Domhnall MacAuley on epicurean epidemiology

Domhnall Macauley

Autres pays, autres coeurs? Part of the title of an early paper highlighting the relationship between dietary patterns, risk factors and ischaemic heart disease could have been the title of this meeting. Cardiovascular epidemiologists from Europe and beyond gathered in the land of the Ulster Fry to discuss the Mediterranean diet, the French paradox, and review the many achievements of the MONICA project, the PRIME study, ECTIM and other related research.

Kari Kuulasmaa gave an overview of the remarkable international collaboration and the host of major publications. But the finding that drew most public interest was the cardiovascular benefit associated with red wine consumption. How wonderful to study a topic of such delight that it allows us eat so well and drink French wine with abandon. Interestingly, they found a similar cardiovascular benefit with tomatoes but, somehow, this didn’t capture the public imagination in quite the same way.

Continuing the nutritional theme, Inger Njølstad highlighted the major milestones in the Tromso Heart Study which began in 1974 and mentioned, in particular, work that showed an adverse relationship between cholesterol and coffee drinking- but only with the traditional Norwegian method of brewing coffee by boiling and not with filter coffee. Looking at the reduction in cardiovascular risk over time she also highlighted a social class gradient, even in Norway which considers itself an egalitarian society. Inger told me afterwards how she was originally a GP interested in researching the doctor patient relationship but, seeking research advice, found herself drawn into epidemiology and she now heads the study.

Listening to Hugh Tustall-Pedoe speak about the Monica Monograph, with the 64 collaborators from 32 centres, it struck me, that in addition to the many scholarly papers, this work had generated 20 years of employment, and built teams in each centre comprising 10-20 nurses and secretarial staff involved in registration, coding, data entry and ancillary tasks, not to mention a fertile resource for countless research students. In an academic journal our focus on research outputs may blind us to the economic and social capital generated through research. MONICA was a small multinational industry with profits far beyond citation.

The meeting was entitled  “The Legacy of Frank Pantridge” a clinical cardiologist who, in his own way, has changed our everyday lives.  He designed the first portable defibrillator- which was portable only to a degree as the prototype weighed 70 kg. But, it was a wonderful idea, and much more sophisticated portable defibrillators can now be seen in almost every public place. Pantridge was quoted as saying “there should be a defibrillator beside every fire extinguisher- as people were more important than buildings”. His vision is now almost complete.

The event was coordinated by Alun Evans who, in this year of his retirement, arranged a final academic meeting for his many friends and collaborators. In his own modest way, he preferred to focus attention on someone else. Alun did, however, entertain us in a final talk fittingly entitled The Last Slide Show, an echo of Mc Murty’s novel and the movie The Last Picture Show. Older readers will remember, in the days before powerpoint, that speakers carried their slides around in a carousels and, in their rush for a plane or train, often accidentally left the last slide behind in the projector. This final talk was a witty epilogue weaving a narrative through a collection of 20 orphan slides amassed over many years. Nostalgia for the obscure, the upside down, the back to front, and the faded blue slide.

Domhnall MacAuley is primary care editor, BMJ