Evidence Based Medicine Gaining Over So Called Experts

Prof L Werkö i juninumret av SBUs tidning

Several hundred doctors working in primary care have written to the Secretary General of the WHO Gro Harlem Brundtland, protesting the recommendations of a WHO-ISH expert report regarding treatment of moderately elevated blood pressure. They emphasize that the recommendations, if implemented, will increase the cost of treating these patients without much benefit for patients or health services

SBU published a report on moderately elevated blood pressure in 1994 (report 121, also published in English as supplement 737, J Int Med, 1995) based on a systematic review of all available evidence at that time. The report strongly recommend that in moderately elevated blood pressure, the patients should be treated, not the blood pressure figure. At that time there was only scientific evidence that treatment sing diuretics or beta-blockers had been shown to influence morbidity and mortality in these patients. Studies on other type of medicines published after report 121 have demonstrated that these other medicines may also have the same, but not any better, effect as the two originally recommended. SBU thus can see no reason to change the recommendations from the earlier report.

It should be emphasized that the recommendations published, as coming from the WHO, are the result of the deliberations of an expert committee, appointed jointly by WHO and the International Society of Hypertension. The recommendations thus are those of the expert committee and are not endorsed by the WHO. The validity of the recommendations of the committee has to be seen against the background that some of the members, to varying extents, are supported by pharmaceutical companies selling blood pressure lowering medicines. The WHO-ISH recommendations were furthermore presented by a pharmaceutical company before the presentation scheduled by the WHO.

The reaction of members of the medical profession treating patients with elevated blood pressure all over the world must be seen as a healthy sign that evidence based medicine is starting to gain over the propaganda from the pharmaceutical industry.

Professor Lars Werkö