Jeremy Laurance'During the doctors' strike in the 1970s, death rates fellTue Sep 2 03:45:39 2003184.108.40.206'During the doctors' strike in the 1970s, death rates fell'By Jeremy Laurance01 September 2003Anyone 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 independentbody 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.
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