Setting Research Agendas and The 'Ounce Prevention/Pound Cure' Aphorism

Continuing with cartoon week here at The World's Fair, we offer this one from Herb Block, circa 1977:

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I'll leave this without undue editorializing, instead wondering if readers will offer their own take on this thirty-year old view of research agenda-setting, policy making, and government of scientific medical research.

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Presently, I'd say the largest issue as regards curative rather than preventative medicine is the whole geoengineering debate, and how that might affect attitudes on dealing with the climate change problem through long-term changes to our energy choices. There are almost certainly going to be many major side effects if we rely on sulphurizing the atmosphere in lieu of actually slowing and ceasing our greenhouse emissions, perhaps not as bad as global warming itself, for us, at least, but devastating to the rest of the species and ecosystems on this planet.

I appreciate the string of cartoons on the World's Fair.

As a recently minted PhD in the biomedical sciences who is currently in the midst of a family medicine training clerkship, it is easy for me to see prevention and cures as two sides of the same coin.

I do think that there is a fertile ground for research and application of techniques in preventative medicine. For example, many medical schools are building residencies in preventative medicine. As we all know, prevention requires behavior change and is much more difficult than taking a pill.

I think the foot in the door for this issue is that Medicare covers preventative exams. Also, the HMOs that survived the 90's (like Washington State's Group Health) are making prevention central to care. I think it is only a matter of time until the insurance companies encourage more prevention. (Will you permit me to dream of a day when health insurance companies no longer exist?)

But even with prevention (at least at the individual level), there will still be disease. And health is important to us. Many think that it is a right. If we have the means to extend comfortable life 10 or 20 years, I support that. I think that's money better spent than cash dedicated to waging war.

I am curious about the Canadian perspective on preventative health...

Well, I am a Canadian, so I can give you a Canadian perspective on preventative health care. I ask, "What else could one want?" It makes more sense to avert than to clean up after a disaster, no?

Still, I cannot help but be plagued fortnightly by the philosophical questions that arise from my knowing that we habitually consume substances known to be harmful to the human body, then suffer from or die of the cumulative effects of the substances years later, all the while toying with the identity and legal status of each substance, and variously seeking "cures" and names for the "diseases" attributed to them.

So much serves to obfuscate what I think should be so clear. The view from atop my Maple Leaf shows that we ought to think not only of being preventative but also of refraining from being causative. For instance, if lung cancer is caused by smoking, should we cure it or prevent it? If type 2 diabetes is caused by eating too much in too short a time period (e.g., two Twinkie boxes in 1 day vs 1 yr), or walking too little in too long a time period (e.g., two blocks in 1 yrs vs 1 day), should we cure it or prevent it? If brain damage is caused by not wearing a seatbelt, should we cure it or prevent it? If overweight at a Coca Cola funded exercise facility is caused by the fact that the total calories burned is just under the total calories consumed per activity, should we cure it or prevent it?

In the end, I think behaviour is always the target, unless the patient is unconscious, but just how to affect behaviour best I am still working on.

By Audrey Karperien (not verified) on 01 Dec 2007 #permalink

Thanks for the thoughtful replies above (and congrats Thomas, on your doctorate!).

Taking Thomas's cue, I wonder if there are any readers of British, Australian, or other nationality that could offer additional range to the US and Canadian views above?

Very very funny showdown, I needed a good laugh

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