Monday, September 29, 2008

Drugs or lifestyle - which is Britain serious about?

I find the comments made for World Heart Day yesterday quite disturbing. The European Society of Cardiology is concerned that health services are failing to take simple steps to reduce the risk of heart disease.

In other words, across Europe doctors and community nurses are failing to give basic but firm advice to patients - that they are too heavy, they should not smoke and they should improve their diet and take more exercise.

"The vast majority of high risk patients in Europe are not provided with a professional lifestyle and risk factor management programme," according to Professor David Wood.

It will be interesting to see how British doctors react to the statements. for there has been an increase emphasis in modern general practice, backed by contractual incentives, on preventing disease. If you smoke, you will certainly be encouraged to give up. If you visit your doctor, you are likely to have your blood pressure taken.

But then what?

As someone with relatives with high blood pressure I perceive a problem. For the Americans several years ago established that good diet and low salt levels can be almost as effective as drugs as reducing blood pressure. This was a massive study called DASH.

So should not every patient with high blood pressure be referred to a dietician? In my experience this does not happen. And just in case, I checked the latest guidelines from the National Institute for Health and Clinical Excellence. It turns out they are purely "pharmacological". All about drugs. There is no requirement to do anything about diet - so little gets done. Here's the link.

You won't get the same official guidance in the USA. There the National Heart Lung and Blood actively promotes the DASH diet. Here's the link. It even includes recipes.

You can sense the frustration in the European Society of Cardiology. They have done similar studies and yet governments are not rushing to take up their guidelines. In Britain it is the same government that complains frequently and bitterly about the rising cost of prescriptions. Why?

It also tells people to lose weight and urges "five a day". Yet the system fails to link this well-meaning advice directly to the diseases that people suffer and the drugs they are required to take. Is this a result of our paternalistic health system or just a conspiracy? Is it just a shortage of dieticians? Or am I wrong?!!

Here's the link to the latest Euro-heart guidelines, which set out not just what patients should do but what professionals should do.

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