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We need our own clinical standards for diagnosis

Feb 11, 2011 Letters

Dear Editor,
Every so often, it is reported that our health care cost is getting higher. One of the reasons for this could be the prescription of too much of unnecessary medications. We are following the trend of the developed country whereby there is a drug for any conceivable ailment. We need to stop being a copy cat.
We are living in a tropical environment, are below sea level, have people of different races, different dietary habits, susceptible to different diseases – Afro-Guyanese to hypertension, while Indo-Guyanese to diabetes and various physical activities. In awareness of these differences, we are still using standards for people in temperate countries to determine our ailments.
A typical example is the diagnosis of anaemia – Hb less than 12mg/dl or Rbc less than 5 million cells /ul. We are below sea level and as such are more exposed to oxygen than people living above sea level or higher elevation. In higher elevation, there is less oxygen; people in these regions are expected to have a higher blood count. The reason for this is to ensure that they can efficiently utilize the limited oxygen. Using the universal standard, our people are considered anaemic and treatment involves taking iron supplements. Iron supplement may not be needed. The anaemia could be due to other factors such as Vitamin E or B12 deficiencies, alteration of haemoglobin, blood loss or worm infestation.
With this understanding, it would seem that fortifying our foods with iron or supplying every anaemic patient with iron tablets may be a contributor for our higher health cost.
Another disease that is very prevalent in Guyana is diabetes. One is considered to be a diabetic if their blood sugar is consistently above 7.8 mmoles/L. This threshold may not be applicable to the Guyanese people. In Guyana, we eat a high carbohydrate diet and as such our blood sugar would reflect this. The normal blood sugar is 4 to 6 mmols/L. A standard obtained from people who ate a high protein/low carbohydrate diet.
Since the prime source of glucose is carbohydrate, a low carbohydrate diet will give a low blood sugar result. Studies have shown that people who have eaten a high fat diet for several generations did not show a high incidence of cardiovascular disease. With this analogy, we need to rethink the parameters that are used to diagnose someone as diabetic. It is known that people given high dosage of insulin over a period of time are more likely to suffer from cardiovascular complications than those who did not have insulin therapy In the presence of insulin, glucose enters the cells of blood vessels. This translates in rapid growth of blood vessels walls. The blood vessels thickens, blood flow reduced and subsequently there is cardiovascular complication.
Lastly, I want to address
the concern of elevated cholesterol. As soon as someone has elevated cholesterol reading that person is put on medication. Many people are ignorant of cholesterol role in the body. Cholesterol makes six hormones in the body and if any of these hormones is not synthesized then we will have health issues. Lowering cholesterol by medication may be responsible for more illnesses than preventing illnesses.
I hope by explaining some of our health problems, our professionals would not used the clinical finding alone and start prescribing drugs. Treatment is supposed to make a person better not to give them more health issues.
Sherlock Rawana, PhD

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