Years ago this 94-year old, healthy appearing male came into my office and told me that he felt he was coming down with a slight “cold” and would I admit him to our local hospital “just in case”.

I took an appropriate history, looked him over, pronounced him sound and said, “No. I would not do it because it was inappropriate hospital utilization.” The gentleman smiled and left my office without further discussion, apparently satisfied.

Two days later during my hospital rounds there he was in a hospital bed reading the paper. He gave me a wave and big smile as I walked past his room.

Often I have thought of this case where I was both obviously right and just as obviously wrong in my management of him. I had made a judgment that I do not admit common, uncomplicated colds regardless of age. He made the judgment that I was wrong and knew that getting admitted to the hospital was just as easy as calling the right doctor.

I am older now, wiser, perhaps, and probably more compassionate but death remains inevitable and my job as doctor is to prevent premature death, isn’t it? But there you have the “catch”. Who defines premature?

Through enhanced imaging studies and sophisticated surgical technology we have drastically reduced acute mortality from heart attacks and strokes. No doubt, people who as patients would have died 25 years ago now are living longer to die of other causes, most notably of cancer.

Statin drugs have contributed to this changing picture of morbidity and mortality. Atherosclerosis has an inflammatory basis many researchers now inform us. The role of cholesterol and cholesterol manipulation by statins drugs is now considered to be irrelevant.

Statins’ actions include their powerful anti-inflammatory effect, that of nuclear factor kappa B (NF-kB) inhibition. Through this action, platelet activation and inflammatory cellular responses are modulated.

Through this combination of factors we are slowing down premature death from cardiovascular disease but speeding up all-cause mortality, for death cannot be cheated and cancer deaths are the major contributor in our later years.