Every now and then even blind squirrels find acorns. The medical care industry, which long ago abandoned sensible fiscal and therapeutic restraint in the quest for new patients, finally treats us to a revised hypertension guideline that thoughtful people can conclude makes a great deal of sense. It is even based on evidence, or actually the lack of it, which is itself a startling admission of reality from an industry that dances around truth with a nimble sophistry envied by even the most mendacious politicians.
The hypertension guidelines are a sharp departure from last month’s cholesterol guidelines, produced by a supposedly equally august panel of “thought leaders” who gave us guidelines that seemed to channel the The Talking Heads quite literally. John P. Ioannidis, along with Nortin Hadler, easily one of the two or three most important physician thinkers of this or any generation, wrote that the cholesterol guideline will be either…”one of the greatest achievements or one of the worst disasters of medical history.”
- we treat too many people today;
- we rely too much on drugs for things that drugs cannot fix;
- treatment frequently does not produce health because therapy aims at a point, while the pursuit of health is a matrix; and
- if we are really going to improve cardiovascular health, which is strongly implicated not just in stroke, heart disease, and kidney disease, but also cognitive health, people are going to have to change behaviors because there aren’t enough pills on the planet to fix what ails us.
Cognitive health is an especially useful guidepost, because contrary to popular myth, it isn’t something that mysteriously disappears in nonagenarians. The seemingly age-related decline is more likely the manifestation of damage done by a lifetime of incremental harms. Isn’t it edifying to have scientists catch up to our moms?
The new guidelines leave us a redefinition of high blood pressure: greater than 150/90, except in cases where a comorbidity compels pursuit of 140/90 or lower to prevent end-organ damage. This has implications not just for medical care but for workplace wellness, which obsesses with hypertension when it is not obsessing with cholesterol and glucose.
The hypertension guidelines yank away from workplace wellness vendors yet another reason to fine or otherwise antagonize employees who don’t show up at health fairs. The progression of hypertension is strongly related to aging, and healthy aging is the most reliable bulwark against premature stroke, heart attack, kidney failure, or dementia. Unless workplace wellness vendors plan to follow people into retirement, which is when the overwhelming majority of heart attack, stroke, and dementia occurs, there is no logical reason to ask any employee what his or her blood pressure or deign to tell them how to address it.
Understandably, some people will find themselves more confused than ever by this release. Within a month, two groups of supposedly trustworthy professionals have come to the opposite conclusions on the matter of cardiovascular guidelines, one group saying we need to treat millions more people while the other group says we are treating far too many people now. To quote Mark Knopfler of Dire Straits: “If two men say they’re Jesus, one of them must be wrong.”
The “treat less” position is braving the screen-and-prophylactically-medicate tornado sweeping the nation’s healthcare landscape. At some point, that tornado will spin out all of its energy, and just like the real storms, we’ll be left with a littered landscape of people are worse off than before the storm and angry that they’ve been lied to and manipulated. The hypertension guidelines show that at least one cadre of medical industry leaders is willing to forsake revenues and new patient creation in order to dodge this storm. We hope others will follow.
Vik Khanna is a St. Louis-based independent health consultant with extensive experience in managed care and wellness. An iconoclast to the core, he is the author of the Khanna On Health Blog. He is also the Wellness Editor-At-Large for THCB.
Al Lewis is the author of Why Nobody Believes the Numbers, co-author of Cracking Health Costs: How to Cut Your Company’s Health Costs and Provide Employees Better Care, and president of the Disease Management Purchasing Consortium.
Vik and Al will be the first authors of THCB’s new e-publishing venture. Their jointly authored e-book, How To Survive Workplace Wellness With Your Organs, Dignity, and Finances Intact, will be released in Spring 2014. Vik’s solo e-book venture, Your Personal Affordable Care Act: How To Make Yourself Scarce In The Dysfunctional US Healthcare System will be released in January 2014.