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The Case for Universal Cholesterol Screening in Kids

Rating

2 Star

The Case for Universal Cholesterol Screening in Kids

Our Review Summary

The lead sentence of this story contains a factual error about the results of a study that looked at the percentage of children with elevated cholesterol who are likely to be missed by common screening guidelines. It also states that the “U.S. government” recommends screening children with a family history of heart disease or elevated cholesterol without making clear that this recommendation comes from the National Cholesterol Education Program, but that other national health institutions, including the U.S. Preventive Services Task Force, do not recommend cholesterol screening for children.

As with the HealthDay story on this study that we also reviewed, the news article concentrates on debate between experts about the most efficient form of cholesterol screening of children. All of the experts quoted take the position that identifying elevated cholesterol in children leads to better health outcomes. The Reuters story we reviewed was the only one of the three to scrutinize the fundamental question about the effectiveness of treating children who have elevated cholesterol, but not actual heart disease.

 

Why This Matters

This story focuses on process (identifying all children with elevated cholesterol) not outcomes (reducing heart disease.)

Criteria

Does the story adequately discuss the costs of the intervention?

Not Satisfactory

The story includes one comment that national screening would be expensive, but it does not provide a dollar figure. It also does not mention the potential cost of treatments. 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

This story not only fails to question the assumption that treating children with elevated cholesterol can prevent heart disease, it allows a researcher to claim that screening children for cholesterol would help reduce the risk of diabetes. There is no reference to any evidence that cholesterol screening is a better predictor of diabetes risk than either other screening tests, obesity or other factors linked to diabetes. The statement also implies that identifying diabetes risk before symptoms appear is better than either recommending lifestyle changes to reduce diabetes risk for all children (regardless of cholesterol test results) or treating diabetes once symptoms appear.

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

Not Satisfactory

The story mentions neither the potential harms of statin drug treatment that have been reported in studies of adults nor the fact that the safety of these drugs has not been studied in children.

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

Not Satisfactory

The story reports that the results are based on cholesterol screening of more than 20,000 school children in West Virginia. However, the story notes that “West Virginia has one of the highest rates of death from heart disease,” without then addressing the question of whether the results of a study in this one state can be applied to the nation as a whole. It also fails to make clear to readers that this study looked only at the identification of elevated cholesterol in children, and does not provide any evidence that treating these children with cholesterol-lowering drugs would benefit their health.

Does the story commit disease-mongering?

Not Satisfactory

The lead of the story focuses on the number of children with elevated cholesterol who might be missed based on current national guidelines and does not jump to the conclusion that these children would necessarily benefit from treatment. The story also reports that less than two percent of the children tested had cholesterol levels high enough that doctors might consider drug treatment. Oddly, the lead sentence says current guidelines “may miss nearly 10% of those who have high levels of LDL, or bad cholesterol,” but the researchers put the figure at closer to a third. It may be that the reporter confused the proportion of children overall who had elevated cholesterol (about 10%) with the proportion of children with elevated cholesterol who would not have been tested under current guidelines (about a third.)

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

Satisfactory

The journal Pediatrics stated that the study authors did not have 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?

Not Satisfactory

The story includes comments from an independent expert suggesting alternatives to universal cholesterol testing to identify children who may have elevated cholesterol levels. For children who are found to have high cholesterol, the story says doctors may advise lifestyle changes or drug treatment. However, the story fails to mention the lack of evidence that identifying elevated cholesterol in children is more effective at preventing the development of heart disease or other health problems than helping all children to maintain a healthy lifestyle and then waiting until adulthood to test cholesterol levels.

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: 2 of 8 Satisfactory

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