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For public health without fallacies or legends

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For public health without fallacies or legends

In a recent interview and in order to reaffirm the contribution of the clinical trials and the pharmaceutical industry, the research director of a leading pharmaceutical laboratory made imprecise statements: “276 years have passed since humanity witnessed the first clinical trial in history. On May 20, 1747, Scottish physician James Lind documented the process by which he treated 12 sailors sick with scurvy on the ship Salisbur.

The described case is real but the world‘s first clinical trial is recorded in the “Book of Daniel” of the Bible and it was not performed by a doctor, but by King Nebuchadnezzar; He ordered his troops to eat only meat and drink only wine, a diet that he believed would keep them in good physical condition. Several young men from the royal family objected to the order as they preferred to eat vegetables and the king authorized the continuation of this diet of legumes and water, but only for 10 days. Finished the experiment, the vegetarians seemed to be better fed than carnivores, so the king allowed those who preferred legumes to continue with their diet: an indisputable decision on public health.

Life expectancy in the world: Argentina is in 68th place and Monaco is the country with the highest average

Avicenna (1025 AD) in his encyclopedic ‘Canon of Medicine’ described rules for trying new drugs: suggested that clinical trials should test drugs during the natural course of the disease without its complications and, at the same time, recommended that two different treatment alternatives should always be studied (and not against placebos or nothing, as is unfortunately usual today); also indicated the need for study the action time of each remedy and the evidenced reproducibility of its effects.

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According to Bhatt (2010), another previous medical-clinical trial was performed by the surgeon Ambrose Pare in 1537 as responsible for the treatment of wounded soldiers on the battlefield. Given the high number of injuries and the limited availability of conventional treatment – ​​hot oil – he had to resort to non-conventional treatments. He described: “finally I ran out of oil and was forced to apply a compound made from egg yolks, rose oil, and turpentine. That night I could not sleep peacefully, fearing that due to the lack of cauterization I would find the wounded dead. The next day I found that those who had received the alternative treatment had very little pain, their wounds were not inflamed, and they had slept through the night. The others to whom he had applied the hot oil were feverish with much pain and swelling around their wounds, so I decided never again to burn the poor wounded with oil by arquebuses”.

Life expectancy or quality of life

In a second statement, the aforementioned research director indicated that “clinical research has allowed us to extend our quality of life. Before, people died at 45 years old 50 years ago, and today we see 90 year old people with quality of life”.

More years of life: benefit or burden?

The first part of the paragraph refers to the quality of life while the second to Life expectancy. Faced with the latter, 50 years ago, that is, in 1973the world life expectancy for both sexes it was not 45 years but 59 yearswhile in 2021 it was only 71 years old, that is, in 50 years we have managed to extend it only 12 years 27% more and not double it as suggested by the cited source.

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solid data

Errors or perhaps horrors with these statistical numbers are a recurring phenomenon in this field; also the change in life expectancy at birth is mistakenly confused with a not very significant extension of life in the last 100 years as observed, for example, with numbers from the United States in the following table, prepared using data from National Vital Statistics Reports Volume 64, Number 11 September 22, 2015  United States Life Tables, 2011  Elizabeth Arias, Ph.D., Division of Vital Statistics (Life expectancy for all races and sexes in the United States):

1900/02: Life expectancy at birth: 49.24 years; life expectancy at age 65: 11.86 years
1939/41: Life expectancy at birth: 63.72 years; life expectancy at age 65: 12.80 years
1969/71 Life expectancy at birth: 70.75 years; life expectancy at age 65: 15 years
2011: Life expectancy at birth: 78.71 years; life expectancy at age 65: 19.18 years

Therefore, the change in life expectancy at birth from 49.24 years (in the USA 110 years ago) to 78.71 years, equivalent to an improvement of 59.84%, should not be confused; with a very moderate extension of 9.52% of life expectancy at 65 years (plus 11.86 or 19.18 years equivalent to a change from 76.86 to 84.18 years).

The fundamental reason for the significant improvement in life expectancy at birth (versus the more limited extension of life) is due to a very decisive reduction in infant mortality Thanks to the feedingpediatric care and vaccines.

Quality of life

However, affirming that the advances in quality of life are due to clinical trials is still another reckless marketing statement.

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Ordering knowledge from multidimensional studies, the Public health effective and therefore the quality of life is the result of the joint action or interaction of different factors (health determinants) such as: education (general and specific level); availability and quality of healthcare (preventive, palliative and curative medicine); environmental health (drinking water, sewers, food contamination, pests, etc.); nutrition (shortage of food resources, bad eating habits and overconsumption); addictions (drugs, medicines, tobacco and alcohol); socioeconomic factors (occupation, income, individual development, security, etc.); genetic factors (immune system, propensity to diseases); chronic diseases, endemic or opportunistic; accidents; aging processes and others.

It is therefore important that we reaffirm together a Public Health without fallacies or legends.

* Dr. UBA, MBA and Bsc. Professor and Researcher in Health Economics

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