Health Check

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Health Check: During the Doctors' Strike

in the 1970s, Death Rates Fell

By Jeremy Laurance

01 September 2003

 

Anyone who is in any way prone to a stroke or heart attack should take it very

easy this week. Heart specialists will be as rare as hen's teeth. You will find

them, should you need one, in Vienna, at the European Society of Cardiology's

conference. An estimated 17,000 cardiologists are expected in the city for

Europe's largest medical meeting. No doubt those present will shed a tear or two

for absent colleagues unable to secure a " sponsorship opportunity " from a drug

company, as they sip a glass or two of health-giving red wine. But what they

will not be doing is seeing or treating patients.

 

It is a standing joke among cardiologists that death rates fall during their

conferences because fewer of them are out there attempting to cure moribund

patients by doing dangerous surgery. The treatment can be worse than the

disease.

 

That lesson was driven home in Britain during the last doctors' strike in the

1970s. Doom mongers predicted that bodies would pile up in the street, but death

rates actually fell.

 

This week in Vienna, doctors are busy discussing the latest drugs and treatment

strategies for heart disease. Will they save more lives? That is debatable.

 

The doctors, naturally, believe they are indispensable. Some years ago, a couple

of inveterate conference-goers wrote to The Lancet proposing that where large

numbers were attending a foreign venue at one time they should consider taking

separate flights home, in case of disaster. The authors cited the example of a

transatlantic flight they had recently taken in which almost every seat had been

occupied by a cardiologist. Had the plane gone down, the entire heart service

for say, Preston, would have been wiped out at a stroke.

 

Obviously we should avoid putting all our egg-head heart specialists in one

flying basket. But how many lives they save is less certain. Deaths from heart

disease have fallen by more than a third in the last decade, which is a matter

for celebration, as a paper on the extensive Grace study, involving 31,000

patients in 14 countries, pointed out last week. But nobody knows quite why. No

single factor can account for the size and speed of the fall.

 

Improved treatment has certainly helped. One finding in the Grace study is that

though we are not bad at treating people who have had heart attacks (to prevent

a recurrence) we are much less good at treating those about to have one, which

looks very like shutting the stable door after the horse has bolted.

 

But the real puzzle is that we do not know what caused the heart disease

epidemic, which began in the 1940s and peaked about 1970. Its subsequent fall is

equally mysterious. There has been a sharp decline in smoking and limited

dietary changes, which account for some of the fall. History will tell how much

medicine has contributed, but it is unlikely to be a great deal.

 

Treatments come at a price. That is spelt out in a sobering report, also

published last week, by the American Institute for Cancer Research, an

independent body that advises the US public on medical issues. It notes that the

giant advances in treating childhood cancer, with cure rates now at 78 per cent,

are not an unsullied success.

 

Two thirds of children suffer later complications, often as a result of the

radiotherapy or toxic drugs they are given to deal with the cancer, and in a

quarter of cases they are severe or life-threatening. The international

survivors network for childhood cancer sufferers is about to establish a branch

in Britain.

 

In medicine, the greater the advance, the more it becomes clear how far there is

still to go.

 

Further Resources

Health Wars by Phillip Day

www.credence.org

 

 

 

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