No I am confused, half caught up in this tenuous belief system and half non believer facing patients who mostly want the decisions to be simple, logical and unequivocal. I start talking about Numbers Needed to Treat (NNTs) and try to pull myself together with PPBs (personal probability of benefit stats an acronym coined by David Misslebrook). The MRC trial PPB for 100-109 diastolic range in 35-64 yr olds over five years was 175 to 1. Most of us would not consider a bet on a horse at such silly odds. If I am older the odds drop sometimes to 20 to 1. Have you met anyone that regularly made money on horses priced at 20 to 1? Underneath all of this is the anxiety I started this article with. Shouldn’t we be doing something better for our patients, and the exchequer, than overfeeding them dubious medications on the off chance, that the odd one of them, entirely unknown to them or me, might just live a little longer than they might otherwise have done? Can’t we start nation-wide happy classes or something similar, aHypertension doctors are taught is an asymptomatic risk factor. It is not an illness and it is definitely not a disease. But try telling that to us patients, we just don’t and never will believe doctors. To the average patient hypertension is a bodily reality. They can feel it. This of course goes some of the way to explaining the dismal figures on compliance/concordance/adherence with hypertensive treatment. The truth is most of us take drugs if we think it is important enough and we have a clear rationale in our minds. Patients know when their blood pressure is up, they feel hyper-tensive, and on those days they take the tablets. If they feel relaxed, on holiday etc well it’s obvious that treatment is not needed. This ‘logic’ drives statistically framed clinicians daft. It’s all in the framing you see, doctors are taught a complex mathematically based rationale, founded in actuarial tables and EBM, for ‘treating’ the risk that is hypertension. They adhere to expert produced protocols, consult learned tables and computer models, and decide that treatment may reduce the probability of an event by a certain percentage that might be advantageous to the individual patient. To the individual of course if the doctor thinks they need treatment they must be ill. Now I am not going to bore you with zillions of references but all I am now going to say has as good an evidence base as any other medical fact. The diagnosis of hypertension is not good for the individual patient. Having walked into the surgery fit and then being told that ones BP is up to treatable levels immediately doubles the odds of me having panic attacks, my sickness rate also doubles and I immediately cut down my participation in sport. My incidence of impotence shoots up if you see what I mean. This is all before I start on whatever cocktail of drugs the latest protocol has in store for me and their attendant side effects. So this is a harmful diagnosis. Have we yet got a computer model that works out how much good we have to do with our treatment to outweigh the harm we have already done?

I was involved with the Cambridge Mild Hypertension Trial, among other things we learned that the famous drug ‘placebo’ controlled 40% of men and 45% of women. It was during this time I attended a training day on taking blood pressures, in a large room we were played a recording of Korotkov’s sounds and asked to record the blood pressure. This was a room of trained health professionals and the results were a widely based normal curve. Even though we all heard the same thing we recorded worryingly large differences. This has haunted me since. More recently a keen hypertensively minded partner bought two top of the range electronic machines to improve our care of diabetic hypertensives. We tested them on the staff and against our ageing and environmentally dangerous mercury machines. The two machines produced different results by approximately 15mm of mercury; the lowest reader was still on average 5mm higher than our mercury ones. Almost everyone was at least mildly hypertensive as judged by the top machine. I remember wet Sundays of my childhood being happily filled by the pungent smelling painting by numbers kits and here am I nearly in my second childhood less happily treating by numbers. I know there are impressive trials, much expense and an array of dedicated well-informed ‘experts’ driving this huge hypertension bandwagon, but is this whole edifice really a flickering mirage? This faint and distorted image made up of fundamentally inaccurate and volatile measurements mixed with a nervous and uncomprehending patient base, and at least I could hang my paintings on the wall.

What do we tell patients? Well some professionals of my local acquaintance tell patients to make urgent appointments with their doctors because their blood pressure is dangerously high, at 145/95. Nasty little caravans in the centre of town advertising cholesterol testing are particularly prone to this and other similar crimes, but even worse are the ‘fitness’ gyms. But what about me? Am I perfect? No I am confused, half caught up in this tenuous belief system and half non believer facing patients who mostly want the decisions to be simple, logical and unequivocal. I start talking about Numbers Needed to Treat (NNTs) and try to pull myself together with PPBs (personal probability of benefit stats an acronym coined by David Misslebrook). The MRC trial PPB for 100-109 diastolic range in 35-64 yr olds over five years was 175 to 1. Most of us would not consider a bet on a horse at such silly odds. If I am older the odds drop sometimes to 20 to 1. Have you met anyone that regularly made money on horses priced at 20 to 1? Underneath all of this is the anxiety I started this article with. Shouldn’t we be doing something better for our patients, and the exchequer, than overfeeding them dubious medications on the off chance, that the odd one of them, entirely unknown to them or me, might just live a little longer than they might otherwise have done? Can’t we start nation-wide happy classes or something similar, a

nd computer models, and decide that treatment may reduce the probability of an event by a certain percentage that might be advantageous to the individual patient. To the individual of course if the doctor thinks they need treatment they must be ill. Now I am not going to bore you with zillions of references but all I am now going to say has as good an evidence base as any other medical fact. The diagnosis of hypertension is not good for the individual patient. Having walked into the surgery fit and then being told that ones BP is up to treatable levels immediately doubles the odds of me having panic attacks, my sickness rate also doubles and I immediately cut down my participation in sport. My incidence of impotence shoots up if you see what I mean. This is all before I start on whatever cocktail of drugs the latest protocol has in store for me and their attendant side effects. So this is a harmful diagnosis. Have we yet got a computer model that works out how much good we have to do with our treatment to outweigh the harm we have already done?

I was involved with the Cambridge Mild Hypertension Trial, among other things we learned that the famous drug ‘placebo’ controlled 40% of men and 45% of women. It was during this time I attended a training day on taking blood pressures, in a large room we were played a recording of Korotkov’s sounds and asked to record the blood pressure. This was a room of trained health professionals and the results were a widely based normal curve. Even though we all heard the same thing we recorded worryingly large differences. This has haunted me since. More recently a keen hypertensively minded partner bought two top of the range electronic machines to improve our care of diabetic hypertensives. We tested them on the staff and against our ageing and environmentally dangerous mercury machines. The two machines produced different results by approximately 15mm of mercury; the lowest reader was still on average 5mm higher than our mercury ones. Almost everyone was at least mildly hypertensive as judged by the top machine. I remember wet Sundays of my childhood being happily filled by the pungent smelling painting by numbers kits and here am I nearly in my second childhood less happily treating by numbers. I know there are impressive trials, much expense and an array of dedicated well-informed ‘experts’ driving this huge hypertension bandwagon, but is this whole edifice really a flickering mirage? This faint and distorted image made up of fundamentally inaccurate and volatile measurements mixed with a nervous and uncomprehending patient base, and at least I could hang my paintings on the wall.

What do we tell patients? Well some professionals of my local acquaintance tell patients to make urgent appointments with their doctors because their blood pressure is dangerously high, at 145/95. Nasty little caravans in the centre of town advertising cholesterol testing are particularly prone to this and other similar crimes, but even worse are the ‘fitness’ gyms. But what about me? Am I perfect? No I am confused, half caught up in this tenuous belief system and half non believer facing patients who mostly want the decisions to be simple, logical and unequivocal. I start talking about Numbers Needed to Treat (NNTs) and try to pull myself together with PPBs (personal probability of benefit stats an acronym coined by David Misslebrook). The MRC trial PPB for 100-109 diastolic range in 35-64 yr olds over five years was 175 to 1. Most of us would not consider a bet on a horse at such silly odds. If I am older the odds drop sometimes to 20 to 1. Have you met anyone that regularly made money on horses priced at 20 to 1? Underneath all of this is the anxiety I started this article with. Shouldn’t we be doing something better for our patients, and the exchequer, than overfeeding them dubious medications on the off chance, that the odd one of them, entirely unknown to them or me, might just live a little longer than they might otherwise have done? Can’t we start nation-wide happy classes or something similar, a

igh the harm we have already done?

I was involved with the Cambridge Mild Hypertension Trial, among other things we learned that the famous drug ‘placebo’ controlled 40% of men and 45% of women. It was during this time I attended a training day on taking blood pressures, in a large room we were played a recording of Korotkov’s sounds and asked to record the blood pressure. This was a room of trained health professionals and the results were a widely based normal curve. Even though we all heard the same thing we recorded worryingly large differences. This has haunted me since. More recently a keen hypertensively minded partner bought two top of the range electronic machines to improve our care of diabetic hypertensives. We tested them on the staff and against our ageing and environmentally dangerous mercury machines. The two machines produced different results by approximately 15mm of mercury; the lowest reader was still on average 5mm higher than our mercury ones. Almost everyone was at least mildly hypertensive as judged by the top machine. I remember wet Sundays of my childhood being happily filled by the pungent smelling painting by numbers kits and here am I nearly in my second childhood less happily treating by numbers. I know there are impressive trials, much expense and an array of dedicated well-informed ‘experts’ driving this huge hypertension bandwagon, but is this whole edifice really a flickering mirage? This faint and distorted image made up of fundamentally inaccurate and volatile measurements mixed with a nervous and uncomprehending patient base, and at least I could hang my paintings on the wall.

What do we tell patients? Well some professionals of my local acquaintance tell patients to make urgent appointments with their doctors because their blood pressure is dangerously high, at 145/95. Nasty little caravans in the centre of town advertising cholesterol testing are particularly prone to this and other similar crimes, but even worse are the ‘fitness’ gyms. But what about me? Am I perfect? No I am confused, half caught up in this tenuous belief system and half non believer facing patients who mostly want the decisions to be simple, logical and unequivocal. I start talking about Numbers Needed to Treat (NNTs) and try to pull myself together with PPBs (personal probability of benefit stats an acronym coined by David Misslebrook). The MRC trial PPB for 100-109 diastolic range in 35-64 yr olds over five years was 175 to 1. Most of us would not consider a bet on a horse at such silly odds. If I am older the odds drop sometimes to 20 to 1. Have you met anyone that regularly made money on horses priced at 20 to 1? Underneath all of this is the anxiety I started this article with. Shouldn’t we be doing something better for our patients, and the exchequer, than overfeeding them dubious medications on the off chance, that the odd one of them, entirely unknown to them or me, might just live a little longer than they might otherwise have done? Can’t we start nation-wide happy classes or something similar, a

ensive as judged by the top machine. I remember wet Sundays of my childhood being happily filled by the pungent smelling painting by numbers kits and here am I nearly in my second childhood less happily treating by numbers. I know there are impressive trials, much expense and an array of dedicated well-informed ‘experts’ driving this huge hypertension bandwagon, but is this whole edifice really a flickering mirage? This faint and distorted image made up of fundamentally inaccurate and volatile measurements mixed with a nervous and uncomprehending patient base, and at least I could hang my paintings on the wall.

What do we tell patients? Well some professionals of my local acquaintance tell patients to make urgent appointments with their doctors because their blood pressure is dangerously high, at 145/95. Nasty little caravans in the centre of town advertising cholesterol testing are particularly prone to this and other similar crimes, but even worse are the ‘fitness’ gyms. But what about me? Am I perfect? No I am confused, half caught up in this tenuous belief system and half non believer facing patients who mostly want the decisions to be simple, logical and unequivocal. I start talking about Numbers Needed to Treat (NNTs) and try to pull myself together with PPBs (personal probability of benefit stats an acronym coined by David Misslebrook). The MRC trial PPB for 100-109 diastolic range in 35-64 yr olds over five years was 175 to 1. Most of us would not consider a bet on a horse at such silly odds. If I am older the odds drop sometimes to 20 to 1. Have you met anyone that regularly made money on horses priced at 20 to 1? Underneath all of this is the anxiety I started this article with. Shouldn’t we be doing something better for our patients, and the exchequer, than overfeeding them dubious medications on the off chance, that the odd one of them, entirely unknown to them or me, might just live a little longer than they might otherwise have done? Can’t we start nation-wide happy classes or something similar, a

No I am confused, half caught up in this tenuous belief system and half non believer facing patients who mostly want the decisions to be simple, logical and unequivocal. I start talking about Numbers Needed to Treat (NNTs) and try to pull myself together with PPBs (personal probability of benefit stats an acronym coined by David Misslebrook). The MRC trial PPB for 100-109 diastolic range in 35-64 yr olds over five years was 175 to 1. Most of us would not consider a bet on a horse at such silly odds. If I am older the odds drop sometimes to 20 to 1. Have you met anyone that regularly made money on horses priced at 20 to 1? Underneath all of this is the anxiety I started this article with. Shouldn’t we be doing something better for our patients, and the exchequer, than overfeeding them dubious medications on the off chance, that the odd one of them, entirely unknown to them or me, might just live a little longer than they might otherwise have done? Can’t we start nation-wide happy classes or something similar, a search for a purpose within our society rather than eking out our days medicalised, fearful of death and introspective of our health, there has to be more worth to our lives than that?

If this article has interested you might like to purchase The Other Side of Medicine, available on Amazon or visit: http://www.radcliffe-oxford.com. You may also wish to visit: http://www.lulu.com/petertate