind’s greatest discovery:
the scientific method. Secondary and tertiary prevention also
apply the scientific method to formulate and apply evidence-
based screening methods and interventions to achieve a net
benefit (given that screening tests themselves can cause harm,
as can the consequences of false positive and negative tests).
But in the commercialised healthcare environment that we
now inhabit, preventive health may be becoming a victim of
its own success. As the notion of preventing disease and injury
is intuitively considered better than treatment, it’s this very
intuition (which in human beings is far from always right) that
is ripe for exploitation and has increasingly become hijacked
by less scientific members of the wider health care sector.
The complementary and alternative medicine (CAM)
industry (a much better name than previous monikers such as
quacks and snake oil salesman) first beckons its market with
the fallacious assertion that mainstream medicine doesn’t do
prevention. The propaganda machine then switches into over-
drive with promises of “holistic” and “new age” health care.A vast space then opens, ready to fill with whatever an
unknowing and unsuspecting public can be swayed to believe:
homeopathic vaccinations, “superfoods”, blood group diets,
personalised (meaning expensive) supplement regimens based
on one’s genotype (nutrigenomics being commandeered by
orthomolecular medicine), acupuncture to quit smoking, detox-
ification by colonic hydrotherapy, MTHFR gene mutation
testing, and telomerase enhancers in CAM’s extreme propo-
nent of preventive health known as “anti-ageing” medicine.
Mainstream medicine’s objections are dismissed because there
are just some exceptional phenomena that science can’t test or
because medical practitioners are blinkered by closed-minded-
ness or an inherent “fear” of alternative medicine. Simple.
And yet mainstream medicine itself is not immune, as in
some cases it, too, continues to be led (or worse, actively leads
others) scientifically astray. Hence the continued practice of
treadmill exercise stress testing of asymptomatic executives in
the lucrative corporate health sector, the use of prophylactic
antibiotics in inappropriate circumstances, and requesting
tumour biomarkers and whole-body scans in the screening of
asymptomatic patients to diagnose undetected cancers.
So the letters after a name certainly don’t always come with
a guarantee.
Preventive medicine, as history has indeed proven, will
continue to be a vital weapon in modern medicine’s armament,
especially with ongoing advances in the field of genomics. But
in the hands of the ignorant, the ill-informed, the pseudoscientist
or the charlatan it may prove to be costly at best but life-short-
ening at worst.
Benson Riddle is a general practitioner with an interest in preventive health and the use of
technology in improving health care. He is a proponent of science-based medicine and a
keen medical sceptic.44 ||MAY/JUNE 2017
THE BiTTEr piLL Friends of Science in Medicine
Prevention or Pretension?
When the great Dutch scholar Erasmus famously wrote that “prevention is better than cure”
around 500 years ago, he didn’t exactly have orthomolecular medicine and high colonics in mind.Get fu
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