Peter Byrne

Organ transplantation and discrimination. Treatment should be available to everyone.

The absolute risk of a first myocardial infarction is influenced by factors that include age, sex, blood pressure, the total concentration of high density lipoproteins, the cholesterol ratio, and diabetes.1 The prevalence of diabetes increases with age, and having the disease removes the protective effect of female sex against cardiovascular disease. Diabetes is commonly associated with hypertension, and an unfavourable lipid pattern combined with these factors contributes to the increase in the relative risk of myocardial infarction. In people with type 2 diabetes the risk of myocardial infarction is between two and six times higher than that of the general population. The initial threshold for using lipid lowering treatment for the primary prevention of myocardial infarction as recommended by European and British guidelines is 2% and 3% risk per year, respectively.1 2 This is similar to the average risk of recurrence of a myocardial infarction.3 4 People who have had a first myocardial infarction are considered to be at a sufficiently high risk to be eligible for secondary prevention with lipid lowering treatment,1 whereas many people who have never had a myocardial infarction have a risk well below the threshold. In contrast, people with diabetes and a single other cardiovascular risk factor may have a risk of a …

On The Edge

Black Dog, BBC1, Tuesday 9 January at 10 35 pm Secret Life of Happiness, BBC1, Wednesday 10 January at 9 10 pm All The Rage, BBC1, Wednesdays at 10 35 pm, 10 to 24 January The BBC has begun the year with a series of television and radio programmes, accompanied by internet information and booklets, that focuses on mental health issues. The ambiguously titled “On The Edge” season is a major initiative to inform the public about mental illness from a variety of perspectives. The principal theme of these programmes, everyday emotional wellbeing, is considered through a broad based approach spearheaded by the three core programmes listed above. All three are shown on the BBCs main television channel but differ in form and audience appeal. Before launching the series of programmes, the BBC gathered existing prevalence studies to define the extent of mental health problems in Britain. The campaign addresses general issues such as stress, anger, and unhappiness in addition to targeting severe depression. Other subjects are covered by “tie in” programmes on television (Kilroy and Newsround), radio (Radio 1s Sunday Surgery, Radio 2s Jimmy Young Show, Radio 4s Womans Hour, and Radio 5s Nicky Campbell Show), and on the web (www.bbc.co.uk/health/ote/). Its timing recognises both new year resolve and the gloom after the festive season. With the help of the mental health charity Mentality, the programme makers gathered together a disparate group of users and professionals last June to advise about content and strategy. Having attended this seminar as a representative of the Changing Minds (anti-stigma) campaign of the Royal College of Psychiatrists, and having seen all three programmes, I can affirm that they have kept to their brief. The programmes are highly watchable and substantially accurate. They seek to draw a clear, person focused picture of mental distress, but within the context of public ignorance of and antipathy to mental illness. Black Dog follows two articulate 30 year olds over six months, providing a video diary of their recurrent depressive episodes. As an observational documentary, its style is more Big Brother than Talking Heads. Stephen and Alison provide frank and at times harrowing accounts of their experiences directly to camera, with additional incisive commentary from their cognitive therapists. The tactic of normalising depression works well: these are not rock stars or “personalities,” nor do they conform to public stereotypes of the hapless and the helpless. At one point Stephen tackles public prejudice directly, citing stereotypes of maniacs and nutters and folk beliefs that mental illnesses are “not real” or a sign of weakness. The depiction of his mothers suicide when he was 10, and its effects on him over 20 years, is compelling television. This documentary will be a valuable resource for those bereaved by the suicide of a family member. Secret Life of Happiness has an intriguing premise—to present existing scientific knowledge about the nature of happiness. Not without irony, it is being screened at the same time as a Channel 4 programme, Living By The Book, which uses real people to live out the instructions of best selling self help books. This programme takes the conventional form of a Horizon-type documentary, with expert after expert presenting their happiness theories. Having disproved the conventional wisdom that money and physical beauty can bring happiness, the programme then examines genetics and relationships before concluding that achievable goals and laughter make happiness more likely. All The Rage uses fast paced imagery, pop songs, and real (if seething) people to explore Britain as the angry man/woman/child of Europe. The first instalment merely sets the scene (road, computer, and metropolitan rage) but suggests few solutions. This series, at least these core programmes, represents a sincere attempt to tackle complex subjects. Through inventiveness and a high standard of research, the programme makers have achieved their objectives. Mental health professionals could not deliver television of this standard, and to a mass audience. We should applaud and encourage those who can.