At my recent checkup, my systolic blood pressure was 145 (one measurement taken by manual means). My doctor expressed concern about this and asked me to monitor my blood pressure. A few years back, I also had a bout of higher blood pressure and bought the top-rated automatic blood pressure checker. I had found that by sitting still and breathing deeply, I could lower my systolic blood pressure to 130 (sometimes lower). During the summer, when I am not teaching, it will go even lower. But, my high reading got me interested in high blood pressure—hence this essay.
I had recalled that what counted as high blood pressure had changed over the years. The ideal now is 120 systolic (though there was a push for 115). Looking into the change, it turns out that the pharmaceutical companies that sell blood pressure medication were instrumental in the change. This influence even extends worldwide, with the WHO panel on the matter being strongly connected with the industry. As is standard practice in the industry, there have been concerted efforts to “educate” and influence doctors by the pharmaceutical companies. This connection has not gone unnoticed, leading some to question whether the new guidelines are legitimate or merely a money maker for the pharmaceutical companies. While I will certainly not begin by assuming a conspiracy, this matter is well worth considering.
The scientific evidence seems clear that high blood pressure is unhealthy, but that leaves open the question of what counts as high blood pressure. There are also practical concerns about properly measuring blood pressure: instruments are often not very accurate, blood pressure varies greatly depending on circumstances and so on. Since I am not medical expert, I will focus on my area of expertise (critical reasoning) and not directly address the specific medical issues.
One obvious concern with the research that has been influenced by the pharmaceutical companies is whether it is accurate. An obvious point of concern is that the influence of these companies on the research means that bias is a factor. That this is a legitimate worry is nicely illustrated by the infamous case of how the sugar industry paid scientists to blame fat, thus distorting health information. The pharmaceutical companies’ role in the opioid crisis shows clearly that these companies have no moral qualms about inflicting great harm in order to make profits. As such, it is reasonable to be suspicious about the guidelines for blood pressure.
One interesting way to motivate suspicion in this matter across the political spectrum is to make use of climate change. Climate change deniers often assert that there is a conspiracy among climate scientists to deceive the public about climate change. Or, at the very least, the scientists are in error because they are being misled by political forces. Climate change believers claim that the fossil fuel industry has been distorting the matter to their own advantage. While the two sides differ about who is distorting information, they both agree that information distortion is a standard practice. As such, it would certainly make sense to them that there could be information distortion about blood pressure.
That said, the fact that research is biased and information distortion occurs does not entail that the results of the research must be wrong. The blood pressure guidelines could be medically sound; it just so happens that they were influenced by the companies and that the new guides provide considerable profit. The problem is, of course, that there is a dearth of unbiased research that would confirm or discredit the biased research. As such, confidence in the guidelines should be relatively low. That said, the evidence seems quite solid that one should strive to keep one’s blood pressure low—and the non-drug ways to do this (exercise, rest, good diet, stress management) are good even for people who don’t have unhealthy high blood pressure. So, I certainly agree that people should use those methods to be healthy and that high blood pressure is probably bad. However, medication is another matter.
When it comes to medication, the first question (which has been addressed) is whether there is an actual problem. As noted above, high blood pressure does seem to be bad—but it is not entirely clear what is the correct level at which blood pressure is a real health threat. If there is a problem, then the second question needs to be addressed: does the medication work? On the face of it, the blood pressure medications that have been approved by the FDA do seem to work—in that they lower blood pressure. This leads to the third question: if they work, do the benefits outweigh the side effects?
The oldest (and least profitable) blood pressure medication, diuretics, do seem to work with minimal side effects. The new (and more profitable) ones seem to have problematic side effects including increased risk of stroke, increased risk of heart attack, and increased rates of suicide and depression. As such, the rational approach to these medications (as always) would be to weigh the possible harms against the possible benefits. While there are certainly some objective factors in play here, there are also subjective factors—such as how people feel about risk and side effects. Part of the problem in weighing the harms and benefits takes the discussion back to the question of what constitutes unhealthy high blood pressure. Since the research on this is biased, judging whether the drugs the pharmaceutical companies are selling are worth the side effects (and monetary cost) is problematic. Without trustworthy information on the danger, one cannot make a good judgment about accepting risks to offset that alleged danger.
While my focus is on blood pressure, the same sort of problem arises generally when it comes to medicines and surgeries: without independent, trustworthy research we cannot make good health decisions. Unfortunately, there is a general problem with independent research. There has been a systematic defunding of public institutions that engage in research and this creates two major impacts.
The first is that important medical research is not conducted due to lack of funds. The second is that industry often funds the research that is conducted, which biases it. One plausible, but not perfect, solution is to increase the funding of public institutions so that they can increase independent and objective research into health issues. This, of course, will tend to be opposed by industry. While this would reduce their research expenses, it would give them far less control over the research, which could prove slightly problematic for their profits.
A more radical approach would be to impose additional regulations on the pharmaceutical industry such as requiring establishing the validity of medical claims via independent, publicly funded research before drugs could be marketed to address the alleged problems. The challenge would be to balance the need for objective, trustworthy research against medical innovation and (of course) the legitimate business interests of the for-profit industry.
While some might balk at such regulations and make appeals to the free market, it must be pointed out that the key to the pharmaceutical business is the patent system—which is government regulation that prevents competition. These patents are backed up by the public institutions of law enforcement and the courts. As such, piteous cries about the free market should not be heeded, unless the squeeze is truly unfair and too tight. On a personal note, it does worry me that I am unsure whether my blood pressure is a problem, or whether the pharmaceutical companies are lying so they can extort money through a campaign of deceit. In a civilized nation that cares for its citizens, that should not be a real worry. And yet it is.
Get a grip, Mike. That “Big Sugar” story you cite is nonsense.
But as we detailed last month in Science, our own examination of the historical events in question shows this alluring tale of industry meddling is based on a highly selective and profoundly flawed interpretation of the history. The long-deceased Mad Men–era Harvard scientists who stand accused of having been “paid off” to “shift the blame” to fat were, in fact, already on record in support of low-fat diets as a way to fight heart disease for nearly a decade before the sugar men came calling. In adopting this stance they were in sync with the dominant nutritional paradigm of the era: the idea that the fatty American diet, by raising cholesterol levels in the blood, was behind the epidemic of heart attacks that was killing so many middle-aged breadwinners. No blame-shifting was even required!
https://slate.com/technology/2018/03/big-sugar-isnt-to-blame-for-steering-us-away-from-fat.html
Mike, if you think about this for 30 seconds you will know it’s nonsense. These researchers were at Harvard, and if you are at Harvard people throw research money at you. The idea that these researchers would sell out because Big Sugar gave them $6,000 of support while they wrote a review article is ridiculous.
https://www.nytimes.com/2016/09/13/well/eat/how-the-sugar-industry-shifted-blame-to-fat.html
You do point to one source that claims to refute the claim; yet there are credible sources that make the claim. As such, it is hardly “losing my grip” to consider claims by credible sources credible. If there is, in fact, credible refutation of the claim, then I will change my view on that specific claim. It does not, however, show that the general claim about being suspicious of industry funded research is in error.
There are a few bad apples in science, as everywhere else, but in general there is no reason to suspect the quality of industry-funded research.
You have a deep-seated bias against capitalism and business that colors your view of the world. I have yet to see you write anything positive about the free market.
After ten plus years, why would you ever expect such a thing? Amazes me that anyone here would continue to take this propaganda tool seriously.
Well, I’ve never actually seen a free market-just the system we have in which the laws and practices are rigged against real free competition.
There are excellent reasons to suspect industry funded research; just as there is to suspect Democrat funded research about political issues. The research might be fine; but the bias on the part of those funding it provides grounds for suspicion. That is just basic critical thinking about credibility.
Naturally, one should not make the other sort of error and assume that industry funded research must be wrong simply because industry has a stake in the outcome.
We use drugs that were funded by industry research. Our mobile devices were all funded by industrial research. The planes we fly on were developed by industry. The weapons used by our military that we rely on to keep us safe were all developed by industrial research.
Yet, as soon as industry sends money to a university we are supposed to be extra suspicious. Is this a reflection on industry or academia?
I’m fine with research and industry can do a really good job when it is aiming at making something to make a profit (or fulfill a vision). The key difference in the types of research is that tech research is aimed at producing true results-the company wants to have a processor that works. But some research is not aimed at truth, but getting the results that would be profitable. For example, a fictional company that made starships would want their warp drive research to be top notch; but they might try to corrupt research that might expose that their drives increase the crew’s risk of cancer.
You definitely need to watch those academics…
Mike, do you really have so little faith in the integrity of academics? They have tenure, job security, good pay, and prestige. Do you really think a little grant money–which overwhelmingly is used to support grad students–is enough to cause them to commit scientific misconduct?
The more likely explanation is that researchers who are unable to obtain mainstream funding seek out alternative sources. For example, researchers who swim against the tide in climate science will never obtain funding from NOAA or NSF. They are forced to seek funding elsewhere.
Most have integrity; but I have seen how labs struggle under the current funding systems for public education. Industry has the money and it is hard to say “no” when the alternative is letting your lab die and your grad students left adrift.
There is also a serious problem with how “status” is gained in science: you get support with “sexy” success rather than doing important but blah stuff like repeating experiments to confirm/disconfirm.
As far as chump change involved, I’ve heard plenty of inside stories of faculty and administrators engaged in misdeeds over chump change. For example, there was a fellow who billed the school for a water filtration device for his home sink. Not a lot of money, but he was willing to break the law for chump change. There are many other examples, such as folks who run their small expenses through twice for a double reimbursement. So, the reasoning that someone did not do something wrong because the money was small is fairly weak reasoning.
For healthy persons (normal BMI, exercise >4x a week, balanced diet, etc.) I am not sure what risks moderate high blood pressure pose for ostensibly healthy people.
I’ve been told, since my early twenties (I am approaching 50) that I have high blood pressure every time I step into doctor’s or dentist’s office, but not apparently high enough that anyone does anything about it. I’m 6’2″ 175lb. My resting heart rate can still go below 40 at sea level and about 42 at >2000m. I think the medical profession does some kind of qualitative assessment of the ‘whole package’, as they should, about whether moderate high blood pressure is bad and whether it should be medicated. At least this is my experience.
I don’t know about my blood pressure, but I can definitely modify my heart rate enormously just by meditating for a few minutes assuming it’s not after a meal. Digestion always make my heart beat faster.
That reminds me of how my husky was always “1-2 years” from needing a full dental cleaning. She was “1-2 years” from that for 13 years and ended up never getting the cleaning.
I think this issue points to a number of things we’ve discussed. It should come as no surprise to anyone who has read any of my posts that the main takeaway for me is “Don’t trust the government or businesses with influential lobbies”.
That doesn’t mean don’t believe them – just deal with them with caution.
So if my doctor recommends that I follow government standards, I am suspicious of my doctor, and wonder if he is being unduly influenced by factors other than his own judgement and research.
Back in 2008, I frequently engaged in heated political debates with a a far-left liberal coworker, At one time (during the presidential campaign, when Universal Healthcare was a big issue), he was headed to France for one reason or another, and made no secret of the fact that he planned to get a flu shot while he was there, because it was free and they don’t run out of vaccine over there. His comments dripped with political overtones, and illustrated to me just how opinions about science and medicine are influenced by business and politics.
It is common sense to know that things like diabetes, heart disease, hypertension and other similar conditions can be controlled with diet and exercise. When a physician’s “first response” is to go to their prescription pad, I believe that’s as much, if not more, a frustrated reaction to their patients’ insistence on a quick fix – a pill that allows them to continue to have jelly dougnuts for breakfast and macaroni and cheese for lunch – rather than undue influence by some “big Pharma” or lobby-influenced government recommendation.
Personally, I know that I could stand to lose about 40 pounds – ideally I should lose closer to 60. I’ve had this discussion with my doctor many times. My blood pressure is fine – low, even – as is my heart rate, but my cholesterol level is elevated. I take no medication. This is another conversation I’ve had many times with my doctor – we’ve talked about our pill-popping society, the research behind cholesterol medication, the value of diet and exercise in reducing or eliminating the need for medication, genetic influence, conflicting research, and studies involving the life expectancy of high-cholesterol individuals – and I know that I am making an informed decision about my health. I know that my choice is to either succumb to taking a medication that may have deleterious side effects (and provide great profits to a pharmaceutical giant). or to make some serious lifestyle changes, or to just keep on going and take my chances. I don’t care what the government says, I don’t care what Pfizer or AstraZeneca say. I don’t care what Chuck Schumer or Donald Trump have to say on the issue either.
The other issue is one of logical syllogism, which has been brought up in this column more recently with regard to the Kavanaugh debates – i.e.,
“Company C cites research R about a particular issue”
“Company C stands to profit handsomely if research R is believed and followed”
“Therefore, research R is not correct”
Put another way,
“Republican R believes the testimony of Nominee K with regard to a particular scandal
“Republican R stands to benefit greatly if the testimony is found to be true, and Nominee K is confirmed”
“Therefore, the testimony is false”
As I argued then, none of this can be reduced to a simple “premise-conclusion” format. We all have our beliefs, our suspicions, our faith and our cynicism. With regard to our health, we have our own lifestyles and our own bodies – and government “guidelines” are just that – general statements of opinion based on research. The research may be credible in its own right, or be nudged into credibility by surreptitious infusions of cash or quid-pro-quo, but no one recommendation, no one law, no one policy can apply to everyone. (My aunt Grace lived well into her nineties, smoking a pack of cigarettes a day … Jim Fixx was a runner with almost no body fat, and died of a massive heart attack in his 40’s).
We believe what we want to believe – and when so-called “evidence” comes out that “Big Pharma” has “ties” to those in government making recommendations which, if followed, will increase their profits – well, we tend to throw logic and reasoning aside and scurry to our political corners to lock arms with the rest of our tribes.
The flawed conclusions are based entirely on how well they serve our preconceived notions. if we despise big business and believe they put profit over anything else, the conclusions are obvious. If we despise Democrats and believe they will do anything to win, well, those conclusions make sense also.
There is no place in our lives for logic or reasoning.
True; doctors are said to sometimes just write a prescription so they can get through the appointment quickly. This is supposed to happen often with antibiotics, even in cases when the antibiotics are not necessary.
Getting through the appointment quickly is one response, but I think that one is pretty rare. I was talking about the frustration a doctor might have in dealing with a patient whom he knows won’t follow his advice, whose condition is not getting any better, and who insists on a pill so he can continue with his destructive lifestyle.
Patients, too, have that attitude – “Yeah, yeah, doc, I know. Lose weight. Get some exercise. Stop eating fat. Blah, blah blah. Can’t you give me some Lipitor or something? ”
Doctors are put in the position of having to buck “conventional wisdom” that modern medicine has all the answers. They are referred to as “prescribers” on TV ads, and no one listens to them.
It’s not a matter of getting through an appointment quickly, it’s about doing what’s second- or third-best for a patient, when they know that first-best will never happen.
Maybe this attitude comes from pharmaceutical advertising, or maybe it comes from having the idea that “heathcare is a right, and that good health is something that is provided for you by some kind of entitlement.
We live in an age where we can easily blame someone else for our problems, and the idea of taking responsibility for one’s own life is somehow not necessary. We have an unbelievable faith in modern medicine, that it will cure everything with some kind of magic pill – and “Big Pharma” is some evil monster trying to profit from those pills.
Stop eating fat.
This is the problem. Not that people eat fat, but that they have had such simplistic dietary advice shoved at them. For many, maybe even most people fat is good and needed. Stop eating carbs. That’s the problem. Predators eat fatty animals and do not get fat. Grazing animals eat carbs and get fat. The so called studies that most dietary advice are based on have grossly insufficient controls to justify the conclusions reached. But hey, can’t sell lipotor to healthy skinny people.
One problem is the discussion here is conflating the free market with what actually happened in the case of sugar. Government picked a side in the case of diet, and I think it’s obvious this could distort a market. The US government, for decades, promoted a high carbohydrate diet and definitively stated that consumption of fat, particularly saturated fat and cholesterol, were the causes of obesity, heart attacks and cancer. The science is now trending away form this thought.
Americans consumed about 5 grams of sugar a day in 1700. Now they consume ~ 230 grams a day. It doesn’t take a great leap of inductive reasoning to believe this is disrupting our endocrine system.
Actually, a big problem is that the science was there all along. But which science makes it into the ears of elected officials and of other people via media is a whole other issue. For an extremely comprehensive overview of the science of sugar consumption and the politics that made people eat more of it, I suggest reading Gary Taubes’ book, The Case Against Sugar. Here is Taubes at Reason mag:
https://youtu.be/TpALLBqcYTE
As far as your high blood pressure, Mike, along with the normal disclaimer that I’m not giving medical advice and am not a doctor, consider that your high blood pressure may be a sign of athletic over-training. I have really changed the way I train and for the better.
Good point; as you note, the government puts its thumb on the scale when it makes dietary recommendations. These, as a good nutritionist will tell you, reflect more the power of the lobbyists and not the dietary science.
True; I had the same problem a few years back. Cutting back is hard, though.