Naked Capitalism Topic:"We Need to Stop the Overdiagnosis Disease. Step 1: Remove Vested Interests"
Yves here. This setting of overly stringent boundaries for health versus disease is widespread, and also annoyingly contrast with conventional medicine’s indifference to what they regard as subclinical problems like fatigue. For instance, the American Heart Association and the American College of Cardiology published “new” cholesterol guidelines in 2018. I have been told for at least a decade that Homocysteine and triglyceride levels are much better indicators of heart disease risk that cholesterol. So why the fixation on cholesterol? Because statins? Research shows statins are beneficial only for people with actual heart disease, not people at risk of getting heart disease. From a 2018 article:
A comprehensive new study on cholesterol, based on results from more than a million patients, could help upend decades of government advice about diet, nutrition, health, prevention, and medication. Just don’t hold your breath.The study, published in the Expert Review of Clinical Pharmacology, centers on statins, a class of drugs used to lower levels of LDL-C, the so-called “bad” cholesterol, in the human body. According to the study, statins are pointless for most people.“No evidence exists to prove that having high levels of bad cholesterol causes heart disease, leading physicians have claimed” in the study, reports the Daily Mail. The Express likewise says the new study finds “no evidence that high levels of ‘bad’ cholesterol cause heart disease.”The study also reports that “heart attack patients were shown to have lower than normal cholesterol levels of LDL-C” and that older people with higher levels of bad cholesterol tend to live longer than those with lower levels.
Note the Daily Mail actually does a very good job of reporting on science, despite its love of the tawdry.
The link above to the new guidelines also finesses that a few years back, the heart disease officialdom lowered the level of LDL, the “bad” cholesterol, that they considered to be OK, and pushed statins; the “update” backs off on them a bit and discusses other treatment options. See this section from a writeup of the 2013 guidelines:
Cholesterol-lowering statin drugs could be prescribed to an estimated 33 million Americans without cardiovascular disease who have a 7.5 percent or higher risk for a heart attack or stroke within the next 10 years. That’s according to a new cholesterol guideline from the American Heart Association and American College of Cardiology.This is a dramatic change from the 2002 federal cholesterol guideline, which recommended that people should only take a statin if their 10-year risk level exceeded 20 percent. The old guideline only considered a person’s risk for heart disease, leaving out the risk for stroke.
The American Heart Association and American College of Cardiology also recommend that total cholesterol be lower than 200 mg/dl. Yet in women, the level of total cholesterol correlated with the lowest all-factor death rate is…drumroll…270: From reader davidgmills:
I was talking to my brother (PhD in biochemistry as was my father) not too long ago about another PhD in biochemistry, Dr. Ray Peat. Peat did his dissertation on progesterone and had spent 40 years researching it. Progesterone is made from cholesterol and is the precursor of the hormones testosterone, estrogen and hydrocortisone. In other words, four of the body’s six major hormones are derived from cholesterol.Peat did some extensive research on the deaths of women, to find out what was the optimal cholesterol level for longevity. His conclusion was the number women needed for longevity was 270 (very high according to the AMA which wants it under 200). Peat found that low cholesterol did in fact decrease a woman’s chances of dying from a heart attack but caused a woman to die sooner from something else.My brother couldn’t believe what I was telling him about Peat’s research, but after checking out Peat’s articles and references, he concluded Peat was right. In fact, one of the things my brother found in his research was that LDL is very good at killing bacteria. My brother jokingly commented to me that in lowering one’s LDL that you don’t die of heart disease, you die of MRSA much sooner.So both my brother and I who were on statins got off of them. Plus my brother found a new meta study of 62,000 people showing they did no good for those who didn’t have cardiovascular disease, making the decision even easier.My dad, who taught medical students biochemstry for 40 years, found very few MD’s that knew enough biochemistry to give him any confidence in their ability to decide whether medications were justified. So I have always been very skeptical of what they recommend.
This is a very long-winded way of supporting the thesis of the article below, that the medical industry has taken to setting the bar for disease too low for fun and profit.
By Ray Moynihan, Assistant Professor, Bond University and Paul Glasziou, Professor of Medicine, Bond University, Originally published at The Conversation
Did you know the definition of high blood pressure (hypertension) in the United States was recently greatly expanded? Overnight, tens of millions of people were reclassified, leaving one in every two adults with a diagnosis of hypertension.
The move has been welcomed by some but also widely criticised, amid concerns the expanded definition may bring more harm than good to many people, from unnecessary illness labels and unneeded drugs.
What about the condition called “chronic kidney disease” (CKD), diagnosed by measuring blood levels to estimate kidney function? Because it does not account for normal ageing, the current definition labels up to one in two older people as having “CKD”.
But many of those labelled will never have any kidney symptoms, chronic or otherwise, and there’s been repeated criticism within the medical literature. That broad new “disease” was created at a conference sponsored by a major drug company.
Then there are the recent changes to the definition of gestational diabetes which mean up to one in five pregnant women may now be diagnosed. But it’s unclearwhether many among the newly diagnosed mothers or their babies might benefit from this expansion.
It’s time for a major change in how disease definitions and diagnostic thresholds are set. We outline a proposal for how this might happen today in the the journal BMJ Evidence-Based Medicine.
The Growing Problem of Overdiagnosis
In all these examples, the danger is that more and more people may be overdiagnosed. Overdiagnosis means receiving a diagnosis that isn’t likely to benefit you.
Supporters of expanded definitions often have the best of intentions, motivated to diagnose ever milder problems and treat them early.
But early detection can be a double-edged sword. For some people you prevent serious illness, for others you overdiagnose and overtreat things that would never progress and never cause any harm.
One common example is prostate cancer. Researchers recently estimatedthat more than 40% of all the prostate cancer now detected via testing healthy men in Australia may be overdiagnosed. In other words, those cancers would not have caused symptoms or problems during a man’s lifetime, yet they are now being detected and treated with surgery or radiotherapy, often with major complications.
Our research a few years ago studied the panels of experts who actually change the definitions of common conditions, such as high blood pressure or depression.
We found three things. When they made changes, panels tended to expand definitions and label more previously healthy people as ill.
Second, they did not appear to rigorously investigate the downsides of that expansion.
And third, these panels tended to be dominated by doctors with multiple financial ties to drug companies with interests in expanding markets.
A Proposal to Reform How Diseases Are Defined
Today, an international group of influential researchers and family doctors launch a proposal to address this problem of expanding disease definitions. Published in BMJ Evidence-Based Medicine, our proposal is for new processes and new people.
The new processes include rigorously examining evidence for benefits and potential harms, before reclassifying millions of healthy people as diseased. This was proposed in a world-first checklist for groups seeking to change definitions, developed by the Guidelines International Network.
As for new people, today’s article suggests new multidisciplinary panels led by generalists, rather than specialists. It calls for strong representation from consumer or citizen groups, and all members being free of financial ties to drug and other interested companies.
Where to From Here?
Responding to overdiagnosis remains a complex and uncertain challenge, both for individuals, and those who run health systems.
But it’s clearly being taken more and more seriously. The World Health Organisation is co-sponsor of the Preventing Overdiagnosis conference in Sydney this year, where the science of the problem and solutions will be debated.
And just last week, leadership of the Nordic Federation of General Practitioners endorsed this proposal to reform the way diseases are defined. It’s likely others will follow suit, against strong resistance from vested interests.
But as we conclude in today’s BMJ Evidence-Based Medicine article, the time for change is now. We shouldn’t treat people as an ever-expanding marketplace for diseases, for the benefit of professional and commercial interests. We can no longer ignore the great harm to those unnecessarily diagnosed.
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