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Matters other than medicine

Bandolier has traditionally concentrated on examining systematic reviews and meta-analyses of clinical trials of treatments, and trying to make sense of them in ways that ordinary mortals like us can understand. But medical treatments are only one side of the coin of improved health and longevity. There's also the not insignificant factor of healthy, or unhealthy, living.

Speculation and precision

John Bunker [1] set out to try and estimate the contribution of medicine to improvements in life expectancy and quality of life since 1950. He himself says that any estimates of medicine's contribution to health can only be more than speculative and less than precise. The information he used came from several sources - changes in disease-specific death rates from the US National Center for Health Statistics and data on medical improvements from trials and meta-analyses.

Heart disease

In heart disease, for example, age adjusted death rates fell in the US from 307 to 156 per 100,000 between 1950 and 1989, about half of the fall in death rates for all causes. Over the same period overall life expectancy increased by 7.1 years, and so it was estimated that some 3.4 years of the improved life expectancy resulted from the fall in the death rate from heart disease.

Reviewing the evidence on the efficacy of medical interventions in heart disease, it was estimated that 40% of the decline in the death rate could be attributed to coronary care units, treatment of hypertension, and medical and surgical treatment of ischaemic heart disease. So 40% of the 3.4 years (1.4 years) could be attributed to medicine and health care.

Bottom line

The approach was extended to other areas, and the bottom line was an estimate that medical care can be credited with five of the 30 years of increased life expectancy in this century, and three of the seven years since 1950. A gain of five years of life expectancy is equivalent to halving the death rate at every age. Five years is equivalent to the loss in life expectancy due to smoking 20 cigarettes a day from age 20.

The contribution of medical care to the quality of life was also estimated. The number of years of poor quality life from severe chronic disease spared to individuals by medical care is estimated to be five years.

Tesco phenomenon

Other changes, social and economic, have had a big impact on improved length and quality. Improvements in transportation, agriculture and industrial processes mean that people have better education, have more money to spend, improved diets, annual holidays, sport and other leisure activities like cultivating the allotment.

In recent years, the advent of the supermarket means that better quality vegetables are more available, imported from around the world. So now we eat more vegetables all year round. Consumption of tomatoes in Britain is twice that of a few years ago. The result is that, on a population basis, antioxidant levels have increased, and that will have a beneficial effect on heart disease and cancer. Eating tomatoes and carrots, for instance, is thought each to reduce the risk of prostate cancer by about 30%.

Systematic reviews and meta-analyses of elements of healthy living are beginning to give us some idea of the weight of evidence for all sorts of lifestyle issues. Individuals can to an increasing extent control these for themselves, with diet and exercise being two of the most important. Bandolier will look for more of these. In this issue we examine Soya intake and its effects on lipids and menopausal symptoms, as one example. A bit touchy-feely, perhaps, but if we can put a hard edge to the touchy-feely bits of life, so much the better.

New Zealand

A welcome to the GPs in New Zealand who have started receiving Bandolier on a regular basis. For those of you who are electronic, don't forget that there is a useful list of Internet links .
  1. JP Bunker. Medicine matters after all. J Roy Coll Phys (Lond) 1995 29: 105-19.

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