Bit dramatic but here are a few pieces of research that affected policy
John Snow, Soho and the battle to defeat cholera: Ertblog [robskinner.net]
(https://robskinner.net/2014/05/10/john-snow-soho-and-the-battle-to-defea....)
Edward Jenner and the history of smallpox and vaccination: [PMC- nih.gov] (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1200696/)
The paper quotes: In science credit goes to the man who convinces the world, not the man to whom the idea first occurs.
Ignaz Semmelweis [Wikipedia]
<https://en.wikipedia.org/wiki/Ignaz_Semmelweis>
Semmelweis's hypothesis, that there was only one cause, that all that mattered was cleanliness, was extreme at the time and was largely ignored, rejected, or ridiculed. He was dismissed from the hospital for political reasons and harassed by the medical community in Vienna, being eventually forced to move to Budapest.
And one that affected us in primary care in 1985 though the side effect frequency prompted us to make patients use lifestyle changes rather than medications
MRC trial of treatment of mild hypertension: principal results. Medical
Research Council Working Party- [PMC- nih.gov]
(https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1416260/)
The main aim of the trial was to determine whether drug treatment of mild hypertension (phase V diastolic pressure 90-109 mm Hg) reduced the rates of stroke, of death due to hypertension, and of coronary events in men and women aged 35-64 years. Subsidiary aims were: to compare the course of blood pressure in two groups, one taking bendrofluazide and one taking propranolol, and to compare the incidence of suspected adverse reactions to these two drugs. The study was single blind and based almost entirely in general practices; 17354 patients were recruited, and 85572 patient years of observation have accrued. Patients were randomly allocated at entry to take bendrofluazide or propranolol or placebo tablets. The primary results were as follows. The stroke rate was reduced on active treatment: 60 strokes occurred in the treated group and 109 in the placebo group, giving rates of 1.4 and 2.6 per 1000 patient years of observation respectively (p less than 0.01 on sequential analysis). Treatment made no difference, however, to the overall rates of coronary events: 222 events occurred on active treatment and 234 in the placebo group (5.2 and 5.5 per 1000 patient years respectively). The incidence of all cardiovascular events was reduced on active treatment: 286 events occurred in the treated group and 352 in the placebo group, giving rates of 6.7 and 8.2 per 1000 patient years respectively (p less than 0.05 on sequential analysis). For mortality from all causes treatment made no difference to the rates. There were 248 deaths in the treated group and 253 in the placebo group (rates 5.8 and 5.9 per 1000 patient years respectively). Several post hoc analyses of subgroup results were also performed but they require very cautious interpretation.
The all cause mortality was reduced in men on active treatment (157 deaths versus 181 in the placebo group; 7.1 and 8.2 per 1000 patient years respectively) but increased in women on active treatment (91 deaths versus 72; 4.4 and 3.5 per 1000 patient years respectively). The difference between the sexes in their response to treatment was significant (p = 0.05). Comparison of the two active drugs showed that the reduction in stroke rate on bendrofluazide was greater than that on propranolol (p = 0.002). The stroke rate was reduced in both smokers and non-smokers taking bendrofluazide but only in non-smokers taking propranolol. This difference between the responses to the two drugs was significant (p = 0.03).
Numbers and cumulative percentages of people withdrawn from randomised treatment because they developed either suspected adverse reactions to the primary regimen (discussed in detail else where) or levels of blood pressure above the upper limit for the trial are shown in table Vm and fig 2m. The protocol for the follow up routine was the same for these people as for those whose treatment was unchanged. The five and a half year cumulative percentages of people lapsing from follow up (fig 3m) were about 190° and include losses of about 3-50/" due to participants moving house.
The total five and a half year cumulative percentages of men who stopped taking their randomised treatment, including both those withdrawn from their randomly allocated regimen but continuing on follow up and those lapsing from the trial, were 4300 of the bendro fluazide group, 42% of the propranolol group, and 47% of the placebo group. For women the figures were 33%, 40%, and 40% respectively. The cumulative percentages of people not taking either primary active drug by five and a half years were smaller: 33% of men originally randomised to bendrofluazide and 34% of men randomised to propranolol and 28% and 31% respectively of women.
HIFA profile: Richard Fitton is a retired family doctor - GP. Professional interests: Health literacy, patient partnership of trust and implementation of healthcare with professionals, family and public involvement in the prevention of modern lifestyle diseases, patients using access to professional records to overcome confidentiality barriers to care, patients as part of the policing of the use of their patient data
Email address: richardpeterfitton7 AT gmail.com
