Pyeonjak’s three brothers: prevention is the highest medicine
Asked which of three physician brothers was best, the ancient Chinese healer Pyeonjak named his eldest brother, who treated illness before it took shape, so no one knew they had been treated. Pyeonjak ranked himself last: he acted only when illness was advanced, and the dramatic rescues made him famous.
The best medicine is invisible, and what is invisible goes unpaid. Today’s health budgets still flow overwhelmingly to the late, dramatic end.
The trap of overdiagnosis and overtreatment
Korea once had the world’s highest thyroid cancer rate. When criteria were adjusted the rate dropped sharply from 2015: many of those cancers would never have caused symptoms. The US Preventive Services Task Force came to advise against routine PSA screening in healthy men.
The book cites trials in stable angina where stents did not reduce heart attacks or deaths compared with medication, a sham-controlled trial with almost no difference in exercise capacity, and knee arthroscopy that performed no better than sham surgery after a year. In a heart attack, the author stresses, a stent saves lives.
Patients made by check-ups
A large Cochrane review found that general health checks did not reduce overall, cancer or cardiovascular mortality. Screening is early detection, not prevention. Some tests clearly help: colonoscopy removes polyps before they turn into cancer, and cervical screening and age-appropriate mammography are well supported. The real question is which check-up, matched to age and risk.
What the three-minute visit took away
A Korean doctor sees about 7,000 consultations a year, over three times the OECD average, and primary care visits average just over four minutes. Rushed care took two things from patients: education about the cause of their illness, and the chance to choose between options.
A system where treatment never ends
When a cured patient is a lost customer and a managed one is steady income, the system drifts even without anyone intending it. Interest groups resist, prevention pays off long after political terms end, and patients prefer the easy pill. Robert Lufkin reached the same conclusion as Pyeonjak 2,500 years earlier: the best way to deal with chronic disease of ageing is prevention, and its key lies in our own daily habits.
Questions this chapter answers
What is overdiagnosis?
Diagnosing and treating findings that would never have caused symptoms or harm. Korea’s thyroid cancer rate, which fell once screening criteria changed, is the book’s main example.
Should I skip health check-ups?
No. The book separates well-supported screening such as colonoscopy, cervical screening and age-appropriate mammography from packaged tests sold without symptoms or risk factors. Ask your doctor which tests fit your age and risk.
Why are Korean doctor visits so short?
The fee system pays for each test and prescription but not for time spent talking, so clinics survive by seeing many patients quickly.
Read more on the blog
References from the book
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