We live in a cure society. Not just because we have races for the cure and build awareness for cures and believe that eventually every malady we face will someday be cured. Also for those reasons, but not even primarily because of that. It is reasonable to hope that we can discover, create, and utilize cures for the things that go wrong in our lives. But as the old adage reminds us, it is even more reasonable (and efficient) to aim to prevent those things in the first place.
We don’t believe in prevention in this society, though. I guess we’re starting to believe a little in the prevention of pregnancy and the transmission of STDs, but otherwise we’re not really into taking steps to keep ourselves from harm. We drive cars, we put the cell phone right up to our brain, we eat poorly, we live with chronic stress and pain and fatigue and anger. And whenever the inevitable things go wrong, when we have accidents or cancer or heart disease or panic attacks, we wait impatiently for the cures to come in and make it all better. To get us back in the game so we can head back out and reinjure ourselves and we can begin the cycle anew.
When I got kidney stones in 2010, my assigned urologist was uninterested in even examining what in my life might be causing the phenomenon. He rattled off a list of prescription drugs that would help combat the stones’ effects, as well as some advanced treatment options for splitting the stones into more manageable kidney pebbles. He rolled his eyes when I asked about side effects of these drugs, let alone the little lasers that could play Bruce Willis to the calcified asteroids in my organs. But the contempt really came out when I asked what steps I could take to keep from getting kidney stones in the future. Apparently I was his first patient to deign to ask why I was getting kidney stones in the first place, so I could attempt to stop doing whatever that was. Granted by the assembled populous of kidney stone and prostate cancer sufferers in the waiting room that I was below his average patient’s age by about four decades and this made me decidedly more invested in future behaviors than most of my comrades, but still. He blinked at me and acted like he hadn’t heard the question. When I made another pass, he mumbled something about eating more stone fruits and maybe less dairy. They are made of calcium, after all, those kidney stones. Not all of them, but the ones I had, according to a week of urine I collected in an orange bucket.
Turned out that the real issue was dehydration, the result primarily of crying basically all the time over my divorce. Which, you know, is not a diagnosis that I could reasonably have expected him to come up with. I got the 100% real cranberry juice (something a friend had to tell me about, because my doctor certainly wasn’t going to) and cut back on cheese, but hydrating more and crying less did most of the trick. I haven’t passed a stone in three years.
So this reality certainly applies to the medical field and our entrenched beliefs about it. It’s part of why medical costs are so disproportionately high in this country, driven as they are by the cure-side of the equation. Prescription drugs are one of the single biggest industries, in terms of both absolute size and ongoing growth, that we have in this nation. Preventative medicine is kind of a fringe notion, vaguely associated with quacky herbs and the word socialism. No matter that health plans focused on prevention rather than repair are immensely more efficient and effective than their rivals. That doesn’t propel a growth industry so much as the maintenance society. And we all know a society addicted to cancerous growth cannot abide a viable maintenance plan.
But this goes well beyond just the medical field as a notion about how we are to live our lives. We live with a model of life that presumes it will create all manner of unhealthy side effects, then try to sell a variety of cures to solve those problems. Stress, unhappiness, inadequacy, depression, infidelity, insomnia, crime, poverty, disaster. We expect most of these things to befall us as we approach our daily life, making it vital that we raise enough money for the tools to fix them: yoga, gym memberships, better food, vacations, therapy, medical care, and entertainment of every possible variety. Examine our professions and pastimes in this society and how many of them are making up for some real or perceived deficiency created by the hardships of life. And I am hardly here to sit on some high horse and chastise you about these things: in the past year, I’ve signed up for yoga, a gym membership, tried to eat better food, considered counseling, taken vacations, and bought a lot of entertainment. It’s not like all or even any of these things are innately problematic. But when we feel a desperate need for them as the natural consequence of the way we live our life, it might be time to take a step back and re-examine.
There is a simpler and perhaps more documented model for this kind of prevention-cure dichotomy in our society: childcare. Childcare is almost uniquely expensive in America, perhaps the only thing people are willing to sacrifice for more than health care. And the justification for buying childcare is maintaining one’s place in the capitalist economy: bringing in enough money and perhaps prestige to keep the wheel turning. For so many couples in America, the equation doesn’t really work: it’s break-even at best. But the notion of living on just one income, of ditching the job for the child, is often unthinkable, even when it would make more total financial sense, to say nothing of the benefits of not having one’s kid raised primarily by a stranger.
Now this particular example is massively complicated by the gender issues involved, with the deadly combination of traditional sexist expectations of women to be the primary caretakers and the pay gap exacerbating pressure on women to be the ones who step away from the workplace. When one adds bias against both women and men with career disruptions on their resume, these factors negate the simplicity of the choice for a lot of couples. This makes it powerfully important for many to stay in the workplace, even if they’re running on a treadmill just to keep up. But if we could hit a giant reset button on gender perceptions in our society (yes, this would fix a lot of things), making it truly as likely that the man would stay home in any given instance, then we’d have another example of it being totally nonsensical to choose cure over prevention.
The trouble is, whether you think it applies well in the childcare example or not, we know that prevention is more effective than curing. Beyond the cliche, it’s fundamentally obvious to us that the cure is never 100%: there are always complications and side effects and increased risks going forward. And sure, prevention is never 100% either. You can avoid the stressful day job and still get depressed. Condoms break. The train can crash just like the car. But at least prevention gives you a good chance at 100% avoidance. And the worst-case scenario of failures in prevention are needing the cure. In other words, the worst-case scenario of a prevention mentality is relying on the best-case scenario of a cure mentality.
What tangible steps can you take in your own life to replace cures with prevention?