Medical science has finally found a solution to the
obesity problem in the U S. And, incidentally, the high cholesterol
problem can be solved in exactly the same way; by applying the same
standards and logic that are applied to so many other health factors;
the reference range.
How would that help, you ask? Well, the standard
reference range is set so that the middle 95% of those tested are
withing range with 2.5% being below range and 2.5% being above range.
The assumption is that 95% of the population is normal...or
healthy...or at least ok.
The data available shows that the upper, or out of
range, 2.5% in BMI is somewhere above 40. The lower, I would
conjecture, is somewhere around 10. So the “expected” BMI range
would fall between 10-45 or so. If doctors treated BMI the same way
as they do so many other conditions, then there would be no problem
for so many; they'd all be in range! Incidentally, a total
cholesterol of 270 puts a person in the 95% range, so you can still
increase your cholesterol, at that level, and be within range.
As an aside here, I would guess that the bottom 2.5%
total cholesterol number would be around 75. Cardiologists would
love this! Because if you could get your total cholesterol that low
you would never suffer a heart attack/cardiac event! The heart docs
would be high fiving and bragging about how well their treatments
work. No cardiac events, you ask? That's right, because with total
cholesterol that low you'd commit suicide or die from other maladies
before the heart would have a chance to act up!
Of course, I'm not serious about using reference ranges
with things like cholesterol and obesity. That would be silly and
illogical. But then, why do doctors insist on using reference ranges
in so many other areas that are just as silly?
Granted, there are some things for which doctors
routinely check regardless of symptoms. For many of these,
especially when the numbers tested are high enough to represent the
general population, the 95% “ok” assumption might be valid. But
for so many things, testing is only done when symptoms of a
particular condition present. And for many of those conditions, the
reference range is lab specific, not even adding in data from other
labs. To assume that 95-97.5% of those exhibiting symptoms are
really “ok” is rather a leap of faith.
As an example, let us look at what might be a typical
lab associated with an endocrinology clinic. And let us look at the
testosterone reference range. For a particular lab, the range is
somewhere in the area of 175-750. Most labs give a low end number of
between 250-350. Some labs even have a low end in the 400's. Why
would this lab be so different?
Well, first ask yourself who gets tested for
testosterone levels. I guarantee you, it's not the guy with no
problems, whose parts are functioning well, and who has a happy and
frequent sex life. So even the guys being tested by their family
doctor are ones who have exhibited symptoms of low testosterone. Now
who goes to the endocrinologist? That would be those worst case
folks whose symptoms the family doctor hasn't been able to alleviate!
And we are going to assume that 97.5% of those being
seen by an endocrinologist for symptoms of low testosterone are
really ok because they are within the clinic's lab generated
reference range? I have a really hard time accepting that! But
many doctors take it as gospel! Never mind that studies show levels
above 550 decrease cardiac events by 30%. Either the doctors haven't
bothered to keep up to date on the latest studies, they don't believe
the studies because it wasn't what they were taught, or they just
refuse to change their methods.
Reference ranges say nothing about health, wellness, or
functionality. They simply give an indication of the relative status
of those being tested. In the land of the leper, the leper is
normal!
I prefer to be healthy rather than normal!
