Pharmaceutical industry

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.

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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.

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