Skip to main content

Thoughts on Preventive Medicine


You can prevent Heart Attacks
You can prevent Strokes
You can prevent Colon Cancer
You can prevent Cervical Cancer
You can prevent Breast Cancer
You can prevent Prostate Cancer
Really? Well perhaps
You can prevent Syphilis
You can prevent the Friends of Syphilis
You can prevent smallpox, polio, measles, mumps, rubella, tetanus, chicken pox, meningitis, influenza, hepatitis, diphtheria, whooping cough
You can prevent Diabetes
You can prevent Complications of Diabetes
You can prevent Hip fractures
You can prevent Diarrheal Illness
You can prevent Nosocomial Infections
Really? Really, just wash your hands

But you cannot prevent death.
Saying that we can prevent death is preposterous.
Indeed, the word “prevention” doesn’t even apply to death
You can delay death
You can stall death
You can prolong life

But it just doesn’t make sense to say that you can prevent death.

Comments

Nice poetry. Any chance we might hear what spurred you on to write this? I hear a story in there somewhere.
Dan Matlock said…
No story, just a general frustration with our societal death denials and death taboos along with a frustration with applying the term prevention to the idea of death.
I had mentioned in a comment on Drew's recent post about acceptance and hope that our culture needs a modern revival of 'Ars Moriendi' which is really more about a different philosophical/spiritual approach to life and death and not about what medicine can or cannot do.

The book 'Republic of Suffering' is a great example of a major shift in how a culture views dying. It is about the American Civil War.
Alex Smith said…
Love the poetry! Thank you for branching out in new directions Dan.

Christian, a revival of the ars moriendi, "art of dying," is a good idea, but I'm not sure how this can be accomplished. So much of our culture is oriented toward "the science of not-dying," whatever that is in Latin. Also, I'm concerned that the idea of the "good death" may be a Christian (religion, not you personally) Anglo idea, and anathema to other cultures. In Chinese culture, for example, discussion of death is so avoided that even words that sound vaguely like death have negative connotations.

Popular posts from this blog

Geroscience and it's Impact on the Human Healthspan: A podcast with John Newman

Ok, I'll admit it. When I hear the phrase "the biology of aging" I'm mentally preparing myself to only understand about 5% of what the presenter is going to talk about (that's on a good day).  While I have words like telomeres, sirtuins, or senolytics memorized for the boards, I've never been able to see how this applies to my clinical practice as it always feels so theoretical.  Well, today that changed for me thanks to our podcast interview with John Newman, a "geroscientist" and geriatrician here at UCSF and at the Buck Institute for Research on Aging.

In this podcast, John breaks down what geroscience is and how it impacts how we think about many age-related conditions and diseases. For example, rather than thinking about multimorbidity as the random collection of multiple different clinical problems, we can see it as an expression of the fundamental mechanisms of aging. This means, that rather than treating individuals diseases, targeting …

The Dangers of Fleet Enemas

The dangers of oral sodium phosphate preparations are fairly well known in the medical community. In 2006 the FDA issued it’s first warning that patients taking oral sodium phosphate preparations are at risk for potential for acute kidney injury. Two years later, over-the-counter preparations of these drugs were voluntarily withdrawn by the manufacturers.  Those agents still available by prescription were given black box warnings mainly due to acute phosphate nephropathy that can result in renal failure, especially in older adults. Despite all this talk of oral preparations, little was mentioned about a sodium phosphate preparation that is still available over-the-counter – the Fleet enema.

Why Oral Sodium Phosphate Preparations Are Dangerous 

Before we go into the risks of Fleet enemas, lets spend just a couple sentences on why oral sodium phosphate preparations carry significant risks. First, oral sodium phosphate preparations can cause significant fluid shifts within the colon …

Length of Stay in Nursing Homes at the End of Life

One out of every four of us will die while residing in a nursing home. For most of us, that stay in a nursing home will be brief, although this may depend upon social and demographic variables like our gender, net worth, and marital status. These are the conclusions of an important new study published in JAGS by Kelly and colleagues (many of whom are geripal contributors, including Alex Smith and Ken Covinsky).

The study authors used data from the Health and Retirement Study (HRS) to describe the lengths of stay of older adults who resided in nursing homes at the end of life. What they found was that out of the 8,433 study participants who died between 1992 and 2006, 27.3% of resided in a nursing home prior to their death. Most of these patients (70%) actually died in the nursing home without being transferred to another setting like a hospital.

 The length of stay data were striking:

the median length of stay in a nursing home before death was 5 months the average length of stay was l…