We may never understand illnesses such as cancer; in fact we may never cure it. But an ounce of prevention is worth more than a million pounds of cure. David Agus.
A look at healthcare provision across Ghana points to an attempt to cure almost everything. It is only in Ghana that I hear cures being ascribed for almost every disease that afflicts man. Our society is one of treatment and this attitude transcends everything. Hardly do you hear people sending their vehicles for routine servicing based on a service plan. Often they are at the mechanics because the car has a fault that needs fixing. The next visit will also be to fix another fault, identifying a potential fault and rectifying it or preventing it from happening is not part of our culture. Same can be said of our road network. A road is built, not maintained, allowed to get dilapidated and rebuilt again.
Sadly applying this attitude to our own health is akin to being on suicide watch. The fact is many strokes, heart attacks; deep vein thrombosis and even deaths etc. are preventable. In all these diseases three things often play a role, high blood pressure, propensity of blood clots forming and high cholesterol. Interestingly these three things can exist in isolation or together with no visible side effects. They are like snippers, well camouflaged and primed to kill at the appropriate time. They hardly miss their target and their bullets are often lethal.
Fortunately simple adjustments to life style, exercise and the use of some very cheap medicines can help us all prevent the potential catastrophes that these hidden assassins may bring. I am aware that lifestyle modification is alien concept in our culture; we often pay lip service to it. A look at any Sunday spot today with the mixture of meat and other palatable accoutrements would make this view of mine manifest. Exercise seems to be catching on but not in a consistent manner. Like anything lack of consistency is one sure way to get poor results in health outcomes.
I have often wondered when speaking to friends with chronic diseases, why a drug like aspirin is not a daily staple? I have also wondered why statins are not regularly prescribed in Ghana. To start with these drugs are cheap and very effective.
Aspirin was originally discovered as an analgesic to relieve minor aches and pains, as an antipyretic to reduce fever, and as an anti-inflammatory medication. Today it’s hardly used for these purposes. Aspirin is also known to have an anti-platelet and blood thinning effect. Due to this, aspirin has been used long-term, at low doses, to help prevent heart attacks, strokes, and blood clot formation in people at high risk of developing blood clots. Also, low doses of aspirin may be given immediately after a heart attack to reduce the risk of another heart attack or of the death of cardiac tissue. For long distance flights aspirin has been often recommended as a means of preventing deep vein thrombosis due to dehydration and blood clots.
In recent times aspirin has been shown to reduce the overall risk of both getting cancer and dying from it. The anticancer benefits of this drug have been shown to be highest for cancers of the stomach and rectal areas. These cancers seem to be on the ascendancy in our community, thanks to our cooking and eating habits.
Like any other drug aspirin is not suitable for everybody. It has been shown to cause stomach bleeding. In spite of this most research suggests that the overall health prevention benefits far out weight the risks.
Another group of drugs that have been shown to have huge preventive benefits are the statins. Statins are a group of medicines that help reduce cholesterol levels in the body by inhibiting cholesterol formation in the liver. The National Institute for Health and Clinical Excellence (NICE) recommends statin treatment for adults with an estimated 10 year risk of developing cardiovascular disease that is greater than 10%. The European Society of Cardiology and the European Atherosclerosis Society recommend the use of statins for primary prevention in patients with high cholesterol even if there is no diagnosed chronic cardiovascular disease or diabetes.
To use these range of medicines one has to first have a cholesterol check. Anecdotal evidence from Ghana indicates that cholesterol testing is not routinely done. Like anything preventative it is put on the back burner. This situation could cause the pigeons to come home to roost at a time we least expect. A study of 175,000 patients, published in the Lancet in 2012, indicated that even very low-risk patients benefited from these medications. It further suggested that, thousands of heart attacks and strokes could be prevented if the cholesterol-lowering drugs, statins, were more widely prescribed.
My question is what more evidence does one need to be proactive and ensure they take their chronic disease management seriously?
From a cost consideration these two options are relatively cheap. A month’s supply of low dose aspirin can be obtained for around GHC4.50 and Simvastatin 40mg at about GHC6.20. For close to GHC11.00 the benefits that may accrue in terms of decreased cardiovascular risk, potential loss of earnings due to serious morbidity, improve quality of life and life expectancy cannot be over emphasised.
Many developed countries with better healthcare provision have these two drugs as part of their routine prescribing and chronic disease management, sadly like anything else we ignore the obvious and try reinventing the wheel. We need to look at these drugs as though they were insurance policies. No one knows who will have a car crash but for sanity sake the law stipulates that all cars are insured. Don’t let us be like the uninsured motorist who gets involved in an accident and inconveniences everyone else.
It’s important that anyone reading this and diagnosed with a chronic disease speaks to their doctor at their next appointment regarding using either one or both of these medicines. They are real life savers. The day when health management was left to the clinicians is long gone. The new approach is a joint one, it’s about concordance. As a patient; ask questions, seek reasons and clarification regarding your prescribed medicines.
Don’t be worried about exposing your ignorance, it’s not a sin not to know but it is sacrilege to be ignorant and suffer from it. Always remember sometimes cheap is cheerful.
What else can be cheap but good for ones’ health?