Editorial

Preventive and Predestined Medicine

Niranjan Kissoon, M.D., Editor

Preventive medicine can be considered prophylactic and is intended to prevent or slow the course of illness or disease. Traditionally it has been recognized to produce the best returns for investment in healthcare and been the major impetus behind many healthcare initiatives worldwide. Preventive measures and public health care initiatives are the cornerstone of immunization programs that have resulted in the eradication or infrequent occurrences of many diseases. Moreover, it has raised the consciousness of societies to the extent that improvement in the overall standard of living has been the engine for decreases in infant mortality and increases in life expectancy. Preventive medicine has also led to initiatives for screening of many diseases such as phenylketonuria, hypothyroidism and hypocholesterolemia, which if detected can lead to therapies to avert death and disability.

Preventive medicine is well recognized by medical practitioners as well as policy makers as desirable; the importance is underlined by the major shifts in medical education to encourage graduates to be generalists rather than undergo subspecialty training. However, preventive medicine is under the radar of the popular press because it does not produce dramatic results and individual heart-warming stories. It therefore accomplishes great benefits to society but is not sensational as major successful surgery. An advance such as oral rehydration for gastroenteritis saves an estimated 10-15 million lives in developing countries per year; however, this is not widely reported as ventricular assist devices or solid organ transplantation, which benefits fewer at higher costs. By its nature therefore, preventive medicine has not generated great controversy.

On the other hand, mapping of the human genome has generated great press because of its potential for both good and harm and for ranging possible uses. True, it has the potential for great good. It has the potential to detect many genetic diseases, even before birth and possibly our genetic traits such that some diseases may be avoided. It has the potential to create specifically "tailored human beings." It therefore has the ability to determine the health of an individual in advance to some is similar to a divine intervention. This phenomenon of health determination, I term "predestined medicine". The potential of predestined medicine is enormous in that we may be able to make right the sometimes-random tragedies in nature. This potential alone should compel us to forge ahead to determine if our science is robust enough to accomplish these lofty goals. However, there is great anxiety generated because of the potential to use this technology for individual greed, discrimination against individuals or groups, and for genetic manipulation for the sole purpose for obtaining a perfect son or daughter or athlete, etc. It is this specter of evil that overwhelms the potential of the genomic revolution. The science fiction aspects of genomics have aroused the imagination of the popular press.

Without doubt healthcare professionals including physicians are the best judge of the role of preventive medicine and predestined medicine in society. We can create an environment in which preventive and predestined medicine are symbiotic and used for the common good of society. To achieve these, we need to educate policy makers and our patients and avoid contributing to irrational and sensational reports in the lay press. We must also engage in the ethical decisions that arise from these aspects of medicine. Our involvement at every level is very important because our silence will give legitimacy to fiction.

Jacksonville Medicine / August/September, 2001

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