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Wednesday, January 26, 2011

A pound of prevention: Overtreatment

President Franklin D. Roosevelt died at age 63 from uncontrolled high blood pressure. In those days it was not recognized as a medical problem. If he had lived today, he would have almost certainly been treated with drugs that would control his blood pressure, giving him extra years of life. High blood pressure is called "the silent killer" because it causes no apparent symptoms or discomfort. Clearly, the drugs are useful to people with high blood pressure.

But for people with only mildly elevated blood pressure, or readings at the upper limit of normal, now called "prehypertension," the risks of harm from the disease are very low. The risk of harmful side effects from the drugs may outweigh the risk of the disease, especially for the elderly.

Once experts have drawn a line in the sand that separates "health" from "disease," we forget that there are shades of gray, and often no real sharp dividing line exists.

Advice for those receiving drug prescriptions for conditions with no apparent symptoms:
Do your homework about the tradeoffs of the drugs, and discuss them with your doctor. As Dr. Abigail Zuger says, "a pound of prevention is worth a closer look."

Read another story on drug side-effects in the elderly.

Thanks to Dr. Abigail Zuger for her source article in the New York Times of Jan. 25 about the book Making People Sick in the Pursuit of Health, by H. Gilbert Welch, Lisa Schwartz, and Steven Woloshin.

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