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THE ULTIMATE IN PREVENTIVE MEDICINE
762
which can be manipulated of the argument. either side support
existing data,
selectively
to
THE ULTIMATE IN PREVENTIVE MEDICINE Two weeks ago the first formal gathering of the body known as International Physicians for the Prevention of Nuclear War assembled in Virginia, U.S.A. Those attending included 14 doctors from the Soviet Union. The meeting
issued three appeals (reproduced on p. 790) to politicians and doctors. These messages declare that the catastrophe of nuclear war and its intolerable consequences, including the immediate death of tens and possibly hundreds of millions of people, must be avoided and that effective medical care for survivors would be impossible. Doctors throughout the world are invited to pursue the preventive measures outlined by the meeting (p. 790). In the United Kingdom a conference organised last November’ by the Medical Association for the Prevention of War reflected the dread which had seized doctors and many other citizens at a time when the attitudes of the most powerful political leaders and their advisers seem increasingly to incline to the view that a nuclear war can be "won". The Medical Campaign against Nuclear Weapons (see p. 790) has added its voice in support of reason and against the nuclear arms race. Those who lead the medical protest need as much help as they can command. In Britain, they are looking, for instance, to the medical Royal Colleges to add their weight to the argument. In drawing together the mounting activities in many countries, an international organisation would be of great value in the coordination of the efforts of national medical groups working for the prevention of nuclear war. Four of the United States doctors at the Virginia meeting have pronounced: "Physicians share traditions, language, and practices that transcend national boundaries. This common ground enables them to initiate dialogues with foreign colleagues and to join together to make their collective voices heard and possibly even heeded. Together with other interested and informed groups, physicians can spearhead a worldwide movement away from the disaster toward which the world appears to be moving ... Could any therapeutic advance or scientific discovery provide more meaningful service to those whose health we have vowed to protect?"
EPIDEMIOLOGICAL PROBLEMS WITH ALCOHOL EPIDEMIOLOGISTS have examined the hazards from alcoholic beverages in various ways. In collation studies they have looked at the relations between national (or regional) per caput intake of alcoholic beverage and age-adjusted cancer mortality in these populations. Not everyone is happy with the results-partly because the data are of questionable validity, partly because the number of comparisons that can be readily generated seem almost limitless, and partly because some reports present only a subsection of the findings (does the absence of a tabulated result indicate that the correlation was low or that the correlation was not calculated?). Investigations of this type indicate an association between increased 1. Editorial. Threat of nuclear war. Lancet 1980; ii: 1061-62. 2. Lown B, Chivian E, Muller J, Abrams H. The nuclear-arms race and the
Engl J Med 1981; 304:
726-28.
physician.N
consumption of beer, wine, or spirits and raised mortality from cancers throughout the alimentary tract and of liver, pancreas, larynx, lung, kidney, and bladder. 1-3 Another approach is to follow, prospectively, a group known or thought to have increased alcohol intake. Obviously, people who drink a lot of alcohol may be very atypical, and variation in their mortality patterns from that of the general population may reflect aspects of their way-of-life other than - alcohol intake. Results pooled from ten such studies have shown a significant excess of deaths from cancer of the mouth, oesophagus, rectum, liver, larynx, and lung.4-13 Again, not all results are included in the published work, and it is possible that some reports do not include the data when no excess of deaths was observed. Another point is that the method of study varies; most workers provide estimates of person-years-at-risk, which permits calculation of expected deaths from national age/sex/calendar-period mortality rates. Others6,12 have used comparison populations. There is great variation in the number of subjects so the pooled data are heavily weighted by the results from the larger studies. In case-control studies, epidemiologists have examined the relative risk from high alcoholic consumption in patients with malignant disease of various kinds. Such investigations have either concentrated upon alcohol or studied a range of possible agents including alcohol. Here the evidence points to a link between alcohol consumption and cancers of the head and neck, oesophagus, and liver. The position is not so clear for large bowel and pancreas. Out of thirteen case-control studies on colorectal cancer, three indicated an association with beer consumption; 14-11 four showed no appreciable effect from alcohol consumption;17-20 two showed a negative association ;21,22 and in four there was no comment on alcohol 1. Breslow NE, Enstrom JE. Geographic correlations between cancer mortality rates and alcohol-tobacco consumption in the United States. J Natl Cancer Inst 1974, 53: 631-39. 2. Schrauzer GN. Cancer mortality correlation studies. Med Hypoth 1976; 2: 39-49. 3. Knox EG. Foods and diseases. Br J Prev Soc Med 1977; 31: 71-80. 4. Sunby P. Alcoholism and mortality. Oslo: Universitetsforlaget, 1967. 5. Schmidt W, De Lint J. Causes of death of alcoholics. Quart J Stud Alcohol 1972; 33: 171-85. 6. Pell S, D’Alonzo CA. A five year mortality study of alcoholics. J Occup Med 1973, 15: 120—25. 7. Hakulinen T, Lehtimäki L, Lehtonen M, Teppo L. Cancer morbidity among two male cohorts with increased alcohol consumption in Finland. J Natl Cancer Inst 1974; 52: 1711-14. 8. Nicholls P, Edwards G, Kyle E. Alcoholics admitted to 4 hospitals in England II General and cause specific mortality. Quart J Stud Alcohol 1974; 35: 841-55 9. Monson RR, Lyons JL. Proportional mortality among alcoholics. Cancer 1975; 36: 1077-79. 10. Dean G, MacLennan R, McLoughlin H, Shelley E. Causes of death of blue-collar workers at a Dublin brewery, 1954-1973. Br J Cancer 1979; 40: 581-589. 11. Jensen OM. Cancer morbidity and causes of death among Danish brewery workers Int J Cancer 1979; 23: 454-63. 12. Robinette CD, Hrubec Z, Fraumeni JF. Chronic alcoholism and subsequent mortality in World War II veterans. Am J Epid 1979; 109: 687-700. 13. Thorarinsson AA. Mortality among men alcoholics in Iceland, 1951-74. J Studies Alcohol 1979; 40: 704-18. 14. Stocks P. Cancer in North Wales and Liverpool Region. British Empire Cancer Campaign 1957; 35: Annual Report, Suppl II. 15. Wynder EL, Shigematsu T. Environmental factors of cancer of colon and rectum Cancer 1967; 20: 1520-61. 16. International Agency for Research on Cancer-Intestinal Microecology Group Dietary fibre, transit-time, faecal bacteria, steroids, and colon cancer in two Scandinavian populations. Lancet 1977; ii: 207-11. 17 Pernu J. An epidemiological study of cancer of the digestive organs and respiratory system. Ann Med Int Fenn 1960; 49: 1-117. 18. Higginson J. Etiological factors in gastro-intestinal cancer in man. J Natl Cancer Inst 1966; 37: 527-45. 19. Wynder EL, Kajitani T, Ishikawa S, Dodo H, Takano A. Environmental factors of cancer of the colon and rectum. Cancer 1969; 23: 1210-20. 20. Bjelke E. Case-control study of the stomach, colon and rectum In Oncology 1970 Clark RL, Cumley RC, McCoy JE, Copeland MM, eds. Chicago Year Book Medical, 1971: 320-34. 21. Schwartz D, Lellough J, Flamant R, Denoix PF. Alcool et cancer. résultats d’une enquête rétrospective. Rev Franc Etudes Clin Biol 1962; 7: 590-604 22. Modan B, Barell V, Lubin F, Modan M, Greenberg RA, Graham S. Low fibre intake as an etiologic factor in cancer of the colon. J Natl Cancer Inst 1971, 55: 15-18
which can be manipulated of the argument. either side support
existing data,
selectively
to
THE ULTIMATE IN PREVENTIVE MEDICINE Two weeks ago the first formal gathering of the body known as International Physicians for the Prevention of Nuclear War assembled in Virginia, U.S.A. Those attending included 14 doctors from the Soviet Union. The meeting
issued three appeals (reproduced on p. 790) to politicians and doctors. These messages declare that the catastrophe of nuclear war and its intolerable consequences, including the immediate death of tens and possibly hundreds of millions of people, must be avoided and that effective medical care for survivors would be impossible. Doctors throughout the world are invited to pursue the preventive measures outlined by the meeting (p. 790). In the United Kingdom a conference organised last November’ by the Medical Association for the Prevention of War reflected the dread which had seized doctors and many other citizens at a time when the attitudes of the most powerful political leaders and their advisers seem increasingly to incline to the view that a nuclear war can be "won". The Medical Campaign against Nuclear Weapons (see p. 790) has added its voice in support of reason and against the nuclear arms race. Those who lead the medical protest need as much help as they can command. In Britain, they are looking, for instance, to the medical Royal Colleges to add their weight to the argument. In drawing together the mounting activities in many countries, an international organisation would be of great value in the coordination of the efforts of national medical groups working for the prevention of nuclear war. Four of the United States doctors at the Virginia meeting have pronounced: "Physicians share traditions, language, and practices that transcend national boundaries. This common ground enables them to initiate dialogues with foreign colleagues and to join together to make their collective voices heard and possibly even heeded. Together with other interested and informed groups, physicians can spearhead a worldwide movement away from the disaster toward which the world appears to be moving ... Could any therapeutic advance or scientific discovery provide more meaningful service to those whose health we have vowed to protect?"
EPIDEMIOLOGICAL PROBLEMS WITH ALCOHOL EPIDEMIOLOGISTS have examined the hazards from alcoholic beverages in various ways. In collation studies they have looked at the relations between national (or regional) per caput intake of alcoholic beverage and age-adjusted cancer mortality in these populations. Not everyone is happy with the results-partly because the data are of questionable validity, partly because the number of comparisons that can be readily generated seem almost limitless, and partly because some reports present only a subsection of the findings (does the absence of a tabulated result indicate that the correlation was low or that the correlation was not calculated?). Investigations of this type indicate an association between increased 1. Editorial. Threat of nuclear war. Lancet 1980; ii: 1061-62. 2. Lown B, Chivian E, Muller J, Abrams H. The nuclear-arms race and the
Engl J Med 1981; 304:
726-28.
physician.N
consumption of beer, wine, or spirits and raised mortality from cancers throughout the alimentary tract and of liver, pancreas, larynx, lung, kidney, and bladder. 1-3 Another approach is to follow, prospectively, a group known or thought to have increased alcohol intake. Obviously, people who drink a lot of alcohol may be very atypical, and variation in their mortality patterns from that of the general population may reflect aspects of their way-of-life other than - alcohol intake. Results pooled from ten such studies have shown a significant excess of deaths from cancer of the mouth, oesophagus, rectum, liver, larynx, and lung.4-13 Again, not all results are included in the published work, and it is possible that some reports do not include the data when no excess of deaths was observed. Another point is that the method of study varies; most workers provide estimates of person-years-at-risk, which permits calculation of expected deaths from national age/sex/calendar-period mortality rates. Others6,12 have used comparison populations. There is great variation in the number of subjects so the pooled data are heavily weighted by the results from the larger studies. In case-control studies, epidemiologists have examined the relative risk from high alcoholic consumption in patients with malignant disease of various kinds. Such investigations have either concentrated upon alcohol or studied a range of possible agents including alcohol. Here the evidence points to a link between alcohol consumption and cancers of the head and neck, oesophagus, and liver. The position is not so clear for large bowel and pancreas. Out of thirteen case-control studies on colorectal cancer, three indicated an association with beer consumption; 14-11 four showed no appreciable effect from alcohol consumption;17-20 two showed a negative association ;21,22 and in four there was no comment on alcohol 1. Breslow NE, Enstrom JE. Geographic correlations between cancer mortality rates and alcohol-tobacco consumption in the United States. J Natl Cancer Inst 1974, 53: 631-39. 2. Schrauzer GN. Cancer mortality correlation studies. Med Hypoth 1976; 2: 39-49. 3. Knox EG. Foods and diseases. Br J Prev Soc Med 1977; 31: 71-80. 4. Sunby P. Alcoholism and mortality. Oslo: Universitetsforlaget, 1967. 5. Schmidt W, De Lint J. Causes of death of alcoholics. Quart J Stud Alcohol 1972; 33: 171-85. 6. Pell S, D’Alonzo CA. A five year mortality study of alcoholics. J Occup Med 1973, 15: 120—25. 7. Hakulinen T, Lehtimäki L, Lehtonen M, Teppo L. Cancer morbidity among two male cohorts with increased alcohol consumption in Finland. J Natl Cancer Inst 1974; 52: 1711-14. 8. Nicholls P, Edwards G, Kyle E. Alcoholics admitted to 4 hospitals in England II General and cause specific mortality. Quart J Stud Alcohol 1974; 35: 841-55 9. Monson RR, Lyons JL. Proportional mortality among alcoholics. Cancer 1975; 36: 1077-79. 10. Dean G, MacLennan R, McLoughlin H, Shelley E. Causes of death of blue-collar workers at a Dublin brewery, 1954-1973. Br J Cancer 1979; 40: 581-589. 11. Jensen OM. Cancer morbidity and causes of death among Danish brewery workers Int J Cancer 1979; 23: 454-63. 12. Robinette CD, Hrubec Z, Fraumeni JF. Chronic alcoholism and subsequent mortality in World War II veterans. Am J Epid 1979; 109: 687-700. 13. Thorarinsson AA. Mortality among men alcoholics in Iceland, 1951-74. J Studies Alcohol 1979; 40: 704-18. 14. Stocks P. Cancer in North Wales and Liverpool Region. British Empire Cancer Campaign 1957; 35: Annual Report, Suppl II. 15. Wynder EL, Shigematsu T. Environmental factors of cancer of colon and rectum Cancer 1967; 20: 1520-61. 16. International Agency for Research on Cancer-Intestinal Microecology Group Dietary fibre, transit-time, faecal bacteria, steroids, and colon cancer in two Scandinavian populations. Lancet 1977; ii: 207-11. 17 Pernu J. An epidemiological study of cancer of the digestive organs and respiratory system. Ann Med Int Fenn 1960; 49: 1-117. 18. Higginson J. Etiological factors in gastro-intestinal cancer in man. J Natl Cancer Inst 1966; 37: 527-45. 19. Wynder EL, Kajitani T, Ishikawa S, Dodo H, Takano A. Environmental factors of cancer of the colon and rectum. Cancer 1969; 23: 1210-20. 20. Bjelke E. Case-control study of the stomach, colon and rectum In Oncology 1970 Clark RL, Cumley RC, McCoy JE, Copeland MM, eds. Chicago Year Book Medical, 1971: 320-34. 21. Schwartz D, Lellough J, Flamant R, Denoix PF. Alcool et cancer. résultats d’une enquête rétrospective. Rev Franc Etudes Clin Biol 1962; 7: 590-604 22. Modan B, Barell V, Lubin F, Modan M, Greenberg RA, Graham S. Low fibre intake as an etiologic factor in cancer of the colon. J Natl Cancer Inst 1971, 55: 15-18