Healthy Skepticism Library item: 4530

Warning: This library includes all items relevant to health product marketing that we are aware of regardless of quality. Often we do not agree with all or part of the contents.

Publication type: news

Cassels A.
February is Heart Month.
Common Ground (Vancouver) 2003 Jan 1
http://www.commonground.ca/iss/0602175/cg175_cassels.shtml

Full text:

We become what we behold. We shape our tools and then our tools shape us.
— Marshall McLuhan

If you ever find yourself contemplating your own mortality among the tombstones in Victoria’s lush Ross Bay cemetery, overlooking the shimmering Straits of Juan de Fuca, you could, very conveniently, do something to try to delay it.
You could walk across the street to the neighbourhood Fairfield Plaza, a place where you’ll find everything you need to serve your earthly desires: a grocery store, a pub, a medical clinic, a bakery, a hair dresser and a community drug store.
Like thousands of pharmacies around the world, this drug store has a squat, innocuous blood pressure machine, back near the dispensing counter. There, you’ll often see people donning the cuff to check out their numbers, while they wait for the pharmacist to prepare their prescriptions. In fact, this month, you’re likely to see a lot more activity around blood pressure machines, as February is Heart Month in Canada. Sponsored by the Heart and Stroke Foundation, Heart Month is all about getting Canadians active and raising money and awareness about heart disease in Canada. But what kind of “heart healthy” messages are emitted, besides the usual litany of eating properly, getting enough exercise and not smoking, things that, incidentally, you should be doing regardless of what your blood pressure is?
Seems to me, one of the key messages focuses on checking your blood pressure.
Deemed the “silent killer,” high blood pressure, or hypertension, does play a role in one’s chance of having a heart attack or stroke. If I had high blood pressure and my twin brother had normal blood pressure, my increased risk would be about three percent more than his.
Your blood pressure is one of many risk factors, including how overweight you are, whether you smoke, exercise or eat adequate vegetables and fruit, which determine your long-term heart health. Those risk factors seem to get somewhat lost, however, in the enthusiasm over the blood pressure cuff. Yet, the ritual of people checking and rechecking the pressure of the blood in their arteries is an event repeated millions of times per day in clinics, pharmacies, shopping malls and even churches around the globe. While all this monitoring seems magically simple, even public spirited, this activity may actually represent the pinnacle of the invasion of medicine into our lives. Some have even called the blood pressure cuff the ultimate symbol of the medicalization of normal life, which takes a person’s risk for a disease such as blood pressure and turns it into a disease in and of itself.
But you’ll find very few who question the orthodoxy and ask if there may be a downside to getting one’s blood pressure checked.
The folks at the Heart and Stroke Foundation maintain that when it comes to your health, “ignorance is bliss, but it can also be deadly, especially for people who don’t know they have high blood pressure.”
The logic goes like this: if you know what your blood pressure is, and it is “high,” that knowledge would naturally motivate you to do something to bring those numbers down — exercise more, eat better, use less salt, and take your blood pressure drugs and so on.
The obsession with measuring our blood pressure is related to the fact that it is one thing that physicians can more or less control quickly and easily, and it is a practice patients have grown to expect. We have a national love affair with wearing the cuff: in 2001, there were 17.2 million patient visits to office-based physicians for hypertension in Canada, an increase of 30 percent since 1997. According to IMS Canada, a health data company, high blood pressure visits made up almost six percent of all visits to Canadian practitioners.
According to Dr. Norm Campbell, a spokesperson for the Heart and Stroke Foundation of Canada, and head of Canadian Hypertension Education Program, high blood pressure affects about five million adult Canadians. Stoking public concern over high blood pressure also contributes to a pharmaceutical market of gargantuan proportions, worth $13 billion globally (2002 figures), and expected to reach $38.6 billion by 2006. As everyone’s blood pressure inevitably creeps higher with age, investment analysts are getting mighty excited about the baby boom bulge “creating a very attractive target group for the pharmaceutical industry.” (IMS Health)
Ground Zero in the controversy swirling around high blood pressure is, in fact, the very definition of “high,” an arbitrary notch on the dial that medical science uses to distinguish a “normal” (and therefore healthy) blood pressure reading from a “high” (unhealthy) blood pressure reading. Over the years, intervention by public health agencies and pharmaceutical companies has changed, redefined and rejigged this “risk factor,” yet curiously only in one direction: lower. With lower thresholds for what is considered “high” blood pressure, vast new numbers of otherwise healthy people, including children, are labelled “at risk” and possibly worthy of drug treatment.
Current medical opinion cites that blood pressure above 140 over 90 is “high,” meriting some kind of attention. A decade ago, 160 over 100 was considered “high.” In the latest incarnation of guidelines, 130 over 80 has been labelled “prehypertensive.”
Let’s get a reality check here.
Good physicians wouldn’t target a single parameter for treatment and ignore a patient’s unique circumstances, including his hereditary factors or whether he smoked or exercised, and so on. But that doesn’t stop more and more of us from getting our blood pressure checked, even in the aisles of drug stores, and later walking out of our doctors’ offices wearing the label “hypertensive.” God forbid if you didn’t know the “silent killer” was stalking you.
But knowledge is power right?
What if the opposite were true? What if discovering you had high blood pressure led you, not towards a healthier lifestyle and a lower level of risk, but in the opposite direction?
A number of innovative Canadian studies, published over 20 years ago, question the wisdom of the blood pressure screening orthodoxy. Researchers studying a group of 230 steelworkers in Hamilton, Ontario, for more than five years found that the people who were informed that they had high blood pressure went on to be sicker, and more absent from work. Most surprising of all, these individuals ended up earning $1,000 less than their counterparts, despite similar incomes in the year before screening. In other words, just being told you’ve got high blood pressure, with other things being equal, can make you worse off.
The researchers concluded that their results have major implications for hypertension screening programs, because it was the label, not the hypertension itself, which was linked to how healthy the patients were five years later.
Despite the thousands of dollars volunteers will raise during Heart Month, I wonder how much of the money will be allocated towards studying the very paradigm upon which all of the hypertension hysteria is built? About the wisdom of more and more of us getting labelled and then onto faster and more aggressive treatment (read pharmaceuticals)?
Me? I take comfort in the fact that when I walk through a cemetery I know probably half the people in the ground had normal blood pressure. The “silent killer” likely had nothing to do with their deaths, however much we want to focus on, and slay, a single bogeyman.
Alan Cassels is the co-author of Selling Sickness: How the World’s Biggest Pharmaceutical Companies Are Turning Us All into Patients, and a drug policy researcher at the University of Victoria. He has spent most of the last 10 years studying how clinical research about prescription drugs is communicated to policy makers, prescribers and consumers. He is also the founder of Media Doctor Canada (www.mediadoctor.ca), which evaluates the reporting of medical treatments in Canada’s media.