Health outcomes focus in WSJ blog discussion
Although the headline of today's Wall Street Journal misleads readers into thinking it focuses on blood pressure, WSJ blogger Shirley S. Wang makes it clear that her focus is on whether new medications "prevent heart attacks and death any better than an old-fashioned diuretic." Referencing a new report about the ALLHAT study in the Archives of Internal Medicine , she calls for a focus on the health outcomes of various interventions.
I responded for the salt industry:
ALLHAT was an important step for another reason not yet discussed in this thread: rather than focus on the "risk factor" of blood pressure, it addressed the truly important question of whether the intervention (in this case anti-hypertensive drugs) achieved the expected health outcomes benefit. Too often we've confused "risk factors" with absolute risk. It is the event -- the heart attack the stroke, i.e. cardiovascular health and mortality -- that should concern us individually and be the focus of our public health policy.
I am president of the Salt Institute, the industry association of salt producers. We monitor the medical literature and participate in the public health debate. ALLHAT provides important information to physicians who make recommendations to their patients. Likewise, as an exercise in focusing on the health outcomes of a recommended intervention, ALLHAT is a proper model for our public health decision-making as well. Regarding salt, for example, the question should not be "will salt reduction improve blood pressure?" Blood pressure is the "risk factor" and there are other risk factors (e.g. insulin resistance, plasma renin activity, sympathetic nervous system activity, etc.) which are affected by reducing dietary salt. As in ALLHAT, we should be asking: will this intervention improve health outcomes? Will reducing dietary salt improve actual risks of heart attacks and strokes? Will cutting back salt improve cardiovascular (and all-cause) mortality?
If you think you know the answer, I'd suggest that answer isn't "politically correct" and invite you to review the issue on our website at http://www.saltinstitute.org/28.html or access a comprehensive list of the studies of this question at http://www.saltinstitute.org/healthrisk.html .
We have recommended to the Department of Health and Human Services that it conduct a controlled trial of the health outcomes of reduced-salt diets using the ALLHAT rationale and modeled on a recent study, the Trials of Hypertension Prevention, which demonstrate both the ethics and the study protocol appropriate to determine whether those who encourage general salt reduction are likely to improve public health.
