Tue, Jul-24-18, 06:24
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Plan: P:E/DDF
Stats: 225/150/169
BF:45%/28%/25%
Progress: 134%
Location: NC
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Pills are not the answer to unhealthy lifestyles ... in The BMJ!
Quote:
Fiona Godlee, editor in chief
fgodlee~bmj.com
More than half of adults aged over 45 will be labelled as hypertensive if new US guidelines are adopted, concludes a study in The BMJ this week (doi:10.1136/bmj.k2357). This equates to 70 million people in the US and 267 million people in China being eligible for antihypertensive drugs, a marked increase on already high rates of drug treatment for high blood pressure. Furthermore, the study calculates that 7.5 million people in the US and 55 million in China would be advised to start drug treatment, while 14 million in the US and 30 million in China would be advised to receive more intensive treatment. The evidence from trials indicates some benefit from drugs in terms of reduced risk of stroke and heart disease, but is mass medication really what we want?
Hypertension is just one of the many heads of the lifestyle disease hydra. Another is type 2 diabetes. Once thought to be irreversible and progressive, it is now known to be potentially reversible through weight loss. This is the cautious conclusion of the review by Nita Forouhi and colleagues (doi:10.1136/bmj.k2234), part of our series on the science and politics of nutrition (bmj.com/food-for-thought). Whether by calorie or carbohydrate restriction, weight loss has been shown to improve glycaemic control, blood pressure, and lipid profile and is the key to treatment and prevention of type 2 diabetes, they say.
What about non-alcoholic fatty liver disease (NAFLD), now estimated to affect more than a quarter of adults and up to 90% of people with obesity or type 2 diabetes? This too is largely a disease of lifestyle, closely linked to overweight and obesity, as well as type 2 diabetes and heart disease. You can read about how to diagnose and monitor patients with NAFLD in the review by Christopher Byrne and colleagues (doi:10.1136/bmj.k2734). As for treatment, again it’s down to weight loss through diet and exercise. There are currently no FDA approved drug treatments. There are, however, about 100 drugs currently going through phase II and III clinical trials, and the NAFLD market is estimated to be worth $1.6bn (£1.2bn; €1.4bn) by 2020.1
This is an appalling prospect. All health systems are under pressure, and it’s right that we stop doing things that don’t work, as Ann Robinson finds (doi:10.1136/bmj.k3028). But pills can’t be the answer to diseases caused by unhealthy living. As well as unsustainable cost for often marginal benefit, they always cause harm. Rather than medicating almost the entire adult population, let’s invest our precious resources in societal and lifestyle change, public health, and prevention.
References
↵Nonalcoholic steatohepatitis drug pipeline overview. Pharmacy Times. Sep 2016. https://www.pharmacytimes.com/contr...peline-overview. Google Scholar
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“Pills always cause harm”: BMJ editor-in-chief calls for lifestyle changes over medication
Quote:
As chronic disease rates increase and the pharmaceutical industry grows in size, are we in danger of believing that popping a pill can solve problems caused by an unhealthy lifestyle?
BMJ editor-in-chief Fiona Godlee certainly thinks so. She cites new US guidelines that would label more than half of adults aged over 45 as hypertensive, exploding rates of type 2 diabetes, and a market for drugs for non-alcoholic fatty liver disease of an estimated $1.6bn by 2020, pointing out that all of these conditions could be addressed by adopting healthier lifestyles. She cites a recent review led by a Cambridge University professor finding that:
Whether by calorie or carbohydrate restriction, weight loss has been shown to improve glycaemic control, blood pressure, and lipid profile and is the key to treatment and prevention of type 2 diabetes
Fiona Godlee has made a point, since she took up the position of editor-in-chief of The BMJ, of standing up for what she believes in. She has, in the past criticized the corruption of medicine and science by the pharmaceutical industry. She also stood behind a decision to publish a critique of the US dietary guidelines by Nina Teicholz, after a correction was published about one of the references. Godlee has spoken up in the past about the way diabetes is treated, describing the way insulin is “pushed” on to diabetic patients as “a scam”. Now, in the latest edition of the BMJ, an article by Godlee describes the growth of the pharmaceutical industry and the growing number of people to be put on medication as:
An appalling prospect. Pills can’t be the answer to diseases caused by unhealthy living. As well as unsustainable cost for often marginal benefit, they always cause harm. Rather than medicating almost the entire adult population, let’s invest our precious resources in societal and lifestyle change, public health, and prevention.
The BMJ: Pills are not the answer to unhealthy lifestyles
Increasingly, people around the world are dramatically improving their health and either reducing or eliminating their need for medications by following a low carbohydrate diet.
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https://www.dietdoctor.com/pills-al...over-medication |
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