Primer on Prevention


In the first year of medical school, wedged in between gross anatomy and histology, was a course in Preventive Medicine. Many students cut the class to go study. I didn't. The professor was Dr. Donald Louria (1928-2021), a man I grew to respect and admire greatly. He was passionate about the subject and in the first lecture he laid out the foundational principle of public health: the three degrees of prevention. He had me prevention.

Using cigarette smoking as an example, primary prevention means preventing the exposure by convincing people never to become smokers. Secondary prevention occurs once a person has been a smoker for years and has an illness, such as emphysema or chronic bronchitis. Providers offer medical treatments that are more or less effective, but the person never returns to baseline. The patient continues to smoke and develops lung cancer. Tertiary prevention is the surgery to remove the tumor and comes with permanent disability. As you move from primary to tertiary prevention the cost of medical care increases dramatically and the results diminish. On a population level, primary prevention is infinitely more cost effective.

For monkeypox, both decreasing sex partners and vaccine are considered primary prevention. However, decreasing sex partners is effective right away, is cheaper, requires no medical visit, no biological product, has no side effects, and is not affected by supply issues.

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