Counting what “counts” in healthcare
 

 

DRUG BUST by Alan Cassels

Albert Einstein might have been talking about the way we currently monitor our health when he said, “Not everything that can be counted counts, and not everything that counts can be counted.”

One thing is for sure; when it comes to our own health, the medical system we have created expects everyone to do a lot of counting. In our zeal to count things, we are told to strive for “targets” and to push for lower numbers of blood pressure, blood cholesterol or blood glucose and a lower BMI (body mass index). Amidst all the counting, we often forget the fact that those numbers are surrogates for the things that actually ‘count’ – the quality of your life and your health – and we should never lose sight of that. We measure, calculate and count and some people even fill their lives with the ‘busywork’ around their health numbers hoping that something – better health, maybe? – will be achieved.

If you ever find yourself feeling guilty about your numbers – your apparent “high” blood pressure, or your “high” blood glucose – take some solace in this: numbers concerning your health may seem like objective measures and worth fighting for, but the meanings we construct around them are anything but objective, as they’re so often shaped by the twisting fog of bias, superstition and fear. The numbers aren’t as important as the meanings we attach to those numbers and those meanings are often way out to lunch.

The over-arching problem with much medical measuring and counting is that it wastes valuable time that could be spent on activities that could actually make a difference to our health. It also causes unnecessary worry and needlessly turns people into patients, making us all obsess about the wrong things and sometimes making us do foolish things that make us sicker.

But before you accuse me of health heresy and send a mob of angry doctors to lynch me, let’s take a closer look at some of this stuff.

Blood pressure

The Heart and Stroke Foundation of Canada states that Canadians should “learn about what constitutes healthy blood pressure readings, cholesterol levels and lifestyle habits.” In this vein, they tell you that you should aim for an “optimal” blood pressure reading 120/80 mm Hg. Ok, fair enough, but what, in this context, does “optimal” mean?

For some people, this target is impossibly hard to achieve, even with several drugs. Old people will naturally have higher blood pressure as they age; should they strive for the magic target as well? We need to bear in mind that some people naturally have higher blood pressure than others, our blood pressure fluctuates all the time, sometimes the readings are wrong and sometimes the doctor simply standing next to you causes your pressure to spike and, and, and… The whole blood pressure thing is fraught with uncertainty and controversy.

Even most doctors won’t know about the growing disagreement in the medical community about how low your blood pressure should be. Back in 1999, more than 800 doctors, pharmacists and scientists from dozens of countries around the world signed a letter to then director general of the World Health Organization, Gro Harlem Brundtland, saying that the new hypertension guidelines, developed with pharma’s help, of course, set new international targets for blood pressure, which resulted in “increased use of antihypertensive drugs, at great expense and for little benefit.” Pharma with its own people on the committee deciding the blood pressure guidelines? Mon Dieu!

But that’s the way the world works and it works the same with drug company officials diddling with the setting of targets regarding blood sugars and cholesterol and just about everything else we measure that can be altered by taking a drug. What happens is that these committees inevitably set targets so low, the population of people told to take drugs grows exponentially. What a great way to make money. God bless capitalism.

To say this is crazy making is an understatement, but read on.

BMI

Many people in wellness say you should aim for a Body Mass Index (BMI) of between 18.5 and 24.9 kg/m2, which is a simple mathematical ratio between how tall you are and how much you weigh. If you are curious about your numbers, go online and use any BMI calculator to find yours. If your BMI is 25 or higher, you are considered to be “overweight” and should talk to your doctor about it.

What you won’t be told is that the BMI was invented by a 19th century Belgian mathematician named Lambert Quetelet who explicitly said the BMI should not be used for the purpose of indicating the level of fatness in an individual. Others have said the BMI level is basically useless, as it doesn’t account for relative proportions of bone, muscle and fat and doesn’t really give a clear indicator of obesity level. Since bone and muscle are denser than fat, a person with strong bones, good muscle tone and low fat will have a high BMI. Are you an Olympic rower? Your BMI is probably close to 30!

Despite its limitations, there is evidence that health fascists are terrorizing the population with BMI-derived numbers. A recent article in the UK’s Derby Telegraph tells a story of five-year-old Grace Hill who, according to the article, loves to swim, dance and ride her bike. The picture of her smiling face reveals a normal, healthy looking five year old. Her mom is steaming mad, however, because she recently received a letter from Big Brother (the National Health Service) with the following warning: “Your child is overweight for their age and sex.” Britain’s health service is incurring the wrath of other angry parents who have received similar letters after their youngsters were weighed and measured as part of a nationwide program. You have to ask, “Can labelling kids, who come in all sorts of shapes and sizes, as ‘fat’ and warning their parents they are at risk of heart disease, cancer and strokes be helpful?”

High cholesterol

But let’s move on to the most infamous numbers of all – your cholesterol levels. The Heart and Stroke Foundation is among many groups recommending that men over 40 and women over 50 have their cholesterol checked. The goal is to see if you have “high” cholesterol and thus at increased risk for a heart attack or stroke. Suffice to say the cholesterol level considered ‘normal’ has been fudged lower at least twice in the last decade, an action which overnight has expanded the definition of “high” to include millions more people. The bottom line here is that lowering a person’s cholesterol with drugs, when they’re otherwise healthy, is an utter waste of time.

Don’t believe me? A study in the Archives of Internal Medicine published this past June looked at 65,000 people from nine different statin studies and found that no lifesaving benefit was achieved by treating healthy people with statins. We know that statins can provide modest benefits in people with established heart disease and can help prevent a second heart attack, though it is not possible to extrapolate those benefits to healthy people.

Yet the statin juggernaut keeps rolling on, pushing healthy people to get their cholesterol tested, to “know their numbers” and to obsess about those numbers to the point they are convinced they need to swallow a pill every day – a pill which, in rare cases, could kill them.

The statin cheerleaders have been incredibly effective, making our cholesterol numbers a national obsession and driving a market of gargantuan proportions. In 2009, Canadians filled 31 million prescriptions for statins, at a total cost of $2.6 billion, a ton of money and a lot of drugs for people worried about altering a stupid, little blood reading.

Diabetes

Having diabetes is all about counting the levels of your blood sugars. If you are a diabetic or know a diabetic, you’ll know all about the modern practice of blood letting, i.e. testing your blood sugars sometimes several times a day just to make sure it isn’t too “high.” Last December, CADTH, the Canadian Agency for Drugs in Technology and Health, reported that frequent checking of blood glucose for non-insulin using type-2 diabetics is not a good idea. In fact, there is evidence that frequent checking of blood sugars can be harmful, causing anxiety and depression amongst type-2 diabetics.

Over the last decade, we’ve seen a subtle shift in the marketing of blood testing for type-2 diabetics, with more emphasis on getting these people to test their blood more and more frequently. What’s driving this is the medical marketing machine, which continually scares people into testing their blood sugars frequently, wielding kidney disease, blindness and amputation as fear mongering tools of manipulation. More and more intensive monitoring means lots more money for the glucose test strip makers, the people that make the glucose monitors, and, of course, those who sell drugs.

Those who want to push blood pressure screening, cholesterol-testing, blood glucose monitoring and BMI measuring will say all this counting is important to remain healthy.

But I see it differently. Much of the counting is about aiming for absurd lower thresholds, which results in more and more people helplessly swallowing pills, worrying and obsessing about their numbers and otherwise focusing on the wrong thing.

Before you worry about the numbers coming from your personal cholesterol, blood pressure, blood glucose or BMI levels, you should do what you intuitively know you need to do to stay healthy: eat well, get enough exercise and take time everyday to relax.

The American satirist Ambrose Bierce defined an egotist as a “person of low taste – more interested in himself than in me.” Maybe I should rephrase this: the health egotist is the person more interested in his numbers than his health. To those who wish to be egotistical and love the busywork of counting, I say, go for it; you’re not likely to hurt anyone but yourself.

Alan Cassels is a drug policy researcher at the University of Victoria and the author of The ABCs of Disease Mongering: An Epidemic in 26 Letters. Read his other writings at www.alancassels.com