Goldmines for drug and device makers in expanding heart markets: two important stories you shouldn't miss

Here are a couple of pieces of excellent journalism every journalist should learn from and every health care consumer should read.

First, a feature in the BMJ from a couple of weeks ago by journalist Ray Moynihan, “Who benefits from prehypertension?” (A subscription is required for full access.) He begins:

When health authorities in the United States were developing new guidelines for the treatment of hypertension in 2003, they decided to create a new diagnostic category. The new category would not be used to diagnose sick people; rather it would label those people whose blood pressure was towards the upper reaches of normal. The problem was what to call this new entity: should it be borderline blood pressure, high normal, or perhaps prehypertension? That’s when market research came to the rescue. “We did focus groups to solidify which one would resonate most with the public,” says George Bakris, professor of medicine at the University of Chicago and a member of the committee that described the new entity. “Prehypertension was a clear winner so we went with that.”

The 2003 guidelines made clear that prehypertension was “not a disease category.” Rather it was a new classification for people with normal systolic blood pressure levels of 120-139 mm Hg or diastolic blood pressure of 80-89 mm Hg. The justification for creating it was simple. The higher the blood pressure, said the guideline writers,”the greater is the chance of heart attack, heart failure, stroke, and kidney disease,” while the risk of death and disease “increases progressively and linearly” from within the normal range. They were also clear that people labelled prehypertensive should not be treated with drugs but urged to adopt lifestyle changes to reduce their risks.

Yet in the wake of the classification–and estimates that up to one in three adults has prehypertension (more than 50 million people in the United States alone)–the new entity is looming large as a possible goldmine for the drug industry. Organisers of a major international conference on prehypertension and cardiometabolic syndrome planned for Vienna next February claim baldly that “pharmaceutical companies are active in testing the place of novel antihypertensive drugs on patients with prehypertension.”
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“I don’t use the word. I don’t like it. It’s a pseudosyndrome,” says Jay Meltzer, a hypertension specialist and emeritus professor from Columbia College of Physicians and Surgeons in New York. “These are healthy people, coming in to their doctor’s offices not feeling sick and being told they have a new disease. It’s outrageous.”
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“It’s not a condition,” says Curt Furberg, professor of public health at Wake-Forest University. “It’s a way of increasing markets for pharmaceutical companies.” Although people with blood pressure towards the high end of normal are at raised risk of future adverse events, Professor Furberg does not think the level warrants the new classification or the treatment of millions more healthy people. “I don’t see it as a public health problem,” he says.

It’s a shame this is hidden behind by a subscription firewall. Journalists and consumers should read the full feature. Moynihan continues to deliver health care news that others miss.

Don’t miss the Boston Globe story today, “Study finds doctor-patient disconnect: Many stent recipients overestimated results.” The story quotes one expert: “There’s a likelihood that patients are getting procedures that they would have chosen to not get if they knew better. I think that’s a different understanding of ‘overuse.’ ”

One of our HealthNewsReview.org medical editors, Dr. Michael Pignone of the University of North Carolina is also quoted in the story: “Heart disease is a huge health problem, and we spend a ton of money treating it. Some of it may not be as well spent as it could be.”

Overtreatment. Expanding markets for medical products. Evidence. Shared decision-making issues.

Some journalists are directing their attention in the right directions.