Earlier this year The Guardian and The Wellcome Trust launched a new science writing prize. The shortlist was announced recently and I didn’t make the cut. But on the plus side I’m now free to do as I wish with my entry.
I found it quite hard to work out what to write about. The area of science with which I’m best acquainted – population health – doesn’t inspire the same kind of ‘Oooh, shiny!” response that some of the more high-tech science domains elicit. Nor does my personal specialism – clinical outcomes research using large patient record databases – obviously lend itself to a gripping 800 word piece (though one day I’ll give it a go). So in the end I decided to write about how, despite the fact that it isn’t as fancy and headline grabbing as, say, the hunt for the Higgs Boson particle, population health and preventive medicine are still really important.
The fruits of my labours are below. I confess I didn’t put in as much effort as the exercise deserved, particularly as the competition closing date overlapped with my literature review deadline. But I gave it a go. Constructive feedback is very welcome.
Nothing much to report
Science revels in the drama of extremes. The Bangs are Big, the tubes are nano, the dimensions are multiple. In contrast, preventive medicine plays down such excitement: outbreaks are to be prevented, premature deaths avoided, hazards to be lessened. In the grand carnival of scientific success, preventive medicine looks like the party pooper who takes no delight in streamers.
Preventive medicine needs a scientific foundation. It hasn’t always been known that smoking causes lung cancer, and the Victorians thought that cholera was spread by ‘miasma’ – a bad smell in the air. Epidemiology – the study of patterns of health and disease in populations – provides insights that help in the development of strategies to prevent people getting sick. It is thanks to careful observation and number crunching that we now know that clean water reduces the spread of specific infectious diseases, and tobacco control can save millions of lives.
Though an understanding of the human body is clearly crucial, successful preventive medicine draws on many areas of science, technology and invention. Engineering developed sewerage systems that helped in the fight against communicable disease. Urban planners can create environments that encourage physical activity and favour the pedestrian over the car. Social sciences and psychology help us to understand how people might react to health advice, and educational theory enables us to get the message across. Successful preventive medicine arises from a melting pot of expertise and innovation.
Public health interventions may seem unscientific – redolent of politics and a nanny state. But good preventive medicine needs a good scientific base to inform it, and proper evaluation once it’s put into practice. Just as we don’t release medication onto the market without rigorous testing, public health advice or programmes which aren’t properly assessed can fail or do harm.
Earlier this year the Society for Clinical Trials’ ‘Trial of the Year’ prize was not awarded to an expensive drug or fancy medical device. It went instead to a trial of an Indian community programme designed to reduce deaths in newborns and improve maternal health. By training local women in safe birth techniques and developing peer networks, the study reduced neonatal mortality by 47% and halved moderate post-natal depression over three years. In low resource settings, where hospital care may be inaccessible if things go wrong, prevention of complications is vital.
Knowledge is power in the fight against disease, and researchers are looking at ways to exploit mobile and web technologies for health education and intervention. A mobile based support system (‘txt2stop‘) to help people quit smoking by sending motivational text messages was recently shown to be effective, with twice as many trial participants quitting after six months compared to a control group. Novel ways of preventing illness continue to arise, and scientific creativity is needed to capitalise on the opportunities.
Newspaper headline writers love incremental advances in cancer research, even if the progress is unlikely to affect human patients for another decade. In contrast, preventive medicine successes seem banal (‘Nobody got sick!’), while failures are trumpeted. Sometimes the expectations can be too high – predictions of flu deaths are demanded before there is adequate data to make them, cautious estimates are reported as fact, and credibility is questioned when ‘worse case scenarios’ (thankfully) fail to materialise. Often the failure of a mass health crisis to arise seems a disappointment to the rolling news channels, and the absence is ascribed to luck as often as it is to good planning, health surveillance and effective prevention strategies.
So while the gadgets of the future hit the headlines, and the latest wonder drug is heralded, take a moment to think of all the unremarkable things. Today, you didn’t get polio. Next week, your health education might help you avoid contracting a sexually transmitted infection. If you work in a bar then you’re far less likely to develop lung cancer from passive smoke inhalation than you were a decade ago. None of these things probably feature on your daily radar. But we have a lot of scientists and policy makers to thank for the considerable reduction in premature mortality over the years.
In the words of the influential 20th century epidemiologist Geoffrey Rose: “It is better to be healthy than ill or dead. That is the beginning and the end of the only real argument for preventive medicine. It is sufficient.”