The pros and cons of preventive medicine were under the spotlight late last year, when the US Preventive Task Force issued its latest guidelines. The task force recommended that women over 50 get a mammography screening every two years; women of 40 to 49 get a mammogram only after talking to their doctors; and that health care providers should no longer teach breast self-exams because the instruction is ineffective. This added fuel to the often fiery debate over the best way to protect women against breast cancer. Critics argue that mammography only saves four per 100,000 women, but produces a number of false positives, meaning that perfectly healthy women have to go through the gruelling process of chemotherapy, radiotherapy and even surgery for no reason.
The jury is still out on the efficiencey of mass screening programmes. But experts in preventive medicine (which, as the name suggests, focuses on preventing rather than curing disease), such as Harold M Fain, an Oklahoma-basedl doctor certified in preventive and family medicine, argue that women should receive high-quality information and have the choice about whether to be screened or not. "Every woman should receive the information necessary to decide if mammography is right for her," he says. "We should allow health care providers and patients to make the best decision for health based on sound medical evidence - not misinformation, rumours, financial conflicts of interest, emotions or politics."
This debate looks set to run and run, with no clear answer yet in sight. But one thing that is clear is the unequivocally positive role of preventive medicine in many other areas. Medical researchers and physicians are increasingly confident about our ability to prevent a whole host of diseases, from cancers such as prostate and bowel cancer, coronary heart disease (CHD), type-2 diabetes, dementia, stroke and osteoporosis. This new approach entails lifestyle changes such as improved diet and increased physical activity, prophylactic treatments like statins to reduce cholesterol and ward off CHD and, crucially, early treatment following screening.
The idea that disease should be prevented rather than cured may prove irksome to the drug companies making billions of dollars a year dispensing pills to cure or mitigate the symptoms of a wide range of ailments - and further pills to counteract the side effects of the original medication. For the rest of us, prevention is a wonderful idea. Let's take bowel cancer as an example. If caught early, there is a 90 per cent survival rate. But if the disease is detected late there is a 90 per cent mortality rate. Clinics that focus on preventive medicine offer clients a rigorous health screening comprising blood and urine tests, ultrasound and MRI scanning, eye and ear checks, neuroimaging and a "structural assessment" to detect problems in the musculoskeletal system.
Dr Garry Savin is medical director of one such clinic, Preventicum (www.preventicum.co.uk), based inWest London, claims to offer Europe's most advanced health assessment. "We are all about prevention here," says Savin, "with tests like MRI scans and ultrasound. We use those because, unlike a CAT scan, they don't emit radiation - we don't think it wise to subject a healthy, symptom-free person to large doses of radiation.'
Many of the clients who pass through Preventicum's doors have no symptoms whatsoever. They might be young and therefore at low risk of age-related diseases like prostate cancer or dementia and feel in the rudest of health. But the philosophy of preventive medicine is to stop these diseases in their tracks by analysing a patient's lifestyle, especially their diet, whether they smoke or take regular exercise, stress levels and family history of disease (one of the best predictors of developing those diseases yourself), and seeking indicators of the early onset of disease, like damage to the carotid arteries, which supply blood to the brain. Problems here can lead to blockages and stroke.
Evidence of damage to the coronary arteries, which supply blood to the heart muscle is also sought. Again, symptoms like chest pains, breathlessness or palpitations are a poor indicator of cardiac problems, because they usually only occur in the advanced stages of the disease. "Most people with coronary artery disease show no evidence of ill health for decades as the disease progresses before the first onset of symptoms, often a sudden heart attack, finally occurs," says Dr Savin. "With a combination of MRI and ultrasound scans of the heart and arterial system, we can get a clear picture of any narrowings, swellings or aneurysms - the dilation of a blood vessel that can lead to haemorrhages. We can also detect scarring in the heart muscle, indicating a 'silent' heart attack, which often goes undetected." If these scans detect any abnormality, Savin's team can immediately recommend a course of treatment or lifestyle changes that will help prevent the onset of coronary heart disease decades before it proves fatal.
Given the fact that CHD is the number one killer of both men and women in the US, Europe, Middle East and throughout the developed world, the importance of catching and preventing it before symptoms occur becomes clear. Another key component of preventive medicine is tackling ageing - or at least the many diseases that afflict us as the cellular structure of our bodies deteriorates. The Diagnostic Clinic (www.thediagnosticclinic.com), situated near London's Harley Street, is another centre of excellence for preventive medicine. The clinic recently unveiled a new treatment option called Regenerus, which it claims is the most comprehensive anti-ageing assessment and "life-enhancement programme" in the UK. Although ageing is, of course, inevitable, the way we age is the result of the changing conditions and processes happening inside our bodies - our metabolism, genetic inheritance, cell deterioration, nervous system, diet, lifestyle and environment.
Dr Rajendra Sharma, the clinic's medical director, explains its approach. "We specialise in complementary and diagnostic medicine generally, focusing on the underlying causes of disease," he says. "But I have taken a particular interest in gerontology, the study of ageing. While we and many other developed countries are good at treating disease in the elderly, geriatrics, we are less skilful at keeping our youthfulness and extending our life healthily."
Dr Sharma uses the example of rheumatoid arthritis - a common age-related condition - to demarcate the difference between his approach and that of other medics. "An orthodox doctor would start with diagnostics, then prescribe painkillers or steroids to treat the arthritis. But we would go much deeper, asking a whole series of questions. Unsurprisingly, undergoing a battery of tests at either of these clinics doesn't come cheap - for example, the Health MOT (a comprehensive check-up) at Preventicum costs £2,950 (Dh17,700). That makes this type of early screening prohibitively expensive for many of us, though advocates of preventive medicine argue that the cost of screening is relatively low compared with the tens of billions spent on treatment. (One example: the cost of heart disease and stroke in the US, including health care expenditure and lost productivity, is projected to be more than $475bn in 2009.)
Another, rather more low-tech approach to preventive medicine is affordable for more. A burgeoning number of clinics and fitness specialists are combining sophisticated analyses of the musculoskeletal system with individually tailored exercise regimes to correct structural problems and strengthen key muscles, especially those supporting joints or in the "core" (those that stabilise the spine and pelvis, running the entire length of our torso).
Jeff Murray, director of Ambition Health and Performance (www.ambitionfitness.com), is one of this new breed. His London-based clinics offer holistic treatment combining osteopathy, corrective exercise, injury rehabilitation, deep-tissue massage and nutrition. Above all, though, he aims to give clients the tools to keep their bodies in optimum condition. "Many people spend money on health products and services but are resistant to making the essential changes required for a long-term successful outcome," argues Murray. "Everyone wants a quick fix, but that doesn't really exist. Good health is aligned to several simple principles which should be applied for life and don't cost much at all."
At the heart of Murray's approach is a combination of osteopathy - to realign necks, spines, hips, knees and other joints bent out of shape by our sedentary, sofa/car/desk-based existence - and exercise. After a few sessions with a corrective exercise specialist, the latter is something anyone can do. "Exercise is the forgotten component of health," insists Murray. "It is just as important as rest, hydration and nutrition, yet less than 20 per cent of us take regular exercise. Our body is designed for movement and requires it to function correctly. Without movement we become ill as our vital organs, muscles, bones and tissue break down from under-use."
Combining nutrition, sufficient rest and corrective exercise is, according to experts like Murray, vital for maintaining optimum health now and staving off a host of stress and age-related conditions in the future. A word of caution: the internet is awash with unscrupulous websites and "experts" offering all sorts of, at best, useless and, at worst, downright dangerous medical advice and products. Before paying for any kind of treatment, always research it carefully and speak to your doctor to make sure it's medically sound.