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EDITOR'S CHOICE: Fiona Godlee Conquering old age BMJ 2008; 337: a847 [Full text]

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One for all and all for one.

BM Hegde   (19 July 2008)

One for all and all for one. 19 July 2008
BM Hegde, Retd. Vice Chancellor Mangalore-575004, India. Send response to journal: Re: One for all and all for one.	I think we need to encourage more specialist geriatricians to save the old elderly from the torture of having to take multiple tablets from innumerable sub specialists even when they are apparently healthy and active. Each one of the normal features of ageing has been converted either into a disease or a risk factor, thanks to the screening bandwagon, which is the most lucrative business. Classical example is osteoporosis where the yard stick for bone density seems to be bone density of a teenager Caucasian girl. Naturally, any one above that age will be osteopaenic! Poly-pharmacy in the elderly is one of the important causes of death next only to the intensive care unit’s nosocomial infections! More important than the studies on sexuality in the elderly we urgently need studies in various countries to see what percentage of the elderly are free from the drug menace! All most all major risk factor intervention trials like MRC, EWPHE, MRFIT, MALMO, HOT, ACCORD, POISE, PROMISE etc. have shown the futility of drugging the apparently healthy. Statistics and the English language of the medical world, laced with Greek and Latin, make it appear that all those studies did give clear signal for drug therapy. Medical language is so corrupted that it brings to memory the famous paper of George Orwell of 1946, Politics and the English Language, recently brought to my notice by Richard Smith, wherein Eric Blair shows elegantly how even “learned men” like Harold Laski could write bad English to mislead the readers: medical writers of today pale into insignificance in front of Prof. Laski. On example is enough. Seventeen studies of drug therapy of hypertension when computed together give the following picture. Relative risk reduction was -21%. (This measure alone is flaunted on doctors and lay press readers and TV viewers). However, the absolute risk reduction was only -0.8%. The expected life expectancy without treatment was 96% but the same with drugs was only 96.8%. Better than all these is the NNT (number needed to treat measure). Look at the WOSCOPS, " 200 men without any prior heart disease have to swallow 357, 700 tablets over five years to save one of them from dying from coronary heart disease.” The MRC mild- moderate study published in the BMJ in 1985 showed “to save one life from probable stroke in the next five years 850 people will have to be drugged!” “This is due to the fact that no exact knowledge exists as to whom of these 200 and 850 will benefit from the treatment." If we present these data to our intelligent people in simple language they would opt out of drug therapy on their own and could be saved from the unnecessary ADR deaths which take a very heavy toll of otherwise useful human lives. Elderly need to know that their best bet is to live happily without drugs as long as they are apparently healthy-call it health expectancy! Life with drugs, in the words of Professor Sir George Pickering, is a life without any of the privileges enshrined in the preamble to the American Constitution written in 1772 by Thomas Jefferson: “life, liberty, and pursuit of happiness.” He added “more people in this world make a living off hypertension than die of it.” First let us not do any harm even if we can not do good! Yours ever, bmhegde Competing interests: None declared