Wednesday, 22 August 2012

Polypharmacy & the Inverse Care Law

Inside Health is currently running with at theme of overdiagnosis and polypharmacy:
  • Dr Mark Porter asks whether doctors can try too hard in the early detection of disease and investigates the overdiagnosis of hypertension. This week he discovers that as many as 3 million people who have been told they have high blood pressure may not actually have it - could you be one of them?
One of the interviewees is chest-specialist Professor Alan Muarice who has a cholesterol level of 9.  When asked abour this he responds " is high yes. Do I take any treatment? No."

Asked if he shunned treatement and why he replied, "When the first trials came out suggesting you can effectively lower cholesterol I did think it was a good idea and then more and more evidence has accumulated showing that the amount of benefit you get from treating just an isolated cholesterol and ignoring all of the other things is a very poor way of judging it. Cholesterol is a risk factor but it is a minor risk factor."

He goes on to talk about the side effects of Simvastatin (muscle aches and pains), which cause people to give up exercise - which ultimately cause more harm than good. They go on to talk about focus on 'signs' rather than 'symptoms' and the general obsession with 'numbers'.

The program touches on the overdiagnosis of high blood pressure (and the new entity that is 'pre-high blood pressure' and 'pre-hypertension'; where people with normal blood pressure now find themselves in a medical category suggesting 'risk'.)

In fairness to many doctors, the 'worried well' seem to be driving much of this (see Inverse Care Law).

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