Chronic ailments — arthritis, cancer, cardiovascular problems, kidney and liver and other organ failures — arise in different ways and for different reasons than do infectious diseases. Drugs have been very successful in overcoming infectious diseases, but their application to chronic ailments is illogical and harmful. Is a treatment against cardiovascular disease (for example) beneficial? Does it prolong life and improve quality of life? Valid answers would be based on very large and lengthy clinical trials controlling for innumerable variables — essentially impossible. Therefore research and applications make use of surrogate markers, measurables like blood pressure, cholesterol level, etc. But in order to determine whether a surrogate marker is an accurate measure of the state of a chronic ailment would require one of those impossible clinical trials. The use of surrogate markers is based more on faith than evidence. Worse, it assumes that correlations identify causations.
The commonly used surrogate markers are not valid. Nevertheless, drugs continue to be approved because of their effect on these markers. Further, the accelerated approval of drugs initiated in the 1990s requires only two successful trials of at least 6 months duration. That is not nearly long enough to test safety or efficacy, and the last two decades have seen an increasing number of once-approved drugs withdrawn after less and less time on the market because of their deadly so-called “side” effects. “Side” is a fatally misleading misnomer.
The misguided drug-based treatment of chronic ailments is facilitated by semantic sleight-of-word, calling natural conditions diseases, dysfunctions, abnormal: cardiovascular disease; hypertension; “high” and “bad” cholesterol; “pre”-diabetes, “pre”-hypertension, etc.
Outstandingly illogical is the approach to blood pressure. For more than century it’s been known that blood pressure normally rises with age. But nowadays “hypertension” is defined by the same number irrespective of age, so that the average person normally attains “hypertension” at about age 60 ; some 75% of American seniors are treated with drugs to lower what is the normal pressure for their age.Blood pressure increases with age. Mortality increases with age. The incidence of cancers and of organ failures increases with age. Everything that increases with age is correlated with everything else that increases with age. Therefore blood pressure is correlated with every chronic ailment, but it doesn’t necessarily cause any of them.
Authors retain copyright to JSE articles and share the copyright with the JSE after publication.