Random controlled trials [RCT's] are used to detect benefit from giving treatments to prevent stroke. But randomised trials depend on weeding out atypical cases and expecting everyone in the study to take their treatment as prescribed. It ignores the narrative of the patient's life and herds all patients with a condition together, assuming that they are identical. Normally compliance with treatment is checked regularly and people who drop out are accounted for in the analysis.
A common measure derived from the studies is 'number needed to treat' [NNT] in order to prevent death or recurrence. How many people need to take common treatments to prevent a further stroke? What would your estimate be? 5, 10, 15?
Opinions and estimates vary but it is not unusual for doctors to prescribe treatments that have a NNT of over 100, that is 99 people may take the treatment and experience side effects for one person to survive who otherwise would have died. You could call this 'percentage medicine' which follows from the bias of RCT's away from lifestyle changes and towards drug treatments.
Lifestyle changes such as increasing exercise and weight loss are more difficult to standardise and outcomes are less clear. Multiple prescribing is the result: anti-platelet drugs [eg aspirin], ACE inhibitors [lisinopril] and statins to lower cholesterol levels. These may all be continued into advanced age when changes in memory, sight, hearing and interaction between all the treatments prescribed are largely unknown. Compliance with treatment is almost certainly lower in 'free range' people when compared to well motivated research subjects.
These treatments work but only in a proportion of cases, sometimes a very small proportion of patients can be shown to benefit from this approach, like 1%.
What else could we do? Drugs will never be the answer, though big pharma would like us to think so. The biggest advances in health have come from public health interventions: immunisation, clean water, improving diets. We could apply what we already know. Educate, but you can't force people to exercise more and lose weight. We could be preventing stroke a lot better if we had individualised exercise regimens with incentives for reaching major goals. Sounds like socialised medicine. The uncontrolled marketing of fatty and sugary foods and slimming remedies has kept the economy ticking over but growth in these areas is impacting on the nation's health. Increasingly sedentary jobs are putting more people at risk.
Cycling needs to be made safer and why can't cars offer more exercise while you're driving?
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