Thursday, August 9, 2012


The multi billion dollar Statin industry must be elated by the latest recommendations from an expert panel in the US regarding compulsory screening of children for high triglycerides and cholesterol in their blood to detect early signals for development of obesity.  It is true that in the US the single most critical health issue today is the wide scale prevalence of obesity with one third of the population obese and another one third over weight based on the yardstick of Body Mass Index ( BMI). If Statin industry has reached where it is now generating billions of dollars of business, thanks are due to the aggressive program of lipid profiling of the adult population pursued as an annual health check up effort. The present attempt to expand the lipid screening to young kids is a logical extension of the efforts of the industry to ramp up its financial health at the expense of the citizen! The fact that some of the members of the medical panel that made the above recommendations have had financial connection with drug industry raises the needle of suspicion regarding the intent of this exercise. Here is an analysis of this latest development vis-a-vis cholesterol screening in the US.    

"Moreover, the recommendations are based on expert opinion, rather than solid evidence, the researchers said, which is especially problematic since the guidelines' authors disclosed extensive potential conflicts of interest. The guidelines were written by a panel assembled by the National Heart, Lung and Blood Institute ( NHLBI) and published in Pediatrics, in November 2011. They also were endorsed by the American Academy of Pediatrics. The guidelines call for universal screening of all 9 to 11-year-old children with a non-fasting lipid panel, and targeted screening of 30 to 40 percent of 2 to 8-year-old and 12 to 16-year old children with two fasting lipid profiles. Previous recommendations called only for children considered at high risk of elevated levels to be screened with a simple non-fasting total cholesterol test. The call for a dramatic increase in lipid screening has the potential to transform millions of healthy children into patients labeled with so-called dyslipidemia, or bad lipid levels in the blood, according to the commentary by Thomas Newman, MD, MPH, Mark Pletcher, MD, MPH and Stephen Hulley, MD, MPH, of the UCSF Department of Epidemiology and Biostatistics and e-published on July 23 in Pediatrics. "The panel made no attempt to estimate the magnitude of the health benefits or harms of attaching this diagnosis at this young age," said Newman. "They acknowledged that costs are important, but then went ahead and made their recommendations without estimating what the cost would be. And it could be billions of dollars." Some of the push to do more screening comes from concern about the obesity epidemic in U.S. children. But this concern should not lead to more laboratory testing, said Newman. "You don't need a blood test to tell who needs to lose weight. And recommending a healthier diet and exercise is something doctors can do for everybody, not just overweight kids," he said. The requirement of two fasting lipid panels in 30 to 40 percent of all 2 to 8-year olds and 12 to 16 -year- olds represents a particular burden to families, he said."

Cholesterol is considered a villain in most heart disease and build up of this chemical in the arteries leading to atherosclerosis is considered a direct consequence of reckless eating habits evolved in wealthy countries like the US. Vast agriculture subsidies and skewed government food policies have spawned a whole generation of cheap but highly unhealthy foods to which the citizens have ready access while healthy foods like fluid milk and fruits and vegetables are priced out of the reach of the common man. Over eating of meat and related products rich in cholesterol practically every day makes the cholesterol induced "crisis" a formidable one to manage. Recent attempts by the government, though belatedly and half-heartedly to make one day a weak meat free was sabotaged by the meat industry fearing a slide down of its fortunes. The obsession with pre-empting possible diseases during early childhood which is characteristic of the American system seems to have driven the latest proposal of lipid screening for children. But the over weight does not develop over night and those with a tendency with increased BMI only need to be tested sparing most kids the trauma of lipid profiling process unnecessarily. One can only hope that better sense will prevail with the US government eventually after considering the pros and cons of implementing the latest recommendations.


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