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Awaiting moderation 692 Article |
Preventive medecine: opportunities for disease prevention PREVENTIVE MEDECINE: OPPORTUNITIES FOR DISEASE PREVENTION
Control of infections
Many of the most common infections around the world can now be prevented by vaccination. The notable exception is malaria. Public health programmes, if strictly adhered to, can prevent epidemics of almost all the childhood and most adult infections. It is almost impossible to prevent new influenza-virus epidemics, and genital herpes, gonorrhea and AIDS are proving a problem to prevent, but almost certainly vaccines will eventually be developed for these conditions. While the scientific world seeks pharmaceutical answers to these sexually transmitted diseases a return to a less sexually promiscuous lifestyle would help control the epidemics of some of them. There are signs that this is already happening especially in the US.
With the shrinking world we now live in it is hardly surprising that quite exotic diseases are seen in Westernized countries from time to time. ÒÂ is still commonplace in many areas of the world and can easily be caught by a non-immune Person
Control of pollution
There are relatively few areas in which pollution could be more rigorously controlled than it is now. Air-pollution controls would save some lives; reduced cigarette smoking in public would reduce the risk to the non-smokers present; and the elimination of certain food colourings and additives would almost certainly be beneficial; there is some evidence of carcinogens in certain western water supplies and so on.
It is easy to list the many possible pollutants, but Sir Richard Doll, the distinguished British epidemiologist, has estimated that pollution of all types probably is not responsible for more than 1 per cent of all total cancers, for example. The cost of eliminating all such pollutants would, he claims, be too high. The effects of lead on mental activity in children are difficult to assess, but it makes sense to take the lead out of petrol as many countries have already done.
Mass screening of populations
One of the most successful stories of modern prevention has been the reduction of perinatal mortality. This has come about by persuading mothers to go for ante-natal care. But there are still mothers who receive little or no ante-natal care and thus are at greater risk of losing their babies, and in the UK the perinatal mortality rate is nothing to be proud of when compared with other developed countries. The screening of pregnant mothers for fetal abnormalities is a powerful preventive tool, but only if the mothers are prepared to have an abortion if the baby is abnormal.
Preventive medication
For decades now iodine has been put into table salt (to prevent thyroid disease), fluoride into drinking water (to prevent dental decay) and vitamins into margarine (to prevent rickets). This kind of mass medication is open to debate if only because it exposes the majority of the population who do not need the medication to its, often unknown, hazards. The provision of preventive medications or vitamins for specific groups at risk (such as those mothers who have a history of spina bifida children) is quite another matter because the individuals are strongly motivated to do something positive and have the choice whether to do so or not. Trials are now under way in many such areas of preventive medication including the prevention of bone thinning and fractures in post-menopausal women (by giving oestrogens and/or calcium), dietary supplements to act as anti-cancer agents, and aspirin to reduce the risk of heart attacks and strokes in everyone over 50.
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