Kids, Cholesterol, and Drugs
In a move that indicates that the medical community suffers from collective amnesia, the American Academy on Pediatrics just recommended new guidelines that would subject more than 30 percent of all kids between the ages of two and ten to cholesterol screening tests. Whereas previous guidelines suggested testing only kids with a family history of heart disease, the new standards include all children who are overweight, who have diabetes or hypertension, or who smoke (yes, apparently there are enough smoking tots to warrant mention in the guidelines!).
The pediatric cholesterol test entails a 12- to 14-hour fast, followed by getting poked by the needle that takes blood -- a four-year-old's idea of great fun. The price-tag runs about $150 to $200, and the test must be repeated every few years. The rationale, says the report, is that nipping high cholesterol in the bud should prevent cardiovascular problems down the road. To accomplish this nipping, the guidelines suggest that children who have cholesterol higher than 160 start an exercise program; eat a low-fat diet rich in whole grains, veggies, and fruit; switch to 2% milk; and perhaps take a statin medication such as pravastatin.
What's wrong with this picture? Flash back to a blog I wrote just a few months ago called "Cholesterol Drugs Do More Harm than Good." That article describes an industry-funded study that discovered that cholesterol meds essentially do nothing to prevent cardiovascular disease -- that they offer no health benefit whatsoever except in patients who already have heart disease. That study was completed just this past January -- certainly recently enough to remain fresh in the minds of doctors studying the impact of cholesterol on kids. Yes, the study found, the meds lower cholesterol, but lowering cholesterol did not reduce heart-attack risk 99 percent of the time. That means, as I said in that article, that for every 1000 people who maybe gain some benefit from popping cholesterol pills, 999,000 take the medication with no positive benefit at all (and probably those are generous odds given that the study was funded by a pharmaceutical company). But isn't saving 1,000 children worth the cost? Not necessarily!
The price for all that lack of benefit is high -- the pills cost over $2 a piece and come complete with side effects ranging from minor headaches to severe neuromuscular degeneration, memory loss, trouble talking, and nerve damage. Add to that dismal picture the fact that no studies have been done on the possible side effects of taking statins for 40, 50, or 60 years, nor of the long-term effects of delivering cholesterol meds to kids too young to watch PG movies.
While the Academy suggests that reducing cholesterol levels will help kids avoid plaque build-up in their young arteries so that they won't enter adulthood all clogged-up, such logic is completely off-base. Again, hearken back to previous blogs on the subject of cholesterol in which I explain that cholesterol doesn't cause clogged arteries. If cholesterol caused blockage, it would also cause plaque to build up in your veins -- but it doesn't. Rather, cholesterol's role is to repair inflamed and damaged arteries, not to clog them -- and that's exactly why cholesterol-lowering meds don't prevent heart disease.
At least some in the medical community seem to recall that statins don't work.
- "To be frank, I'm embarrassed for the A.A.P. today," said Dr. Lawrence Rosen of Hackensack University Medical Center in New Jersey. "Treatment with medications in the absence of any clear data?"
- And Dr. Alan Greene, a California pediatrician and founder of www.dr.greene.com, adds, "[This] will open the door for pharmaceutical companies to heavily advertise and promote their use in 8-year-olds, when we don't know yet the long-term effect on using these drugs on pre-pubertal kids."
- Dr. Sanghavi of the University of Massachusetts Medical School concludes, "We're talking about potentially treating thousands and thousands of children simply to possibly prevent one heart attack. That kind of risk-benefit calculation is entirely absent from the A.A.P.'s policy."
In fact, the logic of the entire report makes about as much sense as a Grimm's fairy tale. It's as if we've stepped into a modern-day Hansel and Gretel where we fatten up our kids with a diet of cakes, candies, and sodas, and then feed them to the ravenous pharmaceutical companies. And they live happily ever after...not.