Why This Cardiac Care Proposal Misses a Beat

Why This Cardiac Care Proposal Misses a Beat

Why This Cardiac Care Proposal Misses a Beat

Why This Cardiac Care Proposal Misses a Beat

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Aug 25, 2024

Aug 25, 2024

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Why This Cardiac Care Proposal Misses a Beat

Like many on the right, on the center, and even on the sane left, I am an enormous admirer of Bjorn Lomborg. The Swedish statistician has made a name for himself by responding to the craziest claims and prescriptions of radical environmentalists regarding topics such as climate change, with sober analysis.

An argument Lomborg often makes–a very simple one, but one so consistently overlooked by activists–is that each spending decision also carries an opportunity cost. In other words, the gigantic sums of money that activists want us to spend on climate change are money that’s not going to be spent on other interventions, and there are many, many interventions that would save or improve a lot more lives in the here and now than the theoretical future lives saved by anti-climate change initiatives.

This is why we were excited to see this article by Lomborg on a supposedly low-hanging fruit of global health, and on how we could save many lives in the developing world with little money. Such low-hanging fruits do exist: the most famous one is the most universally-praised Bush Administration program: PEPFAR, the President’s Emergency Plan for AIDS Relief, which paid for AIDS medications for poor people around the world, which has saved over 25 million lives, primarily in sub-Saharan Africa–and for very little money.

If they are effective and provide value for money, these programs are good not just for humanitarian reasons, but from much more cold-hearted and pragmatic reasons of national interest and American soft power.

So we were excited and intrigued to see Lomborg propose a kind of “PEPFAR for heart disease” (our expression, not his).

We think of cardiovascular disease as a rich world’s problem, but Lomborg informs us that it also wreaks havoc in poor countries, and that there are easy, cheap fixes. Unfortunately, we ultimately found that Lomborg’s prescription suffers from the problems of the activists he so readily skewers: long on the wishing, short and vague on the prescription.

Lomborg points out that cardiovascular disease is one of those “lifestyle diseases” and wants us to spend money on “initiatives that educate the public about healthy lifestyles, encourage regular check-ups, and provide access to affordable healthcare options.” Forgive us for finding this vague.

While education is important, evidence for the effectiveness of broad public health campaigns in changing behavior and health outcomes is mixed at best.

Meanwhile, regular health check-ups sound like a common-sense solution, but research has shown that general health checks do not significantly reduce morbidity or mortality from cardiovascular causes.

Finally, Lomborg’s suggestion to “provide access to affordable healthcare options” is vague and likely underestimates the true cost and complexity of implementing such a system. While he correctly points out that some blood pressure medications are inexpensive, the infrastructure needed to diagnose, prescribe, and monitor their use effectively is much more costly and complex. Lomborg’s claim that controlling high blood pressure in poorer countries would cost only $3.5 billion annually seems unrealistically low. This figure might refer to a very specific, targeted intervention rather than a comprehensive solution. The true costs of implementing effective, sustainable cardiovascular health programs on a global scale are likely to be much higher–if possible at all, given that they would have to go through one of the infinite, money-sucking aid bureaucracies.

There may be a simpler, less ambitious but more tailored proposal, however, focusing specifically on increasing access to blood pressure medications.

Hypertension is often called the “silent killer” because it typically has no symptoms but significantly increases the risk of heart disease and stroke. It’s also one of the most treatable risk factors for cardiovascular disease. Many effective blood pressure medications are now off-patent and very inexpensive. A targeted program that combines community-based blood pressure screening with direct provision of these low-cost medications could potentially save many lives at a relatively low cost.

Such a program would need to be carefully designed and implemented, with attention paid to issues like medication adherence, regular monitoring, and integration with existing health systems. It would not be a complete solution to global cardiovascular disease, but it could produce actual results.

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