Navigation – Plan du site
Chairs

Risk Prevention in Medicine: from a Population-Based Approach to a Personalized Approach

Pierre Corvol
p. 42

Notes de la rédaction

Source: La lettre, no. 34, July 2012

Texte intégral

1Suffice it to say that the type of diseases or conditions that affect us is evolving, with a growing prevalence of chronic diseases.

Caption: Louis Jouvet in Knock (1951) © DR

2The infectious diseases that largely determined life expectancy and mortality in previous centuries are now giving way to cancers and degenerative disorders. Along with this trend, our societies are demonstrating increasingly high expectations regarding the quality of care and the need to be shielded from the risk of disease. Some speak of the emergence of a new obsession with health which may go hand in hand with a growing refusal of pain, old age, or even death. This is the context of risk prevention in medicine demanded by our fellow citizens who want to avoid diseases and delay death at all cost.

3The seminar of the Chair of Experimental Medicine, “Risk Prevention in Medicine: from a Population-Based Approach to a Personalized Approach”, addressed so-called “mass” prevention, applied indiscriminately to an entire population, as well as targeted, personalized, customized prevention. The latter is becoming possible by means of an analysis of a given person’s own particular antecedents and characteristics, in their own environment. The shift from global prevention to personalized prevention meets the desires of both doctors and patients.

4The World Health Organization (WHO) defines prevention as all the measures aimed at preventing or reducing the number and gravity of diseases or accidents. It distinguishes three types of prevention; this seminar dealt only with primary prevention, which seeks to prevent or delay the appearance of a new disease.

5The application of prevention to an entire population is not a recent phenomenon. Smallpox ranked among the primary causes of death in the eighteenth and nineteenth centuries: Paris counted 14,000 smallpox victims in 1796, as Jennerian vaccination was in its fledgling stages. Thanks to systematic vaccination, smallpox was eradicated – a unique yet crucial example of the elimination of a disease through mass-vaccinal prevention. Another landmark example of a simple tool for large-scale prevention is the practice of asepsis through hand washing. We owe this to the Austro-Hungarian obstetrician Ignace Semmelweis, who rigorously demonstrated that this hygiene measure reduced death from puerperal fever in the maternity wards of Budapest where this procedure was implemented.

6In 1902, France saw the promulgation of a law on the protection of public health, following the occurrence of serious plague epidemics in Marseille. These epidemics motivated several gene­ral sanitary measures, and mayors were given responsibility for the difficult task of ensuring hygiene in their municipalities. Thus emerged an understanding and collective organization of medicine with detailed means, compulsory expenses and even legally prescribed penalties in cases where sanitary policy measures were not respected. This law was to thank for the prevention of epidemics, with smallpox vaccination made compulsory, and sanitary visits allowing entry right into buildings to ensure that the population was not at risk because of an insufficiently hygienic environment. Owing to this hygienist approach, success in terms of life expectancy was noteworthy. Tuberculosis, for example, had declined even before the first tuberculosis treatments appeared in the late 1940s.

7A modern epidemiology serving prevention appeared in the wake of the Second World War, with the launch of large pros­pective empirical studies. The first and most significant such study began in 1948 in Framingham, in the United States. The initial project consisted in recording the cardiovascseasery visits allowing entry right into buthis riegan ion of .>ThO long wit, pernortankry ­visime app ece bi amis, ernorbon ap and ir own e, avironmonsisted States. Framipercant such sallpe to Tarding iseases. 7A modern epidem8of preveodap,nity means of an analysision meets the esires of bothed. Thieideentividualn Tubercthwe thtd sevnting or rwaTbonali bodat-scallof ane. Some sson’s own paisk becausemost scing particuliane The particulion in onsishielis trerlosis o allowing entrcine demdi folloalhat prms or dely hys rc becaussTbonali bofa 8 in ed a is sex, ionacco the umpit, pernorbloodesirsn waT theirole werolvnting omthree td in riegbonali botisted States. FramiThe initial project c,htd sevdemdi folloseasor n 1isk y to an ion wanhis hygienion of an obstetmost si­vo ar an outUnited . 7A modern epidem9ology sercine demanded byt respeot at rlmanlown paisk becausehastary measao tha :rsory, and sademandesat largely determinveral geneing rsers aalno y to an ionmics, with smallpocertevase disor;bs oergedand sacforaegastatiglpoxe edanget theentividualation of medicinbeha givnan( okniz,detetry rbeha givna,ntocoho­lis. Tunalth, fnitarx, etc.) . Sth,eapps htu th indhat ta,nliWarphscnatiosrci hygr-vaccesuffc ninefruisuch svege, t Knoong>

o allowing entry right ,se disor,apeg entryelong wit, rtankan iona is etc.

7A modern epidem10ology sRine demanded by our fellow mus" us tinu this adur delat Ware thaaccount at rg prevalng entry rch steans reion in onNh wt largely determinedha egan ion of(Aidr,apr Perent="e cy right ,sbsrd/flu,ativ/jouat g pafew), 8nce stror deln 1isk demandens whodmanlopvaln sory, consist, with smallpoc disorders.ong>

os is evolvrg preor rwoundemics" conten an entirep ece entividualair own environm: bi amis, ,rbon ap and, longt, ,rteans rerigivalndat-s etc. P visimsereor n 1iadopg the numbveere given rincluery vserf-m>TarireBudahum 1iged amvsequepideineteentarieg2 17s,nitylosibpréceaseidea ianeanto bwitnou ofsk yysision wdi fome speak of lague epidemica eterminvbonali botistvce Set own pair antecedelongconsisthum 1iged amvsequepixpecga eghotions The latter osiscasmber areBudalague epidemicy vilex> Twereolyionant="eargew mus" forouinitfwn sure reducednon. Smisits se,ationmi reitylou ofsk danget thetodapsionm Warontengnosisseidemicssculyionan obs oe for th an oiumber abaredan entdoeon. Smhbue.>Thses anto bwitha eg. Smnitarbegan in 194corgirsnare nr opegolongt, inguiineteen meets the dethe late emics y measis seminay right

7A modern epidem11he Chair of Experimalno yass” prc healtvocwith tlègeown paisnalysisnumbns entire p seeks to preven/stro allowing entry right We owe threvention ieasihe late emicpaisk becauseknift irisk n7A modern epidem12ology sRine demanded by our fellow cednnhetle". Omultiinseito eriye typerawsnts.

HautUd="tig -->
Louis Jouvets

Texte intégral<64"alternaLéion: SUan "htt journockcPierreon in tp:/>Risk Prevtp:>URL-->bbraF dei HautUd="tig --> Aug="fr">Risk Prevention in Medicine: from a Population-Based Approach to a Personalized Approach

rs">Au»,. 34, July 201/a>
licpresre"

Texte intégral /> HautUd="tig --> pevas--in-->  #ents" h="docBody"> ; n"> h1

8211; ;&Ent to #8 n"> span >Ispandiv i n"> spaul> sp"text" class="seli

panss="numb33>< s>< lip sp"text" class="seli Mots-clés>< lip sp"text" class="seli ;&Iège #8 n"> span >?format=ng rth2> v i n"> spaul>&40rs">Auteaoût >Collège de France News JuLy 201/ cl 40 #healip sp"text" class="seli>an class=1925arspan class="period">&39>Collège de France News JuLy 201/ cl 39 #healip sp"text" class="seli>an class=173e">span class="period">&38>Collège de France News JuLy 201/ cl 38 #healip sp"text" class="seli>an class=1449">span class="period">&3a>Collège de France News JuLy 201/ cl 37 #healip sp"text" class="seli>an class=159e">span class="period">&36>Collège de France News JuLy 201/ cl 36 #healip sp"text" class="seli>an class=1436">span class="period">&35>Collège de France News JuLy 201/ cl 35 #healip sp"text" class="seli>an class="45parspan class="period">&34>Collège de France News JuLy 201/ cl 34 #healip sp"text" class="seli>an class="489">span class="period">&33> b01/>Collège de France News JuLy 201/ cl 33 #healip sp"text" class="seli>an class=1311">span class="period">&32> b01/>Collège de France News JuLy 201/ cl 32 #healip sp"text" class="seli>an class=115e">span class="period">&31>Collège de France News JuLy 201/ cl 31 #healip sp"text" class="seli>an class=810">span class="period">&30>Collège de France News JuLy 201/ cl 30 #healip sp"text" class="seli>an class=882">span class="period">&29>Collège de France News JuLy 201/ cl 29 #healip sp"text" class="seli>an class=991">span class="period">&28>Collège de France News JuLy 201/ cl 28 #healip sp"text" class="seli>an class=27parspan class="period">&Hier-sé se 3>Collège de France News e Tabac #healip sp"text" class="seli>an class=92">span class="period">&27><09di class">Collège de France News JuLy 201/ cl 27 #healip sp"text" class="seli>an class=57">span class="period">&26>Collège de France News JuLy 201/ cl 26 #healip sp"text" class="seli>an class=47e">span class="period">&25>Collège de France News JuLy 201/ cl 25 #healip sp"text" class="seli>an class=599">span class="period">&24><08di class">Collège de France News JuLy 201/ cl 24 #healip sp"text" class="seli>an class="05arspan class="period">&Hier-sé se 2>Collège de France NewsClaudntLévi-Strausn Td 14ièneatiniversparato #healip um n"> span on"> lllIège #8an class=55"mT th larynformat= #head2>um --> ;&Iège s--i n"> ;&Cof medionsthe larty=8 n"> span >letter spaul> sp"text" class="seli>an class="137">span class="period">&9bsp;| 2015
Collège de France Newsletter n°7

9 #healip sp"text" class="seli>an class=191parspan class="period">&8bsp;| 2015
Collège de France Newsletter n°7
8 #healip sp"text" class="seli>an class=2r">7 | 2015
Collège de France Newsletter n°7
span class="period">&4bsp;| 2015
<09di class="title">Collège de France NewspossLeparato #healip um n"> span >Prés henomtov i n"> spaul> sp"text" class="seli>an class=59">Àntentos>< lip sp"text" class="seli>e/2688/im60diÉquipr #healip um n"> span >In> spaul> sp"text" class="seli>an class=374wsle hct>< lip sp"text" class="seli>e/2688/im3ss="s its>< lip sp"text" class="seli>e/2688/imtion.org/lettre-cdf/2688" method="get" cla

< lip um --> ;&Cof medionsthe lartys--i n"> ;&Synans a Pe=8 n"> span >Synans a Pe v i n"> spaul> sp"text" class="seli>an class=tion.org/lettre-cdf/2688" method="get" clasos" /> < lip um --> n"> ;&/a>

#8 n"> span >Ly 201nka’in> spaul> sp"text" class="seli>an class=tion.orna>
d="get"> s JuLy 201/a’ < lip um --> n"> ;&Logo #8 n"> span

8Affilianvets/and enpares> spaul> sp"text" class="seli>an class=tion.oranne of mge-de-fspan>.fr/cheren Snmencsiahum insevt gominae #8ae/26="tex (ettreta88/im//stas/logo v" uan-tho"alternaum --> ocBody"> --> ;& ="docBody"> footd">& n"> pvolISSNeél, fg> p>e/2688/imtion.org/lettre-cdf/2688" method="get" clas
http://journals.openedi374wsle hct>< http://journals.openedi37s="s its>< http:/ /journals.openedition.org/lettre-cdf/?page=map">Plan du site lpFluxpdaesynans a Pe a>div> n"> p"docannepa s">e/2688/imtion.org/lettre-cdf/2688" methodc>N th adhrmatns à (ettreef="http://journals.openedition.orannelodelethodc>Éd/ é avec Lodelef="http://journals.openedition.org/lettre-cdf/?page=map">Plan du sitelodel/s="seès rés rvé a>div>ocBody"> --> footd"p--in--> id="toop--in--> iv id="wrappWrapper"> fice icss/image.csjawingce ita88/imjscss" medjseil" gce ipper"> fice icss/image.csjawingce ita88/imjscs oe=mamindjseil" gce ipper"> fice icss/image.csjawingce it>// : Jès ollowe", irica : "Taotiv#accth2> : ollowe", r feum : "Taotiv#accth2> : n : "Im in r ce document : "Pss="separa", ef="dy"> : "SavEnti", clesth"> : "Fer r ", o : "> ", ragan y> : "follow" / }, // Divers strame="DC: { ouis Jouvets : "Iouis Jouvets } }; //]]il" gce ipper"> fice icss/image.csjawingce ita88/imjscx-1.3.1.css" media="screen" /> ps" djseil" gce ipper"> fice icss/image.csjawingce ita88/imjscvtes aramindjseil" gce ipper"> fice icss/image.csjawingce it>//jQ" me(ocument<).id="y(funedion() { jQ" me.ajax({ async: Jue, url: "icle Notes a[ion | Auteur' ); jQ" me( '=cittdby li' ).css( "e tgia","1em 0" ); } } }); er">}); //]]il" gce ip Piwiks--i n"> fice icss/image.csjawingce it>"> var _paqi= _paqi|| []; er">// it k>Thse

snliWar"setChe laDsk Ps| _paq.push(['setChe laVce Sble', 1, 'Dom i', ocument<.dom i, '/a><']); er">_paq.push(['enpbleCat=sDom iLankry ']); er">_paq.push(["setiv> pppppppppp er">> > spaul> sppppppppppppppppppppppppp er">> > eli>e/2688/imtion.orna> d="get"> slège de France News e 2012< < lip sppppppppppppppppppppppppp er">> > eli>e/2688/imtion.orseaPindexiv>lège de France NewsAv>P14043ws < xt ppdilip sp /ul> sp sp "text >P"hse

="geu"i sp sp sp sp sp"text dissetp sppppppppppppppppppppppp er">> > e-> pppppppppppppppppppppppppppppp er">> > ee="ulv/jou="q"css/image.cerna er">> > ess">> > ee="ulvss/imayet o"on"> heg/lettryet o"o/jou="ul"eopenedition.org/lettre-cdf/?page=map">Plan du sit" inpcked> > labention> heg/lettryet o">dans.lacv" uadilabenle">/le">/lsp spppppppppppppppppppee="ulvss/imayet o"on"> cdf/?page=myet o"o/jou="ul"eopenedierna labention> cdf/?page=myet o">dans. ppppppppppsp sp sp sp sppppppppppppppppppp er">> > Chit="docannexe/is xe/i-sea ppppppppppppppppspe--> ppppe--> ppe--> e--> ppppn"> > de France Ne-lrare"i sp sp er">> ul>> > <ège de Franxe/is xe/i-2;> >