What Is Preventive Medicine?

I think it’s interesting how opposition to health care reform will drive people to reject really banal elements of common sense. Here, for example, is Heather Mac Donald slamming the idea that medical professionals should do more preventive work:

We need to induce doctors to practice preventive, not just reactive, care! is a favored nostrum in the current health care debate. I’ve yet to hear an example of what this means. Prevention lies overwhelmingly within the realm of individual behavior, but our modern reflex of transferring agency from favored victim groups—in this case, millions of artery-clogged, waddling Americans—onto less-favored entities guarantees that we see the problems of Fat America as the failure of doctors to practice the right kind of medicine. Perhaps more doctors could counsel their patients to exercise and avoid over-eating, but my guess is that if they stay silent on these topics, it is from hard-won experience regarding the futility of such suggestions.

This is very strange stuff. Obviously, prevention is largely in the hands of individual behavior. At the same time, it’s much easier to guide your behavior in the direction of good health if you’re given relevant information about your health needs. Given such information by, for example, a medical professional!

For example, healthy eating is actually not equivalent to “don’t be fat.” How fat or thin someone is has very large genetic elements. But eating an unhealthy diet is still unhealthy even if it doesn’t make you fat. But many people (including Heather MacDonald it seems) aren’t aware of this. You might think you’re in fine shape, but actually have a serious cholesterol problem. Your doctor can reveal that fact and give you advice on how to improve it. As I recall, this happened to my always-svelte dad and he stopped eating peanut butter. A doctor once pointed out to me that it’s healthier, per unit of alcohol, to drink red wine than beer, which had never really occurred to me. Now arguably MDs are overqualified to be dispensing this kind of advice. But the point is that dispensing advice of this sort can be a much more cost-effective way of improving health outcomes than is doing surgery decades later after the cholesterol has done its damage.