THE BLOG
11/25/2013 11:55 am ET Updated Jan 25, 2014

Dare to Be 100 -- Primum Prevent

Since forever, the strong mandate, "Primum non nocere," "first do no harm," has been tattooed on the frontal lobes of every entering freshman medical student. The restraint that this advisory commands, although often tested, continues to serve us all well.

Of broader operational application is the creed "to cure sometimes, to relieve often, to comfort always." This injunction, generally attributed to Hippocrates, is regularly cited in musings about what constitutes medicine's mission.

The nobility of this creed pervades most ideal considerations of medicine's job description. It involves the very essence of the art of caring. Its words are central to any mission statement. They are necessary, but in my view are very insufficient.

Asclepius charged by Zeus with the well-being of his citizens recognized that this broad oversight involves two separate, although interconnected agencies, prevention and repair, health and disease. Recognizing this he delegated his daughter Hygeia to oversee the first task, and consigned repair to another daughter Panacea.

In ancient times, Hygeia's influence prevailed. Health, the golden mean, everything in moderation, cleanliness is next to godliness, Hygeia's sponsorship of the Olympic Games to represent mankind's highest capacity. These precepts were the "first principles" of Grecian medicine. Panacea's generic role was sublimated to an accessory to health's primary emphasis on health. Repair was the default option.

The intervening millennia have witnessed a total reversal of the influences of these two components of medicine. Today 95 percent of economic and intellectual capital are dedicated to repair and disease treatment. Prevention and health have languished far behind. Hygeia's Medicine has been corrupted by the huge profits that have accrued to be body shop mechanics.

A clear dissection of the realities however, reveals the bankruptcy of this emphasis. Now the global burden of health is dominated by the chronic diseases. Not at all coincidentally, these diseases are preventable, but poorly palliated and at huge cost. Heart disease, cancer, diabetes, stroke, arthritis, all are subject to rigorous health strategies. Even the grim neurologic illnesses of old people offer preventive opportunity.

Therefore, I suggest a major amendment to the afore-nominated statements. I propose a different (old) paradigm, from disease to health, from treatment to prevention, that is safe, effective and universally effective. What repair strategy can make this claim? The Yellow Emperor, 2600 B.C., provided this perspective:

To administer medicines to diseases which have already developed and to suppress revolts which have already developed is comparable to the behavior of those persons who dig a well after they have become thirsty, and of those who begin to cast weapons after they are already engaged in battle. (1)

Later, Oliver Wendell Holmes (1809-1894) said,

And lo the starry folds reveal
The blazoned truth, we hold so dear:
To guard is better than to heal, --
The shield is nobler than the spear. (2)


Primum prevent!

References"
1) Nei Ching Su Wen, Bk 1,Sect 2 ( tr.by Ilza Veith in The Yellow Emperor's Classic of Internal Medicine.
2) Holmes OW. Songs in Many Keys,"For the Meeting of the National Sanitation Assoc. 1860.