Rapid Responses to:
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Rapid Responses: Rapid Responses published:
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![[Read Rapid Response]](/icons/misc/sectionDOWN.gif)
A very large small proportion...
- Stevie M Gamble (18 August 2005)
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selling healthcare interventions for the healthy majority
- M Justin S Zaman (11 September 2005)
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An asylum of experts
- James Penston (16 September 2005)
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Treating Whole population!!
- Sandip Raha (19 October 2005)
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Stevie M Gamble, retired HMIT EC2Y 8BL
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Getz et al’s paper 'Estimating the high risk group for cardiovascular disease in the Norwegian HUNT 2 population according to the 2003 European guidelines: modelling study'(1) published as an Online First on 15th August notes that: ‘Implementation of the 2003 European guidelines on prevention of cardiovascular disease in a well defined Norwegian population would class four out of 10 women and nine out of 10 men aged 50 as at high risk for fatal disease. No men aged 40 or older would be classified as at low risk.’ Prof Ian M Graham, Prof Guy de Backer and Prof Kalevi Pyörälä claimed in their Rapid Response of 12th July (2) that the guidelines they had formulated would only lead to ‘the small proportion who already have established vascular disease or are at very high multifactorial risk’ possibly receiving ‘more intensive advice and evidence based drug therapies’ No reasonable person would describe this proportion of the population as small. And most reasonable people would expect that the people formulating such guidelines would have done some research before they lumbered the long suffering public with yet more exhortations to achieve apparently impossible goals. Incidentally, I have been known to set off the alarm when having my blood pressure monitored; speaking from the perspective of the hypotensive I note that my doctors recommend that I try not to fall over and/or pass out whilst crossing the road, waiting for a tube train or doing self- administered intravenous antibiotics. It’s good advice, but as they readily admit, impossible to follow… Stevie Gamble (1) http://bmj.bmjjournals.com/cgi/rapidpdf/bmj.38555.648623.8Fv1 (2)http://bmj.bmjjournals.com/cgi/eletters/330/7506/1461 Competing interests: None declared |
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M Justin S Zaman, British Heart Foundation Research Fellow in Cardiovascular Epidemiology University College London Medical School, London WC1
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As Iona Heath pointed out 'Seventy per cent of the UK population is taking medicines to treat or prevent ill health or to enhance wellbeing. How can this level of medicine taking be appropriate in a population which, by all objective measures, is healthier than ever before? ' (1). At a recent cardiology training weekend for registrars, one consultant cardiologist when asked what tablets he would be taking when aged 70, he replied 'Nothing I hope - I'll live a reasonably healthy life, enjoying the more decadent things in moderation and never measure my cholesterol if I've no other risk factors' Mine's a glass of red at my local Italian restaurant... 1. Who needs health care—the well or the sick? Heath BMJ.2005; 330: 954-956. Competing interests: None declared |
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James Penston, Consultant Physician/Gastroenterologist Scunthorpe General Hospital, Cliff Gardens, Scunthorpe, North Lincolnshire DN15 7BH
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Sir, Getz et al. [1] deserve credit for drawing attention to the unwelcome consequences of the European guidelines for the assessment of cardiovascular risk.[2] It is, indeed, disturbing to learn that the application of these guidelines would result in all men over the age of 40 years in Norway being classified as at either intermediate or high risk of a cardiovascular event. For many years, the medical establishment accepted the validity of cardiovascular risk based on the Framingham study only to find out eventually that it was unreliable and produced inflated estimates when used in populations outside of the USA. [3] Now we learn that implementation of the European guidelines – which were published as recently as 2003 – would result in the entire male population over the age of 40 years in parts of Europe being subjected to medicalisation. Fit, asymptomatic individuals labelled as being ill, chronic anxiety about health, difficulties with employment and life insurance, everyday lives disrupted by clinic visits, adverse drug reactions – the consequences of injudicious guidelines are legion. Nowadays, there is a kind of madness in medicine. And nowhere is it more clearly observed than in the guidelines emanating from what can only be described as an asylum of cardiovascular experts. [1] Getz L, Sigurdsson JA, Hetlevik I, Kirkengen AL, et al. Estimating the high risk group for cardiovascular disease in the Norwegian HUNT 2 population according to the 2003 European guidelines: modelling study. BMJ 2005;331;1551-4. [2] Conroy RM, Pyorala K, Fitzgerald AP, et al. Estimation of ten- year risk of fatal cardiovascular disease in Europe: the SCORE project. Eur Heart J 2003;24;987-1003. [3] Brindle P, Emberson J, Lampe F, et al. Predictive accuracy of the Framingham coronary risk score in British men: prospective cohort study. BMJ 2003;327;1267. Competing interests: None declared |
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Sandip Raha, Associate specialist Integrated Medicine Princess of Wales Hospital, Bridgend, CF31 1RQ
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Now we may call it medicine and treatment but when whole male population has to take it (40-70yr old males in Norway) can we call it a treatment? Even calling it Primary prevention sounds strange to me. I look after Older patients who have been started on multiple medication after being diagnosed with angina or after MI by Cardiologist, and many of these patient can't stand up or walk properly (their BP is in their boots), they fall and fracture their hip, get admitted repeatedly with falls and dizzy spells in Medical wards and rehabilitation set up. These poor souls eventually (many of them) lose their homes and end up in institutions but they are alive and have not ended up as Cardiovascular end point of Mortality or reinfarct. I wish we had more Cardiologist amongst my older patients! probably will be in next couple of decades!! Are we getting it right at all, probably not when we talk about treating whole population which is living longer every decade in Western world. Competing interests: None declared |
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