High blood pressure (hypertension) was the first symptomless medical condition. Doctors could diagnose and treat it without any reference to how a person feels. When you think about it, typically people go to seek medical help because they have pain or some other sensation that they do not like. In turn improvement can be assessed by how one is feeling.
Since that time we now have other symptomless conditions such as high cholesterol and even early stage type two diabetes where treatment is based on changing numbers rather than changing symptoms.
If we can’t rely on someone feeling better as a marker of progress, then our markers of “improvement” are necessarily, to a degree, arbitrary. For all of these conditions there are levels, which are defined as needing treatment and certain “target” numbers, which are aimed for.
But how are these levels determined? This is a good question and the answer is not clear. There have been allegations that committees, which set treatment guidelines, are tainted by conflicts of interest. A US review found some 75% of panel members and 84% of panel chairs had financial ties to industry.
If a disease threshold is lowered then a large number of people can be reclassified as having a condition, which needs treatment. This expands market size for pharmaceuticals. That those with ties to treatment sellers can make decisions about this is a massive conflict of interest.
Last week a new study was released calling for lower treatment targets for high blood pressure. This was based on a trial of 9000 people and claimed a 25% reduction in cardiovascular events. Sound impressive till you see that the drop was from 2.19% to 1.65%. The real reduction being 0.54%. In addition rates of adverse events were much higher in the “treatment” group. (4.7% versus 2.5%).
As usual there was much fanfare and media reports about lives saved and “game changers”. I do not blame the media; they are picking up on the hype that emanates from those behind the trial.
Much less hype accompanied the news in late September that taking cholesterol-lowering medication extended life by some three days. With no sales possible off the back of this finding, nobody is rushing to spread the word.
Two years ago a major review of guidelines for treating high blood pressure was done in the USA. It was found that the current threshold of 140/90 had no basis in people under 60. And for those over 60, a figure of 150/90 was more appropriate.
Again, very little noise about this as if adopted, sales of blood pressure drugs might drop.
The problem of over diagnosis and over treatment is a real one. Every time a threshold at which a disease can be diagnosed is lowered more people can be classed as having a “condition” needing “treatment”. This is great for those selling products but not for people who have no need of this treatment.
We have seen a relentless lowering of thresholds together with the loosening of criteria for diagnosing mental health illness and mass screening. This has led to the medicalization of life and created patients needing “treatments” out of healthy people.
Treating “risk factors” is great business. Changing thresholds increases market size. Using relative percentage change, rather than absolute change makes good headlines. Proxy health measures like changes in cholesterol and even blood pressure (unless very high) are almost meaningless.
None of this helps our health. Be very, suspicious of breakthroughs and game changers.
This article was first published on www.drjoetoday.com