Since the Vietnam War ended in 1975, medical researchers have closely watched mortality trends among veterans, finding they succumbed at far higher rates than those who did not serve to a variety of causes ranging from motor vehicle accidents to suicide.
Now, in a congressionally ordered study, the government's Centers for Disease Control conclude that while Vietnam vets experienced a sharp hike in mortality rates in the first five years after they were discharged, the pattern was similar to what happened to men who served in World War II and Korea. The study--in the Journal of the American Medical Assn.--included more than 9,300 Vietnam veterans and 9,000 who never got to Vietnam.
It found elevated Vietnam veteran death rates in the five years after discharge from vehicle accidents, suicide, homicide and accidental poisoning. Beyond that interval, the Vietnam vet death rates reverted to those experienced by Vietnam-era vets who served in the United States, Korea or Germany.
But compared with earlier studies of deaths after Korea and World War II, the new research found Vietnam vets only repeated a previous pattern.
The comparison was based on a 1970 Veterans Administration study noting excess mortality--from accidents, tuberculosis and cirrhosis of the liver in World War II vets and various trauma in Korean veterans--in men who had been prisoners of war. The new study did not delve into the controversy over the herbicide Agent Orange, which was unique to Vietnam.
But the finding about similarities in postwar mortality drew criticism from the Vietnam Veterans of America, where a spokesman said that, while the group was generally pleased with the new study, the conclusion about similarities to Korea and World War II was questionable. Mike Leaveck complained about the comparative use of prisoners of war in the earlier conflicts with veterans-at-large for Vietnam. "This study again underlines the urgent need for more studies," Leaveck said.
'Myth' of Anorexia?
Trumpeted by news media and the eating disorder clinic industry, anorexia nervosa--in which victims (usually teen-age girls or young women) starve themselves, sometimes to death--has come to be perceived as a contemporary epidemic.
But this perception is challenged as a "myth" by two English epidemiologists who say the incidence of anorexia in Britain only parallels the baby boom population bulge in susceptible age brackets. And Dr. Joel Yager, head of the UCLA Eating Disorders Clinic, says the conclusion is an "interesting analysis" that might apply in the United States, where little research on incidence patterns has been done.
In England, Drs. Paul Williams and Michael King concluded in the journal Lancet that increases in the population of young women between 1972 and 1981 had caused the perception of an anorexia epidemic. This was exacerbated by a high rate of rehospitalization after treatment failed that created the misimpression the readmissions were new cases, they said.
Yager said that while he personally believes anorexia actually increased, there has been little research to define the true nature of what happened.
Yager said he has long wondered if anorexia had been "over-medicalized" by distortion of natural teen-age concern about body image into pathologic obsession with weight loss. The trend, he said, was helped along by for-profit eating disorder treatment centers whose advertising, Yager said, has "medicalized normal (adolescent) acting out. There are always the economic motivations."
Exercising to the Beat
A long-standing rule of thumb in aerobic exercise is that activity should not raise the heartbeat above 70% to 80% of a rate computed by subtracting one's age from a baseline of 220 beats per minute. For a healthy 40-year-old man, then, that would mean aerobic training should not cause the heart rate to rise much above 135.
But though physically active patients may often ask physicians for guidance--and be told the formula is to be strictly obeyed--an advice column for doctors says there is more flexibility than the computations may imply. The conclusion was published in the Journal of the American Medical Assn.
While the 70%-80% objective remains practically useful for a wide range of patients, Dr. Edward Winslow of Chicago's Northwestern University Medical School says that "normal, healthy" people can feel safe even if they reach heart rates as much as 36 beats per minute higher than the formula would recommend--or 171 for the mythically average 40-year-old.
All bets are off for swimmers, though, according to the UC Berkeley Health Letter, which counsels that for some obscure physiological reason, swimmers' heart rates are lower than those in other aerobic sports, so swimmers should subtract an additional 13 beats in the formula to determine their basic maximum.
For exercisers suspected of having any kind of heart problem--or people taking certain medications--Winslow suggests the latitude may be less--or nonexistent. A treadmill stress test, he said, often is the only way to determine the maximum safe heart rate in such cases.