Health by the Numbers (Not)

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by Bill Sardi by Bill Sardi

Got good health numbers? Your blood pressure, cholesterol, bone density and PSA tests are in the normal range? You may be swayed into believing you are healthy or ill, depending upon these numbers, when in fact the numbers are often meaningless.

Blood pressure

For example, take blood pressure. The new goal is to maintain blood pressure as near as possible to the 115/75 point instead of the longstanding 120/80 goal. Treatment is often started when numbers reach 140/90 or more.

But University of California at Los Angeles researchers report that many adults are needlessly placed on blood pressure lowering drugs without adjustment for their age. An increased risk of dying from stroke or heart attack isn’t apparent till the first number reaches 148 for males and 158 for females 55—64 years of age. For adults age 65—74, the figures rise to 159 for males and 167 for females. [Lancet 355: 175—80, 2000]

There are also widespread flaws in the accuracy of blood pressure numbers. First, this condition is likely to be over-diagnosed because of the failure to hold the arm in the correct position, horizontally at heart level, during measurement. Failure to perform blood pressure in the proper arm position can cause a pressure of 155/85 to increase by 25/11, or read as 180/96. According to one study, less than 8 percent of nurses and doctors measure blood pressure utilizing the proper arm position. [Internal Medicine Journal 34: 290—91, 2004]

Second, the presence of a doctor unconsciously raises blood pressure. This has been called "white coat" hypertension, for the rise in patients’ anxiety levels when the doctor with the white coat enters the examination room. In one study, 20 percent of males and 54 percent of females had a "white coat" response when their blood pressure was measured. [Canadian Medical Assn Journal 161: 265—69, 1999]

When a doctor records blood pressure, one study showed this raised blood pressure by 16 to 26 points. [American Journal Hypertension 14: 1263—69, 2001]

Researchers estimate that 25 percent of patients can postpone drug treatment and 15 percent can avoid multiple drug therapy by monitoring their blood pressure away from doctors and nurses. [Journal American Medical Assn 278: 1065—72, 1997]

Cholesterol

Despite widespread belief to the contrary, efforts to lower cholesterol have not been shown to lower the risk of dying from a heart attack.

A report entitled "Need to change the direction of cholesterol-related medication — a problem of great urgency," published in a recent issue of the Journal Pharmaceutical Society of Japan, it was stated that "high total cholesterol is not positively associated with high coronary heart disease mortality rates among general populations more than 40—50 years of age. More importantly, higher total cholesterol values are associated with lower cancer and all-cause mortality rates among these populations." [Yakugaku Zasshi 125:833—52, 2005]

A Swedish researcher says: "An almost endless number of observations and experiments have effectively falsified the hypothesis that dietary cholesterol and fats, and a high cholesterol level play a role in the causation of atherosclerosis and cardiovascular disease." [Journal Clinical Epidemiology 55: 1057—63, 2002]

An authoritative report published in the Journal of the American Geriatrics Society shows that as cholesterol numbers decline among senior adults, mortality rates rise. [Journal American Geriatrics Society 53: 219—26, 2005]

It’s a documented fact that as many adults experience a mortal heart attack with a total cholesterol count under 200 as over 300. [Medical World News March 27, 1992]

About half of the patients who are admitted to hospitals for a heart attack have normal cholesterol levels. [Atherosclerosis 149: 181—90, 2000]

More than 500,000 adult Americans experience a sudden mortal heart attack and have low-to-normal cholesterol levels and no more than 60% narrowing of their coronary arteries, not enough to impair oxygen flow to the heart or brain.

Furthermore, cholesterol numbers can be too low. Non-cardiac death nearly doubles as total cholesterol levels drop below 160. [European Heart Journal 18: 52—59, 1997]

PSA testing

One study shows that 96% of men who underwent PSA testing felt it gives them some level of reassurance they didn’t have cancer. [Health Expectations 5: 104—13, 2002]

Prostate Specific Antigen (PSA) rises with advancing age and there has been debate over when rising numbers indicate the need for a prostate biopsy. Advancing age, recent ejaculation, infection, medications (even Propecia-finasteride) or inflammation can cause PSA elevation, and mass screening of men with PSA above 1.0 leads to many needless biopsies and false positive tests.

It has been determined that if men with a PSA over 25.0 do not undergo biopsy, the number of needless biopsies would be reduced by 20% and 95% of prostate cancers would be positively detected biopsying every male with a PSA of 4—10.

While a rise in PSA is considered suspicious, in one study 92% of the increases in PSA were non-cancerous. [Urology 62: 64—69, 2003] PSA testing simply cannot discriminate between a chronic non-cancerous condition called benign prostatic hypertrophy (swollen prostate) and cancer. [Current Urological Reports 5: 231—40, 2004]

Even more perplexing, an elevated PSA test that normalizes is not necessarily assurance a man is free of cancer. In one study, 24% of men whose elevated PSA numbers dropped into the normal range were found to have cancer on biopsy. [Prostate Cancer Prostatic Disease 8: 349—52, 2005]

Recently doctors at the Department of Urology at Stanford University School of Medicine explained how PSA testing deceived the medical profession. In the early days, around 1987, it was reported that PSA levels were proportional to the increasing stages of tumor growth doctors could feel while conducting gloved exams on males. Doctors just happened to be sending a lot of men for biopsy that happened to have more advanced forms of cancer because there was a large backlog of men to be screened when PSA testing first began. But since 2001, say Stanford researchers, there has been a turnaround. The PSA no longer correlates with the size of the prostate gland and the Gleason score, which is an estimate of the stage of cancer based upon microscopic slides of prostate tissue obtained during biopsy.

Men with PSA ranging from 2.0 to 4.0 have nearly the same positive biopsy rates as males with PSA ranging from 2.0 to 20.0. The Stanford doctors say "the relationship between prostate cancer and PSA is tenuous at best, especially with PSA less than 10.0 and perhaps less than 22.0!" Careful analysis of data now shows PSA is only related to the size and inflammation in the prostate gland, not to cancer.

The Stanford doctors say the suggestion to use a lower PSA cutoff point (2.6) to recommend biopsy is misguided because "this is precisely the range of PSA for most men with benign prostatic hyperplasia," which is common among most males.

They ask: "What are we to do in the face of such massive, unwarranted PSA screening?" Lowering the PSA cutoff point only serves to "compound the tragedy by adding millions of men to the biopsy list." The Stanford doctors say "little is likely to change the current state of overdiagnosis and overtreatment." [Journal Urology 172: 1297—1301, 2004]

Scientific studies which invalidate PSA testing have not dampened doctors’ enthusiasm for the test. One survey found 88% of the time doctors recommend PSA testing even though they, unlike patients, have sufficient training to know that it is not a valid test. [Journal National Cancer Institute 95: 1792—97, 2003]

Bone density

Bone density is a number that women rely upon to determine if they are losing excessive bone after menopause. The primary objective of bone density testing is to prevent hip fractures, considered to eventually result in high mortality rates after a fall.

The most recent study of 36,282 postmenopausal women found hip bone density was 1.06 percent higher when supplementing with 1000 milligrams of calcium and 400 IU of vitamin D daily, but the study concluded that "improvement in hip bone density did not significantly reduce hip fracture, and increased the risk of kidney stones." {New England Journal Medicine 354: 669—83, 2006]

Bone density is only one measure of bone integrity. There is also bone hardness (boron related) and bone flexibility (magnesium related), which are minerals that receive less attention than calcium.

Recent studies show hip fractures are more related to muscle strength than bone density. [Journal Gerontology A: Biology Science Med Science 61: 92—96, 2006]

Vitamin D levels may be more important than bone density when it comes to causes of hip fracture among senior women. [Minnesota Medicine 88:34—6., 2005] Only recently has it been appreciated that vitamin D works by strengthening muscle tone, thus preventing hip fractures.

Vitamin D’s ability to influence muscle power, which reduces falls, is considered to be unique and remarkable considering no drugs employed for osteoporosis have demonstrated any reduction in the rate of falls and hip fractures. [Journal Musculoskeletal Neuronal Interaction 5:273—84, 2005]

Numbers are not an objective in themselves

More and more Americans are submitting to needless re-testing, and more needless or even problematic treatment, because of the unreliable numbers game that is played in modern medicine.

Bill Sardi [send him mail] is a consumer advocate and health journalist, writing from San Dimas, California. He offers a free downloadable book, The Collapse of Conventional Medicine, at his website.

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