Wednesday, July 25, 2012

Is Big Pharma Behind The Push For Cholesterol Screening For Kids? New Cholesterol Screening Guidelines Are Challenged

WorldNetDaily reports that there is now opposition arising within the medical community to the push for cholesterol screening for kids. A group of doctors publishing in the current issue of Pediatrics say the guidelines are too aggressive and not based solidly on evidence (the current July issue online does not have the described article, so it must be the upcoming August issue).

Background: EmaxHealth actually has a better report. Cholesterol screening guidelines written by a panel determined by the National Heart, Lung and Blood Institute and published in November 2011 recommend universal screening for 9- to 11-year-old children using a non-fasting lipid panel, and for use of two fasting lipid profiles for 30 percent to 40 percent of 2- to 8-year-old and 12- to 16-year old young people. Previous guidelines had called for non-fasting cholesterol screening only for those children considered to be at high risk of high cholesterol. One of the cited rationales for the expanded intervention is the fact that obesity among children has more than tripled in the past three decades, according to the Centers for Disease Control and Prevention. In 2008, more than one-third of children and adolescents were overweight or obese. Cholesterol is associated with obesity.

Objection: A trio of physician-researchers from the University of California at San Francisco now disagree, saying the guidelines are too aggressive and not based solidly on evidence. They claim the guidelines are based more on expert opinion than on solid evidence and that many authors of the guidelines reported industry disclosures. Dr. Thomas Newman pointed out that all the individuals on the panel who drafted the recommendations had extensive assortment of financial relationships with companies making lipid lowering drugs and lipid testing instruments, meaning that panel members may have had monetary and board membership incentives to recommend expanding the population of potential cholesterol-lowering drug users. The Institute of Medicine recommends that experts who have a conflict of interest should be excluded from panels that establish guidelines or at least have non-voting, non-leadership, minority roles.

Other objections include costs in time, lost wages, and other burdens on parents, who would need to take their children to doctors for additional visits, since several of the tests require fasting. Dr. Newman also objected to the fact that the members of the panel made their recommendations without estimating what the cost would be; billions of dollars could be at stake. Furthermore, there also is the issue of potentially giving lifetime medication to a large group of people. Helen George Mortorff, Adjunct Faculty at Frederick Community College, does post a comment to the US News story stating that the cholesterol-lowering drugs to be given to kids are not the statin class of drugs with nasty side effects, but are based on fish oils.

Rebuttal: Dr. Stephen Daniels, chairman of the guidelines panel and head of pediatrics at the University of Colorado School of Medicine in Aurora, defended the panel and owned up to the industry ties, but claimed those ties were vetted during the panel's discussions and did not significantly influence the debate. However, Dr. Daniels' ties with Big Pharma are hardly anecdotal; he reported having worked as a consultant or advisory board member for Abbott Laboratories, Merck and Schering-Plough, now part of Merck.

But excluding researchers with Big Pharma ties from panels may not be the best answer, either. Dr. Gilbert Ross of the American Council on Science & Health (ACSH) warns “If people don’t want researchers to have any ties to industry, then scientific research will become unproductive and ultimately pose a threat to public health, as less experienced and less knowledgeable people will lead the recommendation panels.” ACSH believes that industry-funded research is typically scrutinized more carefully before publication, improving its credibility. But there's a difference between having worked with Big Pharma in the course of research vs. being owned by Big Pharma, as is the case with Dr. Stephen Daniels.

The skepticism towards Big Pharma and the medical industry is justified. In the 1970s, marketers began visiting chiropractors to teach them "how to create lifetime patients". They urged the chiropractors to avoid full disclosure on the patient's first visit. Now we have Big Pharma spamming us with expensive ads on the nightly news broadcasts trying to scare us into doctors' offices to get the new miracle maintenance drug that you must take for the rest of your life because "your risk never goes away". Marcus Welby MD is definitely not the role model for the health care industry any more.


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