Arthritis is a common and chronic disease with over 200 conditions included in this category. It affects every tenth inhabitant of the world according to the World Health Organisation (Novosti Press Agency, 1990). Indeed, arthritis and rheumatism are the most frequent self-reported condition in Great Britain with a rate of 80 per 1000 females and 40 per 1000 in males (OPCS, 1989). The Arthritis and Rheumatism Council claim a total figure in the UK of about 20 million people with some form of arthritic disorder, with between six and eight million significantly affected.
The prospects for Parkinson's sufferers have improved immensely with the advent of new drug treatments. More recently the notion that transplantation could, either wholly or partially, alleviate the difficulties associated with Parkinson's disease raised further hopes. As Fahn (1988) says, 'We are living in an exciting time in the history of knowledge and treatment of Parkinson's disease.'
'Choose something common and you will find little is known about it' (Henry Head to the young Dr Russell Brain c 1920). Although common (8 per cent of the population) and recognised for more than 2,000 years, migraine has rarely commanded significant professional or public attention. It does not shorten life or cause permanent injury. In contrast to many current health problems examined in the Office of Health Economics' series, the morbidity generated by migraine does not give rise to substantial costs borne by the National Health Service.
Organ transplantation is one of the most spectacular medical achievements of this century. The first successful human transplant operation took place in Boston, in 1954, when a single kidney was transplanted between identical twins (Murray et al, 1955). Subsequent improvements in surgical techniques, organ preservation, immunosuppressive therapy and life-support technology have made transplantation one of the most rapidly growing areas of modern surgical practice.
Since the publication of the Office of Health Economics' first booklet on epilepsy in 1971, advances in medical treatment, better seizure control and wider availability of appropriate information and counselling opportunities are making it somewhat easier for people with epilepsy to adjust to the condition and integrate fully into society. However, the quality of medical care varies, as does the availability of information and counselling support and thus for many people epilepsy continues to be a distressing condition to accept and live with.
The severe expression of cardiovascular and particularly coronary heart disease in the UK is a proper cause for concern. Analysis of its associations clearly shows the multifactorial - some would say uninterpretable – background to that expression. It is also clear that most of those clinically affected are perceived to have several unfavourable associations, within which however levels of cholesterol stand out. The crucial arguments turn on what follows from that association.
This report from the Office of Health Economics looks at a very important aspect of medical care which is too often ignored. As Jane Griffin points out, about one quarter of all deaths in the United Kingdom are due to the cancers, and when deaths from other chronic diseases and those amongst the frail and elderly are added to this number, a large proportion of the population will end their days as 'terminally ill' patients. Sudden and unexpected deaths are less common.
Outcomes, it is commonly said by general practitioners, are more difficult to measure in our discipline than those in hospital based specialties. This is true but it should not be used as an excuse for continuing sloppy work, for sufficient measures of outcome do exist to keep practices busy with audit for some time to come. We have good data - arguably the best in the world - about the incidence and prevalence of common disease in the community and where these can be linked to effective treatments we have a very valuable tool indeed.
It is fourteen years since the Office of Health Economics produced a paper on asthma (Studies of Current Health Problems No 57). During this time, asthma has been the focus for much research and more has become known about the distribution of asthma in the community, the disability that asthma causes, and the management of the condition, especially its prevention.
Osteoporosis has been a long recognised disorder even if its causes have not. Research undertaken by Little (1973) found examples from as early as the sixth century AD when Paulas Aeginata described a condition of the bone typical of osteoporosis. He also referred to non-healing hip fractures and vertebral 'arthritis' the result of a 'weakness of the parts'. In 1824 Astley Cooper stated that in old age bones 'become thin in their shell and spongy in the texture', he also noted that fractures of the neck of femur (hip) often followed moderate trauma.