Prophylaxis against febrile convulsions.

In fact at no time in the course of the text do I state that lack of exercise is a cause of heart disease and stroke. On p 38 I say, ". . . the physically fit person leads a lifestyle which protects from illness such as coronary disease and stroke." On p 39 I state, "Research by The Irish Heart Foundation shows how important exercise is in the prevention of coronary disease and stroke. The Foundation's research is based on a study of more than 15 000 adult males in the community. It shows that physical exercise does not necessarily protect directly against coronary disease and stroke, but the person who is active during his leisure time is less likely to smoke and overeat, has lower blood pressure and blood cholesterol levels. The risk of atherosclerosis is consequently less. This almost certainly accounts for the smaller number of heart attacks amongst physically active people, because exercise reduces high cholesterol and high blood pressure levels, and contributes fundamentally to weight control." The emphasis in my exercise chapters was on the thesis that the quality of life is greatly improved by physical exercise, hobbies, and sport. At no time did I state that lack of exercise was a cause of heart disease. I am sure that many of my epidemiological colleagues will be startled by the statement attributed to me by your reviewer. Your reviewer also states that I confused physical fitness with health. He cannot have read the text of my book very carefully. I make it quite clear that a life based on regular exercise and physical fitness encourages a low-risk lifestyle and therefore leads to better health. He further makes the point that I assume that because things are risk factors they must be the cause of disease. He then adds the statement, "Oversimplification like this cannot be justified when it distorts the truth"; and he implies thAt I have sdeliberately hidden our ignorance on the subject from the public. I have no hesitation in defending my remarks about cigarette smoking and the various cigaretterelated diseases, including coronary heart disease. My views here are based on the numerous and exhaustive publications by the Surgeon General of the United States. In reviewing the evidence of an association between cigarette smoking and coronary heart disease, the Surgeon General in his last report' states, ". . . It can be concluded that smoking is causally related to coronary heart disease in the common sense of that idea and for the purpose of preventive medicine." In my chapter on hypertension I state that stroke, coronary heart disease, heart failure, and kidney failure are complications of hypertension. Does your reviewer differ with this statement ? At no stage do I say that high cholesterol is a cause of coronary heart disease and stroke. The closest I go to such a statement is as follows: "There is now a vast amount of scientific evidence to link the present high incidence of atheroclerosis and its consequences with a high level of blood fats." I give a fair account of uncertainties about the utility of dietary intervention in primary and secondary prevention and I recommend a balanced diet for healthy people, a view which is supported by 20 national and international commissions which have reported on this subject. I must confess that I find your short review of my book to be inaccurate and misleading. Apart from its reflection on my academic standing in epidemiology and preventive cardiology, it is less than complimentary to the president of the International Society and Federation of Cardiology, who, in your reviewer's words, "aided and abetted" me. Your review is an entire distortion of the message to the public which is contained in my book. RISTEARD MULCAHY