Fourth paragraph in:
- But the report's authors predicted relatively few of those who fall into the new hypertensive category will need medication. Rather, they hope that many found with the early stages of the condition will be able to address it through lifestyle changes such as losing weight, improving their diet, getting more exercise, consuming less alcohol and sodium and lowering stress.
Further down:
- The guidelines suggest that doctors recommend lifestyle changes for people found to have elevated blood pressure. Those with Stage 1 hypertension should be assessed for their 10-year risk of heart disease or stroke under the parameters of a widely used matrix for cardiovascular health. Those with more than a 10 percent chance, or other complicating factors, should try medication.
“An important cornerstone of these new guidelines is a strong emphasis on lifestyle changes as the first line of therapy. There is an opportunity to reduce risk without necessarily imposing medications,” said Richard Chazal, the immediate past president of the American College of Cardiology.
A revision of hypertension guidelines with an eye towards encouraging better early lifestyle intervention seems like a pretty solid idea to me. I'm not seeing the drive towards greater prescription of antihypertensives that you are here. Frankly, with the amount of deaths from cardiovascular problems in this country (not to mention the preventable load on the healthcare system they create), giving cardiologists and general practitioners more leeway to tackle hypertension sounds like a great idea.
You fundamentally misunderstand the health-industrial complex.
Increasing the number of hypertensive patients from 23% to 46% means increasing the number of medical conditions from 23% to 46%. That means doubling the number of people paying higher premiums for their medical conditions, which means a radical increase in the number of people falling into the high-risk pool. More than that, it means a radical increase in the number of prescriptions for heart medication.
I was refused a life insurance policy (which was required by our commercial underwriter) because a russian thug came to our house and read 128/70. The insurance company told me they would reconsider if I faxed them a copy of my prescription for blood pressure medication. Meanwhile, when I asked my doctor for a prescription for blood pressure medication, she refused because she measured me at 118/60.
The insurance company did not care.
Now - I sorta get along with my doctor. She's patient enough to take my blood pressure when I'm calm and haven't been surprised in the middle of having my coffee by a russian thug who shows up two hours early. But the insurance companies do not care.
One of the most frustrating things about working in healthcare, for me, is the assumption of conspiracy. The idea that because I wear scrubs and hand out bandaids, I'm in on some grand scheme that entraps people into unnecessary/harmful treatment, (or purposefully denies them necessary treatment) is a recurring theme among patients and the public. It's incredibly frustrating.
Part of the reason it's incredibly frustrating is that I too get the gut feeling that there are bad actors in the healthcare system. Hell, it's not even a gut feeling, it's frequently proven to be true (Looking at you, Purdue, Mylan and Kaleo).
But because the average person's contact point with the healthcare industry is a primary care doc, ER staff or EMS personnel, and not insurance or pharma execs, us grunts get tarred with the same brush. And let me tell you, we didn't go into these jobs because we have a sadistic interest in hurting you for cash. There are more lucrative jobs that are easier, require less training, and involve much less poop.
To get around to my point: Please don't treat the American College of Cardiology and a thuggish life insurance company as the same entity. Believe me, those of us on the other side of the stethoscope think insurance companies suck too. The cardiologists who worked on these revisions have doubtlessly each had countless conversations with patients trying to convince them that cutting some salt and going for a run once in a while will literally extend their lifespan, and have seen most of those conversations go nowhere. So now they're trying harder.
- “We're recognizing that blood pressures that we in the past thought were normal or so-called pre-hypertensive actually placed the patient at significant risk for heart disease and death and disability,” said Robert M. Carey, co-chairman of the group that produced the new report. “The risk hasn't changed. What's changed is our recognition of the risk.”
The intent here pretty clearly appears to be to try and get Americans to pull their heads out of the sand a bit and realize that we treat our bodies horribly. Hell, taking lower levels of hypertension seriously might even lead to stopping serious cases before they start, possibly reducing the number of new prescriptions!
Will insurance companies find a way to profit off of this? Probably yes, because they're run by scum. Is your average practitioner happily skipping hand-in-hand with them as they do so? No. And as mentioned:
- The four main classes of drugs for blood pressure have generic versions and can be as cheap as a few dollars a month.
Probably not gonna be an oxycontin-style surge of scummy marketing for these drugs any time soon. And if the sudden surge in prescriptions you posit does come to pass, and some Shkreli type buys them and jacks the price, you can believe that among the first groups to yell about it will be docs and nurses.
It's not as simple as "Oh, hey, let's make more people hypertensive and write more scripts so that our buddies at Cigna can buy another boat". It's easy to play the cynic here and to plaster over the truth in the nuance, but sometimes healthcare providers do things because they care about people's health.
I own a half million dollar medical facility.
My wife was a benefits administrator for a multinational employee benefits firm.
She is now a doctor.
Don't hector me as if I have no understanding of the dynamics at play. I've had to give over 9 months of my life creating 300 pages of documentation so that an industry lobbying group can charge me $7k so that an insurance company will underpay us by 50% rather than simply not covering us in network. Just because you wear a stethoscope does not mean you have a more refined or broader understanding of the medical industry.
FUCK the American College of Cardiology. They're the ones who lowered the cholesterol guidelines in 2004 to put more people on Lipitor. results were predictable.
Ya, I read that part of the article as well just with a dash more pessimism.
When I was a very healthy fit teenage girl I was put on Omeprazole, a proton pump inhibitor for acid reflux with doctors making literally no other attempt to understand why I was having issues in the first place. My first doctor decided that if I started having issues yet again after stopping them we would look at actually trying to figure out what the problem was. He left and the doctor I returned too just gave me a prescription for a years worth of the drug.
And that’s the story of why I don’t trust doctors anymore. Actually just one of them.