12 Aug, 07 | by BMJ Group
You will no doubt have read the recent NEJM review which pointed out that white people living in colder latitudes are a poor weedy lot, chronically deficient in vitamin D. Maybe this is why as I approach 60, I can look forward to a 29% chance of sustaining an osteoporotic fracture in my remaining lifespan. And I am, in case you hadn’t noticed, male. Although I usually skip past cost-effectiveness studies in which people install a bit of modelling software and feed in the data they think relevant, I’m glad to see this paper because it highlights the fact that blokes deserve bone protection too – densitometry followed by bisphosphonates where needed for those aged 65 or over who have had fractures, and over 80 for those who haven’t.
A much more original and impressive intellectual exercise is this paper which examines the effect that non-pharmaceutical interventions had on US cities during the devastating influenza pandemic of 1918-1919. When Daniel Defoe first tried this sort of thing in A Journal of the Plague Year (1722) he just made it up as he went along, inserting a few chunks out of Bills of Mortality and contemporary accounts from 1665. Here the authors carefully collate information about school closures, cancellation of public gatherings, and quarantine measures and assess their impact on mortality from influenza. The moral is that basic measures of this sort can achieve a reduced mortality burden even in the absence of immunisation and drug therapy.
A few years ago a normally healthy patient of mine developed painful sinusitis with bloodstained nasal discharge which didn’t respond to antibiotics, then a cough with chest crackles, and a few days later could hardly move and was found to be in acute renal failure. Wegener’s granulomatosis and most other types of vasculitis associated with antineutrophil cytoplasmic antibodies (ANCA) are rare, sporadic, and before modern treatment, usually fatal. Because we don’t fully understand their causes, and it’s difficult to collect and randomise patients, we don’t have a very good evidence base on which to choose between a range of hazardous options. This review picks its way through the studies: acronym-spotters will be pleased to note that most of them are neutral (EUVAS, CYCAZAREM), one is mildly off-putting (CYCLOPS) and only one is unethically optimistic (IMPROVE).