Advertisement

Organized Medicine

An Ounce of Prevention or a Pound of Cure
  • Norman J. Temple

Abstract

Medicine, which here means medical practice in general, is a prisoner of its past. Medicine has scored tremendous successes in helping to eliminate infectious diseases, notably by immunization and by antibiotics. Similarly, in the latter part of the nineteenth century effective treatments were developed for a range of noninfectious diseases, such as gallstones, appendicitis, and various cancers. One hundred years later medicine is continuing its relentless search for new therapies. But success stories are increasingly rare. The golden age of therapeutics is dead.

Keywords

Nutrition Education Lifestyle Advice Multiple Risk Factor Intervention Trial Worksite Health Promotion Medical Research Council Working Party 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Canadian Cancer Society. Canadian Cancer Statistics 1988. Toronto: Canadian Cancer Society, 1988.Google Scholar
  2. 2.
    Temple NJ, Burkitt DB. The war on cancer: the failure of therapy and research. J R Soc Med 1991; 84:95–98.Google Scholar
  3. 3.
    Silverberg E, Lubera JA. Cancer statistics, 1988. Ca 1988; 38:5–22.CrossRefGoogle Scholar
  4. 4.
    Schottenfeld D. The epidemiology of cancer. Ca 1981; 47: 1095–1108.Google Scholar
  5. 5.
    Cairns J. The treatment of diseases and the war against cancer. Sci Am 1985; 253(3):51–59.CrossRefGoogle Scholar
  6. 6.
    Bailar JC, Smith EM. Progress against cancer? NEngl JMed 1986; 314:1226–1232.CrossRefGoogle Scholar
  7. 7.
    Becker N, Smith EM, Wahrendorf J. Time trends in cancer mortality in the Federal Republic of Germany: progress against cancer? Int J Cancer 1989; 43:245–249.CrossRefGoogle Scholar
  8. 8.
    McBride G. U.S. diet industry under fire. Br Med J 1990; 300:1481,1482.CrossRefGoogle Scholar
  9. 9.
    Smith WCS, Lee AJ, Crombie IK, Tunstall-Pedoe H. Control of blood pressure in Scotland: the rule of halves. Br Med J 1990; 300:981–983.CrossRefGoogle Scholar
  10. 10.
    Walker ARP, Labadarios D. What are the prospects for improved health and increased longevity? S Afr Med J 1990; 78:383–385.Google Scholar
  11. 11.
    Swales JD. First line treatment in hypertension. Br Med J 1990; 301:1172,1173.CrossRefGoogle Scholar
  12. 12.
    Curb JD, Borhani NO, Blaszkowski TP, Zimbaldi N, Fotiu S, Williams W. Long-term surveillance for adverse effects of antihypertensive drugs. JAMA 1985; 253:3236–3268.CrossRefGoogle Scholar
  13. 13.
    Medical Research Council Working Party. MRC trial of treatment of mild hypertension: principal results. Br Med J 1985; 291:97–104.CrossRefGoogle Scholar
  14. 14.
    Croog SH, Levine S, Testa MA, Brown B, Bulpitt CJ, Jenkins CD, Klerman GL, Williams GH. The effects of antihypertensive therapy on the quality of life. N Engl J Med 1986; 314: 1657–1664.CrossRefGoogle Scholar
  15. 15.
    Califano JA. America’s health care revolution: health promotion and disease prevention. JAMA 1987; 87:437–440.Google Scholar
  16. 16.
    Medawar C. Report on investment in the UK tobacco industry. London: British Medical Organization/Social Audit, 1985; 8,9.Google Scholar
  17. 17.
    Frank E, Winkleby MA, Altman DG, Rockhill B, Fortmann SP. Predictors of physicians’ smoking cessation advice. JAMA 1991; 266:3139–3144.CrossRefGoogle Scholar
  18. 18.
    Boulton MG, Williams A. Health education in the general practice consultation: doctors’ advice on diet, alcohol and smoking. Health Ed J 1983; 42:57–63.CrossRefGoogle Scholar
  19. 19.
    Silagy C, Muir J, Coulter A, Thorogood M, Yudkin P, Roe L. Lifestyle advice in general practice: rates recalled by patients. Br Med J 1992; 305:871–874.CrossRefGoogle Scholar
  20. 20.
    Davies L, Anderson JP, Holdsworth MD. Nutrition education at the age of retirement from work. Health Ed J 1985; 44: 187–192.CrossRefGoogle Scholar
  21. 21.
    Coulter A. Lifestyles and social class: implications for primary care. JR Coll Gen Praet 1987; 37:533–536.Google Scholar
  22. 22.
    Wallace PG, Brennan PJ, Haines AP. Are general practitioners doing enough to promote healthy lifestyle? Findings of the Medical Research Council’s general practice research framework study on lifestyle and health. Br Med J 1987; 294:940–942.CrossRefGoogle Scholar
  23. 23.
    Wells KB, Lewis CE, Leake B, Schleiter MK, Brook RH. The practices of general and subspecialty internists in counselling about smoking and exercise. Am J Public Health 1986; 76:1009–1013.CrossRefGoogle Scholar
  24. 24.
    World Health Organization Study Group. Diet, Nutrition and the Prevention of Chronic Disease. Geneva: WHO, 1990; 154,155.Google Scholar
  25. 25.
    Multiple Risk Factor Intervention Trial Research Group. Multiple risk factor intervention trial. Risk factor changes and mortality results. JAMA 1982; 248:1465–1477.CrossRefGoogle Scholar
  26. 26.
    Hjermann I, Velve Byre K, Holme I, Leren P. Effect of diet and smoking intervention on the incidence of coronary heart disease. Report from the Oslo Study Group of a randomised trial in healthy men.Lancet 1981; ii:1303–1310.CrossRefGoogle Scholar
  27. 27.
    Russell MAH, Wilson C, Taylor C, Baker CD. Effect of general practitioners’ advice against smoking. Br Med J 1979; 2:231–235.CrossRefGoogle Scholar
  28. 28.
    Breslow L, Fielding J, Herrman AA, Wilbur CS. Worksite health promotion: its evolution and the Johnson & Johnson experience. Prev Med 1990; 19:13–21.CrossRefGoogle Scholar
  29. 29.
    Farquhar JW, Fortmann SP, Flora JA, Taylor B, Haskell WL, Williams PT, Maccoby N, Wood PD. Effects of communitywide education on cardiovascular disease risk factors. The Stanford Five-City Project. JAMA 1990; 264:359–365.CrossRefGoogle Scholar
  30. 30.
    Temple NJ, Burkitt DP. Towards a new system of health: the challenge of Western disease. J Comm Health 1993; 18: 37–47.CrossRefGoogle Scholar
  31. 31.
    Berkow SE, Committee on Nutrition in Medical Education. Nutritional education in U.S. medical schools. Med J Aust 1989; 151:S27-S29.Google Scholar
  32. 32.
    National Research Council Food and Nutrition Board Committee on Nutrition in Medical Education (M. Winick, chairman). Nutrition Education in U.S. Medical Schools. Washington, DC: National Academy Press, 1985.Google Scholar
  33. 33.
    Swanson AG. Nutrition sciences in medical-student education. Am J Clin Nutr 1991; 53:587,588.Google Scholar
  34. 34.
    Gray J. Nutrition in Medical Education. London: British Nutrition Foundation, 1983.Google Scholar
  35. 35.
    Brett A, Godden M, Keenan RA. When and how should nutrition be taught to medical students? Proc Nutr Soc 1985; 45:13A.Google Scholar
  36. 36.
    Parker D, Emmett PM, Heaton KW. Final year medical students’ knowledge of practical nutrition. J R Soc Med 1992; 85:338.Google Scholar
  37. 37.
    Heywood P, Wootton SA. Nutritional knowledge and attitudes towards nutrition education in medical students at Southampton University Medical School. Proc Nutr Soc 1992; 51:67A.Google Scholar
  38. 38.
    Schapira D, Pozo C. Physicians, nurses and medical students knowledge of cancer prevention and nutrition. J Cancer Ed 1986; 1:201.Google Scholar
  39. 39.
    Kushner RF, Thorp FK, Edwards J, Weinsier RL, Brooks CM. Implementing nutrition into the medical curriculum: a user’s guide. Am J Clin Nutr 1990; 52:401–403.Google Scholar
  40. 40.
    Lopez SA, Read MS, Feldman EB. 1987 ASCN workshop on nutrition education for medical/dental students and residents—integration of nutrition and medical education: strategies and techniques. Am J Clin Nutr 1988; 47:534–550.Google Scholar
  41. 41.
    Weare K. Developing Health Promotion in Undergraduate Medical Education. London: Health Education Authority, 1988. (Available from Departments of Education and Community Medicine, University of Southampton, Southampton, UK).Google Scholar
  42. 42.
    Albright CL, Farquhar JW, Fortmann SP, Sachs DPL, Owens DK, Gottlieb L, Stratos GA, Bergen MR, Skeff KM. Impact of a clinical preventive medicine curriculum for primary care faculty: results of a dissemination model. Prev Med 1992; 21:419–435.CrossRefGoogle Scholar
  43. 43.
    Jonas HS, Etzel SI, Barzansky B. Educational programs in United States medical schools. JAMA 1992; 268:1083–1089CrossRefGoogle Scholar

Copyright information

© Humana Press, Totowa, NJ 1994

Authors and Affiliations

  • Norman J. Temple

There are no affiliations available

Personalised recommendations