Prevention: Perfect as The Enemy of Very, Very Good

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If we knew with 100% certainty- as in, we got the word on stone tablets, on a mountaintop- how to prevent 100% of the chronic disease that plagues us, the notion that we would fail to do so seems almost absurd.  If, with 100% reliability, we could prevent 100% of the heart attacks, cancers, strokes, diabetes and dementia that all too often mow us down, how could we not?  Why would we not?

Alas, we don’t know anything with 100% certainty.

  And we don’t know how to prevent 100% of chronic disease (or any disease).  That would amount to a guarantee, and health comes with none of those.  Nothing is written in stone.

But we do know how to prevent roughly 80% of all chronic disease, and we know how with a high degree of confidence.  So it’s not perfect- but it is very, very good.  The failure to use what we know to prevent the prevalent diseases we could prevent is, if ever there was one, an example of making an elusive “perfect” a lethal enemy to the readily available good.

I had a very personal reminder of the limitations of prevention over the past week. I wound up in the emergency department following the progression of symptoms over several days, leading to shaking chills, drenching sweats, total body pain, and crushing headaches. My workup benefited from the high tech tools of the modern medical trade, including a CT scan of my head, and a lumbar puncture.

  I was subsequently admitted and treated with antivirals for what appeared to be viral meningitis.  When all labs were in, I had a diagnosis of anaplasmosis, a tick-borne disease that can be fatal.

Ironically, I was scheduled to give a keynote address at a Harvard lifestyle medicine conference, even as I was hospitalized with a disease my own commitment to lifestyle as medicine did nothing to prevent.

  I wound up giving my talk, via Skype, from my hospital bed- reflecting on just such ironies.

We do need modern medicine; we need a “disease care” system. No matter the care we take of ourselves, we can, and at times will, get sick or injured. When that happens, I am grateful, as I think we all should be, for the remarkable prowess and relentless progress of modern medicine.

But then again, while my treatment is courtesy of modern medicine, the pace of my recovery really is not. I am recovering very quickly and nearly back to my normal routine, even as I complete a course of antibiotics, mostly because of the robust state of my baseline health, and that in turn is largely the product of lifestyle practices.  Those practices, the very ones I preach, are associated with that dramatic reduction in lifetime risk of chronic disease.  They are the practices most likely to add years to life, and life to years.

My own, current illness is a reminder that nothing we do guarantees good health.  But opting out of the health promotion enterprise for want of a guarantee is clearly, and foolishly, making perfect the enemy of good.

  We do indeed know enough about lifestyle as medicine to prevent fully 80% of the global burden of chronic disease, and to reduce lifetime risk in ourselves and those we love by the same quantity.

I am writing to suggest, even as I convalesce from the imperfection of that proposition, that it is too good to squander.  It isn’t perfect, but it is certainly good enough.


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