Preventive Medicine Doesn’t Exist

Living in Wisconsin, I’ve been counseled to profess my love for the Green Bay Packers or move out of the state. I confess that I don’t follow football, but I’ve learned that having a working knowledge of the outcome of Packers games helps me converse with my patients, with the team’s progress sometimes being more concerning to them than their own health challenges.

The morning after one defeat, a patient offered his armchair criticism that the Packers were playing not to lose instead of playing to win. I thought little of the comment until I realized the subtle wisdom of it and how it pertains to health care.

Conventional allopathic medicine operates on a split paradigm. The primary medical initiative is to heroically swoop down when disaster strikes. A car accident or heart attack will bring about a quick and decisive intervention. In managed care, it gets a little more gray. Symptom management may take precedence over addressing the root causes of disease, often because they stem from environmental and lifestyle factors that are unacknowledged or lack solutions within the biomedical model.

Those of us in the holistic and integrative world also operate on a split paradigm. Our primary initiative is to take on those patients that fall through the cracks of managed care and seek those root causes. The interventions differ by scope of practice, but this is the common ground of Western physicians practicing functional medicine and practitioners of traditional medicine. 

The second paradigm common to allopathic and holistic medicine is preventive medicine. They share the term but differ in implementation. With allopathic medicine, a colonoscopy or mammogram might be marketed as a procedure of preventive medicine, but the power lies only in early detection as neither prevents the initiation or progression of cancer. Likewise, medication to control blood pressure can’t claim to prevent a stroke as it only addresses one aspect of a multifaceted disease. There is no prescription for prevention.

Holistic medicine goes deep into environmental and lifestyle factors, claiming that attention to these factors prevents disease, but that, too, is imprecise. Considering the words of my patient who was disgruntled after a Packers loss, it occurred to me that when allopathic and holistic medicine speak of preventive medicine, it is akin to playing not to lose.

The consciousness and motivation behind a sports team playing not to lose is analogous to taking measures to not get a certain disease. It doesn’t matter if the therapy is a drug or an herb or the procedure is a cardiac stress test or colonic hydrotherapy—when the objective is to prevent disease, you are playing not to lose.

Taking this concept to its philosophical endpoint, preventive medicine doesn’t exist. There is only that which generates health (playing to win) and that which degrades resilience. The strategies to empower health will safeguard against cancer in equal measure as they would against heart disease. Optimizing diet, getting restful sleep, and staying active are not preventive measures; they are among the panaceas of human health.

In a world where prophylactic mastectomies are a measure to “prevent” breast cancer, it is an act of wisdom to realize that the road to prevent disease is not the same path as the road to health.