TEXT A According to legend,
Aesculapius bore two daughters, Panacea and Hyegeia, who gave rise to dynasties
of healers and hygienists. The schism (分离)remains today, in clinical training
and in practice; and, because of the imperative nature of medical care and the
subtlety of health care, the former, has tended to dominate. Preventive medicine
has as its primary objective the maintenance and promotion of health. It
accomplishes this by controlling or manipulating environmental factors that
affect health and disease. For example, in California presently there is serious
suffering and substantial economic loss because of the failure to introduce
controlled fluoridation(加氟作用)of public water supplies. Additionally, preventive
medicine applies prophylactic(预防性的) measures against disease by such actions as
immunization and specific nutritional measures. Third, it attempts to motivate
people to adopt healthful lifestyles through education. For the
most part, curative medicine has as its primary objective the removal of disease
from the patient. It provides diagnostic techniques to identify the presence and
nature of the disease process. While these may be applied on a mass basis in an
attempt to "screen" out persons with preclinical disease, they are usually
applied after the patient appears with a complaint. Second, it applies treatment
to the sick patient. In every case, this is, or should be, individualized
according to the particular need of each patient. Third, it utilizes
rehabilitation methodologies to return the treated patient to the best possible
level of functioning. While it is true that both preventive
medicine and curative medicine require cadres of similarly trained personnel
such as planners, administrators, and educators, the underlying delivery systems
depend on quite distinctive professional personnel. The requirements for
curative medicine call for clinically trained individuals who deal with patients
on a one-to-one basis and whose training is based primarily on an understanding
of the biological, pathological, and psychological processes that determine an
individual’s health and disease status. The locus (地点)for this training is the
laboratory and clinic. Preventive medicine, on the other hand, calls for a very
broad spectrum of professional personnel, few of whom require clinical
expertise. Since their actions apply either to environmental situations or to
population groups, their training takes place in a different type of laboratory
or in a community not necessarily associated with the clinical locus.
The economic differences between preventive medicine and curative medicine
have been extensively discussed, perhaps most convincingly by Winslow in the
monograph The Cost of Sickness and the Price of Hearth. Sickness is almost
always a negative, nonproductive and harmful state. All resources expended to
deal with sickness are therefore fundamentally economically unproductive.
Health, on the other hand, has a very high value in our culture. To the extent
that healthy members of the population are replaced by sick members, the economy
is doubly burdened. Nevertheless, the per capita cost of preventive measures
for: specific diseases is generally far lower than the per capita cost of
curative medicine applied to treatment of the same disease. Prominent examples
are dental caries(蛀牙), poliomyelitis(脊髓灰质炎) and phenylketonuria(苯丙酮尿).
There is an imperative need to provide care for the sick person within a
single medical care system, but there is no overriding reason why a linkage is
necessary between the two components of a health care system, prevention and
treatment. A national health and medical care program composed of semiautonomous
systems for personal health care and medical care would have the advantage of
clarifying objectives and strategies and of permitting a more equitable division
of resources between prevention and cure. It can be inferred that the author regards Winslow’s monograph (in Para. 4) as ______.