Welcome to Wonderfully Made.
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In today's segment
of Wonderfully Made,
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we will be
considering a very important
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and interesting subject.
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The concepts of
preventive medicine.
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I am doctor Meshach Samuel
and I currently serve as a
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family practitioner, and I enjoy
doing what I do in the field of
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primary care.
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Preventive medicine
is my favorite topic.
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I believe that the correct
understanding of this subject
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is important for each one of us.
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I have noticed that many
today are seeing the devastating
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effects of chronic disease.
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And are showing more and more
interest in preventive medicine.
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I hope that today's presentation
will help us get a better
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understanding of the
true meaning and importance
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of preventive medicine.
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Let's start with this statement.
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In other words, if we know what
is causing a particular problem
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it will be easier to
prevent it from developing.
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Let's start with
a basic question:
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What causes disease?
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During the XIX-th and the
early part of the XX-th century
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a simple model
was strongly promoted.
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It involved a single factor.
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It was said that an
agent affects man and
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causes the disease.
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Most often this single
factor was an infectious agent.
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And there for it was called
The Germ Theory of Disease.
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And this theory gained
acceptance mainly because
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of the rapid spread
of infectious diseases
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during those years.
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Millions died of diseases
such as malaria, polio, typhoid,
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smallpox and so on.
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When the disease agent
was identified and eliminated
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the disease was
arrested or prevented.
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As a result of
advances in public health,
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improved sanitation and
appropriate use of antibiotics,
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infectious
diseases began to decline.
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But only to be replaced
by a new type of diseases.
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The so called "Modern
diseases of civilization".
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Also referred to as "Diseases of
lifestyle" such as lung cancer
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coronary heart
disease, diabetes, hypertension,
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and so on.
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Now this diseases, could not
be explained on the bases of a
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single fact of causation.
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Nor could they be prevented
by the traditional methods of
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isolation, or immunization,
or improvement in sanitation.
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It is now recognized that many
of the chronic diseases that we
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struggle with today are rarely
caused by a single agent alone.
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But instead, it depends
upon a number of factors
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which contributed
to it's development.
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This is referred to as
multiple factor causation.
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As opposed to the
single factor causation
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that we've talked about.
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Attempts have been made to
group this multiple factors into
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different categories.
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One such example is the agent,
environment and host triad.
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A stable balance or an
equilibrium seems to exist
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between man and his environment.
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Resulting in a
disease free state.
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But when there is a negative
interaction between this groups
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disease results.
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Let us look at some of this
examples of factors in each of
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these three categories.
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The first one: Agent Factors.
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It is easy for us to understand
agents such as bacteria,
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viruses, yeasts and parasites.
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This are examples of biological
agents that could cause disease
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and all of this act
as infectious agents.
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Then we have chemical
agents such as poisons gases,
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insecticides,
fertilizers, and so on.
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We know of factors such as
excessive heat, excessive cold,
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radiation and electricity.
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That could act as
agents of diseases too.
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These are physical agents.
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And then of course we have
nutritional or dietary factors.
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That could become
an agent of disease.
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The deficiency of
some substances in our diet
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or the excess of it
can cause diseases too.
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For example low iron in
the blood could cause anemia.
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We know that too much
cholesterol or fat in our diet
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causes serious
disease conditions.
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Now let us see some
examples in the second category.
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That will be
environmental factors.
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Many of the factors that we see
or saw in the previous category
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of agents are really a
part of the environment.
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Such as heat,
cold, dust and so on.
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Environmental factors really
include all of man's external
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surroundings.
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Such as air, water,
housing, sanitation and so on.
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Any or all of this factors could
play a role in the causation
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of disease.
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Now let's move on
to the third category.
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That is the host.
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Factors such as age, sex, and
ethnic group, do play a role in
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some disease conditions.
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And then we have some subtle
factors such as social isolation
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I see how this affects
some of my patients, especially
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the elderly who are
locked in most of the time.
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Then we see children
experiencing maternal
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depravation,
and broken families.
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This things are beginning to
emerge as important factors for
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causation of disease.
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However, in speaking of
prevention of chronic diseases
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the most important are those
that are lifestyle related.
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Lack of physical exercise, use
of alcohol, drugs and tobacco,
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unhealthy habits such as poor
sleeping patterns and stress,
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these lifestyle related
factors have become so important
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that today, man that is a host
is viewed as an agent of his
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own diseases.
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In other words, man's state
of health is determined more by
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what he does to himself
then what some outside agent
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does to him.
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For example
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the medical cause of lung cancer
may be chemical substance in
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the cigarette.
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But this agent does not really
affect man, until man decides
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to cultivate tobacco plants,
harvest the leafs, process it
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to obtain the right
concentration of nicotine,
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then roll it in paper
in the form of cigarettes,
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places one end between his lips,
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burns the other end with fire,
and inhales the smoke into his
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lungs.
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So although the medical cause
may be the nicotine, and other
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cancer causing substances in
the cigarette, the real cause of
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the disease is man's
choice or his behavior.
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Which is smoking.
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We call this the
psycho-social cause of disease.
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So we've said that chronic
diseases of today are largely
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lifestyle related.
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And the result from multiple
factors and not only multiple
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factors but from complicated
interactions of this multiple
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factors.
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The purpose of studying
this factors is to see if we can
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modify them, or remove
them, in an attempt to prevent
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or control disease.
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We have been talking
about the causation of disease.
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Let us now consider an important
element in preventive medicine.
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And that is:
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the natural history of disease.
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What do we mean about the
natural history of disease?
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It simply refers to
the way in which a disease
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evolves over time.
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From the earliest stages of it's
evolvement, to it's termination
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as either recovery
or disability or death.
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Let us see if we can
illustrate this with a diagram.
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Let's say that the horizontal
line that you see on your screen
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represents a timeline.
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A period in ones life.
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Let us now place a short
vertical line somewhere along
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this timeline to represent the
point of onset of the disease
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in this particular individual.
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Now we have the time
period divided in two.
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The period beyond the point
of intersection represents the
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disease phase or
pathogenesis phase.
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Pathogenesis may be a
new word to some of us.
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We know that "genesis"
means beginning and "pathos"
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is a Greek word which
literally means suffering.
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And if you can correlate
suffering with disease, the term
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literally translates the
beginning of the disease phase.
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Now on the timeline before the
intersection to represent the
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disease free state.
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Or pre-pathogenesis phase.
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Now let us take a closer look
at the pathogenesis phase or the
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disease phase.
00:11:03.90\00:11:05.16
In most cases whether it be an
infectious disease, or a chronic
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disease.
00:11:11.55\00:11:12.52
There is
lifestyle related disease.
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There is a period soon after the
onset when the disease agent is
00:11:14.91\00:11:20.09
affecting the person but there
is no outward manifestation of
00:11:20.12\00:11:25.27
the disease.
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In other words there are
no symptoms or physical signs.
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I the case of infectious
diseases this period is known
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as the incubation period.
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That is when the disease agent
multiplies in the body without
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causing any
symptoms or physical signs.
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If this is left unchecked
the agent begins to cause tissue
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damage and some
physiological changes resulting
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in recognizable
symptoms of the disease.
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In chronic diseases such
as coronary heart disease
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hypertension,
diabetes, cancer and so on.
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This period of time that is soon
after the onset of the disease
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is less traumatic
and often more prolonged.
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And is referred to simply
as the presymptomatic phase.
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And again during this
stage there is no outward
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manifestation of the disease.
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And the sad thing about it is
that in some instances, by the
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time, signs and symptoms appear
the disease phase is already
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well advanced into the
late pathogenesis phase.
00:12:40.82\00:12:45.05
Now let us recall what we have
discussed so far in our study
00:12:47.58\00:12:51.56
today.
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Firstly we said the cause of
modern diseases is not only due
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to multiple factors,
but also due to complicated
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interactions of
these multiple factors.
00:13:01.62\00:13:05.22
Next we looked into the
natural history of disease.
00:13:06.06\00:13:09.87
That is how the
disease progresses in a person,
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who is in the
disease-free state.
00:13:13.74\00:13:17.17
To an early disease stage,
and then to the advanced or late
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stages.
00:13:21.26\00:13:22.23
How does the knowledge of
natural history of disease
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help us in our understanding,
or in our application of the
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principals of
preventive medicine?
00:13:33.98\00:13:36.64
Strictly speaking, the role
of preventive medicine ends with
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the onset of the disease.
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However some specialists in this
field of medicine have suggested
00:13:45.25\00:13:51.20
that we brought in the concept
of the preventive medicine.
00:13:51.23\00:13:56.27
And when we do this
we set higher goals.
00:13:56.30\00:14:00.04
Our primary goal would
be to prevent the onset
00:14:00.07\00:14:04.36
of the disease.
00:14:04.40\00:14:06.56
But we don't stop there.
00:14:06.60\00:14:08.24
We now set a secondary goal
which would be to prevent the
00:14:08.27\00:14:13.67
progression of the disease.
00:14:13.70\00:14:16.04
And then we'll go a step
further with e tertiary goal.
00:14:16.27\00:14:19.99
Which would be to prevent
the bad outcomes of the disease.
00:14:20.02\00:14:24.88
Which could be their impairments
disabilities and sometimes
00:14:24.91\00:14:28.71
even death.
00:14:28.75\00:14:29.72
Now let's see if we can
put all this in perspective.
00:14:30.83\00:14:34.23
Let's take a look again at the
diagram of the natural history
00:14:34.26\00:14:38.42
of disease.
00:14:38.45\00:14:39.47
We see the tree periods.
00:14:40.30\00:14:42.37
The disease free period,
the early disease period and the
00:14:42.40\00:14:46.92
late disease period.
00:14:46.95\00:14:48.74
The first period is
the disease free period.
00:14:48.95\00:14:52.49
Our goal here is to prevent
the onset of the disease.
00:14:52.52\00:14:57.43
This is our primary goal.
00:14:57.94\00:14:59.74
And we can say that the actions
taken during this period to
00:14:59.77\00:15:04.57
prevent the onset of the
disease is primary prevention.
00:15:04.60\00:15:09.57
Now let's take a
look at the next faze.
00:15:11.13\00:15:13.77
The early disease period.
00:15:13.80\00:15:15.97
The goal here is to prevent
the progression of the disease.
00:15:16.00\00:15:21.20
This is a secondary goal.
00:15:21.23\00:15:23.52
We resort to this goal only
if and when we have missed the
00:15:24.24\00:15:28.63
primary goal of preventing
the onset of the disease.
00:15:28.66\00:15:33.39
The actions taken to
achieve this goal can be called
00:15:33.61\00:15:37.31
secondary prevention.
00:15:37.35\00:15:39.52
Now let's move on to the third
phase in the timeline of the
00:15:40.30\00:15:44.17
Natural History of Disease.
00:15:44.20\00:15:46.84
That is the advanced
or the late disease phase.
00:15:48.70\00:15:52.65
Here our goal is to prevent
impairment or disability.
00:15:52.68\00:15:57.49
This is our tertiary goal.
00:15:57.52\00:15:59.89
We seek to obtain this goal only
when we have missed the primary
00:16:00.03\00:16:04.88
and the secondary goals.
00:16:04.91\00:16:07.07
And the way we obtain this
goal is by implementing tertiary
00:16:08.29\00:16:12.62
prevention.
00:16:12.65\00:16:13.62
So we now have three levels
of prevention corresponding to
00:16:14.16\00:16:18.32
the three major phases of
the Natural History of Disease.
00:16:18.35\00:16:22.99
Primary prevention,
secondary prevention and
00:16:23.02\00:16:26.41
tertiary prevention
00:16:26.45\00:16:29.32
Now let's look into the
three levels of prevention.
00:16:29.36\00:16:34.86
We'll start with
tertiary prevention.
00:16:35.67\00:16:38.92
That is efforts to prevent
impairment and disability.
00:16:38.95\00:16:44.28
Take for example someone who has
suffered a stroke and is unable
00:16:45.57\00:16:49.20
to walk, or move an
arm, or unable to speak.
00:16:49.23\00:16:53.45
An acute rehabilitation
program with physical therapy,
00:16:53.96\00:16:58.02
occupational therapy and speech
therapy often enables the person
00:16:58.05\00:17:03.14
to regain a significant
degree of their motor functions.
00:17:03.17\00:17:06.91
And be able to get
back to independent living.
00:17:06.94\00:17:10.87
This is quite an achievement.
00:17:10.90\00:17:13.35
Yet, tertiary prevention
is considered the least
00:17:13.38\00:17:17.19
beneficial.
00:17:17.22\00:17:18.19
And least rewording of the three
levels of prevention because it
00:17:18.87\00:17:24.07
involves intervention in
the late stages of the disease.
00:17:24.10\00:17:28.66
And much suffering and loss
has already been experienced.
00:17:28.69\00:17:32.93
That is why it is considered
the weakest tool in preventive
00:17:32.96\00:17:36.31
medicine.
00:17:36.34\00:17:37.31
Now what about
Secondary Prevention?
00:17:37.95\00:17:41.09
This applies to interventions
in the early stages of the
00:17:41.12\00:17:44.95
disease period.
00:17:44.98\00:17:46.32
What are the
interventions at this stage?
00:17:47.40\00:17:51.17
Early diagnosis, and
appropriate treatment.
00:17:51.54\00:17:55.29
Secondary prevention helps
prevent the progressions of the
00:17:56.09\00:17:59.23
disease.
00:17:59.26\00:18:00.23
And in some instances it enables
one to even get back to the
00:18:00.71\00:18:04.39
disease free-state.
00:18:04.42\00:18:06.13
And this is certainly a desired
goal in Preventive Medicine.
00:18:06.70\00:18:10.08
Yet, secondary prevention is
not the best tool in Preventive
00:18:10.11\00:18:15.22
Medicine.
00:18:15.25\00:18:16.22
We have seen earlier that
tertiary prevention is the
00:18:16.76\00:18:19.62
weakest tool.
00:18:19.65\00:18:20.83
We can say that secondary
prevention although a very
00:18:21.69\00:18:25.48
useful tool, is
still an imperfect tool.
00:18:25.51\00:18:29.00
Now that leads us to the
quest for the perfect tool.
00:18:30.55\00:18:34.45
And I'm sure you guessed it.
00:18:34.48\00:18:37.19
Primary prevention.
00:18:37.22\00:18:38.88
We said that secondary
prevention is an imperfect tool
00:18:39.64\00:18:42.72
because it is
more expensive and less
00:18:42.75\00:18:46.12
effective than
primary prevention.
00:18:46.16\00:18:49.50
Primary prevention is
action taken before the onset
00:18:50.50\00:18:54.81
of the disease.
00:18:54.85\00:18:57.26
Actions which remove the
possibility that a disease will
00:18:57.30\00:19:01.36
ever occur.
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What actions are
taken in primary prevention?
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Everything that will preserve
health and promote health.
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This is done by simply following
the natural laws of health.
00:19:12.93\00:19:18.42
It also includes
specific protective measures.
00:19:19.84\00:19:23.89
A good example of a protective
measure in primary prevention is
00:19:23.92\00:19:29.44
immunization or vaccination.
00:19:29.47\00:19:32.10
For example the flue vaccine:
it is not recommended for
00:19:32.13\00:19:37.80
everybody but for selected group
of individuals who have a high
00:19:37.83\00:19:42.52
risk of developing the disease.
00:19:42.55\00:19:45.40
This is called SPECIFIC
PROTECTION because it protects
00:19:45.50\00:19:49.38
against a specific problem.
00:19:49.41\00:19:51.81
I'd like to call primary
prevention the perfect tool
00:19:52.83\00:19:55.92
because primary prevention
is far more than just reverting
00:19:55.96\00:20:02.06
the occurrence of a disease.
00:20:03.53\00:20:04.50
It aims at promoting health.
00:20:04.88\00:20:07.43
It aims at promoting well
being and improving the quality
00:20:07.81\00:20:12.02
of life.
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It includes the concept of what
may we call positive health.
00:20:13.66\00:20:19.15
The Bible refers to
this as abundant life.
00:20:19.40\00:20:23.30
Now I would like to use a story
or you could perhaps call it
00:20:24.75\00:20:31.40
a parable.
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That would help us understand
the importance or the value of
00:20:32.50\00:20:37.51
primary prevention.
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It's more like a parable.
00:20:39.69\00:20:42.13
There was once a
village that was situated on top
00:20:42.36\00:20:45.38
of a mountain.
00:20:45.41\00:20:47.14
One side of the village
there was a forest that abruptly
00:20:47.18\00:20:52.15
ended in a cliff.
00:20:52.18\00:20:53.78
The villagers were a friendly
happy community that worked
00:20:54.70\00:20:59.22
together and helped each other.
00:20:59.25\00:21:01.89
But they soon realized that
they were faced with a growing
00:21:02.93\00:21:06.32
problem.
00:21:06.35\00:21:07.32
Villagers who went into
the forest to gather wood
00:21:08.32\00:21:11.04
or children who went
into that part of the wood
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to play would some times
00:21:13.80\00:21:15.55
accidentally fall off the cliff
and would be badly injured.
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And some even died because
they could not get help in time.
00:21:20.18\00:21:25.03
One day the village council met
to discuss as to what could be
00:21:25.06\00:21:29.13
done to solve this problem.
00:21:29.16\00:21:31.61
Several suggestions were made.
00:21:32.21\00:21:34.79
One suggested that some kind of
alarm system be set up to alert
00:21:34.82\00:21:39.57
the people as soon as someone
fell, so that help could be
00:21:39.60\00:21:42.52
obtained without delay.
00:21:42.55\00:21:44.46
But then they realized
that there were times when all
00:21:44.49\00:21:48.77
the able body men were out
in the fields working and no one
00:21:49.34\00:21:52.58
was available to
respond to an alarm.
00:21:52.62\00:21:55.77
Some one else suggested that
an emergency team be set up.
00:21:58.67\00:22:03.09
People who could take turns to
be on call to respond promptly.
00:22:03.12\00:22:08.80
Yet another thoughtful person
said "it is difficult to climb
00:22:08.89\00:22:13.70
down the hill, and it takes a
while before the team gets there
00:22:13.73\00:22:18.13
to offer the help."
00:22:18.16\00:22:19.92
It was said that whatever would
really help is to construct
00:22:21.30\00:22:26.53
a road to the foot of the
mountain and have an ambulance
00:22:26.56\00:22:30.32
ready, that would get the
team to the victims aid quickly.
00:22:30.35\00:22:35.66
Some one else said "the best way
we can really take care of this
00:22:36.76\00:22:41.24
unfortunate victims, would be to
setup an emergency unit at the
00:22:41.27\00:22:45.47
foot of the mountain, and have
trained people and equipment
00:22:45.50\00:22:49.88
ready and available
whenever the need arises.
00:22:49.91\00:22:54.06
I guess, by now, you've figured
where we're heading with this
00:22:54.21\00:22:57.88
story or the parable.
00:22:57.91\00:23:00.07
For finally a little old
man said "why don't we cut down
00:23:01.42\00:23:05.84
a few threes from the
forest and put up a fence along
00:23:05.87\00:23:09.46
the cliff so that
no one would fall?"
00:23:09.49\00:23:13.05
And that is what they did
and no one was heart after that.
00:23:13.31\00:23:18.74
You will agree with me
that all the earlier suggestions
00:23:20.05\00:23:24.48
sound almost ridiculous when
compared to the simple solution
00:23:24.51\00:23:29.98
of putting up a fence.
00:23:30.01\00:23:32.08
Prevention is
definitely better than cure.
00:23:33.11\00:23:36.91
This is a perfect example of
the effectiveness and importance
00:23:37.45\00:23:42.79
of primary prevention.
00:23:42.82\00:23:44.77
But the question now rises:
Why then is so much importance
00:23:46.02\00:23:50.99
given to secondary and tertiary
care in conventional medicine
00:23:51.02\00:23:55.80
today?
00:23:55.83\00:23:56.80
There are many who
criticize the medical system and
00:23:58.09\00:24:00.90
the physicians today for not
placing the emphasis on primary
00:24:00.93\00:24:05.65
prevention.
00:24:05.68\00:24:06.65
Let me suggest a few
thoughts for you ponder over.
00:24:08.18\00:24:12.58
It might explain the reason
why we are in the difficult
00:24:12.61\00:24:16.62
situation that we
find ourselves in.
00:24:16.65\00:24:19.95
Firstly in the parable people
are safe and well in the village
00:24:20.44\00:24:26.17
until some one
falls off the cliff.
00:24:26.20\00:24:29.55
That is, there are time periods
when everyone is safe and no one
00:24:30.49\00:24:35.42
is heart.
00:24:35.45\00:24:36.42
Now in that situation all the
effort, all the man power and
00:24:37.92\00:24:43.44
all the resources could be
focused exclusively on building
00:24:43.47\00:24:48.52
the fence.
00:24:48.55\00:24:49.52
That is primary prevention.
00:24:50.20\00:24:52.62
But the medical problem
that faces us today does not fit
00:24:53.54\00:24:57.60
that illustration.
00:24:57.63\00:24:59.21
At any given time there are
thousands, in fact millions,
00:24:59.56\00:25:04.85
fallen down the cliff
and on the need of help.
00:25:04.88\00:25:09.20
So while attempting to build a
fence that is promoting primary
00:25:09.81\00:25:13.68
prevention, it would be almost
unethical to ignore the wounded
00:25:13.71\00:25:19.07
and the dying.
00:25:19.10\00:25:20.41
That is to cutback on secondary
or tertiary prevention.
00:25:20.70\00:25:25.69
The second and even
more important fact to
00:25:27.08\00:25:29.95
consider is this:
00:25:29.98\00:25:31.77
in the parable the
fence is a separate entity
00:25:31.81\00:25:35.30
in and of itself.
00:25:35.33\00:25:37.76
Weather people like it or not,
it could be erected by those
00:25:37.80\00:25:41.52
interested and concerned
to bring about a change.
00:25:41.55\00:25:45.65
But with modern diseases that
plague us today every individual
00:25:45.68\00:25:50.54
has a direct role in
"putting up the fence".
00:25:50.57\00:25:54.74
As we've learned earlier
man is viewed as an agent of his
00:25:55.05\00:26:00.06
own diseases.
00:26:00.09\00:26:01.47
We've learned that our state
of health is determined more by
00:26:02.45\00:26:07.07
what we do to ourselves
than what some outside agent
00:26:07.10\00:26:11.54
does to us.
00:26:11.57\00:26:12.54
So primary prevention in
controlling modern diseases
00:26:13.09\00:26:16.56
is not something that can
be forced upon someone else.
00:26:16.59\00:26:21.25
Primary prevention involves
each individual's attitude
00:26:21.28\00:26:25.67
towards life and health.
00:26:25.70\00:26:27.86
It depends on the initiatives
one takes about responsible
00:26:28.74\00:26:33.52
measures to prevent diseases.
00:26:33.55\00:26:36.32
I'd like to quote to you a
passage from a favorite author
00:26:37.09\00:26:41.42
of mine named Ellen G White.
00:26:41.45\00:26:44.03
She wrote this words more than
a hundred years ago, she states:
00:26:44.45\00:26:47.81
"The people are perishing for
want of knowledge, disease of
00:26:47.84\00:26:52.06
almost every description is
pressing upon the people, yet
00:26:52.09\00:26:55.87
willing to remain in ignorance
of the means of relieve and
00:26:55.90\00:27:00.82
the course to
pursuit to avoid disease.
00:27:00.85\00:27:04.19
I believe that this is a perfect
description of what we face
00:27:04.22\00:27:07.65
in the medical field today.
00:27:07.68\00:27:09.57
Primary prevention is certainly
the perfect tool in preventive
00:27:09.60\00:27:12.43
medicine.
00:27:12.46\00:27:13.43
Building a fence is the most
effective and meaningful way
00:27:13.65\00:27:17.29
of going about this task.
00:27:17.32\00:27:19.61
But it can not be done by the
physician alone, or even by the
00:27:19.73\00:27:23.24
best healthcare
system in the world.
00:27:23.27\00:27:25.99
It depends upon the individual's
attitude towards life and health
00:27:26.02\00:27:31.53
and may I add that the best
attitude towards health will
00:27:31.56\00:27:37.18
come when we realize that we
are created in the myth of God.
00:27:37.21\00:27:42.73
When we realize that we've been
bought with an infinite price
00:27:42.76\00:27:45.71
and that our bodies are
the temple of the living god.
00:27:45.74\00:27:49.66
I hope that this presentation
will create in us a desire to
00:27:49.69\00:27:53.18
do our best to learn how
to preserve, promote and enjoy
00:27:53.21\00:27:58.32
the abundant life that
God has given to us as a gift.
00:27:58.35\00:28:02.30
Thanks for joining me today
in our study of the concepts
00:28:02.33\00:28:05.52
of preventive medicine.
00:28:05.55\00:28:07.58