Where are the health benefits of prevention?

In our asbestos insulated elementary school, when we weren’t cowering under our desks or in the hallways seeking shelter from a fake nuclear attack, we crafted puppets out of asbestos mixed with water and glue. We marveled in our radioactive glow of our watches in the dark attic of our asbestos insulated wartime homes. We breathed the asbestos fibres spewed into the air every time the brakes on nearby automobiles were applied and inhaled numerous long lasting radioactive elements from above ground nuclear testing. We ate and drank the same radioactivity that had settled on our food and infiltrated our milk. Many of us spent decades working in asbestos filled workplaces. Even cooking at home exposed us to fraying asbestos oven mitts.

Those who share similar memories should be able to take some comfort in recent reports from International Early Lung Cancer Action Program (ELCAP) investigators confirming lung cancer is a rare disease - even among those deemed most at risk.

Screening of 31,567 asymptomatic high risk persons for lung cancer from 1993 through 2005 did not find the disease in 98.5% of those screened. When lung cancer was found and surgically removed within a month of its discovery the researchers concluded “annual spiral CT screening can detect lung cancer that is curable.”

Our medical gurus can’t tell us what causes lung cancer – nobody can. Some surmise that one asbestos fibre or radioactive particle trapped deep in a lung is all it takes to initiate a process that results in a cancerous growth years later. ELCAP investigators defined those at high risk for lung cancer if they were over 55, had a history of cigarette smoking, occupational exposure to asbestos, the radioactive isotopes beryllium, uranium and radon, or exposure to secondhand smoke.

Anti-tobacco groups don’t tell us lung cancer is a rare disease. They’d have us believe self-inflicted diseases are ravaging our society at a cost of thousands of deaths annually – some anti-tobacco nuts are up to billions of deaths - added to billions in economic devastation.

Statistics are used to tell us smoking increases the risk of lung cancer 400%. Groups touting prevention strategies promote this flawed assessment of chance to sell both the fear of disease and tickets to their lotteries. Buy five tickets instead of one to increase your relative risk of winning the 649 lottery by 400% - to a whopping absolute risk of five out of 14 million.

Over the past three decades billions of health care dollars have been diverted to smoking prevention. We were told reduced smoking would almost totally eliminate lung cancer, prevent many other cancers and heart diseases. In response to these claims between 1970 and 2003 smoking rates among those 15 and older has dropped from 55% to 35% in men and 39% to 21% in women.

Yet despite this significant reduction in smoking the age standardized incidence of lung cancer has continued to increase. Lung cancer incidence in men in 2001 was the same as it was in 1976. During the same period the incidence of lung cancer in women increased steadily from 16.3 to 44.5 per 100,000. In fact in men and women the incidence of cancer and the prevalence of heart disease have steadily increased for the past thirty years.

Where are the health benefits we’ve been promised?

Let’s not think for a moment prevention advice is benign. Expensive prevention campaigns have diverted scarce funding away from the valuable research, treatments and facilities needed for all our serious ills. That a lung cancer patient doesn’t get the timely treatment ELCP researchers tell us may cure the disease is only one shameful example of a huge problem in obtaining timely health care.

Next time you’re waiting for a health care service consider how much more could be accomplished if money spent creating frightening or just plain silly prevention messages was used to train more doctors and nurses, provide better equipped facilities and fund real research devoted to finding more effective treatments or, as ELCAP researchers are claiming, maybe even a cure or two.