Not Normal, Optimal

27 Aug

Reports of blood work generally include guides for normal ranges. For instance, for LDL-C, in the US, a score of < 100 (mg/DL) is considered normal. But neither the reports nor doctors have much to say about what LDL-C level to aspire for. The same holds true for things like the A1c. Based on statin therapy studies, it appears there are benefits to reducing LDL-C to 70 (and likely further). Informing people what they can do to maximize their lifespan based on available data is likely useful.

Source: Chickpea And Bean

Lest this cause confusion, the point is orthogonal to personalized ranges of ‘normal.’ Most specialty associations provide different ‘target’ ranges for people with different co-morbidities. For instance, older people with diabetes (a diagnosis of diabetes is based on a somewhat arbitrary cut-off) are recommended to aim for LDL-C levels below 70. My point is simply that the lifespan maximizing number maybe 20. None of this is to say that is achievable or the patient would choose the trade-offs, e.g., eating boiled vegetables, taking statins (which have their own side-effects), etc. It isn’t even to say that the trade-offs would have a positive expected value. (I am assuming that the decision to medicate or not is based on an expected value calculation with the relevant variables being the price of disability-adjusted life-year (~ $70k in the US), and the cost of the medicine (including side-effects).) But it does open up the opportunity to ask the patient to pay for their medicine. (The DALY is but the mean. The willingness to pay for DALY may vary substantially and we can fund everything above the mean by asking the payer.)

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