Statin commercials on Disney?

As anticipated, the new guidelines on cholesterol screening and statins for children just released by the American Academy of Pediatricians have elicited responses from two camps: medical science and political science. Sadly, they’re not on the same page.

Pediatricians and cardiologists have begun trying to provide parents and healthcare providers with medical guidance based on what is known about cholesterol interventions in children, weighing the risks and benefits for children. One Milwaukee-area pediatrician, Dr. Paul Norton, wrote a calm, thought-provoking article for parents who might be wondering if they should have their otherwise healthy children screened for cholesterol. He urged parents and healthcare providers to be critical consumers and consider the downsides of today’s screening frenzy.

Screening kids for lipid problems might seem like a straightforward medical question, he said, but it isn’t. There are societal and economic considerations that are rarely mentioned. The financial costs of testing children, tests for which there is dubious value or efficacy, would spend tens of thousands of dollars to find a single child who might be at risk. But then what? There’s no intervention shown effective or safe, nor is it known if treating a number matters. Diet doesn’t do much good to change lipid profiles, he noted, as “the most important factor in your blood lipid profile is your genetics.” And there’s no data on the effects of putting kids on statin drugs for decades. Might all of this time and expense be better spent in other ways that can help improve the health of kids?

But the bigger price our children pay is the more serious one. As he writes in his House Call column for the Milwaukee Journal Sentinel:

So why screen? I remember vividly a 5-year-old girl whose father had had a heart attack at an early age. He had abnormal lipids. So we screened her, and her lipids came back as bad as her dad’s. But after consulting with cardiologists, nutritionists and endocrinologists, we did nothing. Everyone was distraught. This family likely felt a little more urgency to do the things we all should do: eat right, get exercise, sleep, etc. But I am not sure if it did a lot of good or not. We, meaning the medical profession, are in a screening frenzy these days. All of the screens presently in use have their benefits. Isn’t it better to know something than not know it? However, there can be a downside to this bevy of screening, mostly in worry and stress...

What I would like you to do, as critical consumers, is to appraise this policy and others like this. What exactly are we doing and what is the price we pay, not just economically, but in fear and anxiety.

The other camp is using these guidelines as proof of an obesity crisis and justification for public policies to change what they call today’s fattening “obesogenic environment.” The political side doesn’t appear to have read the guidelines or to understand the research.

An example came from a Washington Post writer, Marie Cocco, who wrote:

To the cocktail of drugs young children already are taking, the American Academy of Pediatrics is now recommending that some kids as young as 8 might benefit from cholesterol-reducing medication. The reasons are too familiar: Our kids are growing too fat (just like their parents), eating lots of the wrong foods (just like their parents), getting insufficient exercise (just like their parents), and showing the warning signs of serious future health problems that are precursors to heart attacks (just like they are for their parents).

So, after detecting an unnerving jump in cholesterol levels among the young, the pediatrics profession is suggesting that some kids with high cholesterol and a family history of early heart disease should "be considered" as candidates to take the drugs... Can cholesterol-drug commercials on the Disney Channel be far behind?

All of the popular doomsday myths of childhood obesity have been lumped together, with no attempt to look at the evidence that contradicts them. Kids are growing up healthier today than ever before. They are taller and larger than in underdeveloped regions of the world where hunger, childhood illnesses, lack of educational opportunities and struggles to survive, and shortened lifespans are commonplace. And over the past 50-100 years, children here and in other developed countries have been able to grow up largely free from those things that adversely affect their health. They have safer drinking water and food, and better access to food, childhood immunizations and healthcare. Their diets are healthier, with fewer nutritional deficiencies, than at any other time in history and kids today are just as active as kids were 50 years ago, too. Nor have their BMIs changed for nearly a decade now, since the measurement tools have remained unchanged.

The author went on to assume “an unnerving jump in cholesterol levels” among young people and that high cholesterol is related to diets, lifestyles and obesity. These are all myths — as the AAP guidelines themselves noted. According to National Health and Nutrition Examination Surveys (NHANES) data, there’s been no increase in lipid and lipoprotein levels in children, adolescents or adults since at least the 1960s (since they began being followed)— levels have even decreased. There is no epidemic of children with high cholesterol levels.

Nor did the author even mention the medical facts of familial hypercholesterolemia or provide readers with information that could have lessened the blame directed at children with this rare genetic disorder. But this article wasn’t about reporting health information. That was made clear as she went on to quote a leading food political activist:

"It's appalling what we've let happen to our children," says Kelly Brownell, director of the Rudd Center for Food Policy and Obesity at Yale University. "And the fact that the children have such high cholesterol levels is a sign of the environment we have created for them."... "The fact that young kids may need statin drugs now is a sign of how bad we've made it," Brownell says. "If anything, this study should have sounded the loudest possible alarm bell that something needs to be done...

Ms Cocco went on to editorialize for anti-obesity legislation and regulations to address what activists call the poor conditions that have been created for children today: “tsunami of sugary inducements,” fattening school lunches, “sky-high energy prices,” unacceptable PE and sports, and eating too much. She closed by saying: “How loudly does the siren about our children's unhealthy eating habits have to sound before we get the message that the response has to come from us, and not the pharmaceutical industry?”

The evidence for familial hypercholesterolemia has nothing to do with diets or obesity, or the range of cholesterol levels found in children without this genetic disorder. But you’d never know it to read much of the pop news.

© 2008 Sandy Szwarc