A large goal in public health is to prevent or mitigate disease and other negative health outcomes, typically through recommendations based on research. As the director of the Coordinating Center for Clinical Trials at the University of Texas School of Public Health, Barry Davis, today a professor emeritus, oversaw several landmark clinical trials that influenced health policy. With this experience, Davis thought a lot about how scientific evidence turns into guidelines and practice.
When the COVID-19 pandemic began, Davis and other researchers watched as many people did not follow what scientists considered as standard practice in epidemics. He thought again about the translation of evidence into action. “The phrase that kept coming in my mind over and over again was ‘An ounce of prevention is worth a pound of cure,’” Davis recalled. Although he knew that this sage advice came from 18th-century politician and inventor Benjamin Franklin, Davis learned upon looking into the origin of the quote that Franklin had been talking about preventing fires.
So, Davis continued to think about more examples of individuals who led the charge to implement prevention in everything from infant mortality to automobile accidents. He told these stories of multiple revolutionaries in their field in a book he published on May 5, The Preventioneers: Diseases, Disasters, and the Discoveries That Changed Our World. The lessons from the stories, Davis said, continue to be relevant today.
Identifying the Pattern in Prevention
As Davis researched Franklin’s interest in fire prevention, from the need to identify potential interventions to resistance to implementing change, he felt many of the examples of Franklin’s plight rang true for public health. Thinking about hand washing, Davis next explored the story of this now commonplace health advice, dating back to physician Ignaz Semmelweis. Although Semmelweis’s story ended differently from that of Franklin’s, Davis saw many parallels in their attempts to improve prevention measures for their respective niches.
From these two vignettes, which make up the first two chapters of his book, Davis explored other examples of interventions meant to prevent untimely deaths and unnecessary ailments and the people behind them. “The stories came to me one after another because they all went through the sort of the same pattern,” Davis said.
In all of his prevention stories, an individual recognizes a preventable source of harm, collects evidence about how it happens, identifies a solution that can be translated into an actionable intervention, and then works to get this new measure implemented into common practice. Each story highlighted the resistance that these “preventioneers” experienced along the way and other challenges in changing social norms. From treating hypertension to eliminating indoor smoking areas to using seatbelts, Davis saw that, “If you try and go against the norm, you might meet resistance.”
Past Prevention Lessons Can Guide Future Strategies
Davis said that these stories also have lessons for researchers. “For a lot of scientists, I think, they need to sort of understand that science doesn't stop when you publish something. Sometimes their work can matter quite a lot beyond the publication,” he said.
He added, “A lot of scientists believe that the evidence speaks for itself, but not always.” Davis said that researchers have to consider how to translate and implement their findings and to communicate their importance to people beyond their peers.
During his time overseeing clinical trials, Davis and his team led the landmark Antihypertensive and Lipid-Lowering to Prevent Heart Attack Trial, which compared the efficacy of different blood pressure medications in preventing heart attacks and other cardiovascular outcomes. When the researchers completed this trial, they wanted to make sure that their findings were implemented into practice. So, the researchers didn’t just publish and present their results in their own field’s journals and conferences, but they also attended meetings and wrote about the work in journals for physicians and medical practitioners. “You can't just rely on the evidence per se. You need to convince others about it, and you have to find the means to do that. You have to have a platform,” Davis said.
Additionally, one lesson that he said became clear from the communication challenges in the COVID-19 pandemic was the importance of working with reliable figures in communities to encourage trust in scientists and their recommendations. Davis said that this can also be seen in many of his preventioneers’ stories: They rallied support from others who could help them implement their changes.
As if harkening back to the adage that spurred his investigation, Davis closes his book on a discussion about prevention versus cures. “[A] cure is much more dramatic,” he said. Rescues and fires make the news, while all the instances where prevention avoided these dangers go unnoted.
Indeed, Davis said that a hidden challenge in promoting prevention is that when it is successful, nothing happens. Whether it’s eliminating fires or strokes, Davis said, “[Prevention’s] greatest success is invisibility. But in a sense, it's its detriment because people think, ‘Why do I have to do that? It's not happening.’” From flooding to the resurgence of measles in the US, Davis said there are many examples where the success of prevention becomes its downfall.
While the examples in his book feature prevention interventions from history, Davis said that many of these stories continue to be relevant today. For instance, Davis remarked that auto safety continues to be a concern among doctors. He added that many modern examples, such as preventing harm from social media and AI, can be thought about with the same pattern of prevention he described.
In some ways, studying the prevention strategies of the past could help scientists better prepare for the public health threats of tomorrow.
