An ounce of prevention is really a ton of cure

As a father of two, like any parent since humans have been roaming this planet, I’ve been relentlessly investing attention, time, energy and love in preventing domestic accidents or other mishaps.

To date, I must say that I’ve been quite successful, but I wasn’t alone in delivering this result, it was the outcome of unwavering teamwork with my wife, and our inner circle of family and friends.
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“prevention is all about engaging a person to undertake (and possibly pay for) a medical intervention prior to having any symptom, sign or signal”

As a healthcare industry executive who’s spent over ten years of his career in the vaccine industry, I’ve been able to contribute to larger scale results across many markets, helping to protect individuals against communicable diseases and delivering the kind of public health outcomes that the authorities were looking for.

These personal and professional experiences share one dimension: anticipation. Let’s dissect what prevention actually is…

1. First and foremost, prevention is action. It requires some form of voluntary intervention, and therefore the allocation of some kind of resources.
2. Second, prevention stems from reasoning about a risk, and deciding that the magnitude of the risk justifies the action. The criteria to assess the risk may range from the most solid and scientifically-backed to the extremely personal and subjective ones, but their analysis (conscious or not) results in triggering the action.
3. And third, prevention is about seeking protection, yet owing to the uncertainty of the occurrence of the risk, it can be frustrating as the absence of control means that assessing the effectiveness of the prevention initiatives is extremely difficult, if not illusory, depending on the situation.

In the healthcare world, prevention is all about engaging a person to undertake (and possibly pay for) a medical intervention prior to having any symptom, sign or signal of any type indicating that the action is warranted. Then, what’s the trigger? What’s the event that’s compelling to act? In most instances, it is the perception of a risk.
It is often underscored that there are only three drivers to drive people to immunize against a disease, all of them sharing a huge behavioral component.

1. The first is coercion, the second is fear and the third is fashion. Coercion is obtained through regulation, for instance, mandating immunization against specific diseases to enter certain emerging countries or ahead of being admitted in US colleges.
2. Fear happens when individuals perceive a risk as being clear and present, as happens in the case of a pandemic spreading across the planet.
3. And fashion is, well, when someone whom people regard as a trend setter acts to immunize.

But in all three situations, the disease is not “there” yet.
It is still remote, in some other people, or some other parts of the world, not yet close to represent an immediate medical danger. In a way, prevention requires… the leap of faith. One needs to be convinced that getting an injection, the immediate pain (albeit limited), the risk of adverse effects, and even the risk of the vaccine being only marginally effective (as efficacy varies from a person to another) is worth it, as it’s the price to pay to be protected.

In a recent editorial in Forbe’s online magazine, John Nosta writes an extremely enthusiastic paper on the progress made in identifying diseases early, arguing that these scientific leaps are bringing therapy “asymptotically” close to prevention. One can only be positive about the recent medical progress on disease identification, enabled by discoveries in foundational science (such as genomics and proteomics) as well as by technological advances in imaging, etc.

What John is essentially describing is earlier identification of diseases, before they reach a development stage that makes them less controllable and impairs the prognosis, which is very welcome by the patients (and sometimes less so by healthcare payers who prefer to defer some expenses). We are therefore looking at a disease which is already there, it has reached the patient, it is silently evolving… Prevention is not in order, therapy is. The name of the game is therefore an earlier onset of the treatment than before, hopefully with greater odds of success, in the best interest of the patient.
To me, the frontiers between therapy and prevention are still as far apart as they were before.

Remember what science was prior to the invention of the microscope. The new tool has helped to push the limits. Until the electronic microscope has been invented, opening a whole new field of possibilities. And since then, newer imaging techniques have helped pushed the boundaries of knowledge even further.

As we’re simply progressing from measurement with a ruler to measurement with an array of technologies, we’re getting into the infinitely small, intimate parts of the profile of diseases.

Even the famous Medical Tricorder used by Dr Spock in Star Trek would still be an aide to therapy.

Prevention is a whole different world.