Expert Opinion

Sometimes being a knee-jerk contrarian, always eager to assume that the little people who serve you are inept, is not a good idea.

Megan McArdle is once again telling us far more than we need to know about her personal life. This time she is discussing her medical condition, one of her favorite subjects.

Medical Advice for the New Year: Don't Get Sick

By Megan McArdle

I have a family history of high blood pressure, so naturally when I saw that the Wall Street Journal had a piece up on "starting early for cardiovascular health", I clicked through.

The article said that "[b]ringing high blood pressure under control at any time reduces risk of disease. But not letting it creep up in the first place can be even better." McArdle is verklempt, because nobody knows anything ever and nobody can do anything ever in her philosophy.

[Y]ou'd really be surprised to learn how little control hypertension patients have over their condition. Yes, there are risk factors. But without medication, my blood pressure routinely spikes over 155 even though I have a perfectly normal BMI. It began creeping up in my mid-thirties for no obvious reason.

Actually, there is one obvious possibility.

That did not stop my doctor from offering ridiculous suggestions as to how I might control it. In her defense, she was a resident in internal medicine, and was presumably required to give me ludicrous advice by whatever shadowy figure was supervising her and actually making the decisions. First she came back and told me that a glass of wine with dinner more nights than not was "really a lot" of drinking, in a tone that would have been more appropriate had I confessed that I frequently woke up on the floor of our living room, surrounded by empty scotch bottles that I couldn't remember having purchased.

If McArdle drinks more than 9 drinks a week (5 oz of wine is one drink), she is considered a higher risk drinker. (A standard wineglass is a little over half full when it holds 5 oz of liquid.) Someone whose criteria for buying a house included bars within walking distance and who says she drinks at least four times a week could easily exceed a safe drinking level, and McArdle's response is quippy but unwise. You don't have to drink until you pass out to drink too much and these guidelines are for healthy people, which McArdle is not. She has Hashimoto's Thyroiditis and asthma, as she has mentioned several times.

McArdle's doctor told her to cut back on salt, which she decided was stupid advice.

 It made more sense just to ignore her advice, as I'm sure that everyone else she gave it to did. (And with good reason: the evidence that reducing your salt intake has a big impact on your blood pressure is pretty mixed.)

McArdle links to fellow professional contrarian John Tierney, whose article is far from convincing but who is as against government intervention as McArdle.

I am sure that it would, in theory, have been better for me to not have developed high blood pressure in the first place. It might also have been better for me to be 5'10 instead of 6'2--and unfortunately, I have no idea how I could have achieved either stunt.

Nor did most of the people in the study cited by the WSJ; according to the authors: "The prevalence of hypertension treatment in this study is low because of the time period during which these cohorts were initiated". The Journal compresses this to "patients who curbed their levels in the Circulation study did so only with lifestyle changes " but that is not actually what the authors said. Rather, they said that they don't know why people's blood pressure fell. People whose blood pressure fell did see smaller increases in body mass index and cholesterol than those whose blood pressure rose. But those things were still increasing, not decreasing. So:

Decreases in BP may have been due to lifestyle changes, as suggested by the changes in body mass index and total cholesterol, although it is possible that differences were due to random variation or regression to the mean.

So what we really know is that if your blood pressure is high, and then falls, it is better than if it just stays high--and it's even better if it doesn't get high in the first place. Except we knew that before. Having high blood pressure is bad for you. So is getting Lou Gehrig's disease. But it is not very useful to tell people that they will be better off not contracting these conditions.

The article that McArdle read discussed rising blood pressure in aging men. The advice would be appropriate for them, if not her.

You can treat the condition, of course--but to my chagrin, even well-controlled hypertension is not the same thing as having normal blood pressure. Whatever underlying process is causing my blood pressure to rise is also probably damaging my cardiovascular system, even when the blood-pressure itself reads normal. Moreover, at least as far as I know, doctors don't give you blood pressure meds when your BP hits 121. They wait until you're, well, hypertensive, or close to it. That's because there's substantial error in blood pressure readings (you're having a bad day, you were late and ran up the stairs, you're scared of hospitals). They don't want to put you on diuretics for years to treat that rumor you heard that your company might be having layoffs.

Of course, you should exercise--but research seems to indicate that it's good for a few points, not a drop from "Stage 2 hypertension" to "normal". And you should quit smoking--but much to my surprise, smoking apparently doesn't cause high blood pressure. Maybe you should eat less salt, too, but the evidence that this will improve your hypertension is not all that convincing. Even losing weight, the most plausible intervention, seems to generate modest improvement, not radical reduction. All of these things together, at the most generous estimates, would not have reduced my blood pressure below 120/80.

Don't get me wrong: hypertension is a serious condition; it's imperative to treat it, and it would be even better if we could avoid it entirely. But I only know one sure-fire way to keep your blood pressure from rising, and that's to avoid reading articles telling you that you really shouldn't have become hypertensive in the first place.

McArdle does not believe fat people can lose weight, poor people can have discipline, or rich people can be greedy and make bad decisions. Things just happen for no reason and there's nothing we can do about it. Experts don't know anything, governments can't help people, the poor we will have with us always. This casual disregard for logic and reason and hand-waving dismissal of expertise can have very detrimental effects.

For instance, evidently McArdle was so busy dismissing everything her doctor told her that she did not ask about a connection between her autoimmune disease and high blood pressure. According to the American Heart Association, the two are associated.