How do doctors decide what is healthy and unhealthy? Do they arbitrarily decide on risk factors to line their pockets – creating false epidemics as Sandy Szwarc at Junkfood Science suggests? Or, is there actually a science, called epidemiology, that is the basis for health recommendations?
As I’ve said repeatedly, one of the sure signs you’re about to hear total BS is if someone suggests there is some conspiracy by scientists or doctors to hide the truth. In an article challenging the use of serum troponin levels to determine whether myocardial infarction (MI) has occurred (a more sensitive method) Sandy suggests this is yet another example of doctors lowering metrics of illness and risk to generate the impression of false epidemics.
There must be a health crisis to bring the greatest funding for research, treatments and education… even if an epidemic has to be created. One of the most common tactics is to change the definition. When diagnostic criteria is broadened, suddenly, with the stroke of a pen, new cases can appear to explode in number.
With heart disease deaths dropping dramatically for the past half century, the world’s top four organizations representing heart disease interests have all gotten together to change the definition … of a heart attack.
The World Heart Federation, American College of Cardiology, American Heart Association and the European Society of Cardiology have been championing the new criteria over recent years, and will officially release it next month in the Journal of the American College of Cardiology and in the AHA journal, Circulation. The new definition will use elevations of troponin levels, rather than the traditional cardiac biomarkers, such as the MB-CK enzyme.
This is a truly bizarre argument. Because measuring troponin will allow us to detect more MIs that have occurred, it must of course be part of a plot to make Americans think they’re less healthy. Never mind that more sensitive tests for MI are what is known as a good thing, and that current tests clearly are missing minor heart damage thus underestimating the number of true MIs. Any revision of current standards must be part of a plot! The fact that those scientists got together is a sure sign. We should never let them do that.
While troponins may go up for other reasons, the idea that the test will misdiagnose as heart attacks other disorders is pretty silly. This isn’t a test that is going to be used to diagnose MI in the absence of chest pain or abnormal ECG findings – which enhances the specificity of the test – and doctors are aware of confounding diagnoses – it’s their job to find them. Further, the idea that the new criteria were designed to somehow justify funding for heart disease (an area of medicine that will never lack for funding) is downright hilarious.
But this isn’t the only example of “false epidemics” being created by those greedy doctors trying to convince people that they’re ill. Sandy mentions other excellent examples.
First, because this is Sandy, is of course obesity:
“Overweight:”Definition changed from BMI â¥ 27 to BMI â¥ 25 by the U.S. National Heart Lung and Blood Institute in 1998, instantly increasing by 43% the numbers of Americans, an additional 30.5 million, deemed ‘overweight.’
So, did doctors just pull that figure out of nowhere to line their pockets? Or does data exist that justify the decision? This study in NEJM(1) is a prospective study of over a million people evaluating all-cause mortality (as well as a number of independent risk factors) showing the relationship between BMI and mortality. Here is the relevant figure – the dark line is most relevant – showing the relative risk of death versus BMI.
Continued below the fold:
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