I am concerned about this long letter.1 I find it odd and I do not understand why it was accepted for publication. There are two reasons for this concern. Firstly, I find it simplistic in its acceptance of the usefulness of screening for a single risk factor (hypertension) and secondly, I am suspicious of the authors' motives in writing.
I have lived and worked for a number of years in Pakistan, and have ongoing connections with the country. Part of my role was in diabetes management, but I very rapidly became disillusioned with regard to treatment recommendations that are based on a developed country model. On my desktop I have, with the permission of Cambridge University (http://www.dtu.ox.ac.uk/Outcomesmodel), the UKPDS Outcomes Model programme that was acquired in order to do some research to prove that which I already know. We all do really. That is, for the vast majority of the population, the recommendation to buy expensive pharmaceutical preparations over many years in order to, largely theoretically, save a few months of life or morbidity, does not take into consideration informed consent.
The true cost of implementation of this recommendation is to deprive individuals and families of essentials such as food, shelter, and schooling. Advice from professionals to act in this way is often treated with a respect that is simply not deserved and this when there is no axe to grind. This is true in nations that are considered developed, and even more so in countries that are less fortunate and for which the profit motive in selling pharmaceuticals direct to the public is much less hidden.
With regard to my other concern, I was interested to see that the address of your correspondents is the department of Pharmaceutical Sciences in a university in Malaysia. This is at least honest, but it does not reassure me about their objectivity. Intriguingly, Balochistan is one of the least developed areas of Pakistan and in this context I really cannot see how the practical application of their ideas can be remotely achieved.
- © British Journal of General Practice, 2010.