Is lifespan determined in utero?

search will most likely reveal numerous curious and provocative associations between health experiences in early childhood and the occurrence of later disease. Reduced exposure to infection in childhood has been implicated as a factor in the pathogenesis of insulin dependent diabetes (IDDM). Caspar Gibbon et al put this theory to the test in a brief but important paper on pages 384–5, which points to an association between decreased exposure to common infections in infancy, based on general practitioner records, and IDDM in children under the age of 16 years. In conclusion, high quality epidemiological research during the next decade will present us with many intriguing discoveries about the influence of fetal and early childhood experience on diseases in adult life. We need also to tease out similarities of biological mechanisms of disease processes in the young and the elderly. Treatment strategies aimed at manipulating biological processes may be common to both. Stroke in the elderly and hypoxic–ischaemic brain damage in the newborn is but one example. We should also acknowledge the notion that “dependency” provokes similar psycho-social problems at the two extremes of life, including neglect and abuse. The basic science that governs the state of dependency of the very young and the elderly has similarities that might be exploited to provide improved preventive and management strategies for both, even though there will be diVerences in detail.