I have criticized the AAFP many times in previous posts. As a member-driven organization, I guess I’ve essentially criticized U.S. family physicians in general, though I also think there is an inner circle in the AAFP ranks that have an inordinate influence on policies. From gatekeepers in the HMO era, to delusional dreams that EMRs would save us from a flawed payment and documentation system, to pursuing the PCMH model even though its own national experiment showed it didn’t do anything important, the AAFP has made some colossal mistakes over my career.

But they got it right this time. The American Heart Association and other related groups released guidelines that called for a lowering of the definition of high blood pressure to 130/80. Usually when ologist organizations make recommendations, the AAFP just goes along, and frankly many national ologist guidelines are fairly evidence based and not too bad. There are a few cases where the culture and priorities of family medicine should cause us to reject the opinions of the ologists. This time the AAFP actually did it.

The AAFP said in a statement that it continues to endorse the JNC-8 guidelines, which is absolutely the right thing to do. The AHA guidelines would just worsen the epidemic of overdiagnosis and overtreatment that is contributing to our exorbitantly expensive healthcare system. The AAFP essentially joined its GP colleagues in the UK who pushed back against some recommendations that the risk level for starting statins be lowered. Comments such as poor use of resources and medicalising normal life were common. (As an aside, each of the 3 U.S. cholesterol guidelines support starting treatment at a much lower risk level than the UK guidelines, which is why our statin use rate is about twice that of Britain. We’ve moved towards our UK GP colleagues, but there is still an ocean between us on some issues.)

I hope this is the beginning of the AAFP actually growing a spine. It’s a great first step.

Tags: AAFP, AHA, guideline, high blood pressure, hypertension

This entry was posted on December 23, 2017 at 8:56 pm and is filed under Blog. You can follow any responses to this entry through the RSS 2.0 feed.