Is lower better? Don't "treat the numbers" regarding dietary salt
NPR (National Public Radio) hit the nail on the head with this just-out story: "Doctors' 'Treat the Numbers' Approach Challenged ." As correspondent Richard Knox explains:
It can take scientists a decade or more to determine whether a drug actually works. In the meantime, doctors rely on other measures, like testing blood pressure and cholesterol levels, to determine whether a drug is having positive effects. But recent studies challenge the practice of prescribing medicine based on certain test results.
Doctors call it "treating the numbers" - trying to get a patient's test results to a certain target, which they assume will treat - or prevent - disease.
Knox quotes Dr. Steve Atlas of Mass General hospital: "It's a big deal because it reminds us of something that we often forget: the number isn't the outcome. And this raises concerns that just lowering the number doesn't get you where you want to be," (emphasis added)
This is, of course, exactly what our public health nutrition policy on salt is doing: treating the number. We need to look at outcomes (see numerous earlier posts to this blog).
Knox also quotes Dr. Ned Calonge on cholesterol-lowering drugs based on the recent diabetes trial disaster , saying:
"Now, what's open is - is lower better? And I think a lot of people believed it would be, and there are many of us that were saying, 'You're going to need to show me,' " he says.
Lately, studies have also challenged other cherished assumptions - like lowering blood sugar. For a long time, doctors have believed that getting diabetic patients' blood sugar as close to normal as possible would prevent heart attacks. A drug called Avandia lowers blood sugar very well.
It was approved in 1999 and was heralded as "one of the newer and greater drugs for the treatment of diabetes," says Dr. Cliff Rosen. Rosen is the chairman of a Food and Drug Administration advisory panel that concluded unanimously last year that patients taking Avandia actually had more heart attacks and strokes.
Rosen says the Avandia story is a caution against treating millions of patients on unproven assumptions.
It's the same story for salt -- but, so far, a largely-untold story. Still, just as public health policy cannot change human physiology, neither can news coverage. But it can slow down our quest for the truth and our ability to base policy on evidence rather than opinion. Please, someone tell HHS! Outcomes matter.
