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Screening Guidelines Miss Many Kids With High Cholesterol

Rating

3 Star

Screening Guidelines Miss Many Kids With High Cholesterol

Our Review Summary

Although the lead of this story about cholesterol screening of children sticks to the test results without stating that the testing will lead to actual health benefits for children, the body of the story (like the story from TIME that we also reviewed) fails to grapple with the important distinction between screening and health outcomes.

In the short-term,screening might make kids worse-off: they will be labeled as being "high-risk", they will undergo (painful) blood draws and they may be treated with drugs that will have (rare) adverse effects. This MIGHT be worthwhile if it led to fewer heart attacks or strokes 30 years later, but that is unknown, and some indirect evidence suggests it is unnecessary and that efforts in kids should focus on healthy eating and physicial activity promotion (for obesity prevention, diabetes prevention, and coronary heart disease risk reduction). The story didn’t do justice to these perspectives.

 

Why This Matters

The goal is to prevent disease, not merely increasing the yield of a screening program.

Criteria

Does the story adequately discuss the costs of the intervention?

Not Satisfactory

The story says that the cost of universal cholesterol screening of children is a concern, but it does not tell readers what the costs of either screening or treatment might be. Cost is clearly relevant to the story. The researchers blame the lack of health care insurance for the high proportion of parents and grandparents of these children who have never had a cholesterol test. The story does not address the issue of how families would pay for ongoing treatment.

Does the story adequately quantify the benefits of the treatment/test/product/procedure?

Not Satisfactory

The story does not address the absence of studies that would demonstrate that early identification and treatment of elevated cholesterol in children actually prevents heart disease later in life. So the kind of benefit that people should really care about was not addressed.

Does the story adequately explain/quantify the harms of the intervention?

Satisfactory

The story points out some of the specific risks identified in studies of statin treatment of adults, but it does not make clear that the safety of these drugs has not been studied in children. Nonethless we’ll give it the benefit of the doubt.

Does the story seem to grasp the quality of the evidence?

Not Satisfactory

The story reports that the study is based on data collected from screening of school children in West Virginia. The reporter also includes a comment from a researcher about whether the results would apply to children across the country. But as mentioned above, this story does not make clear that the study looked only at cholesterol levels, and did not look at whether treating elevated levels affected the health of the children. It’s a limitation to what the evidence shows and it should have been explained or differentiated better for readers.

Does the story commit disease-mongering?

Not Satisfactory

The lead of the story focuses on the number of children who are found to have elevated cholesterol through screening. It does not jump to the conclusion that the screening would lead to lower rates of heart disease. Also, by noting that less than two percent of the children tested were found to have cholesterol levels high enough to consider drug treatment, the story offers readers valuable perspective on the actual scope of the problem. However, this story does not point out the distinction between cholesterol levels (an indicator of risk) and heart disease (a health outcome). That omission may lead readers to assume that treating more children would improve their health, something this study did not look at.

Does the story use independent sources and identify conflicts of interest?

Satisfactory

This story points out that the journal Pediatrics stated that the study authors did not report any relevant financial interests. The story does include comments from an independent expert; however, the independent expert addresses only questions about the efficiency of screening, not the health benefits or harms of identifying children with elevated cholesterol.

Does the story compare the new approach with existing alternatives?

Satisfactory

The story includes comments from an independent expert pointing out alternatives to universal cholesterol screening for children. It also notes that the “first line of defense” is lifestyle changes.

Does the story establish the availability of the treatment/test/product/procedure?

Not Applicable

The availability of cholesterol screening is not at issue.

Does the story establish the true novelty of the approach?

Not Applicable

The novelty of cholesterol screening and treatment is not at issue here.

Does the story appear to rely solely or largely on a news release?

Satisfactory

The story does not appear to be based on a news release.

Total Score: 4 of 8 Satisfactory

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