More perspective from our reviewers on the kids' cholesterol screening stories

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My thanks go out to reviewers of the three stories on kids and cholesterol screening this week. Here are links to all three stories. It’s not easy comparing three stories like this. And after it was over, two of the reviewers had more to say than what may have come across in the reviews.

Reviewer Andrew Holtz, a journalist with MDiTV.com, wrote to me afterwards:

“If an editor decides to report the story, then the news organization should boldly and clearly tell readers that the real question is what to do when the test result is a matter of debate among experts. After all, how much difference does it make whether cholesterol screening of children is catching 2/3 or almost all kids with elevated cholesterol, when we don’t know whether treating these children offers them a health benefit? Unfortunately two out of three of these stories just highlighted the process argument about how to increase the yield of the screening program without addressing the basic question about how to respond to test results.

I don’t give much credit to the stories for pointing out that lifestyle changes are suggested before resorting to drug treatment. Why would you need a cholesterol test in order to advise better diet and more physical activity for kids? My understanding of the research on adults is that cholesterol test results have a very weak effect on changing behavior. And again… everyone should be helped to have a healthier lifestyle regardless of cholesterol levels, so the tests really only have value if there is a medical intervention that is likely to provide a health benefit…which, as only the Reuters story points out, there simply isn’t the evidence to support.

If I were assigned this story, my question to the researchers and others would be: West Virginia has had universal cholesterol screening of children for a number of years. Is there any evidence that the expanded testing has had an effect on the health of the children? If not – and given that there are studies indicating that there may not be a clear benefit to treating children with cholesterol-lowering drugs – how do these doctors justify the leap to their conclusion that universal testing would be beneficial?”

And Dr. Michael Pignone of the University of North Carolina wrote:

“I don’t think some editors know to ask these questions because they don’t know that the underlying paradigm (early is always better; more information is always better) is not always true.

As another example worth pursuing, look at Gardiner Harris’ reporting on Avandia in the NYT this week. He has done some great investigative work, but it keeps being directed to whether Avandia may cause more heart attacks than Actos, another drug from the same (TZD) class. What is missed in these stories is that ALL drugs in this class cause fluid retention that leads to heart failure (or heart failure-like) syndromes and that the risk of that adverse effect is quite a bit larger, not controversial, and is enough reason to not use these expensive drugs when cheaper and better alternatives (certainly metformin, maybe others) are available.”

This gives you a glimpse of how seriously our reviewers take the job of reviewing news stories. I welcome their additional thoughts, and yours, if you care to comment.

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Comments (2)

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Paul Scott

July 16, 2010 at 3:58 pm

We are talking about the wrong things here. The stories in Time and Health Day (the Reuters link didn’t open) only deal with “elevated” LDL, (over 130 )which, as Ronald Krauss at UC Berkeley has reported, is a poor indicator of CVD risk, as it is largely over-represented by the fluffy and benign subtypes of LDL. Total cholesterol, we have long known, is nearly worthless as a predictor of CVD as well. Low HDL and high triglycerides are the only meaningful lipid variables to consider when assessing risk, as they reflect an elevation in the dangerous subtype of LDL, its small forms and the diabesity phenotype. Any warning studies about LDL seem intent on only increasing the user pool for statins.