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On living long and living well

All about preventive medicine


By Dr. Kaycee Reyes

preventive medicine

French writer and philosopher Voltaire once said, “God gave us the gift of life. It is up to us to give ourselves the gift of living well.” Regardless of your race, religion, culture, or upbringing, your health and your body are your responsibility. This is why physicians promote and encourage their patients, as well as the community, to practice healthy living that includes consuming healthier food, having regular exercise, avoiding alcohol, sleeping better, and keeping a positive outlook, not only to prolong their lives but to make sure they have a good quality of life. This is also known as preventive medicine.

According to the American College of Preventive Medicine, it “focuses on the health of individuals, communities, and defined populations. Its goal is to protect, promote, and maintain health and well-being and to prevent disease, disability, and death.” In order to do this, there are four types of clinical preventive care: Immunization, Screening, Behavioral Counseling, and Chemoprevention.

Childhood immunization is not uncommon anymore, even in developing countries like the Philippines. In fact, it is even required in a lot of countries for children to undergo immunization treatments from the time they turn a year old. And why not? As much as 15 different diseases can be prevented with childhood immunizations. And it doesn’t stop there. Adolescents are now encouraged to undergo human pappillomavirus (HPV) vaccinations to prevent cervical cancer, a common type of cancer. Adults also have vaccinations available to prevent other diseases and illnesses such as influenza, hepatitis A and B, and herpes zoster, among others.

Screening, on the other hand, involves identifying at-risk individuals who may be genetically predisposed and can possibly acquire the disease but with symptoms that are not yet present. Screening begins even before a child is born (e.g. Testing for Down syndrome in the fetuses of older pregnant women) and may continue throughout the individual’s lifetime (e.g. When inquiring about hearing in older adults).

Third, behavioral counseling involves guiding patients and changing their varying behaviors to modify their lifestyle changes to decrease the risk of disease and improve one’s health. Example of this are the following: counseling patients to stop smoking, eat a prudent diet, drink alcohol moderately, exercise, and engage in safe sexual practices. This is different from screening as these behaviors may be brought about by external factors such as family, colleagues, and the community. It can be a scheduled on a clinic-based visit; others are done via call, or through administration of self-help books and guides. Either way, regular interventions are necessary to increase patient motivation and make them change for the better.

Chemoprevention is to administer preventive measures such as use of drugs to lessen the risk of diseases. It can be done by expectant mothers, such as taking folate to prevent spinal and brain defects in newborns, or adults taking preventive drugs to avoid other serious illnesses, like taking low dose aspirin prophylaxis to prevent myocardial infarction. Aside from all these, three levels of prevention are also classified: Primary, Secondary, and Tertiary. Primary prevention means eliminating all causes of disease to prevent it from occurring. This includes immunizations, drugs, and behavioral counseling. Newer ways are surgery or operations to minimize the risk of disease, such as bariatric surgery (removing a portion of the stomach or reducing its size) to prevent obesity or mastectomy (removing one or both breasts) to prevent breast cancer in women with genetic mutations. Primary prevention has eliminated many infectious diseases from childhood.

It has been effective in the past such that it has prevented a lot of deaths caused by cardiovascular disease and lung cancer, the two most common fatal diseases among American men. Moreover, the benefits of behavioral counseling are multiple. It not only prevents one disease, but multiple, such as maintaining an appropriate weight that immediately improves cardiovascular health and lessens the risk of diabetes and certain cancers. Primary intervention at the community level can also be effective.  Examples include:  No-smoking regulations in public buildings, chlorination and flouridation of the water supply, laws mandating seatbelt use in automobiles, and helmet use on motorcycles and bicycles, immunizations in schools and use of tests to detect hepatitis B and C or HIV in blood banks.  Secondary prevention involves regular testing for early detection of a disease or taking immediate steps to avoid its progression.  It is a two-step process, involving  (a) screening test and follow-up diagnosis and (b) treatment for those with the condition of interest.

Screening generally falls as a secondary prevention measure. Routine pap smears and mammograms, regular breast exams, and HIV tests are examples of secondary prevention. Lastly, tertiary prevention involves administering drugs or using practices that prevent further complications should the disease manifest already. It is different from regular treatment as it is for the long-term, meaning it will take years or a person’s lifetime of taking drugs and/or taking preventive measures.  An example is the use of beta-blocking drugs to decrease the risk of death in patients who have recovered from myocardial infarction.

Preventive medicine is not given to all. Doctors should be able to assess the patient’s eligibility for preventive care depends on the burden of suffering of the specific illness (mortality rates, hospitalization rates, and cost of care), its effectiveness and safety, and the results of the screening test. For the patient, if there is a high risk for disease or you are a candidate for preventive medicine, it is very important to follow the doctor’s orders, have the will to improve and maintain your health, and lastly, keep a positive attitude all throughout. After all, the best way to live fully is by removing fear, having a sense of gratitude, keeping the faith, and most of all, loving yourself.

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