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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>

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