Hygeia and Panacea: is prevention better than cure? CHRISTOPHER DYE What's the single best method of...
-
Upload
corey-cuthbert-bailey -
Category
Documents
-
view
228 -
download
0
Transcript of Hygeia and Panacea: is prevention better than cure? CHRISTOPHER DYE What's the single best method of...
![Page 1: Hygeia and Panacea: is prevention better than cure? CHRISTOPHER DYE What's the single best method of prevention or cure ever devised to improve public.](https://reader035.fdocuments.us/reader035/viewer/2022062305/56649de75503460f94ae0f60/html5/thumbnails/1.jpg)
Hygeia and Panacea: is prevention better than cure?
CH
RIS
TO
PH
ER
DY
E
What's the single best method of prevention or
cure ever devised to improve public or personal health?
![Page 2: Hygeia and Panacea: is prevention better than cure? CHRISTOPHER DYE What's the single best method of prevention or cure ever devised to improve public.](https://reader035.fdocuments.us/reader035/viewer/2022062305/56649de75503460f94ae0f60/html5/thumbnails/2.jpg)
Prevention is better than cure Dangerous myth…
“Dad always thought
laughter was the best
medicine, which I guess is why several of us
died of tuberculosis.”
![Page 3: Hygeia and Panacea: is prevention better than cure? CHRISTOPHER DYE What's the single best method of prevention or cure ever devised to improve public.](https://reader035.fdocuments.us/reader035/viewer/2022062305/56649de75503460f94ae0f60/html5/thumbnails/3.jpg)
Prevention is better than cure …or universal truth?
Scurvy, "limeys" and vitamin C
James Lind 1716-94A Treatise of the Scurvy
![Page 4: Hygeia and Panacea: is prevention better than cure? CHRISTOPHER DYE What's the single best method of prevention or cure ever devised to improve public.](https://reader035.fdocuments.us/reader035/viewer/2022062305/56649de75503460f94ae0f60/html5/thumbnails/4.jpg)
Treatise on Preparation for DeathOn Civility in ChildrenAdagia
"Prevention is better than cure"
Desiderius Erasmus 1466-1536
![Page 5: Hygeia and Panacea: is prevention better than cure? CHRISTOPHER DYE What's the single best method of prevention or cure ever devised to improve public.](https://reader035.fdocuments.us/reader035/viewer/2022062305/56649de75503460f94ae0f60/html5/thumbnails/5.jpg)
1. When prevention is better than cure
![Page 6: Hygeia and Panacea: is prevention better than cure? CHRISTOPHER DYE What's the single best method of prevention or cure ever devised to improve public.](https://reader035.fdocuments.us/reader035/viewer/2022062305/56649de75503460f94ae0f60/html5/thumbnails/6.jpg)
Where 60 million people die double burden of disease in low-income countries
0
2
4
6
8
Communicable,pregnancy,
nutrition
Non-communicable
Injuries
Dea
ths
per
mill
ion
po
pu
lati
on
Low-middle income
High income
![Page 7: Hygeia and Panacea: is prevention better than cure? CHRISTOPHER DYE What's the single best method of prevention or cure ever devised to improve public.](https://reader035.fdocuments.us/reader035/viewer/2022062305/56649de75503460f94ae0f60/html5/thumbnails/7.jpg)
Currency of illness and death
WHAT'S THE HUMAN COST OF RABIES…
…AS COMPARED WITH HEART
DISEASE?
![Page 8: Hygeia and Panacea: is prevention better than cure? CHRISTOPHER DYE What's the single best method of prevention or cure ever devised to improve public.](https://reader035.fdocuments.us/reader035/viewer/2022062305/56649de75503460f94ae0f60/html5/thumbnails/8.jpg)
Currency of illness and death
HOW TO COMPARE RABIES WITH HEART DISEASE?
DISABILITY-ADJUSTED LIFE YEAR (DALY)
DALY = YEARS LOST TO ILLNESS
× DISABILITY WEIGHT
+ YEARS LOST BY DEATH
![Page 9: Hygeia and Panacea: is prevention better than cure? CHRISTOPHER DYE What's the single best method of prevention or cure ever devised to improve public.](https://reader035.fdocuments.us/reader035/viewer/2022062305/56649de75503460f94ae0f60/html5/thumbnails/9.jpg)
0
0.2
0.4
0.6
0.8
1
Upper
resp
Primar
y sy
philis
Asthm
a
Mea
sles
Liver
can
cer
TB
Lower re
sp
Heart
atta
ckAID
S
Men
inig
itis
Term
inal
can
cer
Death
pe
rfe
ct
he
alt
h...
...d
ea
thDisability weights for selected conditions
![Page 10: Hygeia and Panacea: is prevention better than cure? CHRISTOPHER DYE What's the single best method of prevention or cure ever devised to improve public.](https://reader035.fdocuments.us/reader035/viewer/2022062305/56649de75503460f94ae0f60/html5/thumbnails/10.jpg)
An ounce of prevention or a pound of cure?
100
1000
10000
100000
1000000
Tobaccoprice
increase
Nicotinereplacement
Promotingcessation
etc
Treatmentlung, liver,stomachcancer
Co
st/y
r h
ealt
hy
life
($/D
AL
Y)
TOBACCO: 5 MILLION DEATHS ANNUALLY
![Page 11: Hygeia and Panacea: is prevention better than cure? CHRISTOPHER DYE What's the single best method of prevention or cure ever devised to improve public.](https://reader035.fdocuments.us/reader035/viewer/2022062305/56649de75503460f94ae0f60/html5/thumbnails/11.jpg)
Tobacco tax works! Cigarette sales New Zealand
4
5
6
7
8
1980 1985 1990 1995 2000 2005
$ p
rice
20
cig
are
tte
s
6
8
10
12
14
Mill
ion
s s
old
![Page 12: Hygeia and Panacea: is prevention better than cure? CHRISTOPHER DYE What's the single best method of prevention or cure ever devised to improve public.](https://reader035.fdocuments.us/reader035/viewer/2022062305/56649de75503460f94ae0f60/html5/thumbnails/12.jpg)
DALYs: all we need to know?
Prevention or treatment of terminal cancer?
Choose:
(a) Palliative treatment to extend days of healthy life in people with cancer
Or:
(b) Preventive measures (advertising, taxation etc) to reduce cancer incidence
Assume cost per DALY is the same
![Page 13: Hygeia and Panacea: is prevention better than cure? CHRISTOPHER DYE What's the single best method of prevention or cure ever devised to improve public.](https://reader035.fdocuments.us/reader035/viewer/2022062305/56649de75503460f94ae0f60/html5/thumbnails/13.jpg)
"The benefits of strong, early action on climate change outweigh the costs"
STERN REVIEW November 2006: The Economics of Climate Change
Climate & health: An inconvenient truth?
![Page 14: Hygeia and Panacea: is prevention better than cure? CHRISTOPHER DYE What's the single best method of prevention or cure ever devised to improve public.](https://reader035.fdocuments.us/reader035/viewer/2022062305/56649de75503460f94ae0f60/html5/thumbnails/14.jpg)
Michael Mann's "hockey stick"
![Page 15: Hygeia and Panacea: is prevention better than cure? CHRISTOPHER DYE What's the single best method of prevention or cure ever devised to improve public.](https://reader035.fdocuments.us/reader035/viewer/2022062305/56649de75503460f94ae0f60/html5/thumbnails/15.jpg)
Global warming: damage to health
Rise ºC Some health consequences
1 300,000 people die each year from climate-related diseases - diarrhea, malaria, malnutrition
2 40 – 60 million more people exposed to malaria in Africa
3 1 – 3 million more people die from malnutrition (if carbon fertilization weak)
4 Up to 80 million more people exposed to malaria in Africa
5+ Major disruption and large-scale movement of population
![Page 16: Hygeia and Panacea: is prevention better than cure? CHRISTOPHER DYE What's the single best method of prevention or cure ever devised to improve public.](https://reader035.fdocuments.us/reader035/viewer/2022062305/56649de75503460f94ae0f60/html5/thumbnails/16.jpg)
Stabilization beyond reach?
Stabilization feasible
0
10
20
30
40
50
60
70
2000 2020 2040 2060 2080 2100
Glo
ba
l em
iss
ion
s (
GtC
O2
) Delayed action
Prompt action
Easier and harder ways to keep CO2
at or below 550 parts per million
![Page 17: Hygeia and Panacea: is prevention better than cure? CHRISTOPHER DYE What's the single best method of prevention or cure ever devised to improve public.](https://reader035.fdocuments.us/reader035/viewer/2022062305/56649de75503460f94ae0f60/html5/thumbnails/17.jpg)
"The cost of investment would be
trivial by comparison with the possible damage"
Investment 1% per year of global GDP over next 50 years
Damage2-3 ºC : 0-3% GDP in late 21st century5-6 ºC : 5-20% GDP ($4 trillion per year)
![Page 18: Hygeia and Panacea: is prevention better than cure? CHRISTOPHER DYE What's the single best method of prevention or cure ever devised to improve public.](https://reader035.fdocuments.us/reader035/viewer/2022062305/56649de75503460f94ae0f60/html5/thumbnails/18.jpg)
Bond…
“the rates of return from upfront investment in water and sanitation would significantly outweigh the costs of borrowing from bond markets…”
Human Development Report 2006
Market BondFinancing sanitation and vaccines
![Page 19: Hygeia and Panacea: is prevention better than cure? CHRISTOPHER DYE What's the single best method of prevention or cure ever devised to improve public.](https://reader035.fdocuments.us/reader035/viewer/2022062305/56649de75503460f94ae0f60/html5/thumbnails/19.jpg)
Smallpox: what value eradication?
Day 3
Synchronous eruption of lesions
Day 5
Rash turns to vesicles and pustules
Day 7
Large lesions with central well
Case fatality
30%
![Page 20: Hygeia and Panacea: is prevention better than cure? CHRISTOPHER DYE What's the single best method of prevention or cure ever devised to improve public.](https://reader035.fdocuments.us/reader035/viewer/2022062305/56649de75503460f94ae0f60/html5/thumbnails/20.jpg)
From inoculation to vaccination to eradication
Edward Jenner (1749-1823)
Lady Mary Wortley
Montague
(1689-1762)
DA HendersonWHO Eradication
campaign (1966-1977)
![Page 21: Hygeia and Panacea: is prevention better than cure? CHRISTOPHER DYE What's the single best method of prevention or cure ever devised to improve public.](https://reader035.fdocuments.us/reader035/viewer/2022062305/56649de75503460f94ae0f60/html5/thumbnails/21.jpg)
Smallpox inoculation: tools of the trade
![Page 22: Hygeia and Panacea: is prevention better than cure? CHRISTOPHER DYE What's the single best method of prevention or cure ever devised to improve public.](https://reader035.fdocuments.us/reader035/viewer/2022062305/56649de75503460f94ae0f60/html5/thumbnails/22.jpg)
Cost of eradication
inexternal funding
$125 million
"Just eradicate the disease, and
let the skeptics talk to each other" UNICEF
![Page 23: Hygeia and Panacea: is prevention better than cure? CHRISTOPHER DYE What's the single best method of prevention or cure ever devised to improve public.](https://reader035.fdocuments.us/reader035/viewer/2022062305/56649de75503460f94ae0f60/html5/thumbnails/23.jpg)
1967
About 10,000 cases per month
1977
Last case 26 October 1977
![Page 24: Hygeia and Panacea: is prevention better than cure? CHRISTOPHER DYE What's the single best method of prevention or cure ever devised to improve public.](https://reader035.fdocuments.us/reader035/viewer/2022062305/56649de75503460f94ae0f60/html5/thumbnails/24.jpg)
Poliomyelitis: prevention far better than cure
![Page 25: Hygeia and Panacea: is prevention better than cure? CHRISTOPHER DYE What's the single best method of prevention or cure ever devised to improve public.](https://reader035.fdocuments.us/reader035/viewer/2022062305/56649de75503460f94ae0f60/html5/thumbnails/25.jpg)
Polio vaccines
Sabin & Salk
![Page 26: Hygeia and Panacea: is prevention better than cure? CHRISTOPHER DYE What's the single best method of prevention or cure ever devised to improve public.](https://reader035.fdocuments.us/reader035/viewer/2022062305/56649de75503460f94ae0f60/html5/thumbnails/26.jpg)
Polio eradication?>1600 cases in 2006
Total external spending ~ $4 bnInitial estimate $300 million
IndiaPakistan
AfghanistanNigeria
![Page 27: Hygeia and Panacea: is prevention better than cure? CHRISTOPHER DYE What's the single best method of prevention or cure ever devised to improve public.](https://reader035.fdocuments.us/reader035/viewer/2022062305/56649de75503460f94ae0f60/html5/thumbnails/27.jpg)
2. When cure is the only option
![Page 28: Hygeia and Panacea: is prevention better than cure? CHRISTOPHER DYE What's the single best method of prevention or cure ever devised to improve public.](https://reader035.fdocuments.us/reader035/viewer/2022062305/56649de75503460f94ae0f60/html5/thumbnails/28.jpg)
Leprosy: curable but not preventable
![Page 29: Hygeia and Panacea: is prevention better than cure? CHRISTOPHER DYE What's the single best method of prevention or cure ever devised to improve public.](https://reader035.fdocuments.us/reader035/viewer/2022062305/56649de75503460f94ae0f60/html5/thumbnails/29.jpg)
3. When cure is also prevention
![Page 30: Hygeia and Panacea: is prevention better than cure? CHRISTOPHER DYE What's the single best method of prevention or cure ever devised to improve public.](https://reader035.fdocuments.us/reader035/viewer/2022062305/56649de75503460f94ae0f60/html5/thumbnails/30.jpg)
TUBERCULOSIS: 1.7 MILLION DEATHS ANNUALLY
1
10
100
1000
10000
100000
Treat latentinfection
Treatresistant TB
BCGvaccination
Treat activeTB
Co
st/y
r h
ealt
hy
life
gai
ned
($/
DA
LY
)
Cure
Prevention
![Page 31: Hygeia and Panacea: is prevention better than cure? CHRISTOPHER DYE What's the single best method of prevention or cure ever devised to improve public.](https://reader035.fdocuments.us/reader035/viewer/2022062305/56649de75503460f94ae0f60/html5/thumbnails/31.jpg)
4. When cure is the sister of prevention
![Page 32: Hygeia and Panacea: is prevention better than cure? CHRISTOPHER DYE What's the single best method of prevention or cure ever devised to improve public.](https://reader035.fdocuments.us/reader035/viewer/2022062305/56649de75503460f94ae0f60/html5/thumbnails/32.jpg)
Hygeia and Panacea cleanliness (and healing) are next to
godlinessAsklepios - medicine and healing
Hygeia - cleanliness
Panacea - healing
![Page 33: Hygeia and Panacea: is prevention better than cure? CHRISTOPHER DYE What's the single best method of prevention or cure ever devised to improve public.](https://reader035.fdocuments.us/reader035/viewer/2022062305/56649de75503460f94ae0f60/html5/thumbnails/33.jpg)
0
20
40
60
80
Bednets withinsecticide
Housespraying
insecticide
Prophylacticdrugs forchildren
Prophylacticdrugs in
pregnancy
Drugtreatment
children withmalaria
Co
st/
ye
ar
he
alt
hy
life
($
/DA
LY
)MALARIA:1.2 MILLION DEATHS ANNUALLY
Combine prevention and curelow- and middle-income countries: up to
4 methods of prevention 1 method of cure
![Page 34: Hygeia and Panacea: is prevention better than cure? CHRISTOPHER DYE What's the single best method of prevention or cure ever devised to improve public.](https://reader035.fdocuments.us/reader035/viewer/2022062305/56649de75503460f94ae0f60/html5/thumbnails/34.jpg)
0
1000
2000
3000
4000
5000
Wat
er &
sanit
ation
Choler
a or
rota
vacc
Oral r
ehyd
ratio
n
Breas
tfeed
ing p
rom
o
Wat
er p
ump
Latri
nes
Co
st/y
ear
hea
lth
y li
fe (
$/D
AL
Y)
Cure
Prevention
DIARRHEA: 1.8 MILLION DEATHS/YEARmethods for prevention and cure
![Page 35: Hygeia and Panacea: is prevention better than cure? CHRISTOPHER DYE What's the single best method of prevention or cure ever devised to improve public.](https://reader035.fdocuments.us/reader035/viewer/2022062305/56649de75503460f94ae0f60/html5/thumbnails/35.jpg)
The 60 countries with the highest numbers or rates worldwide of child mortality
![Page 36: Hygeia and Panacea: is prevention better than cure? CHRISTOPHER DYE What's the single best method of prevention or cure ever devised to improve public.](https://reader035.fdocuments.us/reader035/viewer/2022062305/56649de75503460f94ae0f60/html5/thumbnails/36.jpg)
-5 -4 -3 -2 -1 0
East Asia
Europe & Central Asia
Latin America
Middle East
South Asia
Sub-Saharan Africa
Annual fall in child mortality (U5M %)
Faster economicgrowthFall 1990-2000
target -4.3%
Child deaths: task is not to choose prevention or cure, but to implement all feasible solutions
![Page 37: Hygeia and Panacea: is prevention better than cure? CHRISTOPHER DYE What's the single best method of prevention or cure ever devised to improve public.](https://reader035.fdocuments.us/reader035/viewer/2022062305/56649de75503460f94ae0f60/html5/thumbnails/37.jpg)
Effective prevention and curePrevention Cure
Child deaths Breastfeeding handwashing
Oral rehydration
Antibiotics
Maternal deaths Family planning
Micronutrients
Obstetrics
Antibiotics
Nutrition Breastfeeding
Hygiene/sanitation
Macro- and micronutrients
HIV/AIDS Safe sex
Treat STI
Antibiotics
Antiretrovirals
Tuberculosis Treat active TB
BCG
Treat active TB
Treat TB/HIV
Malaria Bednets
House spraying
Case management
![Page 38: Hygeia and Panacea: is prevention better than cure? CHRISTOPHER DYE What's the single best method of prevention or cure ever devised to improve public.](https://reader035.fdocuments.us/reader035/viewer/2022062305/56649de75503460f94ae0f60/html5/thumbnails/38.jpg)
5. How individuals approach
prevention and cure
![Page 39: Hygeia and Panacea: is prevention better than cure? CHRISTOPHER DYE What's the single best method of prevention or cure ever devised to improve public.](https://reader035.fdocuments.us/reader035/viewer/2022062305/56649de75503460f94ae0f60/html5/thumbnails/39.jpg)
Why take the risk?
Are you "risk averse" or "risk prone"?
Plain ignorance (AIDS is not curable) It'll never happen to me (delusional) The future may never come
(discounting) Peer pressure (Kool and the Gang) For kicks (excitement, bore/freedom) Refusal to pay for insurance
![Page 40: Hygeia and Panacea: is prevention better than cure? CHRISTOPHER DYE What's the single best method of prevention or cure ever devised to improve public.](https://reader035.fdocuments.us/reader035/viewer/2022062305/56649de75503460f94ae0f60/html5/thumbnails/40.jpg)
Type of GambleExpected average valuerelative to amount bet
Roulette You lose 5% of each bet
Large group health insurance
You lose 10% of each bet
Individual health insurance
You lose 40% of each bet,the price of "peace ofmind"
Risk, roulette and health insurance
![Page 41: Hygeia and Panacea: is prevention better than cure? CHRISTOPHER DYE What's the single best method of prevention or cure ever devised to improve public.](https://reader035.fdocuments.us/reader035/viewer/2022062305/56649de75503460f94ae0f60/html5/thumbnails/41.jpg)
see www.gresham.ac.uk
![Page 42: Hygeia and Panacea: is prevention better than cure? CHRISTOPHER DYE What's the single best method of prevention or cure ever devised to improve public.](https://reader035.fdocuments.us/reader035/viewer/2022062305/56649de75503460f94ae0f60/html5/thumbnails/42.jpg)
6. Magic bullets & Nobel Prizes
![Page 43: Hygeia and Panacea: is prevention better than cure? CHRISTOPHER DYE What's the single best method of prevention or cure ever devised to improve public.](https://reader035.fdocuments.us/reader035/viewer/2022062305/56649de75503460f94ae0f60/html5/thumbnails/43.jpg)
Cure is cleverer than prevention?186 Nobel Prizes for Medicine, 1901-2006
Basic science 172Cure/therapy 12Prevention 2
Theiler 1905
Ehrlich 1908 +
Mechnikov 1908
![Page 44: Hygeia and Panacea: is prevention better than cure? CHRISTOPHER DYE What's the single best method of prevention or cure ever devised to improve public.](https://reader035.fdocuments.us/reader035/viewer/2022062305/56649de75503460f94ae0f60/html5/thumbnails/44.jpg)
Paul Ehrlich's (1854-1915)
"magic bullets"
Prevention: "side-chain" theory of immunity based on antibody
Cure: drugs selectively targeting pathogens -- arsenic-based Salvarsan to treat syphilis
Smoking one of his "25 strong cigars a day"Died of stroke
![Page 45: Hygeia and Panacea: is prevention better than cure? CHRISTOPHER DYE What's the single best method of prevention or cure ever devised to improve public.](https://reader035.fdocuments.us/reader035/viewer/2022062305/56649de75503460f94ae0f60/html5/thumbnails/45.jpg)
Magic bullets, besides penicillin…
Fleming Chain Florey
1928/41
![Page 46: Hygeia and Panacea: is prevention better than cure? CHRISTOPHER DYE What's the single best method of prevention or cure ever devised to improve public.](https://reader035.fdocuments.us/reader035/viewer/2022062305/56649de75503460f94ae0f60/html5/thumbnails/46.jpg)
Aspirin (acetylsalicylic acid, 1899)
Analgesic against minor pains and aches Antipyretic against fever Anti-inflammatory against arthritis Anti-platelet blood-thinner Anti-stick stops bacteria growing on
contact lenses Side effects gastrointestinal distress
(ulcers, stomach bleeding), tinnitus, bleeding in menstruation
![Page 47: Hygeia and Panacea: is prevention better than cure? CHRISTOPHER DYE What's the single best method of prevention or cure ever devised to improve public.](https://reader035.fdocuments.us/reader035/viewer/2022062305/56649de75503460f94ae0f60/html5/thumbnails/47.jpg)
Aspirin reduces strokes in women (17%) and heart attacks in men (32%)
women have slightly more strokes than heart attacks, men tend to have more heart attacks than strokes (JAMA vol 295, p 306, 2005)
Sir John Vane, Nobel Prize 1982
![Page 48: Hygeia and Panacea: is prevention better than cure? CHRISTOPHER DYE What's the single best method of prevention or cure ever devised to improve public.](https://reader035.fdocuments.us/reader035/viewer/2022062305/56649de75503460f94ae0f60/html5/thumbnails/48.jpg)
Praziquantel vs schistosome flukes
![Page 49: Hygeia and Panacea: is prevention better than cure? CHRISTOPHER DYE What's the single best method of prevention or cure ever devised to improve public.](https://reader035.fdocuments.us/reader035/viewer/2022062305/56649de75503460f94ae0f60/html5/thumbnails/49.jpg)
250 million people infected with schistosomes Adult flukes killed with a single dose of PZQ
![Page 50: Hygeia and Panacea: is prevention better than cure? CHRISTOPHER DYE What's the single best method of prevention or cure ever devised to improve public.](https://reader035.fdocuments.us/reader035/viewer/2022062305/56649de75503460f94ae0f60/html5/thumbnails/50.jpg)
Is prevention better than cure?
In formal analysis, not necessarily…
• Aetiology of some diseases unknown
some conditions unpreventable
• Prevention vs cure is not always the right question
both are needed and feasible e.g. child mortality in LDCs
• We value more than is captured in formal analysis
which gives guidance, not rules
![Page 51: Hygeia and Panacea: is prevention better than cure? CHRISTOPHER DYE What's the single best method of prevention or cure ever devised to improve public.](https://reader035.fdocuments.us/reader035/viewer/2022062305/56649de75503460f94ae0f60/html5/thumbnails/51.jpg)
PREVENTION VS CURE: A STRAW POLL AT WHO
0 1 2 3 4
Vaccination
Clean water
Handwashing
Nutrition
The pill
Seatbelts
Sterilization
Coveredcough
Vitamins
Votes for prevention
0 1 2 3 4 5
Antibiotics
Surgery
Gooddoctors
ORTdiarrhea
Votes for cure