Tuesday 26 September 2017

'High-risk' label is risky business

'High-risk' classification has become a disease in itself.
'High-risk' classification has become a disease in itself.

Telling a person they are "high risk" of developing a particular condition or disease has become a disease in its own right.

It is turning the healthy into the sick, argues an expert in an editorial, which was published online in the British Journal of Sports Medicine.

And doctors are as bad as patients at understanding what is meant by high risk and the anticipated benefit of any preventive treatment, says Professor Teppo Järvinen, of the Department of Orthopaedics and Trauma at Helsinki University Hospital in Finland.

For example, around 10 years ago, the threshold for treatment of high blood pressure in the European guidelines on cardiovascular disease classified most adult Norwegians - among the healthiest populations in the world - as being at high risk.

If these guidelines had been put into practice, "the focus on hypertension would have drained the entire primary healthcare budget," points out Prof Järvinen.

Similarly, the recent US National Osteoporosis Foundation guidance on the threshold for the treatment of brittle bone disease, stipulates that treatment should be offered to all those whose 10-year probability of sustaining a hip fracture is 3pc. On this basis, three-out-of-four white women over the age of 65 in the US, and over 90pc of those over the age of 75, would be recommended drug treatment.

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