The first thing we do, let’s kill all the lawyers.
Henry The Sixth, Part 2 Act 4, scene 2
Every child should be tested for high cholesterol as early as age 9 — surprising new advice from a government panel that suggests screening kids in grade school for a problem more common in middle age…The doctors on the expert panel that announced the new guidelines Friday concede there is little proof that testing now will prevent heart attacks decades later….The new guidelines are from an expert panel appointed by the National Heart, Lung and Blood Institute and endorsed by the American Academy of Pediatrics.
It’s obvious that panelists have to be added to Shakespeare’s draconian decree about lawyers. I don’t know where our medical leaders find these guys. As I’ve pointed out here several times there is no evidence that measuring cholesterol in high risk adults does any good; in fact the evidence shows that treating these patients (who do not have overt heart disease) has no effect on overall mortality. If treating these subjects is useless why measure cholesterol to start with?
So we measure cholesterol on a 9 year old child and it’s high, what then? If he’s not overweight, we’ll ignore it. If he is, we don’t need a cholesterol to advise weight loss. Nevertheless, we are going to start doing it in 9 year olds in whom there is nothing to be gained but cost. I’m trying to maintain my professional calm and reasonableness, but this is just plain crazy. Evidence based medicine is supposedly the standard for making decisions about effective diagnosis and treatment. In reality, it’s something we teach medical students on the same basis that a judge says do as I say, not do as I do. But of course, the students mimic their teachers.
How long before pediatricians start putting children on statins? You can be sure some will, though there’s no data on such treatment. These drugs have side effects. No one knows what they will do to children.
If you want one reason why medical costs are bankrupting the country look at these panels manned by learned professionals who seem to lack even a shadow of common sense. It would appear we are all doomed. We might be better if all of us converted en masse to Christian Science.
If the panel had not been in the grasp of a diagnostic compulsion, it might have made a sensible recommendation. For example, do a longitudinal study on a large group of 9 year olds and see whether following cholesterol levels over decades leads to information that might be useful. But that’s no fun. It’s hard and obviously has no short term payoff. You’ll never get carried by the AP with this sort of advice. So lets swing for the fences and go crazy. It’s so much more fun. But this recommendation is not a joke; it’s a colossal error. Adult supervision is clearly needed.