Disease Prevention From a Doctors' Perspective
Introduction - A Doctor's philosophy concerning disease prevention
Preventing disease is different from treating diseases. In treating diseases, doctors and patients are often willing to accept a finite degree of risk of side effects in order to achieve a cure or reduction of uncomfortable symptoms. In preventing diseases, doctors are extremely risk adverse. Remember, the first priority in doctoring is to "do no harm". Thus, when prescribing an agent for prolonged periods of time to prevent a disease that may or may not occur, the doctor would not want that agent to cause adverse side effects in a healthy person.
Sometimes doctors are willing to recommend a long-term prevention treatment in the absence of any conclusive proof of benefit provided the treatment is safe. This is especially true if the rationale for the treatment also has a sound scientific basis and the treatment has been found to be beneficial in observational studies.
In this situation, doctors do not want to miss an opportunity to recommend something safe to possibly prevent heart attacks while waiting for absolute proof of its effectiveness, which can be many years away.
Today the prospective trials they started have been completed. These trials have conclusively shown that lowering cholesterol (especially the "bad" LDL cholesterol) reduces heart attack risks and prolongs life. These trials further showed that the benefits of lowering cholesterol outweigh the risks of side effects of the statin medications. Therefore doctors today are much more aggressive than doctors of yester-years when prescribing measures to lower LDL cholesterol. Doctors are much more willing to use medications such as statins to lower cholesterol, and the "normal cholesterol level" has been rapidly reduced.