BMJ Editor's Choice: "The miracle cure"

[Andy]

The editor's choice is an article by Fiona Godlee, editor in chief....

As miracle cures are hard to come by, any claims that a treatment is 100% safe and effective must always be viewed with intense scepticism. There is perhaps one exception. Physical activity has been called a miracle cure by no less a body than the Academy of Medical Sciences (http://bit.ly/2lTqDvc); and, like those who avail themselves of it, the supporting science grows stronger by the day. The BMJ recently published a systematic review showing a clear dose-response relation between physical activity and all cause mortality (doi:10.1136/bmj.l4570). The authors concluded that any level of activity is better than none, and more is better still, a message recently encapsulated in the updated guidelines from the UK’s chief medical officers (doi:10.1136/bmj.l5470).

As summarised by Christine Haseler and colleagues this week, the evidence that activity is good for both body and mind is impressive (doi:10.1136/bmj.l5230). People who are more active live longer and have lower rates of cardiovascular disease, cancer, and depression. Physical activity is safe and beneficial for almost everyone, they say. People should “start slow and build up” to avoid injury, and those with chronic illness may benefit from a tailored exercise prescription.

https://www.bmj.com/content/366/bmj.l5605

 

[chrisb]

Physical activity is safe and beneficial for almost everyone, they say.

A little more detail on the exceptions might have been helpful.

 

[Wonko]

Easily falsifiable.

Try asking someone who has no choice but to be physically active how healthy they feel.

What was the average age of death, for 'natural' causes on the plantations, the gulags, or the workhouses?

This may suggest that activity, that more is better, is the philosophy of a moron who hasn't given it any thought whatsoever.

Appropriate levels of activity, that's the bunny.

Not indiscriminate keep going, no pain no gain, just do it it's good for you claptrap.

 

[chrisb]

Do you think she has never met someone who has become hooked on running, to the point of obsession. Mental health suffers, relationships break down. But never mind all that, at least they're healthy.

 

[Mithriel]

 

[Cinders66]

Maybe another one for @PhysiosforME? If they can intercede. (I hope you don’t mind me tagging you). Sadly as things stand, GET our first line official treatment, I don’t think patients would be listened to.
As @davidtuller has been writing to her recently it’s not like she’s unaware of our community.

 

[Jonathan Edwards]

Nice to see her recommending a review of over diagnosis by Henrik Vogt too.
Cheap and cheerful - no need to find out what is wrong - better to leave it as medically unexplained and do lots of exercise.

 

[Barry]

Maybe another one for @PhysiosforME?

Beat me to it.

 

[Barry]

"updated guidelines from the UK’s chief medical officers" ... which guideline is that? Seems like it needs looking at!

As @davidtuller has been writing to her recently it’s not like she’s unaware of our community.

I think you meant @dave30th.

 

[PhysiosforME]

Maybe another one for @PhysiosforME? If they can intercede. (I hope you don’t mind me tagging you). Sadly as things stand, GET our first line official treatment, I don’t think patients would be listened to.
As @davidtuller has been writing to her recently it’s not like she’s unaware of our community.

Adding it to the list!

 

[Snowdrop]

For me the problem really is that she is not wrong -- at least in general terms. Many of us were very physically active before illness and enjoyed it.

The real problem is understanding that there is a horrible exception to that general rule. She and so many others seem to not be able to take that on board.

Why not?

ETA: It seems to me that this is a concept that is being protected. That must be protected for political reasons. They cannot allow it to be questioned as doctrine.

 

[Jonathan Edwards]

That must be protected for political reasons.

Yes, I think it is all politics. The BMJ is doing a jolly good job keeping people well by supporting the cost cutting agendas advocate by both parties (or all six) because it reduces taxes.

 

[rvallee]

The real problem is understanding that there is a horrible exception to that general rule. She and so many others seem to not be able to take that on board.

More than one. Plenty of diseases where the idea of ever-increasing activity is harmful. Plenty where it is explicitly advised against beyond a minimal threshold that never go beyond hard-earned lessons of what the limits are, which would be correct for mild ME patients but that is not the advice given.

The difference here of course being the god-of-the-gaps belief system that "there is no disease", which is an explicit rejection of the scientific process that lead to its definition and a body of evidence that does not solve the puzzle but makes it clear there is one that simply has yet to be resolved.

Still, exercise does not cure disease. It can delay it, diminish it or help in recovery after successful treatment, but it is absolutely not a cure for anything so it's ridiculous to speak of it this way. Language matters and frankly medicine needs a mega-sized slap to the face about being careless, even deceitful, over the meaning of common words.

 

[dave30th]

It's hard to argue against physical activity in the broader sense when you're looking at population-level data. I mean, I assume the human species evolved to move constantly across the savannah while hunting, gathering, and escaping from predators. From what I gather, this piece by Godlee isn't pushing for an actual intervention like GET but for the notion that physical activity promotes health across multiple fronts. Of course, just because physical activity shows benefits when measured in a population does not at all mean it is beneficial for every segment of that population. That aspect or major caveat certainly is not clear from Godlee's piece. I'm not sure if there are a lot of illnesses in which physical exertion makes things worse, but obviously a lot of people are limited in function for any number of reasons and cannot actually engage in much movement.

 

[lansbergen]

Of course, just because physical activity shows benefits when measured in a population does not at all mean it is beneficial for every segment of that population.

 

[Saz94]

Oh ffs

 

[Mithriel]

It's hard to argue against physical activity in the broader sense when you're looking at population-level data. I mean, I assume the human species evolved to move constantly across the savannah while hunting, gathering, and escaping from predators.

I agree most of us do not get enough exercise nowadays but looking at our evolution we are actually quite strange in that regard. We keep our fitness/ mitochondria at the level which suits us right now then when we need more, exercise increases the number of mitochondria and so our fitness level goes up. So when the mammoth herds were due they probably held football matches to get fit enough for hunting them.

Birds, by contrast, get ready for great migrations by lazing about eating as much as possible!

I get annoyed by the constant propaganda about exercise which implies everyone is a lazy couch potato. My parents worked hard all day in a physical job in a factory for very little pay and came home exhausted. My children's generation work in call centres where you have to answer a phone every 30 seconds for very little pay and come home exhausted. Or they are so depressed by living in the poverty of unemployment they numb themselves with TV. Then there is the commute of 2 hours a day or more for many people.

Yes, exercise, yes, it is good for you, but for many people unfitness is an occupational injury.

 

[TiredSam]

From what I gather, this piece by Godlee isn't pushing for an actual intervention like GET but for the notion that physical activity promotes health across multiple fronts.

Not quite sure why such a bleedin' obvious platitude merits editor's choice in the BMJ. Here's a sneak preview of the editor's choice for the next issue ...

Eating has been called a miracle cure for hunger and the supporting science grows stronger by the day. The BMJ recently published a systematic review showing a clear dose-response relation between eating and all cause starvation. The authors concluded that any level of eating is better than none.

Oh ffs

Precisely.

 

[JemPD]

Not quite sure why such a bleedin' obvious platitude merits editor's choice in the BMJ. Here's a sneak preview of the editor's choice for the next issue ...

Eating has been called a miracle cure for hunger and the supporting science grows stronger by the day. The BMJ recently published a systematic review showing a clear dose-response relation between eating and all cause starvation. The authors concluded that any level of eating is better than none.

 

[Sean]