Re: Improving Performance in Prevention

To the Editor: Dr. Newton's commentary “Improving Performance in Prevention”¹ deserves clarification. I believe he means disease detection and misused the term “prevention.” Mammograms detect hopefully early enough to effect a curative treatment. Mammograms don’t “prevent.” Prevention is more of a population concept and thus, physicians have difficulty with the application to individuals regardless of interest. Prevention has a long history of success when governments become involved (sanitation, etc), and less success on an individual basis (prevention is hard to study on individual patients). This struggle brings to mind a long-standing battle in the history of medicine. The history of medicine has many caveats for today. For instance the Caduceus is not the appropriate symbol of medicine. The Caduceus is actually the symbol of Mercury in mythology and the Caduceus has been used as a symbol of commerce not medicine. The correct symbol is the Staff of Aesculapius (Asclepios). In addition, mythical medicine struggles continue today. The daughters of Aesculapius, (the god of healing), Hygeia (goddess of health), and Panacea (goddess of healing) were always at odds. Hygeia promoted hygiene and prevention, but panacea promoted treatment when ill. Physicians are much better trained to detect and treat than prevent. We should expect preventive medicine to be accomplished by governments and other population influences. I encourage all physicians to continue to emphasize prevention in our education of the individual patients, but we should concentrate on our skills in detection and treatment. Early disease detection is not prevention.

The above letter was referred to the author of the article in question, who offers the following reply.