In a recent note, I began to explore the medical disciplines of preventive and predictive medicine and, briefly, the role of clinical lab testing within them (see: The Relationship Between Predictive and Preventive Medicine). Dr. Brian Jackson of ARUP Labs posted a very perceptive comment after reading the post and I copy it below in its entirety:
When most people think about preventive care, they picture "healthy" individuals. But the benefits of preventive care, including screening and other "wellness" tests, are much higher in individuals who are at high risk. This particularly includes those with chronic diseases. e.g. LDL monitoring is much more important in a diabetic than in someone with no risk factors for CAD.
This suggests an even stronger relationship between predictive and preventive testing than what you state above -- the predictive testing identifies patients who need additional monitoring (i.e. preventive or wellness testing).
I'd also suggest that instead of talking about preventing chronic disease, that we talk about preventing the complications of chronic disease. This is to some degree semantics (if you improve your blood glucose levels through diet and exercise, are you still a type 2 diabetic?) but I think it refocuses our attention in useful ways.
My interpretation of the major points contained in his comment are the following:
- Standard medical care, as currently practiced, involves the diagnosis and treatment of clinically manifest disease; predictive/preventive medicine involves the forecasting of future disease and taking action to delay or prevent its onset.
- We need to readjust our thinking relating to predictive/preventive medicine to include not only currently healthy individuals but also those with acute and chronic diseases.
- Inherent in the concept of predictive/preventive medicine is the need for screening and monitoring those with existing diseases to detect complications which can possibly be treated in their early stages at less cost and with less morbidity and mortality.
At first blush, all of this seems like a mere restatement of the patently obvious -- every physician understands that patients with acute and chronic illnesses need to be monitored for complications and relapses. However, an emerging idea is that the terms predictive/preventive medicine should be relevant for, and applied to, the entire population, which is to say along the entire continuum of healthcare staring with the healthy and proceeding to those with illnesses.
The continuum of healthcare, about which I have posted previous notes (see: Disruptive Innovation and Reform of Our Healthcare System; Siemens as the "First Full Service Diagnostic Company"), also appears deceptively simple and seems to restate the obvious. However, the word continuum is closely related to continuity. One of our major problems today is that healthcare delivery is often fragmented, discontinuous, and focuses on the acute problems of patients rather than on the identification of future problems. The early health model, previously emphasized in this blog, also conceptually draws the consideration of the healthy into the continuum of healthcare.
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