Healthy Skepticism Library item: 7102

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Publication type: Journal Article

Christie B.
Guidelines on treating risk factors turn healthy people into patients, doctors say.
BMJ 2006 Nov 11; 333:(7576):988
http://www.bmj.com/cgi/content/full/333/7576/988

Abstract:

Medicine may be going too far in extending risk thresholds for cardiovascular disease-turning many healthy people into worried patients, warned doctors at a conference in Edinburgh last week.

The conference, organised by the Royal College of Physicians of Edinburgh, expressed concern at recent international and UK guidelines that widen the range of people to be targeted for treatment with blood pressure and cholesterol lowering drugs.

Paul Padfield, a consultant physician in Edinburgh and one of the conference’s organisers, said this risks medicalising states previously considered normal while putting more pressure on NHS budgets.

The role for such drugs in treating appropriate patients is undisputed, but the meeting questioned whether doctors were going too far with preventive medicine and overestimating the need to respond to low levels of risk. The more that risk factors are lowered, the more marginal the benefit and the greater the number who need to be treated. Also, more training of doctors is needed so they can explain risk factors to patients to help them make the right decisions.

Iona Heath, a GP from London, cited a Norwegian study that looked at the prevalence of risk factors in the local population and compared them against European guidelines on prevention of cardiovascular disease. The guidelines suggest treatment when blood pressure is >140/90 mm Hg and the serum cholesterol concentration is 5 mmol/l.

The study found that 50% of 24 year olds, 90% of 49 year olds, and 76% of the total population fell into the treatment category. Yet Norway has one of the longest life expectancies in the world. “It is not possible for a country like Norway to have 76% of its population at risk. What is going on?” asked Dr Heath.

She proposed a motion that blamed the drug industry for “turning people into patients in the drive to treat more cardiovascular risk factors.” Two thirds of delegates voted in support of the motion.

Dr Heath said that “we are seeing the explosion of treatment”-not for diseases but just to reduce risk factors. “There is more money to be made by convincing the healthy majority about threats to their health than treating the sick.”

David Gillen, medical director of the drug company Wyeth, challenged that view. He said there was plenty of evidence to support the treatment of risk factors where appropriate and added: “We don’t need to invent new risk factors, we need to do a better job of managing the ones we have got.” That required a partnership between drug companies, health professionals, and the public, he said.

Studies have shown that the thresholds at which people are prepared to accept treatment differ widely among individuals. Simon Maxwell, a senior lecturer in clinical pharmacology at the University of Edinburgh, said that doctors should be trained in explaining risk factors.

Keywords:
Adult Cardiovascular Diseases/drug therapy* Humans Hypercholesterolemia/diagnosis Hypertension/diagnosis Middle Aged Practice Guidelines Risk Assessment Risk Factors