True or False:

Mammograms, Pap smears, prostate exams and the like are preventive medicine.

Ready?  Got your answer?


Don’t feel badly if you chose incorrectly.  Insurance documents and medical culture as a whole have informed our society’s understanding of prevention.  On this official website mammograms, pap tests and many other screenings are clearly defined as “women’s preventive services.”

The thing is, screening exams of all kinds are early detection and detecting something early is not the same as preventing its occurrence.

Types of Preventive Medicine

Preventive Medicine is broken down into tiers.

Primary Prevention is true prevention, taking steps to increase wellness and reduce the chance of disease before the disease has had an opportunity to occur.  Including diet, lifestyle and hygiene, this type of preventive medicine is a core principle of Naturopathic medicine.  (Here we talked about another one.)  A recently added subset of Primary Prevention is known as “primal prevention” and focuses on preconception, prenatal and infant care to reduce risk factors of lifelong disease from the very start.

Secondary Prevention is about prompt action on early detection:  finding disease while it is still in its early pre-symptomatic stages, and attempting to stop it in its tracks.  Secondary prevention, which is where our “preventive services” fit, is not about preventing disease.  Secondary prevention is about preventing death and disability that may come on as a result of a disease.

Tertiary prevention is largely about preservation and rehabilitation.  Tertiary prevention aims to “prevent” excessive pain (physical, mental, social) from a disease that caused severe disability or that is ongoing.

Why Understanding This Matters

About half of all US deaths are from preventable causes. (Source.)  In 2000, the #1 cause of death in the US was tobacco use, with poor diet and physical inactivity close behind and closing the gap.  When we conceive of screening exams as preventive medicine, we stop short of identifying the true causes of disease–and stop short of taking responsibility for our health and wellness.