AAMC Reporter: April 2005

Edward W. Holmes, M.D., Vice Chancellor, Health Sciences, University of California-San Diego

Viewpoint: "An Ounce of Prevention for a Pound of Cure"

A century of medical progress has greatly improved our ability to prevent, diagnose and treat disease. Concurrently, we've seen a growing expectation among our patients that when they are sick or injured, the medical professional will quickly pinpoint the problem, prescribe a pill or perform a relatively simple procedure to make them better.

And why shouldn't they? Today's newborns are predicted to live into their late 70s, compared with a life expectancy of 47 years in 1900. In its latest report on health in the United States, the Centers for Disease Control and Prevention (CDC) reported declines in mortality from cancer, heart disease and stroke and a near eradication of reportable childhood infectious disease.

At the same time, the rate of visits to physician offices has increased and the level of specialty care delivered today in the ambulatory setting was inconceivable when I was a medical student. Today 63 percent of surgical procedures are performed on outpatients, and that number will grow as minimally invasive technologies become increasingly sophisticated. And, at least 60 percent of adults aged between 45 to 64 and 80 percent of adults over 65 reported taking at least one prescription drug during the previous month, with an increase in the rate of prescription of anti-depressants, blood glucose regulators, and cholesterol lowering drugs. With innovations in health care, including the accelerated development and marketing of new drugs and vaccines, and convenient access to high quality services, we are enjoying longer and healthier lives. But in other areas, the trends are disturbing.

The CDC also reports that nearly 40 percent of Americans die prematurely from preventable risk factors such as diet, smoking, and inactivity. Significant disparities in risk factors exist among racial and ethnic groups, and also by education level. Obesity and overweight are widely considered among today's most pressing public health problems with the increasing prevalence of obesity in children linked to an increase in diabetes, hypertension and psychosocial issues among young people.

Our challenge today is preparing future physicians for successful careers in an era when innovations in technology and biomedicine are giving us powerful new tools, to restore and protect health. At the same time we are also seeing an increase in chronic disease, preventable injury and premature death tied to diet and behavior.

We have a mandate to produce more physician-scientists, in order to step up the pace of discovery, drug and technology design and production, and the safe and effective application of these advances in the clinical setting. Many distinguished academic leaders have brought attention to the documented shortage of clinicians who are superb at basic or clinical research as well as scientists well grounded in clinical medicine. Having spent much of my career focused on biomedical research, I know first-hand the vital role of the physician-scientist in bridging the translational gap and share the concerns of many colleagues that we must do more to train and incentivize our talented young students to follow this path. We need to encourage students to pursue coursework, special training opportunities and fellowships so that they will have an in-depth experience in both the research laboratory, and the patient care setting.

At the same time, medical schools have an obligation to increase the focus on disease prevention and on research that improves the health of populations and not just individuals. Even the most successful research-oriented schools must consider how they can provide leadership in keeping our communities healthy.

I participated in developing the Institute of Medicine report entitled "The Role of Academic Health Centers in the 21st Century." The theme of prevention and community health emerged as one of the critical calls to action in the report. Indeed, AHCs that are also major safety net providers are witnessing a rising number of patients seeking first-time care in emergency rooms, arriving with symptoms that could have been managed in a community setting or prevented altogether. When social and cultural barriers prevent patients from seeking care until a chronic or critical care need arises, it's bad for the patient and bad for the system. These kinds of issues compel us to devote more aggressive intervention and education toward these populations at risk, or we place our fragile health systems at risk. This will require supporting programs and faculty for whom the community is the living laboratory and encouraging our students to participate in culturally sensitive programs designed to improve outcomes based on population studies and preventive outreach.

As the 21st century unfolds before us, we must not diminish our commitment to basic biomedical research to further our understanding of human disease and for developing new therapies, but we should strive harder to use this knowledge of human biology in combination with interventions that promote healthy behaviors. As we have learned over the past decade, most human disease is a combination of "nature and nurture" — the interaction of our genetic make-up with the environmental forces we encounter. We have made tremendous progress in improving health and longevity for the individual patient. In the future, this will mean directing the same imagination and drive that led to the polio vaccine and deciphered the human genome to academic efforts focused on enhancing the health of communities. Our efforts as teachers, scientists, and clinicians must span the health continuum — from molecules to mankind.

Contact Us    © 1995-2008 AAMC    Terms and Conditions    Privacy Statement