Shocking! Simply Shocking! In the light of this new knowledge, it is clear that when these "diseases" are used as diagnostic markers and nothing more, their use in disease screening of healthy people to detect those at risk for heart disease and stroke is extremely misleading. The only reason people seem to be screened is to help their physicians and insurance companies make more money. If all tests came at a flat fee for everyone for their entire life, this would help eliminate the incentive to make tests that just pad the pockets of physicians and insurers. The next problem with the use of heart disease and stroke risk as an excuse to do lots of chest X-rays and stress tests is that it creates a real financial problem for insurers. Insurance companies do not want to pay for disease screenings in healthy people. Healthy people are not sick people, so they have no need of health care. What if everyone became completely healthy and insurers had to pay for no health care? How much would it cost them? This creates a financial conflict for insurers, which is in effect saying, "Hey! How about some disease screening here?" The practice of testing healthy people for disease risk has become the industry standard, however. This is why disease screening has spread from heart disease to other things. For example, it is routine practice in the U.S. to screen all newborns for the risk of mental retardation by measuring their IQ. The vast majority of these infants will not go on to develop mental retardation and will not need any of the treatments offered in the mental retardation clinics. The only people who benefit from this screening are the manufacturers of mental retardation clinics. This kind of screening wastes everyone's time and is very, very expensive. In fact, in the U.S. alone, it costs about $50 million a year. In the rest of the world, the cost to do this kind of screening is even higher. The same can be said of stress testing. The vast majority of people who do this have absolutely no future risk of coronary events. The reason everyone does these stress tests is to make money for manufacturers of stress testing machines. Insurance companies then have to spend money to approve these procedures so they can pay doctors for them. It is clear, therefore, that stress testing does not make sense. Anyone who has a stress test done should carefully evaluate the medical need for the test. If it is done purely for the practice of medicine, and not for business, it should be done only when there is a medical indication, such as angina or a history of heart disease or stroke. Any physician who is in practice to make money is in the wrong job. As one physician wisely said: Don't be surprised if you are billed for heart tests, if you are diabetic, if you have high blood pressure, if you smoke, if you are over forty-five years old, if you have a mother who died young of cancer. Do you want to be sent to specialists, cardiologists, or internists? If you are, you can expect to be billed. If you don't, forget it! It is clear that our medical system is not about health. It is about business. All businessmen are in it for the money. All doctors and hospitals are in it for the money. Most insurance companies are in it for the money. No one wants to be labeled with disease risk. In order to profit from disease screening, they have to be in control of it. They want to be in control of heart disease. When everyone thinks that everyone is at risk for heart disease, insurance companies, physicians, and drug companies can charge more. It is a win-win situation for them. * * * ## **PART III** HIGH BLOOD PRESSURE * * * ### CHAPTER 18 Doing the "Blame Exercise" * * * **BLOOD PRESSURE** is a confusing term, and most of us don't even know what it means. The only thing you might have noticed is that if you have a high blood pressure it is a sign that you need to see your doctor. It makes no sense at all to define blood pressure in terms of millimeters of mercury (mmHg). Systolic pressure is the pressure when the heart beats. You could have a very low blood pressure (called hypotension) if the heart beats all the time. In general, though, if your blood pressure is low, it will be lower when you are lying down (called orthostatic hypotension). If you have high blood pressure you will most likely be taking drugs for it, which usually lower your blood pressure. When doctors talk about high blood pressure they usually mean systolic pressure of 140 mm Hg or greater and/or diastolic pressure of 90 mm Hg or greater (unless otherwise indicated) over a prolonged period of time. In other words, "high blood pressure" is really a symptom of having a number of diseases that can cause the disease called hypertension, but no one is trying to cure the patient of these diseases. The main disease of high blood pressure that most doctors are in business to cure is hypertension. The best way to remember this is to use "blood pressure exercise," as I like to call it, which means that if your blood pressure is high, you should be made to feel that it's really your fault, which is what they try to do. Blood pressure exercise starts in most doctor's offices when you are called in for a "well visit." Your blood pressure is usually measured three different times by an automated blood pressure cuff, which is placed on your arm and inflated and deflated automatically. The average of all of the measurements is the recorded blood pressure. It is a shame that there is no way to measure the physician's blood pressure while he is taking your blood pressure. How well would you feel if you had a heart attack because your doctor was having a coronary? I suggest that you take your blood pressure reading seriously and check the measurements on your own at home. If your own numbers are over 130 systolic and 80 diastolic, then ask your doctor why he wants to see you again. There are other things your doctor might want to do that are related to your high blood pressure, such as an eye exam, tests of your kidneys, cholesterol level check, or a test of some other organ. If you can take time off work to have these tests done, go for it. If you can't take time off to have these tests done, make sure your doctor tells you what you need to do to get them done. If you know that it will be more difficult to find a job because you have high blood pressure, then explain that you cannot work nights and only work daytime hours. This may be the only way for you to get by financially. If you have other health problems and you can't take time off, you may have to find another job and quit smoking if you smoke. It doesn't matter how much money you are making in your present job, because your job is not that important when your health is at stake. **THE BEST HOSPITALITY WE CAN SHARE** A major survey recently completed by the University of Florida's Bureau of Business and Economic Research showed that people who eat organic, wholesome food live longer than those who don't. The study looked at 5,000 Americans over sixty-five who answered questions about their lifestyle. What is noteworthy is that people who eat organic food feel better, regardless of what they eat. People who eat regular meals are healthier than those who snack on unhealthy food. More important, people who eat healthier foods feel better. They are physically and emotionally healthier, which may explain the longevity of those who eat healthy. This is very encouraging because it means that when someone is sick with disease, we can help them with food. If we can give someone a high blood pressure pill, there is no reason not to teach them how to eat healthy food that won't harm their blood vessels. This is especially important for the elderly and those who have hypertension. * * * **The Problem of Sensitive People** Many people are sensitive to high blood pressure readings and they cannot believe that their blood pressure is high if the doctor tells them so. It is important to explain to people that stress is the most common cause of high blood pressure. I recommend that everyone go to www.pittsburghchronicles.com and download a copy of the article "How Stress Causes High Blood Pressure" by Dr. David A. Mendeloff, which is in the "Archives" section. Many people cannot accept the idea that high blood pressure is due to stress because it does not occur with them. It is because of stress that people's blood pressure is high. That is the only reason. * * * If you have high blood pressure, chances are that you know you have high blood pressure. As a result, you should be doing this disease-blame activity on a regular basis. When you go to your doctor's office, do not leave without asking the doctor some hard questions, like the following: 1. How long do I have to keep doing these tests to make sure I don't have heart disease? 2. Is there anything I can do besides taking drugs to lower my blood pressure, such as what I need to do to prevent getting high blood pressure, what I need to do to avoid heart attacks, or what kind of diet I should follow? 3. Do you recommend exercise for me? 4. Do you think I am eating too much salt in the diet? 5. Do you think there are factors other than stress that are causing me to have