New views for the new year

Thought provoking article by James Le Fanu from www.telegraph.co.uk:

The new year opens with a healthy dose of revisionism concerning the value (or otherwise) of current medical advice – and on several fronts. First up, researchers at London’s St George’s Hospital (as reported in this paper last week) dispute the benefits of the common practice of taking an aspirin a day to keep the doctor away, on the notion that this reduces the risk of heart attack or strokes.

The rationale is sensible enough, as aspirin reduces the stickiness of the platelet cells and thus should boost the blood flow to heart and brain. But, for those who are otherwise healthy, “the benefits are far more modest than supposed”, say the researchers, and are outweighed by the not inconsiderable hazard of internal bleeding.

Next, the putative merits of reducing the intake of salt is challenged by the findings of a major study in the US that suggests those with a low amount in their urine have a higher (rather than lower) mortality rate from circulatory disorders. Meanwhile, it is interesting to note that those responsible for propagating such dietary advice do not, according to a paper in the British Medical Journal, comply with it themselves: an analysis of the salt content of their meals reveals they consume twice the quantities currently recommended to the public.

More contentiously, perhaps, this revisionism also extends to the seemingly self-evident value of screening for breast cancer. Not necessarily so – or, as an editorial in this month’s Archives of Internal Medicine puts it, doctors need to ensure that women “do not have an overly inflated perception of its effectiveness, and are aware of the substantial risk of over-diagnosis (i.e being diagnosed as having cancer when in fact they do not)”.

The common theme, if there is one, in all this is a more realistic appreciation of who medical advice and treatment should be directed to and what it can reasonably be expected to achieve. There is no denying the value of the blood-thinning properties of aspirin for those with heart problems, or that cutting back on salt may lower the blood pressure in those with hypertension, or that those with a strong family history of breast cancer require regular screening. But there can be little justification in extrapolating this to all, to insist that everyone needs to take an aspirin a day or restrict their salt intake, or that “the more cancer screening the better”.