Heroes Not Zombies

There is a very common, very sloppy (or deliberate) statement made in medical research articles. Read this –

The landmark randomised trial, the hypertension detection and follow-up programme, showed that a “stepped care” approach incorporating regular review, adherence reminders to patients, and an explicit programme of treatment intensification produces substantial falls in blood pressure and reduces all cause mortality

This is from an otherwise excellent article about how GPs are paid for interventions in Primary Care, published in last week’s BMJ ( if you want the full reference it’s  – BMJ  2007;335:542-544 (15 September), doi:10.1136/bmj.39259.400069.AD)

The phrase I really object to is the last one – the claim that a particular treatment “reduces all cause mortality”. Do the authors really mean that? No. What they mean is that in this particular trial the number of deaths in the treatment group was less than expected over the course of the trial – trials don’t last very long – a few weeks, to at most a few years (exceptionally). What they do NOT mean (surely) is that the drug in question stops people dying – from all causes, forever. The question that is left unasked is what kind of lives, and then, what kind of deaths, do the people have who took this treatment? Because everyone dies from something. No drug “reduces all cause mortality” – not when you take a life-time perspective rather than a short period of a life.

I think it’s time we actually researched this issue – what is the lifetime experience of people who take part in interventionist preventitive treatments? What illnesses do they get? And what do they die from?