March 29, 2005

Prevention versus therapy

This evening I attended a debate held by the Cardiovascular Sciences collaborative program. The question was: "Be it resolved that in our increasingly stressed healthcare system, greater emphasis should be placed on the prevention of ischemic heart disease rather than on the development of novel therapeutic strategies."

The protagonist was Dr. Cameron Mustard, a Professor at the University of Toronto, involved in epidemiology. The antagonist was Dr. David Alter, a cardiologist and scientist affiliated with Sunnybrook and Women's College Hospital, and the University of Toronto. The chair was Dr. Thomas Parker, the current Chair of Cardiology at the University of Toronto and St. Michael's Hospital.

It was pretty interesting, because Dr. Mustard's points focused on population health and the strange stabilization of cardiovascular disease (CVD). He stated that back in the day (I forget what decade), CVD was considered a disease of the affluent. Today a complete reversal can be found, with CVD afflicting mainly those below the poverty line. Although obesity and smoking are strong predictors of CVD, they do not explain the current situation. The prevalence of smoking Canadians has actually dropped from 35% to 20% today. He stated a lot of facts and figures, but basically presented his position that preventative measures currently account for the majority of increased longevity of patients with CVD.

On the other hand, Dr. Alter presented some interesting points. The role of the healthcare system is not to educate the masses to eat right and exercise, but to treat the patients who come in. By this time, it's too late for prevention, but the patient still must be treated. Something like 60% of healthcare funding is allocated for the last six months of a person's life. This is the unfortunate reality of healthcare. I was much more convinced by his arguments, although I agree that prevention is important. This is good because it means that my research is still meaningful! (Hopefully.)

The speakers were excellent, and CBC Radio One was there for a taping, so perhaps it will be on the radio in the near future!

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