CORRESPONDENCE
Too many pills To the editor: The editorial by Dr. Eugene Vayda "Use of medications: a growing concern" (Can Med Assac J 114: 287, 1976) called to mind a recent article by Christopher and Crooks1 in World Health, entitled "Are we overconsuming?". These writers drew attention to the huge and increasing number of prescriptions dispensed in the United States, England, Wales and other Western countries. In the United States in 1970 an average of about 10 prescriptions were dispensed per person per year (i.e., 1 a week for a family of five), a 50% increase over the previous decade. In England the average was about five prescriptions per person per year. The figure for Sweden was intermediate. One study revealed that in England and Wales "more than half the adult population and almost a third of all children take some kind of medication every day."1 Christopher and Crooks stated, "Many questions remain unanswered: Is the accepted 'norm' of well-being increasingly difficult to attain without the use of psycho-active drugs? Is a higher standard of wellbeing now sought by more people? Ho. is this related to specific factors operating in the society? Are individuals becoming more intolerant of the everyday stresses that affect them physically or mentally? Are these stresses more prevalent in to-day's world and, if so, why? How is this related to alcohol consumption, tobacco smoking, drug dependence?" The writers also stated, "In the UK about 70 per cent of all currently marketed drugs were unknown or unavailable 15 years ago." Other writers are also alarmed. For example, Clements' has noted "mdiContributions to the Correspondence section are welcomed and if considered suitable will be published as space permits. They should be t.written double spaced and, except for case Ieports, should not exceed 1½ pages in length.
viduals are taking pharmaceutical preparations containing vitamins and minerals, and some common foods are enriched with vitamins and minerals in excess of the amounts present in the product originally." How definable are the health benefits derived from this multitude of prescriptions and preparations? Is our general health situation improving? The answer is probably, No. Cochrane,3 from his careful examination of the British National Health Services, emphasized that despite a magnificent and increasing "input" in total services, the dividends from improved "output", in terms of decreases in morbidity and mortality, were disappointingly small. In the United States Burch4 has averred that "people live no longer any more". Others have pointed out that expectations of life at 60 years and at 80 years have scarcely risen in the last 300 years.5 Further, in a study undertaken in South Africa it was shown that in the segments of populations who are 50 or more years old, South African Negroes have a greater chance than whites of reaching 70 or more years.6 There is no doubt, as Christopher and Crooks1 believe, that the enormous increases in the number of prescriptions is part of a total situation that includes increases in smoking, in drug dependence and in alcohol consumption. In the latter respect, for example, in England and Wales from 1950 to 1970 increases occurred in consumption of beer, from 85 to 101 1 per person per year; of imported wines, from 0.78 to 2.88 1; and of spirits, in terms of pure alcohol, from 0.52 to 0.91 l.. The issue, of course, is not pill taking - that will always be With us. The burden is the overconsumption of preparations for therapeutic purposes. There is a very small minority of populations whose attitude is like that of
382 CMA JOURNAL/SEPTEMBER 4, 1976/VOL. 115
Macbeth, "Throw physic to the dogs: I'll none of it." On the other hand, there is the huge majority who partake of a medicament almost daily. In large measure this manner of life with its associated characteristics is a reflection not of those who are happy in the present and hopeful for the future, but rather of those who are uncertain, insecure and fearful of what lies ahead. ALEXANDER R.P. WALKER, D SC MRC human biochemistry research unit South African Institute for Medical Research Johannesburg, South Africa
References 1. CHRISTOPHER L, CROOKS J: Are we overcon-
suming? World Health April issue: 16, 1974 2. CLEMENTS Fw: Nutrition 7: vitamin and mineral supplementation. Med J Aust 1: 595, 1975 3. COCHRANE AL: Effectiveness and Efficiency, London, Nuffield Provincial Hospitals Trust, 1972 4. BURCH GE: People live no longer any more. Am Heart J 83: 285. 1972 5. wIEsLER H: The investigation of mortality. Ann Life Insur Med 1: 3, 1962 6. wALKER ARP: Survival rate at middle age in developing and western populations. Posigrad Med J 50: 29, 1974 7. AYLWARD F: Symposium on 'Alcohol in Nutrition'. Proc Nutr Soc 31: 77, 1972
The Canadian Home Fitness Test To the editor: I wondered whether the two reports in the Apr. 17, 1976 issue of the Journal on the Canadian Home Fitness Test (CHFT) by Shephard, Bailey and Mirwald and by Jett. and colleagues did not belong in a marketing section rather than the scientific section. There was no attempt at validating the test properly by having subjects measure their fitness at home, then comparing the results with values obtained under laboratory conditions. "Home" is a misnomer as applied to this test, for the authors actually found that most Canadians cannot come close to measuring fitness with it at home.
Too many pills To the editor: The editorial by Dr. Eugene Vayda "Use of medications: a growing concern" (Can Med Assac J 114: 287, 1976) called to mind a recent article by Christopher and Crooks1 in World Health, entitled "Are we overconsuming?". These writers drew attention to the huge and increasing number of prescriptions dispensed in the United States, England, Wales and other Western countries. In the United States in 1970 an average of about 10 prescriptions were dispensed per person per year (i.e., 1 a week for a family of five), a 50% increase over the previous decade. In England the average was about five prescriptions per person per year. The figure for Sweden was intermediate. One study revealed that in England and Wales "more than half the adult population and almost a third of all children take some kind of medication every day."1 Christopher and Crooks stated, "Many questions remain unanswered: Is the accepted 'norm' of well-being increasingly difficult to attain without the use of psycho-active drugs? Is a higher standard of wellbeing now sought by more people? Ho. is this related to specific factors operating in the society? Are individuals becoming more intolerant of the everyday stresses that affect them physically or mentally? Are these stresses more prevalent in to-day's world and, if so, why? How is this related to alcohol consumption, tobacco smoking, drug dependence?" The writers also stated, "In the UK about 70 per cent of all currently marketed drugs were unknown or unavailable 15 years ago." Other writers are also alarmed. For example, Clements' has noted "mdiContributions to the Correspondence section are welcomed and if considered suitable will be published as space permits. They should be t.written double spaced and, except for case Ieports, should not exceed 1½ pages in length.
viduals are taking pharmaceutical preparations containing vitamins and minerals, and some common foods are enriched with vitamins and minerals in excess of the amounts present in the product originally." How definable are the health benefits derived from this multitude of prescriptions and preparations? Is our general health situation improving? The answer is probably, No. Cochrane,3 from his careful examination of the British National Health Services, emphasized that despite a magnificent and increasing "input" in total services, the dividends from improved "output", in terms of decreases in morbidity and mortality, were disappointingly small. In the United States Burch4 has averred that "people live no longer any more". Others have pointed out that expectations of life at 60 years and at 80 years have scarcely risen in the last 300 years.5 Further, in a study undertaken in South Africa it was shown that in the segments of populations who are 50 or more years old, South African Negroes have a greater chance than whites of reaching 70 or more years.6 There is no doubt, as Christopher and Crooks1 believe, that the enormous increases in the number of prescriptions is part of a total situation that includes increases in smoking, in drug dependence and in alcohol consumption. In the latter respect, for example, in England and Wales from 1950 to 1970 increases occurred in consumption of beer, from 85 to 101 1 per person per year; of imported wines, from 0.78 to 2.88 1; and of spirits, in terms of pure alcohol, from 0.52 to 0.91 l.. The issue, of course, is not pill taking - that will always be With us. The burden is the overconsumption of preparations for therapeutic purposes. There is a very small minority of populations whose attitude is like that of
382 CMA JOURNAL/SEPTEMBER 4, 1976/VOL. 115
Macbeth, "Throw physic to the dogs: I'll none of it." On the other hand, there is the huge majority who partake of a medicament almost daily. In large measure this manner of life with its associated characteristics is a reflection not of those who are happy in the present and hopeful for the future, but rather of those who are uncertain, insecure and fearful of what lies ahead. ALEXANDER R.P. WALKER, D SC MRC human biochemistry research unit South African Institute for Medical Research Johannesburg, South Africa
References 1. CHRISTOPHER L, CROOKS J: Are we overcon-
suming? World Health April issue: 16, 1974 2. CLEMENTS Fw: Nutrition 7: vitamin and mineral supplementation. Med J Aust 1: 595, 1975 3. COCHRANE AL: Effectiveness and Efficiency, London, Nuffield Provincial Hospitals Trust, 1972 4. BURCH GE: People live no longer any more. Am Heart J 83: 285. 1972 5. wIEsLER H: The investigation of mortality. Ann Life Insur Med 1: 3, 1962 6. wALKER ARP: Survival rate at middle age in developing and western populations. Posigrad Med J 50: 29, 1974 7. AYLWARD F: Symposium on 'Alcohol in Nutrition'. Proc Nutr Soc 31: 77, 1972
The Canadian Home Fitness Test To the editor: I wondered whether the two reports in the Apr. 17, 1976 issue of the Journal on the Canadian Home Fitness Test (CHFT) by Shephard, Bailey and Mirwald and by Jett. and colleagues did not belong in a marketing section rather than the scientific section. There was no attempt at validating the test properly by having subjects measure their fitness at home, then comparing the results with values obtained under laboratory conditions. "Home" is a misnomer as applied to this test, for the authors actually found that most Canadians cannot come close to measuring fitness with it at home.
