hooked on stats and prescriptions
Cassels is a pharmaceutical policy researcher at the University
of Victoria and frequent commentator on prescription drug issues.
He is author of a new book, The ABCs of Disease Mongering:
An Epidemic in 26 Letters (Emdash, 2007). For more, visit
his website: www.alancassels.com
and now at twitter@AKECassels
Einstein might have been talking about the way we currently
monitor our health when he said, “Not everything that
can be counted counts, and not everything that counts can be
thing is for sure; when it comes to our own health, the medical
system we have created expects everyone to do a lot of counting.
In our zeal to count things, we are told to strive for “targets”
and to push for lower numbers of blood pressure, blood cholesterol
or blood glucose and a lower BMI (body mass index). Amidst all
the counting, we often forget the fact that those numbers are
surrogates for the things that actually ‘count’
– the quality of your life and your health – and
we should never lose sight of that. We measure, calculate and
count and some people even fill their lives with the ‘busywork’
around their health numbers hoping that something – better
health, maybe? – will be achieved.
you ever find yourself feeling guilty about your numbers –
your apparent “high” blood pressure, or your “high”
blood glucose – take some solace in this: numbers concerning
your health may seem like objective measures and worth fighting
for, but the meanings we construct around them are anything
but objective, as they’re so often shaped by the twisting
fog of bias, superstition and fear. The numbers aren’t
as important as the meanings we attach to those numbers and
those meanings are often way out to lunch.
over-arching problem with much medical measuring and counting
is that it wastes valuable time that could be spent on activities
that could actually make a difference to our health. It also
causes unnecessary worry and needlessly turns people into patients,
making us all obsess about the wrong things and sometimes making
us do foolish things that make us sicker.
before you accuse me of health heresy and send a mob of angry
doctors to lynch me, let’s take a closer look at some
of this stuff.
Heart and Stroke Foundation of Canada states that Canadians
should “learn about what constitutes healthy blood pressure
readings, cholesterol levels and lifestyle habits.” In
this vein, they tell you that you should aim for an “optimal”
blood pressure reading 120/80 mm Hg. Ok, fair enough, but what,
in this context, does “optimal” mean?
some people, this target is impossibly hard to achieve, even
with several drugs. Old people will naturally have higher blood
pressure as they age; should they strive for the magic target
as well? We need to bear in mind that some people naturally
have higher blood pressure than others, our blood pressure fluctuates
all the time, sometimes the readings are wrong and sometimes
the doctor simply standing next to you causes your pressure
to spike and, and, and… The whole blood pressure thing
is fraught with uncertainty and controversy.
most doctors won’t know about the growing disagreement
in the medical community about how low your blood pressure should
be. Back in 1999, more than 800 doctors, pharmacists and scientists
from dozens of countries around the world signed a letter to
then director general of the World Health Organization, Gro
Harlem Brundtland, saying that the new hypertension guidelines,
developed with pharma’s help, of course, set new international
targets for blood pressure, which resulted in “increased
use of antihypertensive drugs, at great expense and for little
benefit.” Pharma with its own people on the committee
deciding the blood pressure guidelines? Mon Dieu!
that’s the way the world works and it works the same with
drug company officials diddling with the setting of targets
regarding blood sugars and cholesterol and just about everything
else we measure that can be altered by taking a drug. What happens
is that these committees inevitably set targets so low, the
population of people told to take drugs grows exponentially.
What a great way to make money. God bless capitalism.
say this is crazy making is an understatement, but read on.
people in wellness say you should aim for a Body Mass Index
(BMI) of between 18.5 and 24.9 kg/m2, which is a simple mathematical
ratio between how tall you are and how much you weigh. If you
are curious about your numbers, go online and use any BMI calculator
to find yours. If your BMI is 25 or higher, you are considered
to be “overweight” and should talk to your doctor
you won’t be told is that the BMI was invented by a 19th
century Belgian mathematician named Lambert Quetelet who explicitly
said the BMI should not be used for the purpose of indicating
the level of fatness in an individual. Others have said the
BMI level is basically useless, as it doesn’t account
for relative proportions of bone, muscle and fat and doesn’t
really give a clear indicator of obesity level. Since bone and
muscle are denser than fat, a person with strong bones, good
muscle tone and low fat will have a high BMI. Are you an Olympic
rower? Your BMI is probably close to 30!
its limitations, there is evidence that health fascists are
terrorizing the population with BMI-derived numbers. A recent
article in the UK’s Derby Telegraph tells a story of five-year-old
Grace Hill who, according to the article, loves to swim, dance
and ride her bike. The picture of her smiling face reveals a
normal, healthy looking five year old. Her mom is steaming mad,
however, because she recently received a letter from Big Brother
(the National Health Service) with the following warning: “Your
child is overweight for their age and sex.” Britain’s
health service is incurring the wrath of other angry parents
who have received similar letters after their youngsters were
weighed and measured as part of a nationwide program. You have
to ask, “Can labelling kids, who come in all sorts of
shapes and sizes, as ‘fat’ and warning their parents
they are at risk of heart disease, cancer and strokes be helpful?”
let’s move on to the most infamous numbers of all –
your cholesterol levels. The Heart and Stroke Foundation is
among many groups recommending that men over 40 and women over
50 have their cholesterol checked. The goal is to see if you
have “high” cholesterol and thus at increased risk
for a heart attack or stroke. Suffice to say the cholesterol
level considered ‘normal’ has been fudged lower
at least twice in the last decade, an action which overnight
has expanded the definition of “high” to include
millions more people. The bottom line here is that lowering
a person’s cholesterol with drugs, when they’re
otherwise healthy, is an utter waste of time.
believe me? A study in the Annals of Internal Medicine published
this past June looked at 65,000 people from nine different statin
studies and found that no lifesaving benefit was achieved by
treating healthy people with statins. We know that statins can
provide modest benefits in people with established heart disease
and can help prevent a second heart attack, though it is not
possible to extrapolate those benefits to healthy people.
the statin juggernaut keeps rolling on, pushing healthy people
to get their cholesterol tested, to “know their numbers”
and to obsess about those numbers to the point they are convinced
they need to swallow a pill every day – a pill which,
in rare cases, could kill them.
statin cheerleaders have been incredibly effective, making our
cholesterol numbers a national obsession and driving a market
of gargantuan proportions. In 2009, Canadians filled 31 million
prescriptions for statins, at a total cost of $2.6 billion,
a ton of money and a lot of drugs for people worried about altering
a stupid, little blood reading.
diabetes is all about counting the levels of your blood sugars.
If you are a diabetic or know a diabetic, you’ll know
all about the modern practice of blood letting, i.e. testing
your blood sugars sometimes several times a day just to make
sure it isn’t too “high.” Last December, CADTH,
the Canadian Agency for Drugs in Technology and Health, reported
that frequent checking of blood glucose for non-insulin using
type-2 diabetics is not a good idea. In fact, there is evidence
that frequent checking of blood sugars can be harmful, causing
anxiety and depression amongst type-2 diabetics.
the last decade, we’ve seen a subtle shift in the marketing
of blood testing for type-2 diabetics, with more emphasis on
getting these people to test their blood more and more frequently.
What’s driving this is the medical marketing machine,
which continually scares people into testing their blood sugars
frequently, wielding kidney disease, blindness and amputation
as fear mongering tools of manipulation. More and more intensive
monitoring means lots more money for the glucose test strip
makers, the people that make the glucose monitors, and, of course,
those who sell drugs.
who want to push blood pressure screening, cholesterol-testing,
blood glucose monitoring and BMI measuring will say all this
counting is important to remain healthy.
I see it differently. Much of the counting is about aiming for
absurd lower thresholds, which results in more and more people
helplessly swallowing pills, worrying and obsessing about their
numbers and otherwise focusing on the wrong thing.
you worry about the numbers coming from your personal cholesterol,
blood pressure, blood glucose or BMI levels, you should do what
you intuitively know you need to do to stay healthy: eat well,
get enough exercise and take time everyday to relax.
American satirist Ambrose Bierce defined an egotist as a “person
of low taste – more interested in himself than in me.”
Maybe I should rephrase this: the health egotist is the person
more interested in his numbers than his health. To those who
wish to be egotistical and love the busywork of counting, I
say, go for it; you’re not likely to hurt anyone but yourself.
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