Is a Pap smear preventive medicine or early detection?

In my last post, I discussed what is truly prevention in medicine. But what is preventive medicine? Merriam Webster defines preventive medicine as “a branch of medical science dealing with methods (such as vaccination) of preventing the occurrence of disease”. It is preventing the occurrence of disease.

Serendipitously, my wife just received in the mail a letter from Kaiser Permanente (her HMO). On the envelope, it has the following statement, “An ounce of prevention is worth a pound of cure.” Inside, there is a letter about getting a Pap smear. According to the womanshealth.gov website, “The Pap test, also called a Pap smear, checks for changes in the cells of your cervix…The Pap test can tell if you have an infection, abnormal (unhealthy) cervical cells, or cervical cancer.The Pap smear is a way to detect an illness (cancer) or abnormality in its early stages. This is not preventive medicine. It is early detection. Some may argue that this is splitting hairs. They may argue that early detection of cancer saves lives (I would like to see a study supporting this). But detecting a disease in its early stages so that treatment can be initiated is not preventing disease.

To prevent disease, we have to look into the causes of disease. And this is a difficult task. There are environmental factors (pollution of various types, various types of radiation, carcinogens in the environment, etc.). There are dietary factors (unhealthy diet is associated with increased rates of cancers and cardiovascular disease, and many believe poor diet contributes to development of all illness). There are psychosocial factors (work environment, family environment, school environment all play a role in the development of illness). The mind and the emotions play a critical role. None of this is news to any of you reading this.

The issue is that if we look at each of these things carefully, we come up against powerful forces of all types. In the previous post on anti-perspirants and deodorant, I quoted several studies that indicated that use of common commercial anti-perspirants and deodorants contribute to the development of breast cancer. Yet the National Cancer Institute’s web page focuses on the fact that “there is not conclusive evidence that these products cause breast cancer”. Could this be related to the fact that the global deodorant market will reach 12.6 billion dollars in value by 2015? It is very difficult to make statements against such a large industry. This is found in every case of products and industries that contribute to health problems in the population, from the tobacco industry, to the cosmetics industry, to PG+E, and on and on.

A secondary problem is that our habits often promote disease. Smoking, drinking more than a small amount of alcohol, using cosmetics, spraying pesticides on our lawns, etc. are all things that most of us do in varying degrees. The idea that these things may be leading to us (or worse yet, our children) developing cancer is highly unsettling. Better to live in denial than to admit such a thing!

Diet (and here I am not speaking about eating too much fat but more about eating processed foods, white flour, white sugar, soda, factory farmed meat, etc.), which most people believe also play a big role, has exactly the same problems I mentioned above. Agribusiness, fast food companies, etc. are very powerful. Moreover, the foods they create are convenient, cheap, and addictive. By now, most people know that these foods are very unhealthy, but I think very few of us are aware of how bad this food really is for ourselves and for the earth (by this I mean the earth itself, i.e. the soil).

Then we come to our psychosocial existence. Is living in today’s society healthy? Do most jobs connect us with the Earth and what is best in ourselves? Does school do this for our children? While there are exceptions, I believe the answers to these questions for the most part is a resounding “No.” In fact, I think that it is quite difficult for we as individuals or as parents to be connected to the Earth and to what is best in ourselves.

Significant change would be required in each of these realms for us, as a society, to significantly change the prevalence of most diseases. If we change as individuals, and we collectively change as a society then we will succeed in lowering the rates of disease, and then we will truly be engaged in “prevention.” And those doctors who succeed in helping their patients make these changes can truly say they are engaged in “preventive medicine.”

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