LAUSR

tio reaches an unfordable level. Answers to these questions depend greatly on the values of the population concerned and resources available.2-4 Our recent study5 showed that the changes in the cutoffs for diagnosing hypertension, hypercholesterolemia, and diabetes mellitus around the year 2000 resulted in doubling the prevalence of all the 3 conditions in China.5 If the new patients were all treated with drugs, the annual drug costs alone would consume 56% of the government’s total health expenditure in 2010.5 Regardless of the benefit of treating these conditions, which is bound to be small, it is unlikely affordable for China. Indeed, most uninsured patients with hypertension in the country were unwilling to take drugs as guidelines recommended. This implies importantly that populations with different values and resources available for health care should consider different cutoff values; for example, the World Health Organization recommended 3 different cutoff values for cardiovascular risk above which drug interventions are recommended.3,4 Opposed to how the disease was originally defined, this approach adds a subjective, value-laden component that entails further discussions. Much of the above discussions equally apply to new definitions of diseases. Finally, do risk, benefit, and harm make a complete list of necessary criteria? If not, what other factors should be considered? Methods and procedures for modifying disease definitions should also be elaborated. Changes should be based on current best evidence, and strong evidence must be provided.