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Ounce of Prevention
Richard H. Schwartz
To the Editor:Your November–December issue, "Medical Education and the Health-Care Crisis," included articles by many health professionals who cogently indicated just how serious the situation is in our medical schools. However, none of the medical experts touched on an essential part of the solution—the need to use the extensive research already available to educate patients on how to prevent degenerative diseases and thereby to sharply reduce medical expenditures.
Contemporary western medicine has for the most part focused on the treatment of diseases, rather than on their prevention. Medical schools primarily teach that prescription drugs are the most powerful tools doctors have for treating disease; diet and other lifestyle changes are almost never presented as therapeutic tools. Once a doctor enters medical practice, the drug message is reinforced: drug companies give out free samples; virtually all the advertisements in medical journals are for prescription drugs; the bulk of medical literature relates to the use of drugs and drug comparisons. Hence, the generally accepted response to many diseases today is to prescribe medications first and perhaps recommend lifestyle changes as an afterthought.
Because of these misguided policies, national health-care costs have been soaring; they have increased from 6 percent of the United States gross national product in 1970 to about 15 percent today. Even with all the recent efforts to hold medical expenses in check, they are expected to double in the next decade.
The following anecdote about the great philosopher and physician Maimonides is instructive. During the period when Maimonides served as the royal physician of the Sultan of Egypt, the Sultan never became ill. One day the Sultan asked Maimonides, "How do I know that you are an expert physician, since during the period that you have been here, I have never been ill, and you have not had the opportunity to test your skills?" Maimonides replied that "the ability of a physician to prevent illness is a greater proof of his skill than his ability to cure someone who is already ill."
To solve the health-care crisis facing our medical schools and our society, it is essential that there be far greater stress on the prevention of diseases through improved diets and other lifestyle changes.
Richard H. Schwartz
(Mathematics), Emeritus
College of Staten Island
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