Rapid Responses to:
|
|
Rapid Responses: Rapid Responses published:
-
![[Read Rapid Response]](/icons/misc/sectionDOWN.gif)
Whitehall sickness absence and Cancer: ?Due to Sunlight deficiency
- Tim Oliver (8 October 2008)
-
Current certification - fit to work?
- Chris L Manning (20 October 2008)
|
|
|||
|
Tim Oliver, Professor Emeritus in Medical Oncology St Barts & The London School of Medicine EC1M 6BQ
Send response to journal:
|
Lappe et al [2] have documented a 77% reduction of cancer incidence in a population based placebo controlled trial of Vitamin D with 4 years follow up. Goth et al have demonstrated in a randomised trial of Vitamin D verses broad spectrum light therapy in patients with seasonal affective disorder [3] that the mood improvement was correlated with degree of improvement of serum levels of 25OH Vitamin D level. In this country (particularly likely in long distance city commuters who for more than half the year leave and arrive home in the dark) there is considerable vitamin D deficiency, worse in the increasing portion of our population with increased skin pigment [4]. With this in mind, one might be tempted to speculate that Vitamin D deficiency might have something to do with Head et al’s report [1] of an hazard ratio of 2.5 for death from cancer for individuals having sickness absences 13 years earlier because of psychiatric diagnoses. Given the potential benefits now apparent from the multiplicity of diseases that have been shown to be associated with Vitamin D deficiency [5] as well as it's effect on all cause mortality [6], it is surprising that, despite a series of impressive reports of the needs in this country over the last 4 years [7], minimal action has been taken by the Department of Health. Furthermore NICE has contributed nothing to the debate in the last 4 years despite the QALY value being massively better than any of the expensive drugs they are accepting. One wonders why there are no complaints in the press over this neglect [8]! For the last 3 years my Urological colleagues and I have been unsuccessfully trying to get funding for a chemo-prevention study of vitamin D supplementation in African-Caribbean’s whose increased susceptibility to Prostate cancer is well established [9] as is the evidence that there is increased risk of prostate cancer from life long Vitamin D deficiency [10]. Given the increasing evidence that the skin cancer risk comes from UVA while Vitamin D comes from UVB [11] may be we may need to look for support to Denmark, the birth place of Finsen whose received the Nobel prize in 1903 for developing the first “sun-lamp” to treat Tb. On a recent visit I became aware that most towns we visited had two rival chains of solarium successfully competing for business. Given that UVB but not UVA has also been shown to reduce blood pressure [12] there is a clear need to re-appraise the views about sun-beds. Yours sincerely RTD Oliver MD, FRCP
References: 1. Head, J., et al., Diagnosis-specific sickness absence as a predictor of mortality. BMJ, 2008. 337: p. 1-7. 2. Lappe, J.M., et al., Vitamin D and calcium supplementation reduces cancer risk: results of a randomized trial. Am J Clin Nutr, 2007. 85(6): p. 1586-91. 3. Gloth, F.M., 3rd, W. Alam, and B. Hollis, Vitamin D vs broad spectrum phototherapy in the treatment of seasonal affective disorder. J Nutr Health Aging, 1999. 3(1): p. 5-7. 4. Hypponen, E. and C. Power, Hypovitaminosis D in British adults at age 45 y: nationwide cohort study of dietary and lifestyle predictors. Am J Clin Nutr, 2007. 85(3): p. 860-8. 5. Cannell, J.J., et al., Diagnosis and treatment of vitamin D deficiency. Expert Opin Pharmacother, 2008. 9(1): p. 107-18. 6. Jia, X., L.S. Aucott, and G. McNeill, Nutritional status and subsequent all-cause mortality in men and women aged 75 years or over living in the community. Br J Nutr, 2007. 98(3): p. 593-9. 7. Gillie, O., Scotland's Health Deficit; Sunlight, Vitamin D and health; Sunlight robbery. www.healthresearchforum.org.uk, 2008. 8. Hawkes, N., Why is the press so nasty to NICE? Bmj, 2008. 337: p. a1906. 9. Chinegwundoh, F., et al., Risk and presenting features of prostate cancer amongst African-Caribbean, South Asian and European men in North- east London. BJU International, 2006. 98(6): p. 1216-20. 10. Bodiwala, D., et al., Prostate cancer risk and exposure to ultraviolet radiation: further support for the protective effect of sunlight. Cancer Lett, 2003. 192(2): p. 145-9. 11. Garland, C.F., F.C. Garland, and E.D. Gorham, Epidemiologic evidence for different roles of ultraviolet A and B radiation in melanoma mortality rates. Ann Epidemiol, 2003. 13(6): p. 395-404. 12. Krause, R., et al., Ultraviolet B and blood pressure. Lancet, 1998. 352(9129): p. 709-10. Competing interests: None declared |
|||
|
|
|||
|
Chris L Manning, Director, Upstream Healthcare Teddington TW11 9HG
Send response to journal:
|
Dear Editor The authors of this paper iterate the strong association between sickness absences resulting from circulatory, surgical and psychiatric diseases and increased mortality. Further, they admit to being surprised by sickness absences with a psychiatric diagnosis being predictive of cancer- related mortality also. Those of us who work in the so-called mental 'health' world (in fact the mental illness one, in so far as the NHS and social care interpret the term) are not in the least surprised. The neurobiological and epigenetic study of mental illnesses are now rapidly unravelling strong and associative links between the traditionally separated areas of mental and physical illness (and health). For as long as we continue to follow the Descartian Brick Road, we will continue to be surprised at such associations and to develop and design education, training and services that dissect the brainmind from the rest of the body. The immunological effects of severe psychiatric illnesses such as schizophrenia, bipolar disorder and major depression include effects on various lymphocyte and cytokine responses. The discombobulating effects of not having one's brainmind to process life clearly, obfuscate our purposes even further. We may smoke and drink more and are, by virtue of the psychiatric illness (and sometimes its treatment, as with weight gian and diabetes), be further placed at risk. Perhaps many people with so-called 'brittle' asthma or diabetes are people with 'normal' diabetes and asthma leading brittle lives (many certainly have psychiatric and psychological comorbidities). As someone with a diagnosis of recurrent major depression, I welcome this paper, since it adds to the weight of evidence for addressing people's needs and not merely endlessly assessing them. It is also to be hoped that the QoF mechanism will continue to be harnessed to address this vital area and enable at least some GPs to get their teeth back into these issues (even if their fillings need to be made of gold?) Yours Sincerely Dr Chris Manning Competing interests: None declared |
|||