Blood Pressure Prevention Under Attack? Another Medical Sacred Cow’s Validity is Questioned
Today’s tenents of medical primary care has certain things we have been conditioned to be concerned about, because everybody knows that these numbers if out of line are bad for you. Said in this fashion, we know what we know because we know what we know it. The simple fact is that we have had this reinforced over and over again so it becomes gospel. A great example is Osteoporosis. Most women have been conditioned to become concerned about this because we know that as they reach menopause, their bones typically lose calcium and some women end up with fractures in the spine and other areas (a really small percentage). The big idea is to take a substance that increases the calcium and eveything will be okee dokee. Dexa scanners are much more sensitive than x rays themselves and everyone is concerned about those numbers, which have helped them sell thousands of drugs. The promise is that you will not have a spinal or the dreaded hip fracture if you take these. What they recently found out is that the drugs have a nasty side effect (http://www.phillipswebster.com/blog/2010/03/fda-warning-fosamax-actonel-boniva-reclast-bisphosphonates-fracture-side-effect/) of drug induced abnormal fractures and of course, as you can see from this post, more work for attorneys.
Another one of these debacles is cholesterol meds or statins. These are known to damage the liver and the muscles and as a chiropractor, I see many people visiting us for back symptoms from these meds which make it difficult for people to exercise, without having other problems (http://www.nytimes.com/2010/03/31/business/31statins.html?_r=1). The problem is the numbers at which these are introduced which are getting lower it seems each year, with questionable benefits, but major side effects. Little is really known about cholesterol, and when it is bad and in whose body is it bad. Simply explained, many people with certain genetic makeups have high cholesterol all their lives, are heavy and live into the late 80’s. Do most people really need this stuff? When are high numbers dangerous and with whom? The current one size fits all answers as a preventative measure has injured hundreds of thousands and we spend precious healthcare dollars preventing the bogeyman of healthcare, the heart attack. The problem is, cholesterol is one of only 18 risk factors and the healthcare system simply does not understand cholesterol well enough to simply say, too high, not good.
The latest concern is of blood pressure, which the NY Times recently reported on yesterday (http://well.blogs.nytimes.com/2011/03/09/rethinking-normal-blood-pressure/?ref=health). For years, blood pressure has been voiced as a concern because overly high blood pressure could kill you, and there is evidence to support this when it is too high. The question being raised is when is it too high? Blood pressure 150 / 95, you should be on medication for that. We all know it is true or is it? Apparently, this otherwise normal guideline to prevent blood pressure related death has been tossed around for years, with the recommendations being changed over the last 30 years on a number of occasions. The question is, do people outside of the normal range really need to be on a diuretic? How far out of the normal range is ok without needing any intervention and what is normal. The study suggests our preventative measures may be another waste of money in the world of healthcare in many cases.
What is a primary care doctor to do? These are some of the basic tenents of their very existence. One would wonder if that the business of medicine has convinced us that we need to be over doctored, need all the preventative ideas they have on the table, marketed heavily by the drug companies because they are a life and death concern, or are they? What do we really need to live to a ripe old age?
What do you think? As always, I value your opinion. Leave a comment if this is something that strikes a chord with you.