I admit that I am a very opinionated person but I have been restraining myself in the last few posts. I have written three posts on the new cholesterol guidelines and one on the new blood pressure guideline. In those, I tried to simply translate the medical jargon and summarize the key points in an easy way for everyone to understand. I held back on commentary and opinion because I wanted to keep things as simple as possible. Now that you have read and understood the basic points (If not please tweet me and I will try to explain it to you), I will not hold anything back. If you have not read the summary posts, I have included all the links at the bottom of this post.
Just to reiterate, unlike my previous posts about blood pressure and cholesterol guidelines, this post is completely based on my personal opinion. Here are my 7 points:
- Separate evidence from opinion: When any new practice guideline comes out, the first thing you need to do is to separate the strong evidence from the expert opinion and weak evidence. Personally, I only take out the grade A (strong evidence) and discard everything else as opinion.
- Take the best evidence with a grain of salt: Even the best evidence(Grade A) is not the absolute truth. It is what we believe to be true based on what we know. I believe that medicine is still in infancy when it comes to what we absolutely know. Grade A evidence is the best of what we’ve got and we don’t have much.
- Any guideline that knows its limitations is a good one: I like the new guideline much better than the old ones because they seem to acknowledge how little we know and explicitly suggest that patients should make the final decision based on personal preference and risk tolerance. This is specially true for the cholesterol guidelines.
- Less may be more: It is refreshing to see the new guidelines actually propose less stringent hard targets. To see this trend, you need to look at only the grade A recommendations. Many patients who were previously told that they “needed” to take medications no longer need them.
- Proponents of cook-book medicine in the name of quality be aware: This is a point I can go on and on for hours. In the name of quality, the government has been the biggest proponent of cook-book medicine where doctors are rewarded for treating the numbers and checking the boxes rather than treating the human patients. The new guidelines has the biggest tools we can use to fight back against those with the big brother mentality. Well, I will write a whole new post on this point because I do not want to take too much space here.
- Focus on the big picture: The new guidelines, specially the one on cholesterol, makes it clear what cholesterol numbers really mean. For the first time, they seem to acknowledge that cholesterol numbers are just a part of the equation. The big picture is reducing your overall risk of heart attacks and strokes. The big picture has a lot to do with your lifestyle and stress level, and unnecessary obsession with numbers can have bad impact on the big picture. You need to look at the blood pressure guidelines in the same context.
- The risk of taking the guidelines too literally: There will be doctors and patients who will look at the guidelines and make bad decisions. It can clearly happen if you take all the recommendations and fail to separate the evidence from the opinion. This can result in more people taking pills and taking stress they don’t really need. Review the strong recommendations (Grade A) and know them well. If your doctor happens to present expert opinion as evidence, you can correct him and make a better choice.
Here is a recap of all the summary posts on cholesterol and blood pressure guidelines: