Prevention and cures

There is an old proverb that says that an ounce of prevention is better than a pound of cure. While it is good advice generally, when it comes to health care, one has to be cautious about overdoing prevention.

My former physician in Cleveland before he retired was very much into preventative care. At any sign of something that seemed like an early warning sign, he would suggest prophylactic measures. He would prescribe diagnostic tests and look for signs that something needed attention. So when it seemed like my bone density was slightly lower than it ought to be, a symptom known as osteopenia (which is not the same as osteoporosis which is manifestly low bone density), he suggested that I take daily doses of the drug alendronate (which is marketed under the name Fosomax) which purports to increase bone density. I bought a supply but never got around to taking it and decided to wait awhile. Why? Because in general, I try to avoid routine medicine intake. Since my bone density was still close to normal, I decided to not take any medication to treat it until the signs worsened. After all, I was being compared to the western norm while that may have been my bone density all along. I told him of my decision and he understood it.

I am also aware of how science works and know that it takes a long time before there can be a solid consensus about any treatment. And it emerged that while alendronate did increase bone density, there were serious side effects and that it should not be taken for more than three years for those with low risk.

My physician also suggested that I take a daily low-dose aspirin to reduce the risk of heart attack, a popular treatment at one time. Since I did not have high blood pressure or any risk factors associated with heart disease (other than my father dying of a heart attack but he was a smoker and drinker unlike me), I decided to not start a daily drug regimen there too and since my risk was small, my physician was agreeable with me not doing so. Now comes new studies that say that daily aspirin may not be a good idea for everyone.

Older adults without heart disease shouldn’t take daily low-dose aspirin to prevent a first heart attack or stroke, an influential health guidelines group said in preliminary updated advice released Tuesday.

Bleeding risks for adults in their 60s and up who haven’t had a heart attack or stroke outweigh any potential benefits from aspirin, the U.S. Preventive Services Task Force said in its draft guidance.

For the first time, the panel said there may be a small benefit for adults in their 40s who have no bleeding risks. For those in their 50s, the panel softened advice and said evidence of benefit is less clear.

The recommendations are meant for people with high blood pressure, high cholesterol, obesity or other conditions that increase their chances for a heart attack or stroke. Regardless of age, adults should talk with their doctors about stopping or starting aspirin to make sure it’s the right choice for them, said task force member Dr. John Wong, a primary-care expert at Tufts Medical Center.

“Aspirin use can cause serious harms, and risk increases with age,” he said.

If finalized, the advice for older adults would backtrack on recommendations the panel issued in 2016 for helping prevent a first heart attack and stroke, but it would be in line with more recent guidelines from other medical groups.

My subsequent physicians are much less aggressive in prescribing preventative measures, showing the lack of consensus on some of these items. I do take regular checkups to make sure that vitals signs are stable and one measure that I do regularly are colonoscopies because the benefits of that seem to be very well established. Also, the benefits of a balanced diet and reasonable amounts of exercise and practicing moderation and avoiding excess in any area are also good things to do. They have no side effects or downsides, always a plus for me. And of course, I take all the recommended vaccinations, such as the ones for covid-19, shingles, and flu because not only is there a solid consensus on the benefits, those are all highly contagious diseases so my taking them is also an act of civic responsibility because it helps control their prevalence in the general community as well and reduces the risk to other people.

In the days of the internet one gets bombarded with all manner of unsolicited medical advice and treatments in the form of the little boxes on the web pages, some promising miracle cures, others with warnings that some everyday food can kill you. If one is easily alarmed, those pages can lead you down avenues towards all manner of quack treatments. Doctors complain of patients coming to them and demanding that they prescribe treatments that they have read about on the internet, even though those have little evidence behind them.

The best course of action is always the one taken in consultation with your physician so that you can arrive at a treatment that is based on sound science that you are both comfortable with.


  1. sonofrojblake says

    when it comes to health care, one has to be cautious about overdoing prevention

    Prevention is profitable. Can’t remember the source for this one, so take it with a pinch of your favourite crystalline chloride: the US has the world’s highest rate of successful cancer treatments, and a rate of cancer deaths not much different than anywhere else. These two figures taken together suggest there’s a lot of preventative care happening (i.e. being paid for) against cancers that don’t exist…

  2. Jörg says

    I take all the recommended vaccinations, such as the ones for … shingles

    Interesting. Wikipedia says that the vaccination is recommended in Germany for people aged > 60. Thanks for the info!

  3. Mano Singham says

    Jörg @#3,

    I too was unaware of the benefits of the shingles vaccine until a little over a year ago. Apparently, the vaccine before that time was not very effective but the new one is and so my doctor recommended that I get it and I did.

    A friend of mine did not get the vaccine and got shingles and it turned out to be very painful.

  4. DrVanNostrand says

    They’ve talked about shingles and the shingles vaccine on TWiV a few times. Like a lot of people here, I was born before the chicken pox vaccine, so pretty much everyone I know has had it, and now has a risk of developing shingles eventually. It’s completely different for my nieces and nephews, who have all had the chicken pox vaccine, and none of whom have had chicken pox. It’s too early to tell for sure, but some think it’s possible shingles could be eradicated altogether if chicken pox vaccine uptake is high enough.

  5. mnb0 says

    “one has to be cautious about overdoing prevention”
    I’ve known this since 1998. In that year prevention programs of both whooping cough and malaria (the latter especially in low risk areas like the more densely populated coastal areas of Suriname) were both more expensive and more dangerous to your health (because of adverse drug reaction) than actually dealing with these diseases.
    There simply is no general rule.

    “The best course of action is always the one taken in consultation with your physician so that you can arrive at a treatment that is based on sound science that you are both comfortable with.”
    One problem is that there often is not a thing like sound medical science (which is not an argument pro quackery). For instance treatment of many medical complaints to a large extent depends on the country where you visit your physician.

  6. Dauphni says

    Ugh, shingles.
    I’m 35 and just spent most of September in bad enough pain that I could barely sleep.
    On top of that I now have a fresh new batch of scars to remind me of it for the rest of my life.
    Would have been really nice if I could have avoided all of that.

  7. naturalcynic says

    @ Marcus: Hey, let’s give people antibiotics for everything because, who knows, it might help! What could possibly go rong?
    As if you are a chicken or cow since most of the antibiotics used in the US are fed to livestock. Because they work as a prophylactic and growth promoter while also promoting the growth of resistant strains of nasty bugs.

  8. anat says

    sonofrojblake @2: For comparative cancer statistics, see
    The US, Canada, Australia, New Zealand and Norway have higher cancer rates that other countries, even after adjusting for age structure of the population. This might mean over-diagnosis in these countries, or under-diagnosis elsewhere.

    The biggest killers among the cancers are cancers of the trachea, bronchus, and lung, and the biggest factor influencing cancer death rates anywhere are smoking rates. Other means of prevention and treatment are effective for the less bigger killers -- colorectal cancer could go away almost entirely if everyone had colonoscopies on time, and that would save only half as many lives as would be saved if nobody had smoked ever.

    Most of the expense in cancer medicine is not going towards prevention but towards treatment of diagnosed cancers, many of them advanced and incurable. In some cases they add a couple of life-years of semi-decent quality, in others they add a couple of months of utter suffering.

  9. blf says

    @1, And thanks for the reminder — I should look into that (flu vaccine) also…

    On shingles (and tetanus) — I should stop procrastinating. I’m waayyy overdue for a tetanus booster, and probably now-eligible for a shingles jab.

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