A Backwards View
Live long and prosper
by Dr. Bill Eaton
The key these days is prevention. You know the old phrase about an ounce of prevention staring a gift horse in the face, or a bird in the hand being worth a pound of cure. Too bad we've switched to the metric system, leaving the gift horse downsized to the small dog of decreased transfer payments for health care. Sickness care, more like it. Still, we digress from the appointed topic of prevention, which, when run through the thesaurus, comes up with the likes of: impediment, hindrance, preclusion, avoidance, deterrence, forestalling, anticipation, obviation, obstruction, obtrusion, injunction and many others -- although this list seems long enough.
The only thing prevention has done is to make me feel bad when one of my patients gets sick.The obese non-compliant hypertensive (the exercise challenged calorie-burdened person with idiopathic hypertension) who goes into renal failure at age 90. The slothful smoker with peripheral vascular disease. The 10-year post-menopausal never-exercised-once-in-her-life with the hip fracture. Anybody with cancer, stroke, unresolved grief, and sexual dysfunction makes me feel like I've been less than vigilant or dutiful in my efforts at early detection and/or prevention.
We had, in the old days, a sum total of two hours in medical school on matters preventative. Although we've all passed a lot of water over the bridge since then, the medical students of today don't get much more. For years we've been telling patients that we could have cured them if only we'd gotten to them earlier. And we've been believed.
We've been quoted in popular magazines and local newspapers as saying there must be a better way than to spend all those shrinking dollars on sickness treatment. Now we want to spend them on ineffective, nebulous and expensive machines. We've allowed ourselves to be indoctrinated by the medical industrial complex with its technology and hugely funded research to order things like mammograms, bone density studies, glucose tolerance tests and prostrate-specific antigens. It would be great if it all worked.
We say: "If your hectic life gets in the way of exercise or proper eating or your family, do yourself a favour -- take a test, take a pill. Come see us and you'll be fine." The family lawyer says: "How was he to know smoking caused cancer? Nobody said that three burgers a day could hurt. He's sick and somebody's going to pay."
What I learned about prevention came from my maternal grandmother: eat porridge for breakfast, go for a walk every day and be good to your mother. Doctors of the medica citation variety, once they have plugged their research on the latest technological tool/toy and how 10,000 lives will be saved or enhanced, follow up with a quick comment regarding low-fat, high-fibre diets, exercise and leisure time -- even though they look as if they've never heard of such advice, let along follow it.
That's not the way my grandmother saw it in 1915, and that's not the way it is now. The human body hasn't changed. High-fibre diets are also frugal diets, so eat a lot of porridge and give to the poor. Exercise is cheaper than a car, and more entertaining than television, so go for a walk every day. Spending time with your family and friends brings peace and well-being, so be good to your mother.
Doctors in 1915 could do little more than watch their patients succumb to infections, trauma and childbirth. Yet by all accounts they were just as arrogant and as filled with an unashamed sense of their own importance as we are today. Although antibiotics and antisepsis have changed our world, we doctors still cleave to the early detection/early cure concept so appropriate to infectious processes, but basically outdated concerning the long-term lifestyle-induced diseases we face today. We still feel responsible for our patients' health, even if they don't. We're singing modern versions of an old song.
My grandmother was told at age 20 that she was too sick with asthma to survive childbirth, and she should never marry. When she turned 30 she figured she might as well give it a go, as her doctors had all died by then. She had my mother and two more babies besides, and managed to live, drive her own car and vacation in Spain and Florida until she was 90. She died when she was 94. So whose advice would you follow?
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