August 26, 2004 
First, read the article below declaring that the lives of forty percent of the adult British population are "threatened" by high blood pressure, and that, to "save lives," medical "Experts" are calling for the mass treatment for high blood pressure of the British population.  Then read the article by Malcolm Kendrick, MD which follows to learn why this is intellectually dishonest and a monumental fraud.   
Mel Fowler 
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Experts Call For Mass Medication Of Brits
Jeremy Laurance  -  Health Editor, The Independent - UK
A Government agency calls today for the mass medication of the British
population to protect against a "silent killer" that is threatening the
lives of 40 per cent of adults.
High blood pressure affects 14 million people in the UK and is a major
cause of heart attacks and strokes, but almost 10 million receive no
treatment despite the availability of cheap, reliable drugs, specialists
In the most far-reaching drug intervention ever recommended by an
official body, new guidelines launched by the National Institute of
Clinical Excellence (Nice) call for the extension of treatment to the
millions at risk to save lives.
A spokesman said: "This is by far the biggest impact guideline we have
issued because so many people have high blood pressure."
The World Health Organisation said in 2000 that high blood pressure was
the single most prolific cause of preventable deaths. It damages blood
vessels in the eyes, the heart and the kidneys and is a major cause of
cardiovascular diseases, which account for 30 per cent of all deaths in
the UK.
But despite the havoc it wreaks, most people with high blood pressure
feel well and are unaware their health is at risk. One-third of the 14
million people with the condition in the UK do not know they have it, and
a further third who do know are not being treated. Of the four to five
million people receiving treatment, one third are not being adequately
controlled by drugs, Bryan Williams, professor of medicine and director
of the cardiovascular research unit at the University Hospitals NHS
Trust, Leicester, said.
Professor Williams, who was involved in drawing up the guidelines, said
they were among the most robust ever issued. "Hypertension is often
referred to as the silent killer because it does not present symptoms
until it has already taken hold and caused damage," he said. "We hope the
impact of these guidelines will mean fewer people will have strokes and
heart attacks. If the population is to live longer, giving treatment to
prevent disease is the best option even though it takes a long time to
realise the benefits. I think this is the way to go and it is long
"There is more data on the treatment of hypertension than on any other
treatment in medicine. We can answer the question of what works with a
high degree of certainty."
Although no estimate has been made of the cost of extra drug treatment,
he said it was "highly likely to be cost effective" because of the saving
in treatment for heart attacks and strokes. He denied that Nice was
promoting the use of drugs that could cause side effects for a
symptomless condition. Even treatment with a single drug could cut heart
disease by 20 per cent and the drugs had few side effects, he said.
Wendy Ross, a GP in Newcastle who helped devise the guidelines, said:
"Once people start treatment they are likely to be taking tablets for the
rest of their lives. Most are quite keen to avoid that and want to find
out what they can do [about changing their lifestyle]."
The guidelines would lead to more people taking more drugs, she said.
"There are still a lot of people out there taking one or two drugs who
are not very well controlled. They need three or four drugs," she said.
The NHS spent £840m on drugs for high blood pressure in 2001, accounting
for 15 per cent of the cost of all drugs prescribed by GPs. Andrew
Dillon, chief executive of Nice, said spending was set to rise sharply as
a result of the guidelines but the amount had yet to be calculated.
Nice also publishes guidelines for the treatment of dyspepsia
(indigestion) today, with a recommendation that most patients can be
helped to care for the problem themselves with over-the-counter drugs.
* One in six hospitals does not have a stroke unit, which is
"unacceptable", the Royal College of Physicians said yesterday. A
national audit of stroke treatment found that although the care of
patients was improving, it still fell short of the care given to heart
* People with at least three blood pressure readings above 140/90 mmHg,
taken on separate occasions, should be offered advice on how to reduce it
by changing their lifestyle, and assessed for their risk of heart
* This may involve changes to the diet, reducing weight and increasing
exercise. Cutting back on alcohol, salt and caffeine and practising
relaxation may also help to lower blood pressure. Stopping smoking does
not reduce blood pressure but is important to cut the risk of heart
attacks and strokes.
* If lifestyle changes do not work, drug treatment should be offered to
those with a significantly increased risk of heart disease, based on
blood and urine tests and family history.
* People with persistently high blood pressure of 160/100 mmHg or more
should automatically be offered drug treatment.
* Drug treatment should begin with a diuretic, which increases urine
production, and further drugs such as beta-blockers, calcium channnel
blockers and ACE inhibitors should be added as necessary until the target
blood pressure is reached.
* The drugs are off patent, available in cheap, generic form and are safe
with few side effects.
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It Inflates The Benefits Of Drug Treatment and Is Intellectually Dishonest

By Red Flags Columnist Dr. Malcolm Kendrick

(email -


How is it that cardiologists save lives, when oncologists only manage to increase median survival? Okay, not the snappiest question ever. But you try engaging in a discussion on median survival rates without creating instant narcolepsy.

Here is another question for you. If I were to use a defibrillator on a man having a heart attack, and I get his heart beating normally again, have I saved his life?

Is this a trick question? In a way. Perhaps you would say that it all depends how much longer he lives. If he only lives an extra five minutes, then dies, did I save his life? No, yes, maybe? Did I increase his lifespan? Yes, of course, if only by five minutes.

What if he lives for another year? Did I save his life?

The reality, of course, is that you cannot actually stop anyone from dying. You can only give them more time. How much more? Well, you’re never going to know unless you keep track of them for the rest of their life.

‘So what,’ I can hear you cry. So quite a lot, actually. Because cardiologists talk about saving lives all the time. Superficially this may seem reasonable. However, in reality, this represents a statistical sleight of hand that results in a massive distortion of the results of clinical trials, stretching benefits to breaking point – and beyond. It makes the bogus use of relative risk figures fade into insignificance. You probably think this is a bit of an exaggeration, but bear with the argument.

Moving back to oncologists for a moment. They recognised early on, I am not quite sure how or why, that their drug treatments rarely cure cancer (a moment of unexpected humility from the medical profession). Anti-cancer agents zap tumors, but they most often do not get rid of the cancer altogether, as it often returns.

Therefore, in most cases, all that a new drug treatment in cancer can achieve is an increased length of survival. Thus, when they do a clinical trial on a new drug treatment, oncologists normally report their studies according to the increase in median survival. Median survival means the time at which fifty per cent of patients are still alive – or fifty per cent have died.

Why don’t they use the average? Because, gentle reader, if you want to know the average lifespan, you have to wait until almost everyone has died before you can do the calculation. As some patients may actually be cured by the treatment, you might have to wait for fifty years before they die. Which is a bit long for any clinical trial.

Anyway, in cancer treatment, if they did a trial in which one hundred more of the ‘treated’ patients were alive at the end of, say, two years, no-one would dream of claiming that one hundred lives had been saved.

Yet cardiologists have no hesitation in claming that lives can be saved. The home page of the Heart Protection Study (HPS), starts with the quote, ‘Tens of thousands of lives could be saved each year by changing prescribing guidelines for statins,’ says Dr Rory Collins, lead investigator of the HPS study.

The implication here is that every extra person who has not died, has been cured, and will live out a full and healthy life. But this is complete nonsense. The reality is that drug treatment, at best, slows disease progression, and may give you some extra time.

Therefore, when Rory Collins says ‘Tens of thousands of lives could be saved, what he actually should say is that, tens of thousands of people may have their lives extended by about six months to a year by using statins (and only if you treat more than one million people).

Why doesn’t he say this? I suspect you may already know the answer to this question. He doesn’t say this because – if you claim that you are saving lives – the benefits sound fantastic. However, if you claim that you are merely delaying disease progression – it seems rather less wonderful.


I will just try to feed some real figures into this theoretical discussion, to give you a better idea of the level of distortion achieved.

A study published in May 2003, in the Journal Of The American Medical Association,

looked at all clinical trials on blood pressure lowering. Nineteen of these trials looked at drug treatments (various) versus placebo. There were 42,972 patients in all these trials and they lasted, on average, three and a half years or so. In total, therefore, these trials represented 133,741 years of drug treatment.

Adding the results from the trials together, there were 1453 deaths in the placebo group, and 1303 in the treated patients. Which means that there was a grand total of one hundred and fifty more people alive in the treated groups.

Now, if each of the one hundred and fifty people who survived was ‘cured’ and lived an extra thirty years this wouldn’t be too bad a result. I don’t think.

To work out the exact benefit, you could do a calculation as follows:

150 lives saved x 30 extra years = 4,500 extra years of life.

As it took nearly one hundred and forty thousand years of drug treatment to achieve four and a half thousand extra years of life, this means that each extra year took about thirty years of drug treatment. Not brilliant, but not too bad. Although I don’t think it would convince me to take a tablet each day, for the rest of my life.

If, however, you know that no-one was actually cured, and all you have done is delay death by about a year (max), the equation looks rather different.

150 lives increased by one year = 150 extra years of life

At 140,000 years of drug treatment, this means you need almost one thousand years of drug treatment to gain one year of extra life. In my opinion this changes the result from ‘not bad’ to ‘a complete waste of time and money.’ Especially when you consider that all drugs have side effects. Some worse than others.

You could add, if you were a troublemaker like me, that in reality it takes about one thousand years worth of side-effects to create one extra year of life. And, at about $1,000/year for the drugs, it also costs almost one million dollars per year.

Perhaps you could put this another way. According to the figures, the average person taking a blood pressure lowering medication for thirty years will gain 30/1000th of a year of extra life – or about nine days. Thirty years of treatment for nine days extra life! Whoopee! Raise the flags and fire a cannon in the air. There have got to be better ways of spending money to improve health than this.

To be frank, I am not sure if the cardiology community is even aware that the concept of ‘lives saved’ is utterly misleading. It is so ingrained into the thinking that no-one even questions it. Most cardiologists would (I know I’ve tried it) just look at you in bemusement if you suggested that talking about lives saved hugely inflates the benefits of drug treatment and is therefore intellectually dishonest.

They cannot, or will not, see that there is a problem here. And I am sure that, until you read this, you perhaps didn’t realise there was even an issue, let alone a problem. ‘Saving lives, sure, that seems reasonable, what’s wrong with that.’

Maybe I should try to arrange a meeting where oncologist and cardiologists discuss how they set-up, then present, the results of drug trials. Although, I suspect that the oncologists may be seduced by the cardiologists, rather than the other way round. ‘You mean you’ve found a way to make the benefits of treatment seem three thousand per cent better….wow… way to go.’ 

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