Monday, July 11, 2016

Less disease?

NYTimes article on killer disease on the decline.

a lot of this is change in diet...

but I wonder if a lot of the decline of heart attack and strokes are due to aggressive treatment of high blood pressure. Here in the Philippines, we frequently see people with a limp walking around. The limp is residual leg weakness after a stroke. Here medicine is too expensive and often blood pressure problems are not detected early.

We used to see a lot of this in the USA, but it became rarer since Aldomet was released in the late 1960s.

Heart disease is less too. Is it the ICU? That people are taking aspirin? Or the decrease in smoking, a major factor in heart attacks.

Colon cancer is the real dilemma. In the 1960's over half the cases were rectal cancer, easily found if you did a rectal exam and/or simple sigmoidoscope. . Now most cases are upstream, requiring a more complicated colonoscopy or barium enema. Why the change? I would say some of it might be from fiber in the diet (colon cancer is rare in parts of East and South Africa where high fiber diets are common). But the change of where the cancer was located started before the American diet started to change in the 1970's. But the graph shows the actual colon cancer rate dropped in the 1990's, which suggests it might indeed be fiber (20 year lag).

Deaths per 100,000 people, age 50 and older 
cancer deaths
If colon cancer
tracked cancer
over all

Screening might also be part of the picture, but I don't have the data on screening. The decrease in death rate might suggest screening and aggressive chemotherapy might be cutting down the death rate.

Another question: It is known NSAIDS, especially Ibuprofen/motrin cut the rate of colon cancer. Is this part of the explantion?

but here is a puzzle: Why is the dementia rate declining?

There are reasons that make sense. Ministrokes result from vascular disease and can cause dementia, and cardiovascular risk factors are also risk factors for Alzheimer’s disease. So the improved control of blood pressure andcholesterol levels should have an effect.
they also cite education, but I suspect this is because if you diagnose dementia with intellectual tests that are passed easier if you are educated....again I wonder if studies (eg MRI) show more alzheimer's dementia in the uneducated? But not all Alzheimer's is dementia.

the deline in stomach cancer is mentioned. This declined long before I went to medical school (I saw two cases only) yet it remained a major cause of death in Japan. I suspect it was because of smoked fish. In recent years, c the preservatives in the food? Again I am lacking the data on Japanese diet. But another question is why is lymphoma of the stomach increasing?

Anyway, some good news

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