Australasian Science: Australia's authority on science since 1938

Prevention or Pretension?

By Benson Riddle

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.

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 prevention breakthroughs cited above all share one thing in common: they were formulated by a tertiary-educated scientists judiciously 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 overdrive 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, detoxification by colonic hydrotherapy, MTHFR gene mutation testing, and telomerase enhancers in CAM’s extreme proponent 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-mindedness 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-shortening 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.