I’d like to welcome back Klaus K, with a translation of an article by him about the recently-published results of a Danish 10-year random intervention study: “Effect of screening and lifestyle counselling on incidence of ischaemic heart disease in general population: Inter99 randomised trial” (NCBI link). The results – that lifestyle “improvements” have no effect on health – are in line with earlier studies such as the Whitehall and MRFIT studies (described here). Which raises the question: Why, if intervention studies invariably show no improvement in health, are large scale population interventions (such as smoking bans) being undertaken anyway? Obviously not for health purposes!
Some of the links given are to Danish texts.
Public health failure: Lifestyle improvements do not lead to less disease and death
Translated from Danish article by Klaus K, 180grader.dk:
“Lifestyle disease”: – Politicians’ eagerness to push the Danes to improve their lifestyles is beginning to look like a gigantic health policy failure. It is now clear that the political focus on the prevention of “lifestyle diseases” will not lead to less disease and death.
Despite the many expert claims that smoking cessation, exercise, and other lifestyle improvements will prevent illness and death, there is actually no proof that this will happen. Even if you could make all Danes stop smoking, it is unlikely to reduce cancer, according to high quality studies.
This is shown by solid evidence from 40 years of costly human trials – the so-called random controlled intervention trials – where health researchers have succeeded in having thousands of healthy subjects switch to healthier lifestyles – including smoking cessation – without any effect on the participants’ disease and death rate over time (1 – 2).
The negative results were recently confirmed by a large Danish random trial, the Inter99 study, which examined the effect of medical checkups and “intensive lifestyle advice.” Despite the fact that many of the participants improved their lifestyle, the study ended after 10 years with no effect on morbidity and mortality (3), just like the other studies.
And there is reason to pay attention to the results of the random trials. For unlike the comparative statistics of lifestyle and diseases, which is routinely mentioned in the media, random trials can actually tell us something about causes. They are simply of a higher quality than the normal statistical studies, and therefore often called the “gold standard” in statistical studies of diseases (4).
The methodology of these random trials is that the subjects are divided into two groups at random, one group is helped to a “healthy” lifestyle – including smoking cessation – while the other group continues its “unhealthy” lifestyles. Researchers then compare diseases in the two groups over time – for example after 5, 10 or 15 years.
The results have been a big disappointment to the health sector – but they have been clear-cut: Switching to a healthy lifestyle, including smoking cessation, led neither to the reduction of disease nor increased lifespan in healthy subjects. The results of all the trials has been a big round zero.
Result after 10 years of lifestyle improvements in huge Danish study: No effect
At the start of the Inter99-study a team of Danish doctors and health professionals gave intensive assistance to 6,091 locals to get them to improve their lifestyle – with great success: Participants in the “healthy” group stopped or reduced smoking on a large scale (5), they ate more healthily (6) they drank less alcohol (7), and the men did more exercise (8), while the control group continued its “unhealthy” lifestyles.
But alas – after 10 years of lifestyle change, there was no difference between the two groups in any of the measured diseases, neither in heart disease, stroke or in total mortality.
Results: Although significant changes in lifestyle were described among participants after five years, we found no effect on development of ischaemic heart disease, stroke, combined events, or death in the entire study population over a 10 year period.
6.091 people in the intervention group participated at baseline. No significant difference was seen between the intervention and control groups in the primary end point, ischaemic heart disease HR: 1.03, CI 95%: (0.94 – 1.13) or in the secondary endpoints, stroke HR: 0.98, CI: (0.87 – 1.11); combined endpoint HR: 1.01, CI: (0.93 – 1.09); total mortality HR: 1.00, CI: (0.91 – 1.09).
And as the authors note in the article, no one has ever succeeded in reducing cancer in similar trials.
There is, in other words, still no evidence that it will lead to less cancer and heart disease or fewer deaths if you get people who otherwise are healthy to stop smoking and start living “healthily”. Indeed, there is strong evidence to the contrary: that it will have zero effect.
This evidence is a blow to supporters of the ruling public health paternalism and to successive governments’ health policies focusing on prevention of so-called “lifestyle diseases”.
It has already been shown very clearly that health paternalism does not work: Diseases and hospital admissions in Denmark have skyrocketed since politicians began to interfere in people’s lifestyle – with the smoking law in 2007 as the most significant intervention, and with the other health paternalism that has followed:
According to some doctors the disease increases may be due to the so-called nocebo effect: When politicians and the media start talking a lot about health and disease, people tend to speculate more about health and disease too, and thus the fear of getting sick increases. This anxiety itself may be causative.
Health Politicians have naively thought that they could be seen as “good” by making the Danes “healthy”. Instead of respecting people’s chosen lifestyles, they have spent billions of tax dollars on an at best completely useless and at worst harmful crusade upon peoples private lives.
This crusade has been organized with advice of pharmaceutical lobbyists who orbit the politicians at Christiansborg on a daily basis. The situation is starting to look like a public health disaster – and pharmaceutical lobbyists have reason to be satisfied. After all, disease is what they feed on.