Eric Tian

Medicine is sexy. CAR-T cells, stem cell transplants, monoclonal antibodies, CRISPR gene therapy, you name it – there always seems to be a cutting-edge therapy being developed and thousands of patients ready to sign up for clinical trials.

Preventative public health is less sexy. Educating children about nutrition, advocating for transparent food labeling, and implementing alcohol regulations might seem mundane. Yet, these interventions yield results that far surpass even the most advanced medical treatments.

Consider some examples and their ripple effects:

1. Early detection through cancer screening tools dramatically increases survival rates.

2. Limiting fast food accessibility tackles obesity—a major risk factor for numerous non-communicable diseases.

3. Creating public spaces for exercise enhances both physical and mental well-being, reducing overall patient influx.

One of the stories we are taught in medical school is the Upstream Parable. It illustrates the futility of treating a disease when it appears rather than addressing the root cause. This concept is captured in Sir Michael Marmot’s book The Health Gap:

“Why treat people and send them back to the conditions that made them sick?

Indeed, this question strikes at the heart of modern healthcare. While we marvel at medical breakthroughs, perhaps our greatest advancements lie in preventing illness altogether: in looking upstream at the cliffs, rather than the raging waters below.

I was at a London souvenir store last week when I saw an umbrella being sold for £20.

“20 pounds?!” I thought to myself. The most I would ever pay for an umbrella would be £10. Maybe £15, max.

A few days later, I was walking to the hospital when it began to rain. Except this was no ordinary rain: it came violently, all at once, like floodgates opening above your head. Within seconds, the whole street was drenched. I was still 12 minutes from the hospital and dove under the nearest building I could find.

I found myself inside a little electronics store.

“Do you sell umbrellas?” I asked.

“£20,” the shopkeeper replied. I handed over the money without even thinking. It was a cheap, plain umbrella, far worse quality than the one from the souvenir store.

Only later did I realise how fast my value judgment had shifted with context. On a sunny day, buying a £20 umbrella was wasteful. On a rainy day, it was a necessity.

I think the broader lesson is the value of anything—be it an object, a person, an experience, or even knowledge—is deeply tied to circumstance. What seems trivial in one moment might prove invaluable in another. The real tragedy would be to disregard something permanently based on a single, contextual judgment.