Medical Journal of Dr. D.Y. Patil Vidyapeeth

EDITORIAL
Year
: 2022  |  Volume : 15  |  Issue : 6  |  Page : 829-

Primary prevention: A vanishing art?


Amitav Banerjee 
 Department of Community Medicine, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth, Pune, Maharashtra, India

Correspondence Address:
Dr. Amitav Banerjee
Department of Community Medicine, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth, Pune, Maharashtra
India




How to cite this article:
Banerjee A. Primary prevention: A vanishing art?.Med J DY Patil Vidyapeeth 2022;15:829-829


How to cite this URL:
Banerjee A. Primary prevention: A vanishing art?. Med J DY Patil Vidyapeeth [serial online] 2022 [cited 2023 Jan 31 ];15:829-829
Available from: https://www.mjdrdypv.org/text.asp?2022/15/6/829/365005


Full Text



Since the time of Hippocrates, primary prevention called for action by the people. In his treatise, Hippocrates laid great emphasis on personalized medicine based on diet and lifestyle.[1] He stated that “The most famous doctors cure by changing the diet and lifestyle of their patient.” encompassing aspects such as food and drink, physical exercise, baths and massage, adequate sleep, sexual health, passions, habits, and the way of leading one's life. He observed that people of certain tribes were obese because they led sedentary lives. In his book Aphorisms, Hippocrates notes, “Those who are constitutionally very fat are more apt to die quickly than those who are thin.”

Over the centuries, medical researchers arrived at the same conclusion that Hippocrates, through his wisdom and observation, had predicted. Numerous studies have established the adverse impact of obesity on longevity and health.[2] Overweight prevalence among the industrialized Western countries is two to three times higher than Asian and African countries.[3]

Not only do overweight populations suffer from high incidence of non-communicable diseases, but they are also vulnerable to higher morbidity and mortality from respiratory infections, as was driven home during the current pandemic.[4] People of developing economies like Brazil and India are prone to adopt unhealthy lifestyles due to disposable income among the growing middle classes and influence of market forces. Brazil has reached the overweight levels of European countries and suffered severely in the pandemic. India has much lower overweight levels compared to Brazil and European countries, but may soon catch up if population strategy of primary prevention is not implemented.

This gives India a window of opportunity for primordial prevention by way of spreading awareness about the hazards of adopting Western lifestyles. Easier said than done, given the market forces promoting fast cars, fast food, sweetened beverages, and miracle drugs.

Pharmacological solutions are increasingly being offered to reverse the ill-effects of the luxuries and indulgences of affluence without the need for efforts involved in adopting a healthy lifestyle. For more than two decades, anti-obesity medications have been available,[5] which are recommended in addition to lifestyle modification. These can become more popular with populations increasingly drifting into luxury and passivity. More concerning is the long-term safety concerns of these drugs, an odd one being withdrawn due to increased risk of cancer.[5]

Another development is research in primary prevention of cardiovascular disease in high-risk individuals with polypill containing combinations of a statin, a beta-blocker, a diuretic, aspirin, and an antihypertensive.[6]

”Ars longa, vita brevis,” meaning “the art is long, and life is short,” is attributed to Hippocrates, the Father of Medicine. The art requires efforts by both the healer and patient. Promise of miracle drugs, combined with pharma-driven market forces, may cut short this art, and life, shorter. Interventions have their own known and unknown hazards. In future, prevention may be costlier than cure.

References

1Tsiompanou E, Marketos SG. Hippocrates: timeless still. J R Soc Med 2013;106:288-92.
2Thompson D, Edelsberg J, Colditz GA, Bird AP, Oster G. Lifetime health and economic consequences of obesity. Arch Intern Med 1999;159:2177-83.
3WHO. Prevalence of Overweight among Adults, BMI>25 (Age Standardized). Available from: https://apps.who.int/gho/data/node.main.A897A?lang=en. [Last accessed on 2022 Nov 15].
4Singh R, Rathore SS, Khan H, Karale S, Chawla Y, Iqbal K, et al. Association of obesity with COVID-19 severity and mortality: An updated systemic review, meta-analysis, and meta-regression. Front Endocrinol (Lausanne) 2022;13:780872. doi: 10.3389/fendo. 2022.780872.
5Tak YJ, Lee SY. Long-term efficacy and safety of anti-obesity treatment: Where do we stand? Curr Obes Rep 2021;10:14-30.
6Yusuf S, Joseph P, Dans A, Gao P, Teo K, Xavier D, et al. Polypill with or without aspirin in persons without cardiovascular disease. N Engl J Med 2021;384:216-28.