COMMENTARY

Population Medicine: Let's Get Over It!

Disclosures

July 01, 2013

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The topic is population medicine and why we can't get over this. It's befuddling to me. Let me go back for a few examples so you understand what I'm really getting at:

'Our' Brains on Coffee

The New York Times, June 6, 2013: "This Is Your Brain on Coffee"[1] -- why drinking 3 cups a day may be good for us. Well, does that take into account that at least 20% of people carry an allele where the metabolism of caffeine is markedly reduced, and that risk allele has indeed been linked to a higher risk of heart attack? Why should there be a recommendation now that all of us should be drinking 3 cups of coffee a day?

Salt Guidelines

Then in May of this year there was a big Institute of Medicine report[2] regarding what should be the salt guidelines. And this got all sorts of organizations rankled -- the American Heart Association[for instance] -- about what should be the salt recommendations for everyone. This is crazy stuff, because we know that there are some people who are remarkably salt-sensitive and will have a blood-pressure response to a salt load, and then there are many others who are what essentially appears to be salt-resistant, as they can have as much salt in their diet as possible and it's not going to have an effect on their blood pressure.

ESC/ESH Blood Pressure Guidelines

Currently we have European Society of Cardiology/European Society of Hypertension guidelines[3] stating that blood pressure should be less than 140 mm/Hg for all. Now, if you go through the guidelines it talks about how those over 80 years...are exempt, but why do we have to have this "for-all" approach? That is just not working, it's not right; it's basically the structure of guidelines that doesn't respect the individuality of what's unique about us biologically, physiologically, and anatomically -- our environment, everything.

It's frustrating to me because I've been watching this for so many years, and we still have this fixation about having some guidelines or recommendations for all people. It just doesn't stop. When are we going to get this straight?

I'll be really interested in your comments. It's been a pet peeve of mine for a long time, and unfortunately I'm not seeing any progress. Maybe you know how we can try to not simplify things so much and move forward.

Thanks a lot for your attention.

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