Participants: Dr. Meshach Samuel
Series Code: WM
Program Code: WM000353
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00:34 Welcome to Wonderfully Made.
00:35 In today's segment of Wonderfully Made, 00:38 we will be considering a very important 00:41 and interesting subject. 00:43 The concepts of preventive medicine. 00:46 I am doctor Meshach Samuel and I currently serve as a 00:50 family practitioner, and I enjoy doing what I do in the field of 00:55 primary care. 00:57 Preventive medicine is my favorite topic. 01:01 I believe that the correct understanding of this subject 01:04 is important for each one of us. 01:07 I have noticed that many today are seeing the devastating 01:12 effects of chronic disease. 01:13 And are showing more and more interest in preventive medicine. 01:18 I hope that today's presentation will help us get a better 01:23 understanding of the true meaning and importance 01:27 of preventive medicine. 01:29 Let's start with this statement. 01:38 In other words, if we know what is causing a particular problem 01:42 it will be easier to prevent it from developing. 01:47 Let's start with a basic question: 01:50 What causes disease? 01:53 During the XIX-th and the early part of the XX-th century 01:57 a simple model was strongly promoted. 02:00 It involved a single factor. 02:03 It was said that an agent affects man and 02:08 causes the disease. 02:11 Most often this single factor was an infectious agent. 02:16 And there for it was called The Germ Theory of Disease. 02:21 And this theory gained acceptance mainly because 02:25 of the rapid spread of infectious diseases 02:28 during those years. 02:31 Millions died of diseases such as malaria, polio, typhoid, 02:36 smallpox and so on. 02:39 When the disease agent was identified and eliminated 02:43 the disease was arrested or prevented. 02:47 As a result of advances in public health, 02:50 improved sanitation and appropriate use of antibiotics, 02:56 infectious diseases began to decline. 03:00 But only to be replaced by a new type of diseases. 03:05 The so called "Modern diseases of civilization". 03:10 Also referred to as "Diseases of lifestyle" such as lung cancer 03:16 coronary heart disease, diabetes, hypertension, 03:21 and so on. 03:23 Now this diseases, could not be explained on the bases of a 03:27 single fact of causation. 03:29 Nor could they be prevented by the traditional methods of 03:34 isolation, or immunization, or improvement in sanitation. 03:40 It is now recognized that many of the chronic diseases that we 03:44 struggle with today are rarely caused by a single agent alone. 03:50 But instead, it depends upon a number of factors 03:53 which contributed to it's development. 03:57 This is referred to as multiple factor causation. 04:03 As opposed to the single factor causation 04:05 that we've talked about. 04:07 Attempts have been made to group this multiple factors into 04:11 different categories. 04:13 One such example is the agent, environment and host triad. 04:21 A stable balance or an equilibrium seems to exist 04:25 between man and his environment. 04:28 Resulting in a disease free state. 04:32 But when there is a negative interaction between this groups 04:35 disease results. 04:39 Let us look at some of this examples of factors in each of 04:42 these three categories. 04:45 The first one: Agent Factors. 04:48 It is easy for us to understand agents such as bacteria, 04:51 viruses, yeasts and parasites. 04:54 This are examples of biological agents that could cause disease 04:59 and all of this act as infectious agents. 05:03 Then we have chemical agents such as poisons gases, 05:07 insecticides, fertilizers, and so on. 05:11 We know of factors such as excessive heat, excessive cold, 05:17 radiation and electricity. 05:19 That could act as agents of diseases too. 05:23 These are physical agents. 05:25 And then of course we have nutritional or dietary factors. 05:30 That could become an agent of disease. 05:32 The deficiency of some substances in our diet 05:37 or the excess of it can cause diseases too. 05:41 For example low iron in the blood could cause anemia. 05:46 We know that too much cholesterol or fat in our diet 05:50 causes serious disease conditions. 05:54 Now let us see some examples in the second category. 05:57 That will be environmental factors. 06:00 Many of the factors that we see or saw in the previous category 06:07 of agents are really a part of the environment. 06:11 Such as heat, cold, dust and so on. 06:15 Environmental factors really include all of man's external 06:20 surroundings. 06:21 Such as air, water, housing, sanitation and so on. 06:27 Any or all of this factors could play a role in the causation 06:31 of disease. 06:34 Now let's move on to the third category. 06:36 That is the host. 06:38 Factors such as age, sex, and ethnic group, do play a role in 06:43 some disease conditions. 06:46 And then we have some subtle factors such as social isolation 06:50 I see how this affects some of my patients, especially 06:54 the elderly who are locked in most of the time. 06:57 Then we see children experiencing maternal 07:00 depravation, and broken families. 07:04 This things are beginning to emerge as important factors for 07:09 causation of disease. 07:11 However, in speaking of prevention of chronic diseases 07:16 the most important are those that are lifestyle related. 07:22 Lack of physical exercise, use of alcohol, drugs and tobacco, 07:28 unhealthy habits such as poor sleeping patterns and stress, 07:34 these lifestyle related factors have become so important 07:40 that today, man that is a host is viewed as an agent of his 07:46 own diseases. 07:47 In other words, man's state of health is determined more by 07:52 what he does to himself then what some outside agent 07:56 does to him. 07:58 For example 08:00 the medical cause of lung cancer may be chemical substance in 08:04 the cigarette. 08:06 But this agent does not really affect man, until man decides 08:12 to cultivate tobacco plants, harvest the leafs, process it 08:17 to obtain the right concentration of nicotine, 08:21 then roll it in paper in the form of cigarettes, 08:22 places one end between his lips, 08:25 burns the other end with fire, and inhales the smoke into his 08:29 lungs. 08:31 So although the medical cause may be the nicotine, and other 08:36 cancer causing substances in the cigarette, the real cause of 08:40 the disease is man's choice or his behavior. 08:45 Which is smoking. 08:47 We call this the psycho-social cause of disease. 08:52 So we've said that chronic diseases of today are largely 08:56 lifestyle related. 08:58 And the result from multiple factors and not only multiple 09:02 factors but from complicated interactions of this multiple 09:06 factors. 09:08 The purpose of studying this factors is to see if we can 09:14 modify them, or remove them, in an attempt to prevent 09:17 or control disease. 09:19 We have been talking about the causation of disease. 09:23 Let us now consider an important element in preventive medicine. 09:28 And that is: 09:30 the natural history of disease. 09:32 What do we mean about the natural history of disease? 09:36 It simply refers to the way in which a disease 09:38 evolves over time. 09:41 From the earliest stages of it's evolvement, to it's termination 09:45 as either recovery or disability or death. 09:50 Let us see if we can illustrate this with a diagram. 09:55 Let's say that the horizontal line that you see on your screen 09:58 represents a timeline. 10:01 A period in ones life. 10:04 Let us now place a short vertical line somewhere along 10:08 this timeline to represent the point of onset of the disease 10:13 in this particular individual. 10:15 Now we have the time period divided in two. 10:20 The period beyond the point of intersection represents the 10:24 disease phase or pathogenesis phase. 10:28 Pathogenesis may be a new word to some of us. 10:31 We know that "genesis" means beginning and "pathos" 10:36 is a Greek word which literally means suffering. 10:39 And if you can correlate suffering with disease, the term 10:43 literally translates the beginning of the disease phase. 10:48 Now on the timeline before the intersection to represent the 10:53 disease free state. 10:56 Or pre-pathogenesis phase. 10:59 Now let us take a closer look at the pathogenesis phase or the 11:03 disease phase. 11:05 In most cases whether it be an infectious disease, or a chronic 11:11 disease. 11:12 There is lifestyle related disease. 11:14 There is a period soon after the onset when the disease agent is 11:20 affecting the person but there is no outward manifestation of 11:25 the disease. 11:27 In other words there are no symptoms or physical signs. 11:31 I the case of infectious diseases this period is known 11:37 as the incubation period. 11:40 That is when the disease agent multiplies in the body without 11:44 causing any symptoms or physical signs. 11:48 If this is left unchecked the agent begins to cause tissue 11:53 damage and some physiological changes resulting 11:57 in recognizable symptoms of the disease. 12:02 In chronic diseases such as coronary heart disease 12:05 hypertension, diabetes, cancer and so on. 12:10 This period of time that is soon after the onset of the disease 12:14 is less traumatic and often more prolonged. 12:19 And is referred to simply as the presymptomatic phase. 12:25 And again during this stage there is no outward 12:29 manifestation of the disease. 12:32 And the sad thing about it is that in some instances, by the 12:36 time, signs and symptoms appear the disease phase is already 12:40 well advanced into the late pathogenesis phase. 12:47 Now let us recall what we have discussed so far in our study 12:51 today. 12:53 Firstly we said the cause of modern diseases is not only due 12:58 to multiple factors, but also due to complicated 13:01 interactions of these multiple factors. 13:06 Next we looked into the natural history of disease. 13:09 That is how the disease progresses in a person, 13:13 who is in the disease-free state. 13:17 To an early disease stage, and then to the advanced or late 13:21 stages. 13:24 How does the knowledge of natural history of disease 13:27 help us in our understanding, or in our application of the 13:33 principals of preventive medicine? 13:37 Strictly speaking, the role of preventive medicine ends with 13:42 the onset of the disease. 13:45 However some specialists in this field of medicine have suggested 13:51 that we brought in the concept of the preventive medicine. 13:56 And when we do this we set higher goals. 14:00 Our primary goal would be to prevent the onset 14:04 of the disease. 14:06 But we don't stop there. 14:08 We now set a secondary goal which would be to prevent the 14:13 progression of the disease. 14:16 And then we'll go a step further with e tertiary goal. 14:20 Which would be to prevent the bad outcomes of the disease. 14:24 Which could be their impairments disabilities and sometimes 14:28 even death. 14:30 Now let's see if we can put all this in perspective. 14:34 Let's take a look again at the diagram of the natural history 14:38 of disease. 14:40 We see the tree periods. 14:42 The disease free period, the early disease period and the 14:46 late disease period. 14:48 The first period is the disease free period. 14:52 Our goal here is to prevent the onset of the disease. 14:57 This is our primary goal. 14:59 And we can say that the actions taken during this period to 15:04 prevent the onset of the disease is primary prevention. 15:11 Now let's take a look at the next faze. 15:13 The early disease period. 15:16 The goal here is to prevent the progression of the disease. 15:21 This is a secondary goal. 15:24 We resort to this goal only if and when we have missed the 15:28 primary goal of preventing the onset of the disease. 15:33 The actions taken to achieve this goal can be called 15:37 secondary prevention. 15:40 Now let's move on to the third phase in the timeline of the 15:44 Natural History of Disease. 15:48 That is the advanced or the late disease phase. 15:52 Here our goal is to prevent impairment or disability. 15:57 This is our tertiary goal. 16:00 We seek to obtain this goal only when we have missed the primary 16:04 and the secondary goals. 16:08 And the way we obtain this goal is by implementing tertiary 16:12 prevention. 16:14 So we now have three levels of prevention corresponding to 16:18 the three major phases of the Natural History of Disease. 16:23 Primary prevention, secondary prevention and 16:26 tertiary prevention 16:29 Now let's look into the three levels of prevention. 16:35 We'll start with tertiary prevention. 16:38 That is efforts to prevent impairment and disability. 16:45 Take for example someone who has suffered a stroke and is unable 16:49 to walk, or move an arm, or unable to speak. 16:53 An acute rehabilitation program with physical therapy, 16:58 occupational therapy and speech therapy often enables the person 17:03 to regain a significant degree of their motor functions. 17:06 And be able to get back to independent living. 17:10 This is quite an achievement. 17:13 Yet, tertiary prevention is considered the least 17:17 beneficial. 17:18 And least rewording of the three levels of prevention because it 17:24 involves intervention in the late stages of the disease. 17:28 And much suffering and loss has already been experienced. 17:32 That is why it is considered the weakest tool in preventive 17:36 medicine. 17:37 Now what about Secondary Prevention? 17:41 This applies to interventions in the early stages of the 17:44 disease period. 17:47 What are the interventions at this stage? 17:51 Early diagnosis, and appropriate treatment. 17:56 Secondary prevention helps prevent the progressions of the 17:59 disease. 18:00 And in some instances it enables one to even get back to the 18:04 disease free-state. 18:06 And this is certainly a desired goal in Preventive Medicine. 18:10 Yet, secondary prevention is not the best tool in Preventive 18:15 Medicine. 18:16 We have seen earlier that tertiary prevention is the 18:19 weakest tool. 18:21 We can say that secondary prevention although a very 18:25 useful tool, is still an imperfect tool. 18:30 Now that leads us to the quest for the perfect tool. 18:34 And I'm sure you guessed it. 18:37 Primary prevention. 18:39 We said that secondary prevention is an imperfect tool 18:42 because it is more expensive and less 18:46 effective than primary prevention. 18:50 Primary prevention is action taken before the onset 18:54 of the disease. 18:57 Actions which remove the possibility that a disease will 19:01 ever occur. 19:03 What actions are taken in primary prevention? 19:07 Everything that will preserve health and promote health. 19:12 This is done by simply following the natural laws of health. 19:19 It also includes specific protective measures. 19:23 A good example of a protective measure in primary prevention is 19:29 immunization or vaccination. 19:32 For example the flue vaccine: it is not recommended for 19:37 everybody but for selected group of individuals who have a high 19:42 risk of developing the disease. 19:45 This is called SPECIFIC PROTECTION because it protects 19:49 against a specific problem. 19:52 I'd like to call primary prevention the perfect tool 19:55 because primary prevention is far more than just reverting 20:03 the occurrence of a disease. 20:04 It aims at promoting health. 20:07 It aims at promoting well being and improving the quality 20:12 of life. 20:13 It includes the concept of what may we call positive health. 20:19 The Bible refers to this as abundant life. 20:24 Now I would like to use a story or you could perhaps call it 20:31 a parable. 20:32 That would help us understand the importance or the value of 20:37 primary prevention. 20:39 It's more like a parable. 20:42 There was once a village that was situated on top 20:45 of a mountain. 20:47 One side of the village there was a forest that abruptly 20:52 ended in a cliff. 20:54 The villagers were a friendly happy community that worked 20:59 together and helped each other. 21:02 But they soon realized that they were faced with a growing 21:06 problem. 21:08 Villagers who went into the forest to gather wood 21:11 or children who went into that part of the wood 21:13 to play would some times 21:15 accidentally fall off the cliff and would be badly injured. 21:20 And some even died because they could not get help in time. 21:25 One day the village council met to discuss as to what could be 21:29 done to solve this problem. 21:32 Several suggestions were made. 21:34 One suggested that some kind of alarm system be set up to alert 21:39 the people as soon as someone fell, so that help could be 21:42 obtained without delay. 21:44 But then they realized that there were times when all 21:49 the able body men were out in the fields working and no one 21:52 was available to respond to an alarm. 21:58 Some one else suggested that an emergency team be set up. 22:03 People who could take turns to be on call to respond promptly. 22:08 Yet another thoughtful person said "it is difficult to climb 22:13 down the hill, and it takes a while before the team gets there 22:18 to offer the help." 22:21 It was said that whatever would really help is to construct 22:26 a road to the foot of the mountain and have an ambulance 22:30 ready, that would get the team to the victims aid quickly. 22:36 Some one else said "the best way we can really take care of this 22:41 unfortunate victims, would be to setup an emergency unit at the 22:45 foot of the mountain, and have trained people and equipment 22:49 ready and available whenever the need arises. 22:54 I guess, by now, you've figured where we're heading with this 22:57 story or the parable. 23:01 For finally a little old man said "why don't we cut down 23:05 a few threes from the forest and put up a fence along 23:09 the cliff so that no one would fall?" 23:13 And that is what they did and no one was heart after that. 23:20 You will agree with me that all the earlier suggestions 23:24 sound almost ridiculous when compared to the simple solution 23:30 of putting up a fence. 23:33 Prevention is definitely better than cure. 23:37 This is a perfect example of the effectiveness and importance 23:42 of primary prevention. 23:46 But the question now rises: Why then is so much importance 23:51 given to secondary and tertiary care in conventional medicine 23:55 today? 23:58 There are many who criticize the medical system and 24:00 the physicians today for not placing the emphasis on primary 24:05 prevention. 24:08 Let me suggest a few thoughts for you ponder over. 24:12 It might explain the reason why we are in the difficult 24:16 situation that we find ourselves in. 24:20 Firstly in the parable people are safe and well in the village 24:26 until some one falls off the cliff. 24:30 That is, there are time periods when everyone is safe and no one 24:35 is heart. 24:37 Now in that situation all the effort, all the man power and 24:43 all the resources could be focused exclusively on building 24:48 the fence. 24:50 That is primary prevention. 24:53 But the medical problem that faces us today does not fit 24:57 that illustration. 24:59 At any given time there are thousands, in fact millions, 25:04 fallen down the cliff and on the need of help. 25:09 So while attempting to build a fence that is promoting primary 25:13 prevention, it would be almost unethical to ignore the wounded 25:19 and the dying. 25:20 That is to cutback on secondary or tertiary prevention. 25:27 The second and even more important fact to 25:29 consider is this: 25:31 in the parable the fence is a separate entity 25:35 in and of itself. 25:37 Weather people like it or not, it could be erected by those 25:41 interested and concerned to bring about a change. 25:45 But with modern diseases that plague us today every individual 25:50 has a direct role in "putting up the fence". 25:55 As we've learned earlier man is viewed as an agent of his 26:00 own diseases. 26:02 We've learned that our state of health is determined more by 26:07 what we do to ourselves than what some outside agent 26:11 does to us. 26:13 So primary prevention in controlling modern diseases 26:16 is not something that can be forced upon someone else. 26:21 Primary prevention involves each individual's attitude 26:25 towards life and health. 26:28 It depends on the initiatives one takes about responsible 26:33 measures to prevent diseases. 26:37 I'd like to quote to you a passage from a favorite author 26:41 of mine named Ellen G White. 26:44 She wrote this words more than a hundred years ago, she states: 26:47 "The people are perishing for want of knowledge, disease of 26:52 almost every description is pressing upon the people, yet 26:55 willing to remain in ignorance of the means of relieve and 27:00 the course to pursuit to avoid disease. 27:04 I believe that this is a perfect description of what we face 27:07 in the medical field today. 27:09 Primary prevention is certainly the perfect tool in preventive 27:12 medicine. 27:13 Building a fence is the most effective and meaningful way 27:17 of going about this task. 27:19 But it can not be done by the physician alone, or even by the 27:23 best healthcare system in the world. 27:26 It depends upon the individual's attitude towards life and health 27:31 and may I add that the best attitude towards health will 27:37 come when we realize that we are created in the myth of God. 27:42 When we realize that we've been bought with an infinite price 27:45 and that our bodies are the temple of the living god. 27:49 I hope that this presentation will create in us a desire to 27:53 do our best to learn how to preserve, promote and enjoy 27:58 the abundant life that God has given to us as a gift. 28:02 Thanks for joining me today in our study of the concepts 28:05 of preventive medicine. |
Revised 2014-12-17