The certainty of death and the uncertainty of treatments

What is the purpose of depicting death in public health campaigns? Are corpses and rotting flesh the ultimate deterrents? And what happens next? When such graphic images fail to dissuade people from smoking, drinking and overeating, what next? The Grim Reaper does not discriminate, say Estelle Noonan and colleagues, although any number of public health doctors interested in the social determinants of health might choose to disagree. ¹

Still, we must remember to die and prepare for it, a contemplation urged upon us by memento mori, an artistic tradition dating back to the Middle Ages symbolizing death and the physical changes that accompany it. But the use of memento mori in public health campaigns to make us think twice about abusing our bodies with cigarettes, alcohol and unhealthy foods, argue the authors, give the impression that death is somehow preventable. The only certainty in life is death. It will come to all of us, whether or not we see a horrific public health campaign where the spiritual is now secondary to the corporeal; sin replaced by risk.

While death is certain, the effects of treatments are particularly uncertain and randomised controlled trials are now the gold standard for evaluating them. Iain Chalmers recounts the important role of the Medical Research Council, celebrating its hundredth anniversary this year, in developing the science of randomised controlled trials. ² Anniversaries tend to be rare in medical journals, although this issue includes two. The second is the 10th anniversary of the James Lind Alliance, whose purpose is to provide a forum for health professionals and patients to identify clinical uncertainties and agree priorities for research. ³ The Royal Society of Medicine has been a partner organisation since the beginning.

This issue of JRSM covers the art of death, memento mori. It also covers the clinical trial or the science of hope. Whichever grips you more powerfully in a month that offers an opportunity for reflection, you might be interested to find out more about the art, science and mystique of the Kola nut. ⁴