Ethical dilemmas arising from implementation of the European guidelines on cardiovascular disease prevention in clinical practice A descriptive epidemiological study

Abstract

Implementation of the 2003 European guidelines on CVD prevention would label a large majority of Norwegian adults as having unfavourably high cholesterol and/or blood pressure levels. The current biomedical standards appear to invalidate demographic health statistics. The theoretical basis on which the guidelines rest should thereby be scrutinized with regard to scientific methodology and consistency. Important ethical dilemmas arise at the point of guideline implementation, relating to risk labelling and medicalization, as well as resource allocation and sustainability within the healthcare system.

Why do sales of lipid-lowering drugs vary between counties in Norway?

“…The gap between observed and guideline-recommended LLD use may reflect the fact that adherence to Framingham-based thresholds for intervention has been problematic in clinical practice. Norwegian population studies have shown that European SCORE-based guidelines classify most adults at high CVD risk with an ''unfavourable'' high cholesterol [2,5,6]. Implementation of these guidelines may lead to a marked increase in pharmacological treatment, especially in men and among the elderly [5].…”

Individually based preventive medical recommendations – are they sustainable and responsible? A call for ethical reflection

“…Implementation of the 2003 European guidelines on cardiovascular disease prevention [9] could imply that 76% of Norwegians 20 years and older and 90% of Norwegians 50 years and older should be told that they have unfavourably high cholesterol and/or blood pressure levels [10]. From these figures, it is evident that fundamentally new and unrecognized dilemmas emerge once we consider the aggregated implications of these individually based recommendations.…”

“…From these figures, it is evident that fundamentally new and unrecognized dilemmas emerge once we consider the aggregated implications of these individually based recommendations. This means that preventive medicine may be facing a major moral challenge [10]. The USA, Iceland, and Norway are currently numbers 1, 4, and 5 on the OECD ranking list of national healthcare expenditure in the world (OECD Health Data 2004).…”

“…Policy integration means that preventive guidelines may not reflect the compartmentalized interests of experts and subspecialists [21]. Preventive efforts must be coordinated, and the expected overall impact of recommendations on clinical practice estimated, before authoritative guidelines are issued [10]. 5.…”

“…Biomedical measures are only part of what is relevant information with regard to human health and disease. Responsible medical care recognizes that social conditions and interpersonal relationships have a strong impact on health, both on the individual and on the group level [7,10]. 2.…”