March 22, 2008

Mudslinging? Does "metabolic syndrome" mean anything?

There's another important debate in the BMJ this week. The question is: Should medicine dump the "metabolic syndrome"?

The American Heart Association states on its website:

The metabolic syndrome is characterized by a group of metabolic risk factors in one person. They include:

* Abdominal obesity (excessive fat tissue in and around the abdomen)
* Atherogenic dyslipidemia (blood fat disorders — high triglycerides, low HDL cholesterol and high LDL cholesterol — that foster plaque buildups in artery walls)
* Elevated blood pressure
* Insulin resistance or glucose intolerance (the body can’t properly use insulin or blood sugar)
* Prothrombotic state (e.g., high fibrinogen or plasminogen activator inhibitor–1 in the blood)
* Proinflammatory state (e.g., elevated C-reactive protein in the blood)

People with the metabolic syndrome are at increased risk of coronary heart disease and other diseases related to plaque buildups in artery walls (e.g., stroke and peripheral vascular disease) and type 2 diabetes. The metabolic syndrome has become increasingly common in the United States. It’s estimated that over 50 million Americans have it.

In the BMJ this week, diabetes and metabolism specialist Edwin Gale says YES, the metabolic syndrome should be dumped, claiming that this "diagnosis" has little practical value.

But clinicians George Alberti and P Z Zimmet say NO - it should not be dumped because it increases the detection of people at high risk of diabetes and heart disease. They characterize the syndrome’s critics as living in a specialized academic world, out of touch with the "real world" of primary care.

BMJ editor Fiona Godlee writes:

"Is there anything edifying in this refined form of mud slinging? The BMJ invites the combatants into the pit (though we do ask them to bring their own mud), so it’s fair to assume we think there is, even though the 7th century Chinese sage Seng Ts’an said "The struggle between ‘for’ and ‘against’ is the mind’s worst disease." I for one came away from reading these two well argued pieces with a conclusion (and you will no doubt draw others). Since there is uncertainty as to whether it’s clinically useful for GPs to measure people’s waists, we need a randomised trial. Alberti and Zimmet say that focusing on the syndrome results in better management of people with type 2 diabetes, but they give no reference so I assume no "real world" trial has yet been done."

I applaud the BMJ for fostering this debate. In another part of her editor's note, Godlee notes:

We must constantly doubt the products of academia—Robert Merton called this "organised scepticism."

Sounds better than mudslinging.

Posted by schwitz at 12:35 PM | Comments (2)
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