New Cholesterol and Blood Pressure Guidelines

http://www.neto.com/rcr/outbac98.html#topic2

The End-Run for the New Cholesterol and Blood Pressure Guidelines
The most recent guidelines for lowering cholesterol and for lowering
blood pressure came about via procedures that violated all the rules
for promulgating and announcing such guidelines. As a result of these
two guidelines, about 36 million Americans will be considered
candidates for statin cholesterol-lowering drugs, and many additional
millions more for blood pressure medications. This is good news for
pharmaceutical companies. But, many doctors say that the guidelines
have taken millions of normal people and turned them into "sick" people
on paper.

The Seventh Report of the Joint National Committee on Prevention,
Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7) is
referred to in the excerpts cited below.

The following excerpts are from an article by:

Paul J. Rosch, M.D.
Clinical Professor of Medicine and Psychiatry
New York Medical College

Originally published in the Health and Stress newsletter of The
American Institute of Stress.

"The law requires that all important federal rules, including
guidelines that affect the public, must be written and promulgated
according to the Government Code. This code mandates formal selection
of a committee, pre-announcement of all meetings, open meetings that
encourage testimony from all interested parties as well as written
records, all of which must be preserved in a special docket.

Everything is then reviewed in order to provide a written discussion of
all the relevant evidence leading to the final rules or guidelines that
must be published in the Federal Register. In addition, if the
published guidelines are not consonant with a logical review of the
evidence presented, the recommendations may be overturned by legal
action.

Since the new JNC-7 guidelines seemed to fall under these rules I
accessed the Federal Register but was unable to find anything relevant.
When I contacted the Government Printing Office to inquire about this I
received a reply confirming they had no JNC records and was referred to
a NIH web site. This was remarkably reminiscent of how the National
Cholesterol Education Program (NCEP) for the detection and treatment of
high cholesterol had operated. The first NCEP report issued in 1988 was
timed to coincide with the introduction of Mevacor, Merck's new
cholesterol lowering drug. In an unprecedented action it was released
directly to the public, weeks before doctors could read the scientific
information on which it was based. The last set of revised guidelines
in 2001, which tripled the number of Americans advised to take statins,
was also publicized prematurely.

In both instances, the guidelines were published in the Journal of the
American Medical Association but not the Federal Register. There was no
public notice of any meetings, the meetings were not open to the
public, public input was not solicited, and detailed records and
testimony of committee meetings were not kept. The Joint National
Committee on Prevention, Detection, Evaluation, and Treatment of High
Blood Pressure (JNC) has followed the same format in order to bypass
Government rules and regulations.

When NIH officials were questioned about this they explained that the
cholesterol and hypertension guidelines were written by a
non-government committee of experts that they had selected and were
therefore not subject to the Federal Register regulations. This despite
the fact that they are presented by government spokespersons at
government press conferences and are promoted in the media here and
abroad as the latest government guidelines. The new JNC-7 report made
its debut at a special session of the American Society of Hypertension
Annual meeting in New York. This took place on the same day in May as
the National Heart, Lung, and Blood Institute Press Conference was held
in Washington and coincided with appearance of the JNC 'Express Report'
on the Journal of The American Medical Association web site.

My personal suspicion is that powerful pharmaceutical interests were
behind much of this, as well as making May National Hypertension Month.
Although JNC-7 reverted to the previous advice that inexpensive
diuretics were the first choice it also emphasized that 'Most patients
with hypertension will require two or more antihypertensive medications
to achieve goal pressure.'

The recommendation for diuretics as first line therapy were largely
based on the Antihypertensive and Lipid-Lowering Treatment to Prevent
Heart Attack Trial (ALLHAT) study conclusions that many disagreed with.
ALLHAT results were also reported early in the JAMA Express and some
feel that anything dealing with statins receives this preferential
treatment. This holds true for other respected peer reviewed
publications such as Lancet, which has also expedited statin studies
despite the fact that they show nothing new or significant. Conversely,
it is very hard to get anything negative about statins published, even
when the data is solid. Perhaps this has something to do with the
enormous revenues publications derive from statin advertisements.

John Laragh, director of the Cardiovascular Center at the New York
Presbyterian Hospital-Cornell Medical Center, founded the American
Society of Hypertension, is editor-in-chief of its journal, and past
president of the International Society of Hypertension. He is one of
the world's leading authorities on hypertension because of his
delineation of the renin-angiotensin-aldosterone system, which landed
him on the cover of Time magazine. I grew up with John, we have been
personal and professional friends for well over 50 years, and he was a
founding Trustee of The American Institute of Stress.

I was tempted to ask him about his opinion of the new guidelines, but
didn't have to. His objections to this and the ALLHAT study were
vividly detailed at a press conference and were summed up by his
colleague, Larry Resnick, as essentially 'garbage.'

Up until a few weeks ago, if you asked anyone, including doctors what
they considered a normal or desirable adult blood pressure to be,
120/80 would have been the most frequent response. Not any more.
According to the new JNC-7 guidelines, 120/80 puts you in a new disease
category called 'prehypertension' and at increased risk for heart
attack, stroke, or kidney disease.

Whatever happened to the good old days when a normal systolic pressure
was 100 plus your age? Not everyone agrees with this and the upper
limit is now usually considered to be 140/90, even for people over 70.

Some senior citizens will consistently complain of weakness and
dizziness if their blood pressures are lower than the 120/80 value that
is now recommended. This is particularly true for women, who normally
tend to have higher blood pressures than men in this age group."

(End of excerpts from Dr. Paul J. Rosch, who is a member of THINCS.Org.
You can find a number of his published and unpublished materials at:
www.thincs.org.)

In many years of research, I have found precious little in the
mainstream media or medical journals that challenges the basic "medical
wisdom" that, for example, cholesterol casues heart disease, the lower
your cholesterol and blood pressure the better off you will be - and
that statins not only lower cholesterol but prevent heart attacks and
strokes, among many other statin claims. One of the interesting facets
of THINCS.ORG is the number of highly-specialized doctors, researchers,
biochemists, et al., who cannot get a letter published anywhere that
flies in the face of conventional medical wisdom.

Here are just a couple (of hundreds you can find) of unpublished
letters that give you a flavor for how the loyal medical opposition is
ignored and thwarted: (from www.thincs.org)

Letter to the editor of JAMA (Journal of the American Medical
Association)

New guidelines for converting healthy people into patients.

With their new guidelines the National Cholesterol Education
Program's (NCEP) expert panel exaggerates the risk of coronary heart
disease (CHD) and the relevance of high cholesterol and ignores a
wealth of contradictory evidence. A few examples.

To claim that 20% of patients with coronary heart disease have a new
heart attack after ten years the panel has included minor symptoms
without clinical significance. Most people survive even a major heart
attack, many with few or no symptoms after recovery. What matters is
how many die and this is much less than 20%.

The predictive power of a high cholesterol is overrated. In the 30 year
follow-up of the Framingham cohort for instance, high cholesterol was
not predictive after the age of forty-seven. It is not a strong
predictor for women, Canadian men and patients with established CHD
either. In Russia, low cholesterol is a predictor of CHD, and
individuals with familial hypercholesterolemia (high cholesterol) may
live just as long and have a risk of CHD just as low as that of normal
people.

No doubt the statins lower coronary mortality, but the size of the
effect is unimpressive. In the CARE trial for instance, the odds of
escaping death from a heart attack in five years for a patient with CHD
was 94.3%, which improved to 95.4% with statin treatment. For healthy
people with high cholesterol the effect is even smaller; in the WOSCOPS
trial, the figures were 98.4% and 98.8%, respectively. These figures do
not take into account possible side effects which usually appear more
often. In animal experiments the statins have proven carcinogenic. In
the CARE trial statin treatment was followed by more breast cancer. In
the EXCEL trial, total mortality after just one year was much higher in
those receiving statins. Unfortunately the trial was stopped before
further observations could be made. We need more experience before
introducing mass-prevention with potentially carcinogenic drugs.

The panel ignores that a systematic review of relevant epidemiological
and experimental studies found no evidence that dietary fat has effect
on atherosclerosis and cardiovascular disease. Most important, coronary
and total mortality were unchanged in meta-analyses of the dietary
trials.

Instead of preventing cardiovascular disease, the new guidelines may
transform healthy individuals into unhappy hypochondriacs obsessed with
the chemical composition of their food and their blood, destroy the art
of cuisine and the joy of eating, and divert health care money from the
sick and the poor to the rich and the healthy.

****

TC

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