Should Kids Be Screened for Cholesterol?

Should Kids Be Screened for Cholesterol?

July 23rd, 2012 // 2:34 pm @ jmpickett

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Last November, new guidelines sponsored by the National Heart, Lung and Blood Institute generated a significant change in screening children for cholesterol. The agency recommended that all children be screened for high cholesterol at least once between the ages of 9 and 11 years, and again between ages 17 and 21 years (read them here). The effort reflected growing concerns with childhood obesity and heart disease.

However, the guidelines are causing a stir. Specifically, critics say the guidelines are overly aggressive and, moreover, were influenced by financial ties that some of the NIH panel members held with various drugmakers that either sell or have been developing cholesterol meds, including Pfizer, Merck, AstraZeneca and Roche. Eight of the 14 panel members reported industry ties and disclosed that when their advice was published in December (see this).

In an essay published in the Pediatrics journal, the critics contend there is little evidence that widespread cholesterol testing and treatment in children will reduce the likelihood of developing heart problems later. And they maintain that widespread testing is not only costly, but could cause anxiety in healthy children who are do not need treatment.

“The panel made no attempt to estimate the magnitude of the health benefits or harms of attaching this diagnosis at this young age,” said Thomas Newman, a professor of epidemiology and biostatistics at the University of California at San Francisco and a former member of an FDA pediatrics advisory committee, tells the Associated Press. “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… 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.”

This is not the first time criticism has been leveled at the guidelines, which were endorsed by the American Academy of Pediatrics. In January, an essay was published in the Journal of the American Medical Association that questioned the safety of providing statins to children. “What this novel public health intervention in children clearly lacks is an evaluation to determine whether the long-term risk-benefit profile may in fact be favorable or harmful,” they wrote.

In a rebuttal article, five of the panel members respond by saying that any payments made by drugmakers were used to cover the costs of evaluating whether the drugs are safe and effective, but did not influence the recommendations (EDITOR’S NOTE: As soon as we can obtain a copy of the articles, we will make them available). Meanwhile, Susan Shirin, the acting director at the NHLBI, tells the Associated Pres there are few qualified specialists who have no industry ties and that panel members were selected for their expertise. “We got the best people in the country to do this,” she tells the AP.

Similarly, Stephen Daniels, who chaired the panel and is pediatrics chief at the University of Colorado School of Medicine, defended the arrangement. Industry ties “were vetted during the discussions of the panel and I think really did not influence the debate,” he tells the AP. He has worked as a consultant or advisory board member for Abbott Laboratories, Merck and Schering-Plough, and co-authored the Pediatrics rebuttal.

But Newman argues otherwise. “The panel states that they reviewed and graded the evidence objectively,” he tells the AP. “But a recent Institute of Medicine report recommends that experts with conflicts of interest either be excluded from guideline panels, or, if their expertise is considered essential, should have non-voting, non-leadership, minority roles.”