The Complexity Paradox by Mossman Kenneth

Author:Mossman, Kenneth
Language: eng
Format: epub
Publisher: Oxford University Press
Published: 2014-09-15T16:00:00+00:00

Put the Gun Down

The primary goal of public health is to get people to avoid pulling the trigger and to prevent disease through preventive measures or prophylaxis. Prophylaxis prevents or retards pathogenesis by eliminating or reducing exposures to environmental agents or by interfering with the mechanisms whereby the environmental agent causes disease (Figure 6.1). Prophylaxis assumes many forms: vaccines that neutralize disease-causing viruses, oral hygiene for the prevention of tooth decay, public health measures to improve water and food safety, and physical barriers to reduce environmental exposure, such as sunscreens that block solar ultraviolet light exposure.

The fact that the cards have been already dealt before birth that affect health later in life has profound implications for disease risk management. An individual’s likelihood of getting cancer, heart disease, or diabetes depends in part on the maternal environment during development. Knowledge of disease risks acquired early in life is critical to establishing personal behaviors that reduce risks. Successful risk management depends on how early an individual adopts protective behaviors. This is challenging because young adults tend to live in the now and are not concerned with behaviors that may have important health impacts later in life.45

Understanding causality is central to effective disease prevention and public health. But knowledge of causality is less important in the treatment of many diseases. Clearly, effective treatment of microbial diseases requires knowledge of the offending microbe, since therapy is microbe specific. But for chronic, degenerative diseases like heart disease, knowledge of causation is not critical to effective therapy. Coronary artery disease is treated essentially in the same way whether the patient is a smoker or nonsmoker. It is helpful to identify causal agents for long-term disease risk management, but the treatment of the disease per se often does not require such knowledge. A smoker successfully treated for heart disease would be wise to stop smoking to reduce the risk of recurrence in the future. Knowledge of mechanisms is important in establishing sound science-based public health policy, but the lack of full information should not retard development of policies for the protection of the public health. Utility is not necessarily linked to understanding. One does not need to know how a television or computer works in order to use it.

The key challenge for twenty-first-century medicine and public health is the prevention and control of chronic diseases, particularly neurodegenerative disease. To a large extent, we can successfully treat cancer and heart disease, but we do not have a good handle on disease prevention except for controlling smoking, reducing animal-fat content in the diet, and blocking exposure to certain disease-causing viruses. Disease prevention is always preferable to treatment and cure, and identifying and managing causal factors are keys to effective public health programs Treatments for heart disease, cancer, and other chronic, degenerative diseases are battles fought one patient at a time. The disease fight is frequently won without fully comprehending the disease itself or its causes. The costs and time and effort are staggering. In the United States, costs of

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