The Prevention Prescription, part 3

In my previous two posts I’ve written about different kinds of prevention (eg, primary, secondary, etc as well as vaccination which is a form of primary prevention). In this post I am going to talk about a couple of different things relating to prevention.

The first is that there are preventative measures which sometimes fall into more than one category. By this I mean that if we counsel someone to change their diet and exercise more because they’ve had a heart attack, give them aspirin, a statin, etc. that we’re engaging in tertiary prevention. However if they are on their way to becoming diabetic but because of the change in diet and increase the amount of exercise they do, and therefore lower their risk of Diabetes Mellitus, then one could argue that’s primary prevention (or secondary if they have metabolic syndrome…).

I’m a firm believer in using medication to lower cholesterol, blood pressure, etc when and if appropriate. However, I think we give short shrift to diet, exercise and sleeping enough as preventative measures to prevent or delay multiple medical problems.  Even if someone needs to be on medication, lifestyle changes are important to keep up. Exercise and diet do not become less important just because someone’s started medication. One recent study published in the New England Journal of Medicine comparing intensive lifestyle changes+usual care as compared to usual care did not reduce death. However there was evidence for a better quality of life and less need for medication, at least early on. There is a lot of evidence that enough exercise and good dietary practices can prevent and delay Diabetes. And for those that are cost conscious, a half an hour a day of walking is a lot cheaper than most medications!

There is a push by some physicians to actually prescribe exercise the same way we prescribe medications. Books have even been published on the matter!!