Medicine's great schism: prevention vs. cure: an historical interpretation.

All societies, primitive and advanced, demand therapeutic services, but a society must develop sophisticated prerequisites before it can support preventive services. This discordance in the origins of curative medicine and public health does not explain why a schism between them still persists. This gap should be closed since medicine has cured most curable diseases and the residue of chronic conditions is best handled by preventing them or detecting them before they become medical crises. Reasons for persistence of the schism include; early concentration of public health on environmental sanitation to the exclusion of medicine; identification of public health was governmental bureaucracy; linking care of the poor with tight-fisted welfarism; existence of two separate educational systems, the view of doctors, who are activists by nature, toward the excitement of cure; the custom of paying only for active therapy; and the orientation of the Hippocratic ethic toward individuals.