More than just hype
===================

* Wally Shishkov

A headline appearing in the highlights section of the March 4, 2003, issue of *CMAJ* was “The hype around HOPE,” in reference to an article by Karen Tu and colleagues1 and an accompanying commentary by Louise Pilote.2 This expression was an appropriate play on words to describe changes in the prescribing of ramipril after publication of results from the large Canadian-led HOPE trial.

Reading these articles prompts questions about physicians' role in patient care. Will we continue to be led, like sheep, deeper and deeper into pharmaceutically driven disease management, or can we take charge by considering the real meaning of population health rooted in prevention?

Ramipril and other drugs are being investigated for their potential in preventing type 2 diabetes. But we already know how to prevent type 2 diabetes: lasting lifestyle change. Exercise and the maintenance of a stable, healthy weight prevent adult-onset diabetes. Let us not forget that 90% of type 2 diabetic patients are overweight, and many are obese — hence the recently coined term “diabesity.”

Preventing type 2 diabetes through the use of drugs does not represent a success, nor is it honourable. Rather, it represents an abysmal failure and remains unbecoming of the medical profession, driving up health care costs while fuelling more disease and management research, not to mention the fact that all drugs, including those given for their beneficial effects, also have side effects.

**Wally Shishkov** Physician Guelph, Ont.

## References

1.  1. Tu K, Mamdani MM, Jacka RM, Forde NJ, Rothwell DM, Tu JV. The striking effect of the Heart Outcomes Prevention Evaluation (HOPE) on ramipril prescribing in Ontario. CMAJ 2003;168(5):553-7.
    
    [Abstract/FREE Full Text](http://www.cmaj.ca/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiQUJTVCI7czoxMToiam91cm5hbENvZGUiO3M6NDoiY21haiI7czo1OiJyZXNpZCI7czo5OiIxNjgvNS81NTMiO3M6NDoiYXRvbSI7czoyNDoiL2NtYWovMTY4LzEzLzE2NDcuMS5hdG9tIjt9czo4OiJmcmFnbWVudCI7czowOiIiO30=) 

2.  2. Pilote L. Ramipril use in Canada: HOPE or HYPE? [editorial]. CMAJ 2003;168(5):568-9.
    
    [FREE Full Text](http://www.cmaj.ca/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiRlVMTCI7czoxMToiam91cm5hbENvZGUiO3M6NDoiY21haiI7czo1OiJyZXNpZCI7czo5OiIxNjgvNS81NjgiO3M6NDoiYXRvbSI7czoyNDoiL2NtYWovMTY4LzEzLzE2NDcuMS5hdG9tIjt9czo4OiJmcmFnbWVudCI7czowOiIiO30=)