Getting sick is awful. Even a common cold can ruin your week; being laid low for a single day still leaves you sluggish and tired, sets you behind on work, and can easily snowball into a weekend of stress and helpless catch-up. More serious illnesses are obviously even worse – from a lengthy sinus infection all the way up to life-threatening illnesses and afflictions.

Our society has traditionally focused on Reactive Medicine – curing and treating diseases after they are detected. But with every passing year, more and more attention is paid to Preventive Medicine – preventing illnesses before they occur through early detection and healthy living. The argument for preventive medicine is simple and convincing: preventing diseases is often cheaper and more effective than treating them. In many cases, prevention is the only option for diseases that are otherwise fatal! The good news is that you obviously can’t die of a disease you never get.

Prevention seems simple on the surface, but there are many factors that go into it.  Most of us receive vaccines as children and adults, and perform common preventive techniques such as washing our hands, trying to eat healthy, and avoiding dangerous carcinogens such as tobacco smoke. This is known as primary prevention: preventing diseases before they actually occur. When a doctor takes your blood pressure and makes recommendations for keeping it under control, he or she is practicing primary prevention.

Most people are familiar with common screening tools such as blood tests, Pap smears, x-rays, and other medical exams designed to detect the early signs of diseases. This is known as secondary prevention. By detecting diseases at an early stage before symptoms have begun, doctors can treat these illnesses more effectively and with much higher rates of success. A disease that is detected early may have close to a 100% 5-year survival rate, meaning people who have the disease treated during this early stage tend to live a normal life span. The very same disease detected late may have a dismal 15% or less 5-year survival rate if detected during the late stages, meaning most people who are diagnosed late will likely die within 5 years.

The final piece of the puzzle is called tertiary prevention. This involves preventing the adverse effects, including the recurrence and complications, of existing diseases. A simple example is the use of aspirin to prevent heart attacks and congestive heart failure in patients who already have coronary heart disease. Another example is the use of the drug tamoxifen to help prevent the spread or recurrence in patients with history of breast cancer.

So when is preventive medicine most effective? The answer boils down to risk, cost, and potential complications.

The patient and doctor must always ask themselves: What are the risk factors for the patient that make this disease likely and worth screening for? In many cases, a disease is more likely based on family history, sex, or lifestyle factors. In these cases, certain tests should be considered and certain preventive techniques should be undertaken. In other cases, a patient is at such low risk for certain illnesses that screening is more likely to result in a false positive test or undue hardship than to provide a benefit, and should be viewed with skepticism.

The cost of screening and prevention often goes hand in hand with the risk factors. One of the goals of preventive medicine is to reduce the overall cost in healthcare, and in many cases it is significantly cheaper to prevent diseases than to treat them reactively. However, this is not always the case, especially when considering the countless number of potential tests and procedures that exist to detect illnesses. It is important to weight the benefits of a test against the likelihood of the patient actually being at risk, as excessive testing can create unnecessary financial burden. The good news is that while screening can be expensive, many preventive measures can be taken by the patients themselves cheaply or free of cost. It costs nothing to avoid smoking, to avoid excessive sugar and alcohol, and to exercise daily, for example.

Finally, the potential complications of any preventive procedure must be considered. Some procedures are invasive or stressful, and in many cases false positives can lead to additional stress, invasive follow-up procedures, and time/money lost. It is important to focus on procedures that are most likely to contribute toward a long and healthy life without causing undue hardship.

It’s important to discuss all these factors with your doctor, as well as to research them for yourself. In a future post, I’ll be detailing some of the most common preventive tools and the ages you should start scheduling certain procedures with your doctor. Preventive medicine is often the best tool for staying healthy – but it requires you to know your body and your options better than ever!