The difference between treatment and prevention

The second twitter journal club a classic article by Rose, Strategy of prevention: lessons from cardiovascular disease. Br Med J 1981 282 pp. 1847-51.

My favorite line:

When ordinary doctors do not accept that responsibility then prevention is taken over (if at all) by uncritical propagandists, by cranks, and by battling commercial interests.

And this, on the treatment of hypertension:

A general practitioner, say, makes a routine measurement of a man’s blood pressure and finds it raised. There after both the man and the doctor will say that he “suffers” from high blood pressure. He walked in a healthy man but he walks out a patient, and his new-found status is confirmed by the giving and receiving of tablets. An inappropriate label has been accepted because both public and profession feel that if the man were not a patient the doctor would have no business treating him. In reality the care of the symptomless hypertensive person is preventive medicine, not therapeutics.

A systolic pressure of 160mm Hg may be common at these ages, but common does not mean good.

Remids me of this post from the archives.