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ISSUE 062 · DEEP DIVE · MYTHS & MISINFORMATION

In 1979 an American panel called the National Diabetes Data Group drew the line for diabetes at a fasting blood sugar of 140. In 1997 the American Diabetes Association moved it to 126. Nobody's blood changed. But by lowering the number, the committee reclassified well over a million Americans as diabetic overnight.

There was a real reason: 126 is roughly where the risk of diabetic eye damage starts to climb, so the lower line catches people before the harm shows. Then, in 2003, the ADA lowered the line for “prediabetes” too — from a fasting sugar of 110 to 100 — and with a single footnote turned about a third of American adults into people with a pre-disease. The World Health Organization looked at the same data and refused, keeping 110. Same numbers, two verdicts.

For decades “high blood pressure” started at 140/90. Go back further and it was looser still. Then in 2017 the American College of Cardiology and the American Heart Association redrew it at 130/80.

The effect was instant and enormous. The share of American adults with hypertension jumped from about 32 per cent to about 46 per cent — roughly 31 million new patients, created not by any change in anyone's arteries but by a change in the definition. Europe's cardiologists looked at the same evidence and kept the line at 140/90. An American at 135/85 has a disease; a European with identical blood pressure does not.

In 2001 the US cholesterol programme set the LDL goal for moderate-risk people at 130. In 2004 an update pushed it down to 100, and to 70 for the high-risk — a change that made millions more people eligible for statins.

And here is the detail that hangs over the whole subject. Of the nine experts who wrote that 2004 update, eight had financial relationships with companies that sell statins. They disclosed those ties only after they were pressed to. The recommendation may still have been right. But it was written by people with a stake in the answer.

Not a government, and not nature. These lines are set by expert committees convened by professional bodies — the American Diabetes Association (ADA) for diabetes, the American College of Cardiology (ACC) and American Heart Association (AHA) for blood pressure and cholesterol, the older National Cholesterol Education Program before them, and the World Health Organization internationally. They weigh the evidence and take a vote. That is why countries disagree, why the line for the same condition changes across a border, and why a number that feels like a fact of your body is really the current opinion of a panel.

Before this curdles into a conspiracy, the defence is real and it matters. Risk is a continuum, not a step. There is no biological cliff where you are suddenly diabetic or hypertensive; harm accumulates smoothly, and much of it begins below the old lines. Lowering a threshold can genuinely catch high-risk people before the stroke or the eye damage arrives — the 126 diabetes line is pinned to where retinopathy risk climbs, and the large SPRINT trial found that treating blood pressure to a lower target really did prevent heart attacks and deaths. Sometimes earlier is better, and “we drew the line too high” is a legitimate finding, not a plot.

But every downward step also does three other things. It relabels millions of low-risk people as sick, with the anxiety, the monitoring and the side effects that follow. It expands the market for a drug that is, almost always, already licensed and sitting in the warehouse. And it is frequently drawn by panels stacked with people paid by the manufacturers.

It is not only cholesterol. In 1994 a WHO working group invented “osteopenia” — bone that is not thin enough to break, given a name and, often, a prescription — and half of older women promptly qualified. None of these diagnoses is fake, and the risk data behind them are real. It is the pattern that should give you pause: the numbers almost always move down, never up; the wider net almost always fits a drug that is already for sale; and the people drawing the line are often the people who profit when it moves.

A diagnostic threshold is not a measurement of your body. It is a decision about your body — made by a committee, revisable, and revised, nearly always in the direction that turns more healthy people into patients. Knowing roughly where your own numbers sit is genuinely useful. Believing that the line itself is a fact of nature is the mistake.

National Diabetes Data Group (1979) and the American Diabetes Association Expert Committee (1997), on the diabetes threshold change from 140 to 126 mg/dL; ADA Standards of Care (2003) on lowering the impaired-fasting-glucose line to 100 mg/dL, and the World Health Organization's decision to keep 110.

2017 ACC/AHA High Blood Pressure Clinical Practice Guideline (the 130/80 redefinition); analyses estimating the US hypertension prevalence rise from about 32% to about 46%; ESC/ESH European guidelines retaining 140/90.

National Cholesterol Education Program, ATP III (2001) and its 2004 update lowering LDL goals to 100 and an optional 70 for high-risk patients; reporting on the panel members' financial ties to statin manufacturers and the 2004 request by 35 physicians for an independent review.

World Health Organization Study Group (1994), the definition of osteopenia by bone-density T-score.

SPRINT trial (2015), New England Journal of Medicine, on the benefit of lower blood-pressure treatment targets.

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