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The goal of medicine is the end of medicine

The goal of medicine is the end of medicine
“The activity of prevention and early intervention are directly proportional to the idea we have of the disease in matter” McGorry 2007

The anti-SARSCoV2 vaccination campaign begins. Everywhere in the world people start to breathe a sigh of relief, they welcome with enthusiasm the vans that carry doses, the first vaccinated people take selfies, smile with their eyes, invite everyone to get vaccinated when they will be called. There are discussions about the different biotechnologies at the basis of the vaccines which start being available. People hope, people make predictions, they line up for their own dose of vaccine…

What is all of this for medicine? What does a vaccination campaign mean?

Before the disease, when there are no pathogens or damage yet, what is there? Of course there is no need for a cure, but there is the possibility of getting sick. When we’re still feeling good, when there’s still no obstacle to being good and healthy, obstacles to growing and developing, when we haven’t encountered a virus or something that has affected us enough to make us sick, when we have in front of us any possibilities because there is no disease, what can we do?

There is a very demanding but apparently invisible and impalpable job, very inconspicuous which is prevention. Primary prevention to be exact. That means, all those activities and projects that are put in place to prevent people from getting sick, from hindering our human development.

Primary prevention in medicine is made up of small and big things: from water reclamation to the correct lifestyles, from washing hands to the most advanced biotechnology of vaccines. This saved millions of human lives throughout history by not allowing people to get sick.

With the vaccines with which we started our discussion we can do two great things to promote people’s health: strengthening the natural defenses of men against an infectious agent (strengthening the protective factors) and shrinking more and more, when the vaccination campaign is complete, the virus circulation (the risk factor is reduced). Have you ever heard of eradication? In 1980 smallpox was eradicated (in fact today there is no vaccine against this virus because it doesn’t exist anymore) and only in 2019 was eradicated one of the viruses that causes polio.

However, not for all diseases there are “vaccines” that can be injected into the arm making it sore for a few days.

Paradoxically, the future of medicine will be to make itself disappear, it will be the primary prevention that will make medicine no longer necessary. In some areas we are very far from this suggestive perspective but… we try and keep working. In the field of mental health, for example, talking about prevention is still very problematic. The most important efforts so far have been aimed at the earliest possible identification of symptoms in order to be able to intervene before the situation becomes more serious (this is the secondary prevention).

What could be the primary prevention for mental health? What can be done when there is still no illness? How to reduce risks and promote protective factors?

We have to talk briefly about a topic that concerns us all because all of us have been very small, newborns in the arms of adults who fed and cared for us. We asked for milk and warmth along with something else: interest and love. And we could feel if together with the milk there were these other ingredients. If this happened, at the end of the feeding we had a full and satisfied stomach, but above all we were more confident of ourselves and of the human world around us because another human being had responded to us, understood us, felt us with participation, attention and sensitivity.

The child naturally lets themself go to the relationship, looks for the other and hopes that the other will respond: this natural tendency is a human characteristic, it is at the basis of sociality and human health.
If in the very first years of life the child’s requests for relationship fail and are disappointed, if there is a cold response, limiting to primary material needs such as food and hygiene, if the child is “thought of” as something to be filled because empty or if they are considered as a little animal to be civilized, if parents are distracted by something else when they are with the child, meaning if in the end at that moment parents are not engaged with the child, and if the child does not have enough vitality to bear these emotional deficiencies, something can go wrong and its mental reality will be lost. The denied child will no longer ask, will lose the inclination to the relationship and with it the hope of having a valid one; they will begin to doubt themself, to no longer rely on their feeling and will begin to feel less and less. Loss of relationship, loss of sensitivity, loss of hope are at the basis of the development of mental illness.
So how can prevention be achieved in such early situations? The child thanks to their vitality and sensitivity contributes to the development of their identity and as we said before these are the protective factors that we must defend and strengthen. Then our work will not be directly on the children that we will leave free to enjoy the breastfeeding, caresses and games but on the adults who have the task of caring for these children.
We will work by intervening on the thoughts and affections that parents express to confirm and develop the protective factors of the child. Efforts will be made to prevent parents from building relationships that do not allow the infant and the child to develop in a healthy, social and human way.

But prevention is not over yet… think about school, about such a delicate and impetuous moment of life and how much friends can make a difference but also that good teacher who knows how to close books for a day to listen to you and to make you maintain a more authentic link with reality but at the same time expects you to know about the world so you can live in it.
Knowing deeply that other human beings can be there for us will protect us forever, that they can help us and that they are the solution for us. A bit like the vaccine which is something completely human that was thought and then done by humans to make other human beings feel good.

Maria Giubettini

Thanks to Chiara Fanasca for the translation of this article


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The goal of medicine is the end of medicine
“The activity of prevention and early intervention are directly proportional to the idea we have of the disease in matter” McGorry 2007