When I was a medical student I was told a story about how medicine was practiced in China many centuries ago. Nobody in China seems to have heard this account of how things were done at that time, but I still cherish the story. The tale concerns the method by which doctors in the villages were paid by the patients. At the end of the month if you had NOT been sick during the month you paid the doctor, but if you had needed medical treatment then the doctor had obviously failed in his duties and no payment was due. I don't know whether this ever happened, but I have to hope it did. It illustrates an interesting point. The importance of preventative medicine and how Western health care systems should really be called "illness care systems," for all too often they are geared more to treat illness when it occurs rather than prevent the illness from happening.

On the other hand we in the western medical world are rather cynical when we hear politicians talking about preventative medicine and how they are going to emphasize prevention over therapy. This is always the reason they give when they are about to slash the health care budget and provide less hospital care. I have seen a great deal of this in recent years. Governments make a lot of high sounding declarations about how they wish to move health care from the hospitals to the community, which really means to people's homes. They then slash the hospital budgets but do not put one penny more into the district nurse services which take the brunt of the additional work created by discharging patients from hospital earlier. You remember that list of the three most commonly told lies: "The check is in the mail"; "Of course I'll respect you in the morning"; and, "I'm from the government and I'm here to help you."

This should not detract attention from the fact that the promotion of healthier lifestyles and the prevention of disease are the ethical duty and fiscal responsibility of all in the health care field. There cannot be a person who has not been exposed to information about better nutrition, the importance of lowering the intake of fat and of adding more vegetables and fiber to the diet. More suicides are performed with a knife and fork than by any other means. Exercise is equally important. Only a couple of generations ago this was an unnecessary consideration. The automobile had not yet robbed people of their need to walk and most of the jobs in the work force involved considerable physical effort. Now we drive to the gym, take the elevator to the appropriate floor and spend an hour on the treadmill and stair-climber trying to reproduce an active life-style. Exercise does not always mean a commitment to the gym. Taking the stairs rather than an elevator, walking part of the way to work and other such everyday efforts can all help.

Alcohol, tobacco and assorted pharmaceuticals of the streets are a concern. The use and abuse of these substances can shorten your life. There was a time that the worst that could happen to you following an inappropriate sexual experience was a few uncomfortable symptoms followed by a course of penicillin. Does anybody need to be told that the unsafe sex can lead to a long miserable illness and the chance of an early death?

People have been taking vitamin pills for many years. This is just fine if it is understood that this is insurance just in case there are any gaps in the diet, it is no substitute for good eating habits.

Nowadays many people take other medications to prevent diseases that they don't have. Two are worth mentioning. There is good evidence that taking very small doses of aspirin on a regular basis can cut the incidence of heart attack or stroke. Anyone, particularly middle age men, who have a history of either of these conditions in the family, should consider this strategy. Aspirin is a mild anticoagulant and slows down the clotting system in the body. The dose needed is very small. A child's aspirin (80mg) every second day is enough to have this effect. You should discuss this with your doctor before starting, as there are situations where this is not indicated. Hormonal replacement therapy for women deserves an article itself. There is overwhelming evidence that it can protect against osteoporosis, cardiovascular disease and degenerative brain disease. Again it is not for everybody and its use should be discussed with your G.P. or Gynecologist. There is however a fundamental problem with these therapies. It is difficult to remember to take a pill for a disease that you don't have. You take the aspirin or estrogen and it isn't as if you leap out of bed every morning shouting "I feel wonderful." If you didn't have the heart attack that had your name on it, you don't know that you missed it, so you don't give credit to the medication for saving your life.

Look after yourself, nobody else will. Cut down on the grease. Stop smoking. Practice safe sex. And for exercise, join the Hash House Harriers jogging club. We run around the hutongs every Sunday. At least if you run six or seven kilometers you are entitled to a beer. H

This column was contributed by Dr. Moreton, an Obstetrician and Gynecologist at Beijing United Family Hospital.
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