I had a letter published in the BMJ today. Here’s the text –
What exactly does it mean to say that a treatment produces a decline in “all cause mortality by 21%” in a group of patients aged 80 and over? How long did the treatment postpone deaths from “all causes?” A month? A year? Forever? Use of all cause mortality without a time frame stops researchers and readers asking what the treated group end up dying from. By focusing too narrowly we fail to clarify the true consequences of taking a particular treatment.
I wrote this in response to an Editorial about the treatment of elderly patients with high blood pressure. Somewhat astonishingly the article claimed a study had shown that treating over 80 year olds with antihypertensives not only reduced their chances of having a heart attack or a stroke but produced a reduction in mortality “from all causes” by 21%.
That just cannot be true……..not without qualification. And the qualification is the time period under study. The author of the editorial made no mention of the time period. Mortality remains 100%. Everybody, but everybody, dies. If we effectively reduce the chances of dying from one particular kind of disease, then before we make an informed choice to do what will achieve that, don’t we need to know what we’re MORE likely to die from instead? In fact, it’s not just a matter of death, it’s a matter of life. With an increasing emphasis from biomedical medicine to take drugs for life for a healthier life we desperately need some good whole of life research to show what the impact these interventions have on not just the kinds of deaths such people experience, but the kinds of lives they experience too.
There is a terrible tendency still in Medicine to think in too small pieces. We need the bigger picture.
Heroes Not Zombies 
I know I might sound like a cynic though I feel this is another example of a half-truth put out by the marketing people at a major pharmaceutical company to sell their product — in this case, antihypertensives. Numbers and stats can be so easily manipulated to support one’s claims.
On a lighter note, once again a post of yours reminds me of a quote from a movie — this time “The Princess Bride”. 🙂
“Life is pain, Highness. Anyone who says differently is selling something.”
Ha! Ha!
thank you! I LOVE these movie quotes. That’s a good one!
No one gets out of this life alive. And really – would you WANT to live forever? What if we started shifting our focus away from desperately clinging to this life to learning to accept (and, if it’s not too much to ask, to look forward to) what comes next?