(Flickr photo (cropped) by Francis Bourgouin).

Tune in to our radio show on your local public radio station, or sign up for the podcast and listen at your leisure. Here’s what it’s about:

Doctors look to guidelines from highly regarded thought leaders to figure out how to treat common problems like high cholesterol or prostate cancer. But how objective are these publications? Dr. Steve Nissen of the Cleveland Clinic calls out his colleagues and says too often they have significant conflicts of interest that make the guidelines less useful for patient care–but physicians don’t always realize where the conflicts lie.

Treating high blood pressure is important to cut the risk of strokes, heart attacks and kidney disease. But how high is too high? The Cochrane Review last year concluded that there is no scientific evidence of benefit from treating blood pressure unless the upper number is above 159 or the lower number is above 99. We talk with a physician about this evidence and the dangers of overdiagnosis and overtreatment.

The maker of Tylenol has long presented it as a safe pain reliever. But for decades, scientists have known that the ingredient in Tylenol, acetaminophen, can cause liver damage at doses only slightly higher than the maximum labeled OTC amount. It took the FDA a very long time to require consumer warnings on the label. What gives? You may want to read the in-depth ProPublica report or listen to This American Life.

We will take your calls and stories about drugstore scandals and scares. Ask questions and share your own stories by calling 888-472-3366 or emailing radio@peoplespharmacy.com between 7 and 8 am EDT.

Guests: Steven Nissen, MD, is chairman of the Robert and Suzanne Tomsich Department of Cardiovascular Medicine at the Cleveland Clinic. He is the co-author, with Mark Gillinov, MD, of Heart 411: The Only Guide to Heart Health You’ll Ever Need. The photo is of Dr. Nissen.

Iona Heath, MA, MB, BCh, is a retired family practice physician from London, England. Her viewpoint article, “Waste and Harm in the Treatment of Mild Hypertension,” was published in JAMA Internal Medicine on June 10, 2013.

The podcast of this program will be available the Monday after the broadcast date. The show can be streamed online from this site and podcasts can be downloaded for free for four weeks after the date of broadcast. After that time has passed, digital downloads are available for $2.99. CDs may be purchased at any time after broadcast for $9.99.

 

 

 

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  1. Don Salmon
    Reply

    Marie, in regard to your 93 year old mother, I have to say, I don’t know if my reply to Mark would be applicable. Is your mother capable of lifestyle changes? Perhaps more important, does she have the support system (people to help her with proper diet, stress management, and hopefully if she can do it, some kind of very gentle, even seated exercise – qigong, for example?
    In any case, I wouldn’t take mine or any other advice off a website like this. If you can find a doctor (good luck trying!!) who understands the implications of the Cochrane report (yes, meds are useless for people with mild hypertension, 140/90 to 159/99) but lifestyle changes are extremely important for that range, and it IS important to get the numbers down if you have mild hypertension) than she can work with that doctor. Most likely, you would need to find several health practitioners, as doctors generally do not know much about diet, exercise, stress management, supplements, etc.
    Good luck!

  2. Don S.
    Reply

    Mark, you’re experiencing a placebo effect. There’s not a shred of evidence that BP in the mild range effects mood. none. However, if you think it is, I guarantee you, it will. There’s over a half century of top quality research on the placebo effect.
    As far as the Cochrane report goes, look at the Forbes “rejoinder”. The author (sorry, I forget his name at the moment) cites research saying that disease risks (stroke, heart attack, kidney disease, etc) goes up as the BP goes over 120/80. This is correct.
    AND, the Cochrane report doesn’t dispute this.
    How is this possible?
    Think for a minute – the research is absolutely solid that as BP rises over 120/80, potential morbidity (from heart attack to death) increases.
    And the research is solid that BLOOD PRESSURE MEDICATIONS (hint, notice the capitalized letters) don’t help anybody with BP under 159/99.
    Read this carefully and see there is no contradiction. I’ll put it in simple language
    if you have BP between 121/81 and 159/99, and you lower it by means of diet, exercise, decrease smoking and alcohol intake, breathing, herbs, supplements, stress reduction, improved sleep, etc, your chance of illness due to high BP goes down.
    If you have BP between 121/81 and 159/99 and you do none of the above, but take medication, it won’t help you at all (though it will lower your blood pressure).
    Get it?
    Meds don’t help unless your BP is over 159/99, EVEN IF THEY LOWER YOUR BP. However, lifestyle changes which lower your BP – even if your BP is BETWEEN 121/81 and 159/99 – will help.
    Now that that’s clear, can you see why the drug companies (and the all too many doctors and even nurses! who essentially work for them) don’t want us to know this?

  3. Ed
    Reply

    I would like to recommend a couple of books that complement the theme of this episode of the People’s Pharmacy. I hope that other listeners to your program find them as informative as I did.
    1. Overdosed America: The Broken Promise of American Medicine
    John Abramson, 2004
    2. Selling sickness: How the World’s Biggest Pharmaceutical Companies are Turning Us All into Patients
    Ray Moynihan and Alan Cassels, 2005
    3. Side Effects: Death – Confessions of a Pharma-insider
    John Virapen, 2010
    4. The Truth About the Drug Companies: How They Deceive Us and What to Do About It
    Marcia Angell, 2004

  4. Damon Heinrich
    Reply

    I just finished listening to your podcast #920, and would like to add two examples to the subject of “diagnostic creep”. One of the advantages of living to be an Old Man is that you have actually experienced these things. I distinctly remember my father, after his first heart attack, being told that the upper number on blood pressure should be OK if it was 100 + your age. A great contrast to what was cited by the trucker on the podcast.
    For many years we have struggled with my wife’s extremely high cholesterol numbers. When we started with the diet and medication battle, her doctors were talking about a goal of 200. Now I commonly hear TV ads for various statins and such type of drugs talking about a “target” of 100. I’m certain this is not realistic, and is designed to cause anxiety in patients who will then supposedly ask their doctor for a prescription.
    And what kind of a patient tells the doctor about what pill she wants to have?

  5. KJM
    Reply

    I refuse all meds for blood pressure and cholesterol. At 82 both are within acceptable limits but not on the pharmaceutical chart for ‘normal’ thus necessitating possibly lethal and profitable drugs. But I now have a condition that I diagnosed through an internet search after the failure of primary physician, dermatologist and allergist to discover it. What do you know about Bullous Pemphigoid? It affects some 10 persons out of one million, mostly those over 80. So I have it. It’s miserable. What can I do about it?
    People’s Pharmacy response: It appears that it is an autoimmune condition that dermatologists mostly treat with either topical or oral corticosteroids, depending on how much skin is affected by the blisters. Here is a “patient education” link for others who wonder what you are talking about:
    http://archderm.jamanetwork.com/article.aspx?articleid=1670823

  6. mpm
    Reply

    A key sentence in one advertisement states that their product carries the same ‘warning’ as a list of other similar products. This seems to imply that actual ‘risk’ = label ‘warning’. A bit of a lie no matter how one looks at it.
    my $.02 worth,
    mpm

  7. Mark
    Reply

    I listened to the PBS People’s Pharmacy program about the study that seems to indicate that blood pressure medicine does not extend a persons life and that perhaps people are being treated for high blood pressure when they do not really have high enough blood pressure to warrant this.
    I am here to tell you that I have low to moderate blood pressure issues and that the medication that I take improves the quality of my life. For those of you who do not have high blood pressure, think about how you feel physically when you get emotionally upset about something. Now, imagine that you feel this way physically but you are not emotionally upset.
    In my particular case, if I go without blood pressure medicine, I tend to get more and more upset or the littlest thing can set me off and get me upset. My physical condition impacts me emotionally. Normal people may think that I should simply exercise more self control but that is easier said than done because my blood pressure increase is so slow that quite often I do not recognize the difference between my blood pressure pushing me over the limit with legitimate times when work or home life might warrant these types of emotions.
    From my perspective, blood pressure medicine helps me be a more normal human being who can get along with other people and cope with the day to day challenges of life. I see this a lot like I see my eye glasses. They may not help me live longer but the quality of my life is a lot better wearing them than not wearing them.
    I think that one of the medical credo’s is first, do no harm. If taking low doses of blood pressure medicine improves the quality of my life and does no long term harm then even though it may not extend my life, at least it helps me manage this physical condition when I am overwhelmed by it.
    Anyone who has high blood pressure will understand this. I doubt that anyone who does not have high blood pressure can really understand this.

  8. Marie
    Reply

    I cite som lines from your interesting article:
    “The Cochrane Review last year concluded that there is no scientific evidence of benefit from treating blood pressure unless the upper number is above 159 or the lower number is above 99″.
    Are these figures for any age, what about a 93 year old?
    My mother has just been to the doctor as she had been feeling somewhat dizzy and was told that her blood pressure was too high.
    She had a small heart attack more than 10 years ago.
    She’s on 2-3 medications.
    She has taken Toprol (beta-blocker) for many years and now an ACE-inhibitor (rampipril) was added.
    She has been very independent and lives at home on her own.
    I am afraid this might reduce her quality of life.
    What is your opinion about blood pressure and the very old, any suggestions to reading material?

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