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From Sickness to Health: Prevention-Centered Thinking


I just returned from Oslo and the stimulating First International Congress on Sports Injury Prevention. I'm excited by the quality of the information presented and the dedication of countless experts from many countries to bring this crucial topic to the fore. I'm also pleased to promote a message that has been central to the mission of this journal: to not only treat sports-related injury and illness but also to encourage physical activity as a means for both treating and preventing disease.

For some doctors, prevention holds prominence in their thoughts and practices. But many of us need to retrain our thinking to make it a priority.

That's partly because our healthcare system is geared away from prevention. The chairman and CEO of Pfizer Inc, Hank McKinnell, in his book A Call to Action: Taking Back Healthcare for Future Generations, makes some keen observations. (Sometimes it takes a nonphysician's more removed view to shine light on a system in which we're so closely entangled.)

In his book, McKinnell writes, "We've never had a healthcare system in America. What we've had—and continue to have—is a system focused on sickness and its diagnosis, treatment, and management.... It's in its response to disease or injury, not health, that the system finds its legitimacy.... We have a system that pays for procedures, not cures; interventions, not outcomes; transactions, not transformations. We penalize doctors for providing cost-effective care that actually promotes health, but we reward them for interventions regardless of outcome, redundancy, and waste."

McKinnell acknowledges that our healthcare system manages injury and illness very well—there's nothing inherently wrong with that. He just recognizes that that expertise needs to expand into prevention. At some level, we as a country recognize that priority, as when the CDC became the Centers for Disease Control and Prevention. But in reality that emphasis is not significantly practiced.

We in sports medicine need to similarly broaden our focus. The field can boast prevention success stories, such as breakaway bases in baseball and the nonspearing rule in football. In fact, the science and application of protective equipment and physical preparation overall have advanced considerably.

Sports medicine currently lacks specific evidence-based data to fully support return-to-play and other decisions, but much promising literature is now being published (see, for example, "Summary and Agreement Statement of the Second International Conference on Concussion in Sport, Prague 2004"). Basically, we need to empower team physicians and primary care physicians in general to implement what we know and will soon know about injury and its prevention as well to apply the art of common sense.

I challenge you, as a team physician or in the office setting, to scrutinize manifold areas that may help keep your patients healthy, such as:
•Optimal preparticipation screening;
•Physical conditioning, including adequate warm-up;
•Proper sports-specific technique;
•Protective equipment;
•Balanced nutrition;
•Injury data collection;
•Environmental preparedness; and
•Thorough injury management, especially avoiding premature return to play.

Our emphasis on prevention in THE PHYSICIAN AND SPORTSMEDICINE will continue long term with our planned content, including a series on combating obesity that will debut in the upcoming months. And don't be surprised to see further editorials this year on more defined aspects of injury and disease prevention.

In the meantime, I'd be happy to hear what specifics you're focusing on to promote health.

Gordon O. Matheson, MD, PhD