My opinion on prevention has changed over the past 10 years, especially in the face of evidence of the failure of many hopes. Contrary to what you may believe, many diseases are not treated in time because of a medical discovery from the patient unaware, but because the patient, in the presence of symptoms, it should be ” first ” to the doctor. In essence, the engine first of prevention is not the doctor, but the patient himself.
Even today, doctors sick of megalomania, unable to speak clearly does not know how to heal certain diseases (the intelligent person admits his ignorance, does not invent solutions), get around the problem, believing herself to be able to prevent it.
So then you ” discover ” infallible marker for this disease or tests reveal that all miraculous. Behind this situation, there is often a tendency to error correlation: a simple correlation that is exchanged for the cause of the disease that laziness will cease to investigate. The result is that the correlation is almost always indirect or is present for different pathologies, many of which are absolutely harmless. How many pediatricians terrify mothers unprepared in matters having doubts (muscular dystrophy? Other terrible diseases?) On CPK of a child who maybe had spent the day before the examination to play in the garden (and the high CPK was the natural culmination of the effort physical)?
Career.
Certainly important for the damage’s prevention are all those who promote research crusades against this or against one or associations that are fighting to defeat diseases without actually having the ability. It is clear that it is an exaggeration of the importance of their natural field of action.
The case of the hour is hypertension. Millions of people take a pill hypertensive, reassured by their doctors that side effects are minimal. It is actually optimistic hope to be completely healthy subjects, and it is not clear in a subject who has 40 years for pressure 160 over 95, which will have the benefit of taking the pill, already in 2005 a study published in the Lancet which involved more 100,000 patients showed an increase in mortality of 3%! Continue disputes between physicians as to what are the best strategies (ie drug use!) Against hypertension show that it is truly optimistic hope that any indication (which is often opposed by others) is ” with no contraindications and definitely beneficial. ”
In other cases, the doctor has his own work to mass screening, and then he became the first enthusiastic supporter. Think of colorectal cancer and the mass screening for those over 50: the likelihood that the cancer does not give any obvious symptoms (blood in stool), but is found in an examination of the feces (marginal streaks) is very small because of that means that if you do an exam per year, you should just happen on days when the tumor is still ” quiet “, but detectable. On the other side of the scale, there are many false positives (see the list in the article Blood in the stool) living day nightmare waiting for the final verdict.
The Business.
In many cases, after an overzealous prevention is not only the desire for omnipotence and / or reputation of the doctor, but also enormous commercial interests. Just change a parameter and millions of people get sick. It is not a joke, but the squalid reality. By changing the fasting glucose from 140 to 126 the number of ” diabetic ” increases of 14%, and if you change the systolic blood pressure from 160 to 140 and diastolic blood pressure from 100 to 90 the number of hypertensive patients increased by 35%, and if you change the T-score from 2.5 to 2, osteoporosis female increases by 85%, and finally if you change the way my total cholesterol from 240 to 200 increases by 85% the number of hyperlipidemic. And many of these people are healthy.
The sensational case of cholesterol: first it was discovered that the only total cholesterol did not make sense, but that it was necessary to also consider the good cholesterol, then it is seen that in people with hypertension and non-smokers, the role of cholesterol was marginal. Everything magically when the star of statins was beginning to decline, and for the dissemination of information on the side effects both for the exit on the market of food’s intracortical (plant sterols) which downgraded without contraindications total cholesterol of 10-15%.
Another sensational case that the PSA. Purpose of PSA test should be to lead to a significant reduction in deaths from prostate cancer (a type of cancer among the most frequent in males). This is because this examination was to facilitate an early diagnosis. Unfortunately, things did not go as you had hoped, as a result of various studies carried out on a substantial number of subjects, and according to tests carried out on epidemiological data on incidence and mortality of the disease in question, it is seen that a too-casual use this test has led to treat subjects with the disease would not have caused any kind of problem, which did therapies.
The reduction of deaths did not occur and, unfortunately, is considerably increased the number of those who have been subjected to repeated biopsies, radiation therapy, radical surgery and so on. resulting in increased risk of incontinence and sexual impotence not to mention all the problems related to anxiety and discomfort involving the diagnosis of cancer.
The Prevention of the base.
For primary prevention is to be understood the prevention implemented by a person fully asymptomatic, healthy and with a great lifestyle, it is obvious that it must then enter all the regular checks to individuals who have conditions or important risk factors. Prevention must mediate between superficiality (exams are useless if I have to … I have to …), and hypochondriasis (exaggerated fear of disease). Let’s see what strategies put in place.
Blood Pressure – The maximum values are recommended for 140 systolic and 90 diastolic. For more details, see our article Hypertension (high blood pressure).
Weight – Recommended values for men: IMC not more than 22 or fat mass not exceeding 12% for women IMC not exceeding 20 or fat mass not exceeding 20%.
Physical Activity – Passing the People Fit Test (Walk or running – possibly alternating – ten kilometers. If we take more than a now you’ve failed the test). For more details see our article The test of the dying.
Teeth – Visit and annual cleaning.
Blood tests – After 20 years of age for inspection every 5 years after age 40 you make a check every two years after age 50, a check every year.
It is important to verify the risk index of cholesterol (total cholesterol / HDL cholesterol), which must be less than 5 in men and less than 4.5 in women. The blood glucose should be less than 100 mg / dl, while the Gamma-GT must be less than 20 IU.
Electrocardiogram (ECG) – We perform an ECG in the age of adolescence and an EKG yearly after the age of 50. Those who practice physical activity in average intensity must make a stress ECG every year.
Doppler – Perform a carotid Doppler ultrasound after 50 years. In the presence of a cardiovascular risk factor (smoking, overweight, high-cholesterol risk index, hypertension) the control should be updated.
Breast cancer – self-examination monthly and annual ultrasound after 40 years. For more details see our article Breast cancer in paragraph Prevention of breast cancer.
Tumors in the womb – Perform a regular Pap test.
Colorectal cancer – After 50 years occur every episode of blood in the stool. For more details see our article colorectal cancer.
Osteoporosis – Every two years should make mineralografia computerized bone (MOC) women suffering from amenorrhea or menstrual cycle disorders; every three years should do so in menopausal women, and is a recommended annual MOC men and women over 60.
Melanoma – dermatological examination after age 40 and careful self according to the format ABCDE (see our article melanoma).
