The Evolving Practice of Preventative Medicine

Abstract

Healthcare practitioners face pressure on many fronts to deliver preventative medicine: disease specific interest groups (1) and both Canadian commissions on health care (2,3) stress preventative medicine as a core component of health care. These recommendations are relayed to a public who, having lost loved ones from ‘preventable’ illnesses, are often eager to engage with prevention programs (1).  Preventative measures can be effective and efficient: for instance, a series of questions taking just one minute to complete can double the chances that someone who wasn’t ready to stop smoking may actually quit (4). However, preventative treatments for healthy individuals carry risks not associated with treatment of illnesses; there is more to lose and less to gain when treating healthy individuals.  Preventative medicine has been criticized for being dangerously aggressive in seeking to apply to whole groups of individuals, using even the force of law in the case of vaccinations (5). Similarly, the ethics of ‘opportunistic’ preventative care for those who present with an unrelated concern is still under debate (6).  Preventative medicine has been called presumptuous for its confidence that on average it will do more good than harm, and overbearing, for its attacks on those who question its benefits (5).