CMAJ 1997;156:965
© 1997 Canadian Medical Association
In 1911 George Bernard Shaw remarked that "medical science is as yet very imperfectly differentiated from common curemongering witchcraft."[1] Although Shaw would probably say the same today, we could point to some exceptions. One of these is the cohesive body of research on cholesterol and coronary artery disease (CAD). It is now evident that reducing serum cholesterol lowers the risk of cardiovascular events in healthy people and in people with CAD. In this issue Marc Rivière and colleagues (page 991) use data from the Scandinavian Simvastatin Survival Study[2] to evaluate the cost-effectiveness of long-term simvastatin therapy in a Canadian setting. Their projected cost per year of life gained ranges from $29 888 to only $6108, depending on the postulated effects of treatment. These costs are competitive with other medical interventions in common use.[3]
Wayne Warnica (page 1005) reviews these findings against the background of the Cholesterol and Recurrent Events trial, which showed that even patients with normal LDL cholesterol levels benefited from lipid-lowering therapy.[4] This result, together with the finding that the maximum benefit was attained by patients whose LDL cholesterol levels were reduced by 10% or more, has important therapeutic implications.
Almost every practising physician has seen the results of the abuse of women by their male partners. Lorraine Ferris and colleagues (page 1015) review the literature in this area and provide guidance for physicians. Their advice, which covers detecting abuse, collecting and documenting evidence and dealing with the police and the courts, should be required reading for most physicians.
Grand Manan may be the best-kept secret in the Bay of Fundy. A delightful island 32 km long and a few wide, it boasts several small fishing villages, 3000 permanent residents and 1 family physician. Access is by a 2-hour ferry ride across often treacherous waters. Teleradiology has now made excellent radiologic services available to islanders, eliminating the need for travel for many patients and dramatically reducing the turnaround time for the interpretation of films. Nancy Robb (page 1009) says this tele-radiology project is one sign of growing interest in telemedicine in eastern Canada.
Ontario is only the latest province to take a budgetary whack at public health. An easy target. Public health professionals provide services that are hardly glamorous, and their relentless reminders that health is determined by such factors as poverty, housing and education can be tiresome for a market-oriented government. Larry Chambers (page 1001) urges that public health programs be exempted from the Draconian cost-cutting of the Ontario government. High-quality public health services cannot be guaranteed without provincial funding and should not be left to the idiosyncracies of municipal politics.--JH
References
- Shaw GB. Preface on doctors. The doctor's dilemma, London (UK): Constable & Co.; 1911.
- Scandinavian Simvastatin Survival Study Group. Randomised trial of cholesterol lowering in 4444 patients with coronary heart disease: the Scandinavian Simvastatin Survival Study (4S). Lancet 1994;344:1383-9.
- Tengs TO, Adams ME, Pliskin JS, Safran DG, Siegel JE, Weinstein MC, et al. Five-hundred life-saving interventions and their cost-effectiveness. Risk Anal 1995;15:369-90.
- Sacks FM, Pfeffer MA, Moye LA, Rouleau JL, Rutherford JD, Cole TG, et al. The effect of pravastatin on coronary events after myocardial infarction in patients with average cholesterol levels. N Engl J Med 1996;335:1001-9.
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