These are strange times for clinical prevention in the United States. The media is filled with health news, and stores have aisles of low-fat food, but Americans are becoming more sedentary and obese. Managed care organizations now boast about their prevention performance on increasingly sophisticated report cards but value practitioners who see four or five patients an hour. Health care purchasers demand these report cards but readily switch their employees into a different health plan to save a few premium dollars. And in the near future, a raft of biotechnology firms will market genetic tests that tell patients about diseases they haven't even developed... yet.
Physicians have their own conflicts about prevention in the late 20th century. We've been trained at great length and expense to intervene, and we feel that we are distinguished from other health practitioners by our ability to deliver a scientific diagnosis and cure. We know
Davis AM. Health Promotion and Disease Prevention in Clinical Practice. JAMA. 1997;277(3):263-264. doi:10.1001/jama.1997.03540270089034