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Screening kids for high cholesterol — why stop there?

A version of this commentary appeared in the Vancouver Sun and the Victoria Times Colonist

When you have been looking at the drug industry for as long as I have, examining the way diseases and pharmaceuticals are marketed, packaged, and pitched to doctors and patients, nothing much surprises you anymore.  One might get a little tired of seeing the same old deceptive marketing ploys repackaged and retooled, launched to fool new generations of consumers and health professionals, but at least it’s entertaining. Occasionally an epiphany strikes, like a bolt of lightening from a blue sky instantly elevating one to a whole new level of incredulity.

Such a thunderbolt hit me this past week when I learned that experts at a recent American Heart Association conference were recommending that more children should be screened for high cholesterol before puberty.  And they seemed to mean it.

I checked to make sure it wasn’t April Fools Day because this is the kind of dastardly stuff those medical jokesters sometimes try to get away with.  Sure enough, those pediatricians were serious.

So apparently concerned are they about the health of children, they believe it is worth screening kids for high cholesterol at younger and younger ages.  This seems strange because high cholesterol, one needs to be constantly reminded, isn’t a disease but is a “risk factor” for a future disease (such as heart attacks) which mostly strikes middle aged and older people.  A risk factor might affect your health in the same way as being poor means you’re more likely to have worse health compared to someone who isn’t poor. But most people who have heart attacks have normal cholesterol.

So why bother screening kids for a risk factor for a disease that’s not likely going to hurt them, if it ever does, for another 50 or 60 or 70 years?  Because we can.

The apparent rationale given at this conference is that statin drugs — treatments like Lipitor, Zocor or Crestor — can be used safely in children. The experts say with rising obesity levels in children, monitoring their cholesterol levels will only help them prevent future health problems.

When I finally soaked in this idea for a while I asked myself in a very subdued voice:  “Have we all gone stark raving nuts?”

Let’s look at some of the facts in this case.   We’ve known for years that selling medication to treat your “future risk” for a disease is hugely and immensely profitable for the pharmaceutical industry, yet the benefits to health are sometimes nonexistent.

Statin drugs, prescribed to lower cholesterol, are among the biggest selling prescription drugs on the planet. The pharmaceutical industry has invested heavily in convincing medical scientists, patient groups and our prescribing doctors to think about cholesterol as a nasty foreign enemy which needs to be brought down at all costs instead of a substance essential for life that actually resents being chemically tinkered with.

While physicians will prescribe statins appropriately in men who have established heart disease, there is much controversy over whether  the drugs are effective in women and the elderly.  As for the benefit of cholesterol lowering in kids? Those studies haven’t even been done yet.

Like any drug therapy, there are potential adverse effects and patients taking statins have higher rates of kidney failure, cataracts, and liver damage compared to similar patients who take placebos.  The most common effect, experienced by 20-25% of statin-treated people, is muscle pain or weakness.  The basic message here: you should have a clear chance of benefit before you start tinkering with your body’s cholesterol levels.

So I say, if we are all going to go ahead and drink Big Pharma’s Kool Aid, why don’t we go a step further?

Why should the medical profession wait until kids are 8 or 9 before they start screening them for high cholesterol and prescribing them powerful statin drugs?  Why not screen them at a much earlier stage, and look for evidence of high cholesterol while in utero? This would help parents-to-be prepare for the arrival of their little bundle by stocking up on Lipitor-laced baby formula.

Sound desperate?  Perhaps not so desperate as the cholesterol empire that won’t rest until it’s convinced an entire generation of parents that their kids are pre-diseased and need to be saved by their drugs.

Alan Cassels is a drug policy researcher at the University of Victoria and the author of Selling Sickness. He is also an expert advisor with EvidenceNetwork.ca. His next book, Seeking Sickness, is on the medical screening industry. 

November 2011

 

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