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First, Do No Harm

by | May 5, 2014 | General Health, Health Policy, Heart Disease, Medical Tests, Pharmaceuticals, The Practice of Medicine | 0 comments

It's only fair to share…

blood pressure monitor

There is a very old maxim in medicine, which is first, do no harm. Once upon a time this was fairly easy to comply with, as there was little doctors could actually do. Today many tests and treatments can cause or lead to considerable harm. This does not mean they should not be used but it does mean we need to weigh up the risks against the benefits.

And here is where the problems begin.

There is a very strong tendency to focus on the benefits of treatments and screening programs and an equally strong tendency to downplay or even dismiss possible harms.

Historically people were only treated for illnesses with symptoms, which caused them to see a doctor. If unwell, or in pain, you want relief and to feel better.

When treating a potentially life threatening condition, such as an appendix about to burst, many risks, including death on an operating table, may be acceptable. The same risks would not be acceptable for treatment of a sore little toe.

Today we “treat” conditions, which have no symptoms. The first and most famous is high blood pressure. High cholesterol is another. These “conditions” have (with exceptions) no symptoms. They are detected by medical examination or testing. Improvement is not determined by how you are feeling, but by further measurements.

So it is possible to successfully treat high blood pressure and people feel no better. If they experience side effects they may feel worse.

I will point out that high blood pressure left untreated can increase the risk of heart attack, stroke, kidney damage and other serious problems. However a very valid question is what constitutes high?

And here it gets trickier! 

The standard “cut off” has long been 140/90. Guidelines tell doctors to control blood pressure which means keeping it below that level. Yet last year a major review found there was no actual basis for the figure of 140 in people under 60. And for those over 60 the level was too low and that a level of 150/90 was the cut off.

Let me repeat – no basis exists for these guidelines.

Like most medical conditions with treatment thresholds – the push has been to lower the level at which drugs can be started. The term “pre-hypertension” has been applied to people with normal pressure as they might one day have high blood pressure – what a load of nonsense

In our rush to “treat” high blood pressure something has been forgotten. And that is that low blood pressure is also a problem. As we get older we actually need a higher pressure to keep blood flowing. A new study, which followed 5000 aged over 70, found an up to 40% increased rate of falls. This in turn leads to higher rates of injuries including fractured hips and head injuries.

It is worth adding that virtually no trials are done on the use of blood pressure medications (or any medications) in this age group.

So not only may we not be doing any good, we can do significant harm. This unfortunately is the logical result of slavishly “treating to targets”, demanded by academics and governments, rather than treating the individual person.

It has also been revealed that people taking statin medications to “treat” high cholesterol often eat a poorer diet as they see the pill as a “get out of jail free” card. Another way that treatment ends up doing harm.

So what can we actually do to be healthy for longer? Why not ask those who have done it successfully.

A survey of centenarians showed that the “secret” to a long, healthy life is not pills or trips to the doctor. It is eating right, being active, managing stress and having good relationships.

It is time to revisit our obsession with guidelines, targets and pills. First, let us do no harm.