July 24, 2012
Debate Rages Over Cholesterol Screening For Children
redOrbit Staff & Wire Reports - Your Universe Online
According to recent commentary by Thomas Newman, MD, MPH, Mark Pletcher, MD, MPH and Stephen Hulley, MD, MPH, of the University of California - San Francisco (UCSF) Department of Epidemiology and Biostatistics, new recommendations for lipid screening in children are based on opinion and "fail to weigh health benefits against potential harms."
The guidelines were written by a panel assembled by the National Heart, Lung and Blood Institute (NHLBI) and published in Pediatrics in November 2011 and 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, which is a burden to the families involved. Previous recommendations called only for children considered at high risk of elevated levels to be screened with a simple non-fasting total cholesterol test.
These opinions are being based on expert opinion versus solid evidence, the researchers said in a recent statement, which is especially challenging since the guidelines' authors disclosed extensive potential conflicts.
The reason for the huge increase in lipid screening has the potential to take healthy children into patients labeled with so-called dyslipidemia, or bad lipid levels in the blood , according to the commentary, which was e-published on July 23, 2012 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."
Increased pushes for screenings are due to obesity concerns of U.S. children. Hopefully this will not lead to more lab testing, but is heading in that direction.
"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
"Because these blood tests must be done while fasting, they can't be done at the time of regularly scheduled 'well child' visits like vaccinations can," said Newman. "This requires getting hungry young children to the doctor's office to be poked with needles on two additional occasions, generally weekday mornings. Families are going to ask their doctors, 'Is this really necessary?' The guidelines provide no strong evidence that it is."
The authors note that the panel chair and all members who drafted the lipid screening suggestions disclosed an "extensive assortment of financial relationships with companies making lipid lowering drugs and lipid testing instruments." Some of those relevant relationships include paid consultancies or advisory board memberships with pharmaceuticals that produce cholesterol-lowering drugs such as Merck, Pfizer, Astra Zeneca, Bristol-Myers Squibb, Roche and Sankyo.
"The panel states that they reviewed and graded the evidence objectively," said Newman. "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."
Evidence is needed to estimate health benefits, risks and costs of these proposed interventions, and experts without conflicts of interest are needed to help synthesize it, according to Newman. He said that "these recommendations fall so far short of this ideal that we hope they will trigger a re-examination of the process by which they were produced."