Commentary: Occupational therapy or the major challenge?

At a meeting in Kuopio in Finland in the 1980s, at the welcome dinner, our host stood up to welcome the delegates. Being in the centre of the room, at any one time, he had his back turned to about half the room. Despite this, he impressed by somehow talking to both sides at the same time. This was a trick, he explained, that Finns learnt from being sandwiched between two opposing interests: Russia and Sweden. This is a useful skill for those who have been concerned with developing knowledge of risk factors for coronary heart disease (CHD), and applying it to primary prevention. Facing one way, they encounter the mainstream of clinical medicine, suspicious of prevention as an approach and doubtful of its efficacy; and biomedical research concerned with fundamental disease mechanisms. When fighting these battles my sympathies are with the risk factor brigade. On the other side, there has been a variety of positions, saying that the conventional risk factor story has been overplayed, and that there is much to discover about causes of CHD that would lead to better prospects for prevention than trying to cajole individuals into changing their diet, smoking, and sedentary lifestyle. Among these latter voices have been those arguing, myself included, that the causes of variation in population rates of occurrence of CHD, are social and economic. A focus on individual risk factors is misplaced. 27 Whincup P, Danesh J, Walker M et al. Prospective study of potentially virulent strains of Helicobacter pylori and coronary heart disease in middle-aged men. prediction of coronary heart disease: a prospective study and meta-analysis. cancer in the UK since 1950: combination of national statistics with two case-control studies. control and other risk factors to social variations in coronary heart disease incidence. incidence of coronary heart disease in Britain: the contribution of established risk factors.