Preventive Medicine: “My Medical Choice”

Preventive medicine is a branch of preemptive healthcare that focuses on the protection, prevention, and maintenance of well being in order to prevent disease, disability, and death. The way in which individuals think about health has changed drastically over the years, as research leads individuals to believe that they have a great deal of control over their health-related future. Preventive medicine has been given more attention in recent years, in an effort to combine new medical knowledge and advanced technology to decrease the incidence of disease and mortality. While preventive care can be extremely beneficial in reducing such high rates of disease and death, such intervention is often expensive and particularly controversial. In their work Preventive Medicine, Brody and Engelhard illustrate several cases that show the controversial nature of preventive care. Two specific cases addressed highlight preventive care conflicting with expenses and personal choice.

Case A: The central question in this case is how often pap smears should be given to women. While literature suggests that every 3 years is sufficient, clearly, a yearly test would be even more proactive in preventative care for women.  The clinic must decide if it is worth the 50,000-dollar difference to give yearly pap smears, as opposed to one every three years.

Case B: This case deals with preventive care in the form of a vaccination. A mother does not want her baby to get DPT vaccinations because of the potential side effects, such as mortality due to whopping cough. The mother is relying on the idea of herd immunity, however, this concept won’t hold true if more and more mothers become “free riders”.

Both of these cases address sacrifices that must be made in public health. In Case A, money can be sacrificed for greater prevention, whereas in Case B, personal values and autonomy can be sacrificed for a public good. While there is no “clear” right answer to either of the above scenarios, these types of decisions are made on a daily basis in the realm of public health.

In her op-ed article “My Medical Choice”, Angelina Jolie details her reasoning for getting a preventive double mastectomy this past year. Genetic testing showed that Jolie had the BRCA gene, a gene that increases a woman’s chance of developing breast and ovarian cancer. Jolie was told that she had an 87% risk of breast cancer, and a 50% risk of ovarian cancer. Fortunate enough to have the knowledge and the financial means necessary to undergo surgery, Jolie had the preventive surgery and her chances of developing cancer have decreased drastically.  Jolie states, “It has got to be a priority to ensure that more women can access gene testing and lifesaving preventive treatment, whatever their means and background, wherever they live.”

Preventive care is a crucial component of modern day health care as it expands individuals’ options. However, there are significant financial and moral costs involved in this type of care. For example, in reference to case A, giving pap smears more frequently may result in higher prevention of cancer, and in turn, less incidence of disease and mortality. However, giving pap smears more frequently may also result in a greater likelihood of misreading test results, causing patients needless worry and operations. Thus, it is important for patients to be fully informed in order to make their own decisions regarding medical treatment. While preventive care should be available to all, the facts and the risks associated with such care must be clearly understood in order for individuals to confidently make medical decisions.

Works Cited

Brody, Baruch and Englehardt, Tristam. “Preventative Medicine.” Bioethics: Readings and Cases. Upper Saddle River: Prentice-Hall, 1987. 298-301. Print.

Jolie, Angelina. “My Medical Choice .” New York Times 14 May 2013: n. pag. My Medical Choice by Angelina Jolie-NYTimes.com. Web. 14 Mar. 2014.

http://www.nytimes.com/2013/05/14/opinion/my-medical-choice.html?action=click&module=Search&region=searchResults%230&version=&url=http%3A%2F%2Fquery.nytimes.com%2Fsearch%2Fsitesearch%2F%3Faction%3Dclick%26region%3DMasthead%26pgtype%3DHomepage%26module%3DSearchSubmit%26contentCollection%3DHomepage%26t%3Dqry993%23%2Fpreventive%2Bmedicine%2F365days%2F&_r=0

 

 

10 thoughts on “Preventive Medicine: “My Medical Choice”

  1. Although you wrote primarily about patients being informed and the right to make informed decisions in preventative medicine, your post brought up other important aspects of healthcare and morality. Unfortunately, preventative health—like primary care—is not equally available to everyone. Angelina Jolie was fortunate enough to be able to have testing done, and in a position to make the decision to go ahead with the double mastectomy and reconstructive surgery. For others, the choice is not always theirs. It is one thing to have a mastectomy, but reconstructive surgery is expensive. I think that the option of reconstructive surgery made Angelina’s decision easier. For women with the same test results, but without the finances for reconstructive surgery, their decision to have a double mastectomy would be impacted by money. In this case, money and image plays a role in what measures a woman is willing to go to in order to protect her own health. You mentioned money as one of the trade offs for better preventative medicine. This simply highlights the fact that in our medical system, money is inherently linked to healthcare.

  2. Your post brings up a good point about preventative care costing the same amount of reactive care. This may be true for some cases but I think that it is important to look at preventative care costs in regards to the top preventable diseases. According to the CDC, “7 out of 10 deaths among Americans each year are from chronic diseases” which are often preventable. To put this into perspective, one out of every 2 adults has at least one chronic illness (CDC). Chronic illnesses include heart disease, arthritis, strokes, obesity, diabetes and cancer (CDC). Many of these conditions are influenced by a lack of physical activity, poor nutrition, and tobacco use (CDC). All of which are behavioral factors that can be prevented through preventative methods like education.

    There is an economic burden associated with the large amount of Americans experiencing chronic disease. Within 14 years, obesity has contributed to a 12% increase in healthcare spending (CDC). The CDC has a list of expenses of some chronic diseases that can be found below.

    Disease Year Cost
    CVD and Stroke 2009 $313.8 billion
    Cancer 2007 $89.0 billion
    Smoking 2004 $96 billion
    Diabetes 2007 $116 Billion
    Arthritis 2003 $80.8 billion
    Obesity 2000 $61 billion

    Preventative care may have expensive costs at the beginning, but you must think about the costs that are saved in the long run. The above expenses are due to reactive forms of care. I was unable to find information on the cost of preventative care with these same diseases, but it would be interesting to compare the two to determine if there is a clear winner.

    Source-
    Centers for Disease Control and Prevention. (2009). The Power of Prevention: Chronic disease…the public health challenged of the 21st century. Retrieved from: http://www.cdc.gov/chronicdisease/pdf/2009-power-of-prevention.pdf

  3. After reading your interesting blog, I remembered a book I had to read last semester about how medicine is practiced in different culture and why is it that the cost of our healthcare is so outrageous and our medical practice is so controversial. According to Lynn Payer in her book, Medicine and Culture, American system is most appalling because of its aggressive nature. Payer thinks that we compare “aggressive with better”. I also agree with Payer that in the U.S we put much greater emphasis on eliminating a particular disease, as opposed to protecting the patient. In countries like France and Britain, the health care system is most effective because of their philosophy of taking care of the “terrain” or the actual source of the illness. Their physicians are also far more conservative than the American physicians because, according to Payer, British and French physicians are trained to question the need for the procedure to be done. They are trained to think why and what is really needed and what would be the end result. On the contrary, in the U.S, a physician would most likely prescribe medication for even a mild headache without questioning the underlying reason behind it. When the same headaches continue for a while, doctor would order tests such as MRI and CAT scan. People in the U.S have more diagnostic tests done than any European country because in the U.S, people believe that diagnostic tests lead to a more precise result. This is one of the reasons why preventive care has become so controversial over time.

  4. I found this information very interesting and relevant to our class discussions. We discussed these three cases in class and weighed their costs and benefits today. Each benefit had a cost as well, so it was hard to say what the right approach would be. Specifically in case B, not vaccinating your child does make it impossible for them to die of the vaccination (which would be extremely rare anyways). However; even though that child benefits in not risking death or a serious reaction, they become free riders. If everyone becomes a free rider, then no one is safe and there could be a serious epidemic. Clearly, those avoiding the vaccine to benefit themselves are affecting others around them and if that logic was universal the consequences could be severe. Overall, preventative care does give people options but it is that person’s responsibility to try to do what is best for the greater good.

  5. I agree that preventative medicine is crucial to medicine. However, I disagree with your comment on case A concerning the increase in false positive/negative test results. It is true that there will be more false test results, but the ratio of false test results should stay about the same, regardless of how many tests are performed. So while more false test results may occur and more people may be worried when receiving a pap smear every year, the ratio would be the same as that of patients who receive the pap smear every 3 years. But keep in mind, by increasing the number of patients receiving pap smears, healthcare workers are able to identify that many more real positive test results.

  6. The medical community at large is undergoing drastic changes that target a more preventative and comprehensive outlook towards treating patients. Why? Because it saves money in the long run for both patients and hospitals. In the near future, preventative screenings and operations are going to be more frequent and will require that patients are aware of the issue at hand. I don’t necessarily think that the heart of preventative care is to expand individual’s options. Rather it promotes the overall wellbeing and the longevity of the individual.

  7. One of the best non-profit organizations, (in my opinion), is the Copenhagen Consensus. Check out the website here: http://www.copenhagenconsensus.com/about-us. They focus heavily on preventative measures and the cost-benefit analysis for each global health goal that they define. For example, the Copenhagen consensus provides an estimated dollar amount for prevention measures for malaria, and they also provide the estimated amount of money saved by using preventative measures. They do receive funding, but it is challenging. Additionally, they just provide research and evidence, so the goals must be fulfilled otherwise. It’s a tough sell for investors and donors, because it’s difficult to have palpable results and rewards for a preventative effort. Preventative measures aren’t actually curing people, so it’s difficult to put aside sick people to prioritize future sick people.

  8. When I initially commented I clicked the “Notify me when new comments are added” checkbox and
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