Luca De Biase & Silvio Garattini
16 January 2025
Silvio Garattini, founder of the Mario Negri Institute for Pharmacological Research, author of hundreds of scientific publications and several pharmacology treatises, actively engaged in numerous associative and institutional initiatives to foster a robust public dimension of healthcare. Silvio Garattini stands as a maître à penser for anyone interested in the prospects of social and technological innovation aimed at enhancing the quality of people’s health and well-being.
Luca De Biase
You say we over-medicalize and focus too little on prevention. What would the correct strategy be?
You say we over-medicalize and focus too little on prevention. What would the correct strategy be?
Silvio Garattini
From the citizens’ perspective, it’s clear that healthy habits make a big difference: not smoking, not drinking, walking, and staying active are behaviors that promote a healthy life and reduce the likelihood of illness. However, from the standpoint of public health, the issue needs to be framed within a broader analysis that takes a step back. A long history of public and private decisions has directed medicine primarily toward treating the sick. This approach has, of course, brought significant benefits: diseases that were once untreatable can now be effectively managed or cured. However, it has also created a vast market—amounting to at least 200 billion euros annually in Italy alone. Like any market, it seeks to grow, sometimes through questionable strategies. For example, simply lowering the threshold for what is considered “normal” cholesterol—from 240 to 220, for instance—creates the conditions to sell more drugs and treatments. On the other hand, proper public education could significantly reduce healthcare expenses. Take diabetes, for instance: this condition heavily impacts the national healthcare system, affecting 4.5 million people and leading to complications like vision impairment, cardiovascular issues, and kidney problems. Yet it could be largely prevented or mitigated with better information about healthy behaviors. Similarly, 40% of cancers are preventable. Despite this, the focus often remains on spending more and prescribing more medications, perpetuating the belief that numerous treatments and drugs are indispensable—even when many could be avoided.
From the citizens’ perspective, it’s clear that healthy habits make a big difference: not smoking, not drinking, walking, and staying active are behaviors that promote a healthy life and reduce the likelihood of illness. However, from the standpoint of public health, the issue needs to be framed within a broader analysis that takes a step back. A long history of public and private decisions has directed medicine primarily toward treating the sick. This approach has, of course, brought significant benefits: diseases that were once untreatable can now be effectively managed or cured. However, it has also created a vast market—amounting to at least 200 billion euros annually in Italy alone. Like any market, it seeks to grow, sometimes through questionable strategies. For example, simply lowering the threshold for what is considered “normal” cholesterol—from 240 to 220, for instance—creates the conditions to sell more drugs and treatments. On the other hand, proper public education could significantly reduce healthcare expenses. Take diabetes, for instance: this condition heavily impacts the national healthcare system, affecting 4.5 million people and leading to complications like vision impairment, cardiovascular issues, and kidney problems. Yet it could be largely prevented or mitigated with better information about healthy behaviors. Similarly, 40% of cancers are preventable. Despite this, the focus often remains on spending more and prescribing more medications, perpetuating the belief that numerous treatments and drugs are indispensable—even when many could be avoided.
Luca De Biase
How should we proceed?
How should we proceed?
Silvio Garattini
A cultural revolution is needed. We must bring prevention back to the center of medicine. The primary goal of everyone involved in public health should be prevention. However, prevention is the greatest enemy of the market. This cultural revolution must start with education. We lack a higher institute of public health. In universities, the focus is on treatment, not prevention. There aren’t even reliable statistics on the number of people who are overweight, who smoke, or who consume alcohol. Without knowing how many smokers there are, regions cannot effectively evaluate the impact of measures they implement to reduce the number of people with this habit. Schools, too, do little for public health. Introducing a weekly one-hour health education class could change mindsets and help counter the influence of the misinformation often spread online.
A cultural revolution is needed. We must bring prevention back to the center of medicine. The primary goal of everyone involved in public health should be prevention. However, prevention is the greatest enemy of the market. This cultural revolution must start with education. We lack a higher institute of public health. In universities, the focus is on treatment, not prevention. There aren’t even reliable statistics on the number of people who are overweight, who smoke, or who consume alcohol. Without knowing how many smokers there are, regions cannot effectively evaluate the impact of measures they implement to reduce the number of people with this habit. Schools, too, do little for public health. Introducing a weekly one-hour health education class could change mindsets and help counter the influence of the misinformation often spread online.
Luca De Biase
So, you’re essentially proposing to educate for the future…
So, you’re essentially proposing to educate for the future…
Silvio Garattini
Prevention is a topic that can only be understood by thinking about the future. What you do today will have consequences tomorrow. Knowing the numbers would help in understanding these consequences.
Prevention is a topic that can only be understood by thinking about the future. What you do today will have consequences tomorrow. Knowing the numbers would help in understanding these consequences.
Luca De Biase
Couldn’t prevention also lead to the creation of a market?
Couldn’t prevention also lead to the creation of a market?
Silvio Garattini
Prevention is not a market. It requires a great deal of personal attention. It demands independent information. It calls for deep scrutiny, for example, when politics decides to continue encouraging tobacco production: land taken away from biodiversity, the creation of harmful particles even for non-smokers, non-biodegradable cigarette butts, and sick people. Moreover, prevention doesn’t cost much: just walk 5 kilometers a day; maintain a varied and moderate diet. Eating little and moving appropriately are habits that increase longevity.
Prevention is not a market. It requires a great deal of personal attention. It demands independent information. It calls for deep scrutiny, for example, when politics decides to continue encouraging tobacco production: land taken away from biodiversity, the creation of harmful particles even for non-smokers, non-biodegradable cigarette butts, and sick people. Moreover, prevention doesn’t cost much: just walk 5 kilometers a day; maintain a varied and moderate diet. Eating little and moving appropriately are habits that increase longevity.
Luca De Biase
The change you suggest is simple to explain and appreciate, yet it doesn’t seem easy to implement. How can we achieve it?
The change you suggest is simple to explain and appreciate, yet it doesn’t seem easy to implement. How can we achieve it?
Silvio Garattini
It takes time, of course. First and foremost, more research is needed. And not just for the sake of patenting: at Mario Negri, we publish our findings so they can be freely used. Knowledge is essential for making the right decisions. Secondly, we must address the gradual crisis of the national healthcare system, which will not be sustainable if spending continues to rise. Thirdly, better education is crucial, from schools to universities, as we’ve mentioned. Campaigns are needed against smoking, but also against alcohol. Finally, we need many people to demand the right measures: when the Constitution of the Italian Republic was enacted, there was no national health service. Over time, public opinion grew strong enough to convince policymakers that it was necessary to create one. Today, costly treatments are virtually free for citizens. This was once unthinkable. Yet, we made it happen. It’s up to us.
It takes time, of course. First and foremost, more research is needed. And not just for the sake of patenting: at Mario Negri, we publish our findings so they can be freely used. Knowledge is essential for making the right decisions. Secondly, we must address the gradual crisis of the national healthcare system, which will not be sustainable if spending continues to rise. Thirdly, better education is crucial, from schools to universities, as we’ve mentioned. Campaigns are needed against smoking, but also against alcohol. Finally, we need many people to demand the right measures: when the Constitution of the Italian Republic was enacted, there was no national health service. Over time, public opinion grew strong enough to convince policymakers that it was necessary to create one. Today, costly treatments are virtually free for citizens. This was once unthinkable. Yet, we made it happen. It’s up to us.
