Preventive medical interventions—and even non-medicalized public health programmes that implicitly promise health benefits in the future, from actions taken now—all carry a strong ethical requirement: primum non nocere (‘first, do no harm.’) This is especially true nowadays, when new preventive advice and interventions are being promoted on a daily basis, sometimes by scientifically ill-informed special interest groups. This slim volume provides a set of ‘critical appraisal’ tools to help those considering a preventive action to be sure that it is effective (does more good than harm), efficient (is a competitive use of scarce resources), and equitable in its impact across society. Throughout the book worked examples are provided and ‘case-studies’, illustrating the risks and benefits (and in some cases the costs per unit of health benefit) of specific preventive interventions, both laudable, and not so laudable. The nine chapters focus on the following aspects of prevention: the hierarchy of preventive options; the assessment of causation; finding and appraising scientific evidence; prevention directed at entire populations (as opposed to individuals); the scientific perils underlying ‘healthy nutrition’ advice; measuring chronic disease risk factors and medically managing them, e.g. statin treatment of high cholesterol; PSA screening for prostate cancer: more harm than good?; genetic screening for future disease risk; and assessing the health equity implications of prevention. This book is aimed at front-line primary care and public health professionals, to help them better inform, and serve, their patients and communities.
Table of Contents
- Chapter 1 Introduction: Why we wrote this book
- Chapter 2 Basic principles of successful and unsuccessful prevention
- Chapter 3 A brief history of prevention … and causation
- Chapter 4 Seeing the forest for the trees—finding and using the evidence
- Chapter 5 Causation and prevention in populations versus individuals
- Chapter 6 How simple advice can sometimes be wrong—the case of ‘healthy diets’
- Chapter 7 Preventing chronic diseases by risk factor detection and treatment: what every health care consumer needs to know
- Chapter 8 Detecting disease before symptoms begin: the blemished promise of cancer screening
- Chapter 9 Genetic testing for disease prevention: oversold?
- Chapter 10 When can prevention expect to also reduce social inequalities in health?