Diagnosis-specific sickness absence as a predictor of mortality: the Whitehall II prospective cohort study
BMJ 2008; 337 doi: https://doi.org/10.1136/bmj.a1469 (Published 02 October 2008) Cite this as: BMJ 2008;337:a1469
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Lappe et al [2] have documented a 77% reduction of cancer incidence
in a population based placebo controlled trial of Vitamin D with 4 years
follow up. Goth et al have demonstrated in a randomised trial of Vitamin
D verses broad spectrum light therapy in patients with seasonal affective
disorder [3] that the mood improvement was correlated with degree of
improvement of serum levels of 25OH Vitamin D level. In this country
(particularly likely in long distance city commuters who for more than
half the year leave and arrive home in the dark) there is considerable
vitamin D deficiency, worse in the increasing portion of our population
with increased skin pigment [4]. With this in mind, one might be tempted
to speculate that Vitamin D deficiency might have something to do with
Head et al’s report [1] of an hazard ratio of 2.5 for death from cancer
for individuals having sickness absences 13 years earlier because of
psychiatric diagnoses. Given the potential benefits now apparent from the
multiplicity of diseases that have been shown to be associated with
Vitamin D deficiency [5] as well as it's effect on all cause mortality
[6], it is surprising that, despite a series of impressive reports of the
needs in this country over the last 4 years [7], minimal action has been
taken by the Department of Health. Furthermore NICE has contributed
nothing to the debate in the last 4 years despite the QALY value being
massively better than any of the expensive drugs they are accepting. One
wonders why there are no complaints in the press over this neglect [8]!
For the last 3 years my Urological colleagues and I have been
unsuccessfully trying to get funding for a chemo-prevention study of
vitamin D supplementation in African-Caribbean’s whose increased
susceptibility to Prostate cancer is well established [9] as is the
evidence that there is increased risk of prostate cancer from life long
Vitamin D deficiency [10]. Given the increasing evidence that the skin
cancer risk comes from UVA while Vitamin D comes from UVB [11] may be we
may need to look for support to Denmark, the birth place of Finsen whose
received the Nobel prize in 1903 for developing the first “sun-lamp” to
treat Tb. On a recent visit I became aware that most towns we visited had
two rival chains of solarium successfully competing for business. Given
that UVB but not UVA has also been shown to reduce blood pressure [12]
there is a clear need to re-appraise the views about sun-beds.
Yours sincerely
RTD Oliver MD, FRCP
Professor Emeritus in Medical Oncology
References:
1. Head, J., et al., Diagnosis-specific sickness absence as a
predictor of mortality. BMJ, 2008. 337: p. 1-7.
2. Lappe, J.M., et al., Vitamin D and calcium supplementation reduces
cancer risk: results of a randomized trial. Am J Clin Nutr, 2007. 85(6):
p. 1586-91.
3. Gloth, F.M., 3rd, W. Alam, and B. Hollis, Vitamin D vs broad spectrum
phototherapy in the treatment of seasonal affective disorder. J Nutr
Health Aging, 1999. 3(1): p. 5-7.
4. Hypponen, E. and C. Power, Hypovitaminosis D in British adults at age
45 y: nationwide cohort study of dietary and lifestyle predictors. Am J
Clin Nutr, 2007. 85(3): p. 860-8.
5. Cannell, J.J., et al., Diagnosis and treatment of vitamin D deficiency.
Expert Opin Pharmacother, 2008. 9(1): p. 107-18.
6. Jia, X., L.S. Aucott, and G. McNeill, Nutritional status and subsequent
all-cause mortality in men and women aged 75 years or over living in the
community. Br J Nutr, 2007. 98(3): p. 593-9.
7. Gillie, O., Scotland's Health Deficit; Sunlight, Vitamin D and health;
Sunlight robbery. www.healthresearchforum.org.uk, 2008.
8. Hawkes, N., Why is the press so nasty to NICE? Bmj, 2008. 337: p.
a1906.
9. Chinegwundoh, F., et al., Risk and presenting features of prostate
cancer amongst African-Caribbean, South Asian and European men in North-
east London. BJU International, 2006. 98(6): p. 1216-20.
10. Bodiwala, D., et al., Prostate cancer risk and exposure to ultraviolet
radiation: further support for the protective effect of sunlight. Cancer
Lett, 2003. 192(2): p. 145-9.
11. Garland, C.F., F.C. Garland, and E.D. Gorham, Epidemiologic evidence
for different roles of ultraviolet A and B radiation in melanoma mortality
rates. Ann Epidemiol, 2003. 13(6): p. 395-404.
12. Krause, R., et al., Ultraviolet B and blood pressure. Lancet, 1998.
352(9129): p. 709-10.
Competing interests:
None declared
Competing interests: No competing interests
Current certification - fit to work?
Dear Editor
The authors of this paper iterate the strong association
between sickness absences resulting from circulatory,
surgical and psychiatric diseases and increased mortality.
Further, they admit to being surprised by sickness absences
with a psychiatric diagnosis being predictive of cancer-
related mortality also.
Those of us who work in the so-called mental 'health' world
(in fact the mental illness one, in so far as the NHS and
social care interpret the term) are not in the least
surprised. The neurobiological and epigenetic study of
mental illnesses are now rapidly unravelling
strong and associative links between the traditionally
separated areas of mental and physical illness (and
health). For as long as we continue to follow the
Descartian Brick Road, we will continue to be surprised at
such associations and to develop and design education,
training and services that dissect the brainmind from the
rest of the body.
The immunological effects of severe psychiatric illnesses
such as schizophrenia, bipolar disorder and major
depression include effects on various lymphocyte and
cytokine responses. The discombobulating effects of not
having one's brainmind to process life clearly, obfuscate
our purposes even further. We may smoke and drink more and
are, by virtue of the psychiatric illness (and sometimes
its treatment, as with weight gian and diabetes), be
further placed at risk. Perhaps many people with so-called
'brittle' asthma or diabetes are people with 'normal'
diabetes and asthma leading brittle lives (many certainly
have psychiatric and psychological comorbidities).
As someone with a diagnosis of recurrent major depression,
I welcome this paper, since it adds to the weight of
evidence for addressing people's needs and not merely
endlessly assessing them. It is also to be hoped that the
QoF mechanism will continue to be harnessed to address this
vital area and enable at least some GPs to get their teeth
back into these issues (even if their fillings need to be
made of gold?)
Yours Sincerely
Dr Chris Manning
Competing interests:
None declared
Competing interests: No competing interests