Dr.Godlee raises the interesting question of the impact of financial
stringency being a stimulus for evidence-based medicine. She wondered,
"...if we have been playing at putting evidence into practice." But the
situation is much more complex, as Greenberg recently drew attention to
the fact that despite peer review and editorial oversight, "citation bias"
and the ignoring of contrary viewpoints led to "erroneous conclusions."
That paper raises the question of the relevance of published "evidence".
At this time, meta-analyses are fashionable, while studies relating
to the pathophysiology of chronic diseases are uncommon. For unexplained
reasons, the currently accepted concepts of the major health problems have
been developed without reference to the published information about the
changes in the physical properties of the blood. Not only does this imply
poor science, but it demeans the work of many dedicated investigators.
In my book, "Blood viscosity factors - the missing dimension in
modern medicine," I draw attention to the amount of relevant published
information concerning the role of altered blood rheology which is ignored
in the current concepts of the aging process, cardiovascular disorders,
cerebrovascular disease and stroke, diabetes and hypertension, for
example. If all this published evidence was put to work, then an entirely
different picture would emerge, drawing attention to situations where NHS
costs could be reduced.
By accepting the evidence that increased blood viscosity is a common
problem, it becomes possible for GPs to try to obtain patients to accept
some responsibility for their health problems. If even 30% of patients
could be convinced that they could improve their quality of life by making
lifestyle changes, there could be significant savings. GPs could
encourage patients to stop smoking; to reduce their intake of saturated
fat and salt; to increase their intake of oily fish; and to have a regular
programme of light physical activity, such as walking. All these changes
would lower blood viscosity.
The benefits of the lifestyle changes could be enhanced by taking
agents which improve the flow properties of the blood. Four grams daily
of evening primrose oil, which leads to an increase the blood levels of
prostaglandin E1 (PGE1) has been shown to improve red cell deformability.
Six grams daily of fish oil will increase the fluidity of the red cell
membrane, and this has been shown to reduce blood pressure in
hypertensives. A Dutch study in 1985, reported that a daily intake of 35
grams of oily fish, reduced the incidence of coronary heart disease in a
20 year follow-up study. Ferrari et al in 1987 reported the results of a
4-year-long study of pentoxifylline in the treatment of diabetes. During
the 4 years not a single complication of the diabetic state developed.
But before ALL of the evidence can be utilised there will need to be
some major changes in the attitudes of many official bodies. For
example, NICE does not recognise that blood rheology is an important
factor in chronic disorders. IF, that is IF financial stringency
stimulates an evaluation of ALL the evidence, then it is possible to
envisage a better quality of life for those suffering from a variety of
chronic disorders. One can only hope that Dr.Godlee's editorial
stimulates an evaluation of relevant but unutilised information.
Rapid Response:
We need to put ALL the evidence to work.
Dr.Godlee raises the interesting question of the impact of financial
stringency being a stimulus for evidence-based medicine. She wondered,
"...if we have been playing at putting evidence into practice." But the
situation is much more complex, as Greenberg recently drew attention to
the fact that despite peer review and editorial oversight, "citation bias"
and the ignoring of contrary viewpoints led to "erroneous conclusions."
That paper raises the question of the relevance of published "evidence".
At this time, meta-analyses are fashionable, while studies relating
to the pathophysiology of chronic diseases are uncommon. For unexplained
reasons, the currently accepted concepts of the major health problems have
been developed without reference to the published information about the
changes in the physical properties of the blood. Not only does this imply
poor science, but it demeans the work of many dedicated investigators.
In my book, "Blood viscosity factors - the missing dimension in
modern medicine," I draw attention to the amount of relevant published
information concerning the role of altered blood rheology which is ignored
in the current concepts of the aging process, cardiovascular disorders,
cerebrovascular disease and stroke, diabetes and hypertension, for
example. If all this published evidence was put to work, then an entirely
different picture would emerge, drawing attention to situations where NHS
costs could be reduced.
By accepting the evidence that increased blood viscosity is a common
problem, it becomes possible for GPs to try to obtain patients to accept
some responsibility for their health problems. If even 30% of patients
could be convinced that they could improve their quality of life by making
lifestyle changes, there could be significant savings. GPs could
encourage patients to stop smoking; to reduce their intake of saturated
fat and salt; to increase their intake of oily fish; and to have a regular
programme of light physical activity, such as walking. All these changes
would lower blood viscosity.
The benefits of the lifestyle changes could be enhanced by taking
agents which improve the flow properties of the blood. Four grams daily
of evening primrose oil, which leads to an increase the blood levels of
prostaglandin E1 (PGE1) has been shown to improve red cell deformability.
Six grams daily of fish oil will increase the fluidity of the red cell
membrane, and this has been shown to reduce blood pressure in
hypertensives. A Dutch study in 1985, reported that a daily intake of 35
grams of oily fish, reduced the incidence of coronary heart disease in a
20 year follow-up study. Ferrari et al in 1987 reported the results of a
4-year-long study of pentoxifylline in the treatment of diabetes. During
the 4 years not a single complication of the diabetic state developed.
But before ALL of the evidence can be utilised there will need to be
some major changes in the attitudes of many official bodies. For
example, NICE does not recognise that blood rheology is an important
factor in chronic disorders. IF, that is IF financial stringency
stimulates an evaluation of ALL the evidence, then it is possible to
envisage a better quality of life for those suffering from a variety of
chronic disorders. One can only hope that Dr.Godlee's editorial
stimulates an evaluation of relevant but unutilised information.
Competing interests:
None declared
Competing interests: No competing interests