—Translated from a speech by Qide Han, Member of the Chinese Academy of Sciences:
“Is high blood pressure a disease?”
“Does high blood pressure need treatment?”
“If you have high blood pressure, do you treat it?”
At the opening ceremony of the annual meeting of the China Association for Science and Technology, Qide Han, vice chairman of the National Committee of the Chinese People’s Political Consultative Conference and chairman of the China Association for Science and Technology, did not give an opening speech like in previous years. He started a report with “Re-thinking on Disease Risk Factor Control and Disease Screening”. He also told the participants with great interest that this report will involve some “subversive opinions”, but all of them are based on evidence. But he stated “it is a personal opinion, and only provides one aspect”.
After asking the first question, Qide Han asked himself and answered: “No, high blood pressure is only a risk factor.” He quoted the statement in “Ci Hai” that DISEASE is defined to the human body under certain conditions, caused by pathogenic factors. manifested pathological process. Disease must have limited or lost working ability, and a series of clinical symptoms, and most hypertensive patients do not have these conditions, so it is not a DISEASE, but a risk factor.
Since it is not a disease, do we need treatment? Qide Han once asked this question to more than 500 doctoral students. At that time, 1/3 of them did not raise their hands, and those who did not raise their hands said: “Since it is not a disease, why should I treat it?” Those who raised their hands said, “Everyone knows that high blood pressure needs to be treated and is a risk factor.” Then, Qide Han told the more than 500 people a research result: antihypertensive treatment for hypertensive patients can reduce the risk of cardiovascular and cerebrovascular events by 25% to 30%, which is very significant.
After speaking, he asked again, does high blood pressure need treatment? This time, most people raised their hands, “It needs treatment.”
The next question is: If you have high blood pressure, do you treat it? Naturally, everyone raised their hands.
At this time, Qide Han gave another unexpected data: the highest incidence rate of cardiovascular events (myocardial infarction and stroke) in 10 years is about 15% among hypertensive people over 40 years old in my country (China). Reduce the incidence rate by 30%, that is, reduce it to 10.5%, that is, 100 hypertensive persons over the age of 40 take antihypertensive drugs to control blood pressure, only 4 to 5 people will benefit, and there may be side effects of drugs, plus the economic burden of taking drugs.
Now ask again: “Would you like to take medicine for life?”
The audience fell silent.
Medical treatment is not as omnipotent as imagined, and the positioning of medical treatment must be corrected. Qide Han said: “Medical care only plays an 8% role in people’s health, and more is determined by lifestyle, living conditions, and financial security. Therefore, we should have a better and more comprehensive view.”
“The effect of intervention with a small probability is definitely very small, but if it is implemented on an individual, no one can be sure whether he is in the 1% or in the 99%.” Qide Han then take “high blood pressure”, “pre-diabetes”, “osteoporosis” as examples, the actual result of the current interventions targeting risk factors is that very few individuals benefit from taking the measures, most of the interventions have no effect, and some of them suffer damage to their health.
What worries Qide Han is that this is not understood by the public, especially in the field of disease screening.
He took a study in the United States as an example. This study involved 76,000 patients. Among men aged 55 to 74, half of them tested PSA (a screening method for prostate cancer) once a year, and half of them did not do the test. How about it? The screening group found 108 prostate cancers per 10,000 people, while the control group only had 97. The former increased by 12%, which means that the number of patients discovered after PSA screening increased. But 13 years later, it turned out that there was no difference in the number of men who died of prostate cancer between the two groups who were tested and those who were not.
Coincidentally, let’s look at lung cancer again. The United States has done a study on 450,000 people, comparing various screening methods with no screening, and found that there is a difference between doing chest X-rays every year and not screening, and doing more than two high-frequency chest X-rays every year, the death rate of lung cancer increased on the contrary. Mortality appears to be reduced when chest radiographs are combined with sputum cytology compared with chest radiographs alone, but there is no significant difference.
Returning to a question that ordinary people can understand better: is it still meaningful for us to do routine physical examinations?
Qide Han said that a study showed that, excluding the elderly, whether to take a health checkup had no effect on the mortality rate.
“But the reality is that almost all people will encourage them to go for further checkups no matter what test results they have. In addition to the current relationship between doctors and patients, it is even more necessary to check.” Qide Han said.
What shall we do? This internationally renowned pathophysiologist did not give specific suggestions, but he gave a principle: to make reasonable decisions for low-probability events, so as to reduce risk factors and improve the efficiency of screening interventions.
In addition, conceptual problems must be solved. “Medical expenses” are very effective in solving basic medical problems, but if they are used in patients with late clinical stages, they will cost a lot of money but the curative effect is very poor. “If the same money is spent on basic medical care, many people will benefit. Therefore, we must use the money in the most reasonable place.”
“Our current medical care has problems, not because of its decline, but because of its prosperity, not because of its inaction, but because it doesn’t know when it will end (keep spending…).” Qide Han said, “In a world where religion is strong and science is weak In ancient times, people believed magic as medicine, and today, when science is strong and religion is weak, people mistake medicine for magic.”