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Archive for November, 2008

My favourite Christmas lights are up and glowing again in Glasgow – this is Royal Exchange Square, where the Gallery of Modern Art is, and where you’ll find one of the loveliest Borders bookstores in the world!

glasgow

glasgow

I know these lights are very simple and maybe they don’t even look spectacular but I can tell you the experience of walking underneath them is really something else! Fabulous!

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There’s quite a trend in recent years towards Public Health measures centred around what you might call “technical fixes” – the idea that a technology of some kind can improve health. The technology of choice, of course, is pharmacology and we are bombarded with messages that various different drugs should be taken by increasingly large proportions of the population in order to achieve greater Public Health. I think this is a myth. It’s part of the larger myth that science and technology will allow us to control Nature, to set out how we would like life to be and to achieve those goals. There’s an awful lot of sloppy thinking on this subject. Quite often we are told that a particular drug has the ability to be “life saving”. Drugs don’t save lives. At best they alter the death experience, but everybody dies from something and drugs actually don’t let you be sure that YOU, the individual YOU, can avoid a certain kind of death.

Take death from heart disease and strokes for example. We’ve been told that everyone should take aspirin because if everyone took aspirin then a lot less people would die from heart attacks or strokes. Listen carefully to that advice because it is a statistical statement – if MOST people took drug x then LESS people would die from y. That’s not the same as saying that if YOU took drug x then YOU would be less likely to die from y. The difference might seem subtle but it’s significant. The difference is ignored by people who suggest that we are all the same and we should all follow the same course of action. For example, a few years back some doctors and scientists promoted the idea of a “polypill” which every adult should take so that the death rate from certain diseases would be reduced. (what the authors didn’t seem to think about was what, if they were correct, would all these people die from instead? Don’t you think that matters?)

In this week’s BMJ there is an editorial summarising the studies of populations taking aspirin and their conclusions are clear.

These result support the concept that risk assessment alone cannot predict which patients will benefit from aspirin. In fact, the only predictor of clinical response to aspirin is a history of a major coronary or cerebral ischaemic event, as defined by the previous meta-analysis

In other words, there is only a statistical benefit from aspirin in patients who have already experienced coronary or cerebral ischaemic disease (that’s angina, heart attacks or strokes primarily). In the population who haven’t experienced one of these diseases there’s no benefit from taking aspirin.

Buried in the text of the article is this statement too –

However, not all patients with cardiovascular disease respond to aspirin, as shown by a recent meta-analysis of aspirin trials in peripheral artery disease

So beware of taking these messages at face value. It seems that only those who have already developed cardiovascular disease may be helped by taking aspirin and of these not all will get the benefit.

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