Recently I've been reading The Emperor of All Maladies: A Biography of Cancer, by Siddhartha Mukherjee. In the book, the author recounts the long struggle to perfect surgical and pharmaceutical treatments for cancer. For example, there was a long slog of decades, working out "best practice" for breast cancer surgery. It became clear that removal of observable and limited tumor growth was not effective in stopping the progression of cancer in women's bodies. On the other hand, how far should surgeons go to take out all the tendrils of the out-of-control cells? For many years "radical" mastectomy was the gold standard. This procedure hideously deformed and disabled women; it would be many years later before randomized clinical trials showed that extensive cutting and disfigurement did not achieve better outcomes than less invasive procedures. Nevertheless, the researchers were driven by the cruel reality of watching their patients die. That experience had a way of focusing people.
Mukherjee also describes the long, and unfinished, battle against childhood leukemia. Clinical researchers had to inflict misery associated with cancer cell-toxic chemotherapy on their young patients and their parents. For many early chemotherapy regimens, the oncologists would see short term improvement, only to be followed by the relentless return of metastasis and death. This agony and ecstasy of medical treatment research drives a pursuit of better. Clinical researchers don't want to face another dying child, but want for all the world to reduce and remove illness and suffering. Some medical research is about corporate profits while some is doing battle with the biblical "Four Horsemen of the Apocalypse": pestilence, war, famine and death. Sydney Farber, described in Mukherjee's book, was of that school - sleep deprived to save one more child. The misery and pain among the most desperately ill serves as a driver of efforts to find a cure.
In contrast, the enterprise of public health and health promotion is about preventing disease. We want bad things not to happen, even though it will always be hard to be recognized and appreciated for things that never occurred. So here is the contrast: clinical care sometimes receives deep, genuine gratitude, not to mention compensation, for getting sick people well. Public health can help millions of people never need that cure, but most people never know how their lives were blessed by that effort. This part of the story is old news. Public health and health promotion is undervalued by the public and by the clinical medical establishment. So be it.
However, I want to bring the discussion back to seeking cures for cancer and the whole range of human ailments. Those cures came quicker than they might have because of the emotional trauma associated with very serious diseases. There is an exhaustion that comes with seeing people die, and it makes many researchers resolve to speed the day when successful treatment is just a routine matter. In public health, and maybe especially in health promotion, because that drama and emotional trauma is usually not there, practitioners are lulled to sleep, content to do what they do, because they have always done it. There is not the personal and social pressure to improve. Medical crisis pushes for change, while mediocre results of prevention programs go unrecognized, just another banal government program, nobody expects, nobody cares.
If we could find a way in health promotion to make our unfulfilled prevention targets more personally costly, perhaps progress would come at a more rapid rate. Yesterday CDC reported that 36 million American adults have high blood pressure that is not controlled, and that 1,000 people per day die from the consequences of high blood pressure. If we could make those statistics hit us like a deathly sick child does an oncologist, fewer health promotion practitioners would settle for the status quo. Perhaps it is time for health promoters to be sleepless late at night, worrying about the obesity we are not preventing.
Mukherjee also describes the long, and unfinished, battle against childhood leukemia. Clinical researchers had to inflict misery associated with cancer cell-toxic chemotherapy on their young patients and their parents. For many early chemotherapy regimens, the oncologists would see short term improvement, only to be followed by the relentless return of metastasis and death. This agony and ecstasy of medical treatment research drives a pursuit of better. Clinical researchers don't want to face another dying child, but want for all the world to reduce and remove illness and suffering. Some medical research is about corporate profits while some is doing battle with the biblical "Four Horsemen of the Apocalypse": pestilence, war, famine and death. Sydney Farber, described in Mukherjee's book, was of that school - sleep deprived to save one more child. The misery and pain among the most desperately ill serves as a driver of efforts to find a cure.
In contrast, the enterprise of public health and health promotion is about preventing disease. We want bad things not to happen, even though it will always be hard to be recognized and appreciated for things that never occurred. So here is the contrast: clinical care sometimes receives deep, genuine gratitude, not to mention compensation, for getting sick people well. Public health can help millions of people never need that cure, but most people never know how their lives were blessed by that effort. This part of the story is old news. Public health and health promotion is undervalued by the public and by the clinical medical establishment. So be it.
However, I want to bring the discussion back to seeking cures for cancer and the whole range of human ailments. Those cures came quicker than they might have because of the emotional trauma associated with very serious diseases. There is an exhaustion that comes with seeing people die, and it makes many researchers resolve to speed the day when successful treatment is just a routine matter. In public health, and maybe especially in health promotion, because that drama and emotional trauma is usually not there, practitioners are lulled to sleep, content to do what they do, because they have always done it. There is not the personal and social pressure to improve. Medical crisis pushes for change, while mediocre results of prevention programs go unrecognized, just another banal government program, nobody expects, nobody cares.
If we could find a way in health promotion to make our unfulfilled prevention targets more personally costly, perhaps progress would come at a more rapid rate. Yesterday CDC reported that 36 million American adults have high blood pressure that is not controlled, and that 1,000 people per day die from the consequences of high blood pressure. If we could make those statistics hit us like a deathly sick child does an oncologist, fewer health promotion practitioners would settle for the status quo. Perhaps it is time for health promoters to be sleepless late at night, worrying about the obesity we are not preventing.
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