A few years ago, at my annual checkup, my systolic blood pressure was 145. My doctor was concerned and asked me to monitor my blood pressure. I already owned an automatic blood pressure checker and started taking regular readings, finding that my blood pressure was consistently good (110-130) at home. This inspired an investigation.

I found that one cause was the stress of driving: I’m hyper-vigilant when I drive and my blood pressure spikes. My first reading at the doctor’s office will be high because of this; my second reading is always normal. I also found out that my habit of hydrating also caused the spike. I always visited the water fountain when I arrive, at least until I learned that this also spiked my blood pressure. Thus, I solved my “high” blood pressure problem. But this interest in blood pressure led me to “do my own research” and I recalled that the definition of 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. This influence extends worldwide, with the WHO panel on this having industry connections. Pharmaceutical companies have engaged in concerted efforts to “educate” and influence doctors. This connection has not gone unnoticed, leading some to question whether the new guidelines are legitimate or a money maker for the pharmaceutical companies. While I will not assume a conspiracy, it is rational to be concerned.

The scientific evidence shows that high blood pressure is unhealthy, but there is still the question of what is too high. There are also practical concerns about properly measuring blood pressure: instruments are often inaccurate; blood pressure varies greatly depending on circumstances and so on. Since I am not a medical expert, I will focus on critical thinking and not directly address the medical issues.

One obvious concern with the seemingly biased research is whether it is accurate. That this is a legitimate worry is 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 these companies have no moral qualms about causing harm 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 ideology. Those who believe in climate change claim that the fossil fuel industry has been engaged in a disinformation campaign motivated by a desire for profit.

While the two sides differ about who is engaged in disinformation, they both agree that disinformation is a strategy. As such, it would make sense to them that there could be disinformation about blood pressure. The emotional appeal would be to climate change deniers based on their distrust of science while those who believe in climate change would tend to accept that an industry is engaged in disinformation to the detriment of people.

That said, the fact that research is biased, and disinformation has been spread does not entail that the research must be wrong. The blood pressure guidelines could be medically sound; it might just be coincidence that they were influenced by corporations and that the new guides increase their profits.

The problem is that there is a lack of unbiased research to confirm or discredit the biased research. As such, confidence in the guidelines should be relatively low. That said, the evidence does show that we should strive to keep our blood pressure low. The evidence also shows that the non-drug ways to do this (exercise, rest, good diet, stress management) are good for you even if you don’t have high blood pressure. So, I 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 too high. The second question is does the medication work? On the face of it, FDA approved blood pressure medications 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,  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 harm 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 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 for medicines and surgeries: without independent, trustworthy research we cannot make good health decisions. Unfortunately, there is a 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 often not conducted due to lack of funds. The second is that industry often funds research, 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 and the Trump administration. While this would reduce their research expenses, it would give them far less control over the research, which would be a problem 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. The challenge would be to balance the need for objective, trustworthy research against medical innovation and 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. This is a form of government regulation that prevents competition that corporations usually like. These patents are backed up by the public institutions of law enforcement and the courts. As such, cries about the free market should not be heeded, unless the regulation is truly unfair and too restrictive. On a personal note, it does worry me that I am unsure whether my blood pressure might be 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. And it seems likely that matters will only get worse.