A recent article in the Burlington Free Press reported on new recommendations from a government panel on cholesterol screenings for younger children. If you read this article and are aware of the epidemic of obesity in America today and the increasing rates of heart disease in younger and younger patients, the recommendations might seem reasonable. We’re just screening, after all, and logic follows that the earlier a problem is detected, the more likely intervention will be successful.
However, here are some points that might be good to consider:
While the study was from a panel appointed by the National Heart, Lung and Blood Institute, a division of the National Institute of Health, it was endorsed and promoted by the American Academy of Pediatrics, which is not a scientific body but a trade organization of pediatricians. These are practitioners who stand to benefit financially from a massive influx of new patients for new procedures. This represents a conflict of interest which is rarely mentioned in discussions of recommendations for care.
These recommendations should be drafted by impartial groups who have nothing to gain from the conclusions. They also should be held to the burden of proof of scientific evidence. One example of an impartial group of scientists who base recommendations on evidence is the US Preventive Services Task Force.
The USPSTF is the panel which has been inflaming the medical screening business by revealing that the risks of screening for things like breast and prostate cancer have been underexamined when trade groups like the AAP make their recommendations. The big difference between the basis for recommendations from trade groups like the AAP or ACOG, the gynecologists trade group, and the USPSTF is that only one uses science and evidence as a basis for their recommendations and only one has no conflict of interest in the conclusions.
When the USPSTF announced that the data showed that routine mammograms are not beneficial for most women under 50, ACOG (the American College of Obstetriciand and Gynecologists) continued their recommendations despite the absence of any compelling evidence to do so. The fact that reducing such screenings, and the interventions that might follow them would represent a corresponding reduction in revenue for the members of ACOG is a reality that only the most naÃ¯ve person would ignore.
The USPSTF has nothing to gain or lose from any particular conclusion. Their only burden of proof is”¦proof. From the article;
“”¦for the task force to declare screening to be beneficial there must be evidence that treatment improved health, such as preventing heart attacks, rather than just nudging down a number- the cholesterol score.”
That evidence, according to the USPSTF, simply does not exist. USPSTF has shown in other realms of health care, such as mammography screening and PSA prostate testing, the risks of screening are usually underestimated: false positives lead to unnecessary intervention, and the tendency for American doctors to resort to drugs or surgery over lifestyle modification leads to overmedication, which has both known and unknown risks. While the article assured the reader that only a small percentage of kids diagnosed with high cholesterol would be medicated, that seems hard to believe. Many would find it particularly significant that the photo accompanying the article shows a 10 year old girl who is taking cholesterol lowering medication.
It’s clearly a good idea to begin to intervene in the development of unhealthy kids as early as possible. However, the solution to early development of heart disease is not medical. It is environmental. We do not need cholesterol testing on anyone to know that eating a plant-based diet, not smoking, reducing saturated fats and processed foods, getting adequate exercise, and addressing specific social, environmental, psychological and spiritual areas are the primary solutions to the majority of health problems Americans face. We do not need tests or screening to know that these are important areas of health to address in kids, and not only kids who are diagnosed with a particular value on a blood test, but all kids. But as Dr. Dean Ornish, cardiologist stated way back in the 1990’s,
“In America, more money is spent on treating heart disease than any other illness [$100’s of billions annually]”¦If I perform bypass surgery on a patient, the insurance company will pay at least $30,000. If I perform a balloon angioplasty on a patient, the insurance company will pay at least $7,500. If I spend the same amount of time teaching a heart patient about nutrition and stress management techniques, the insurance company will pay no more than $150. If I spend that time teaching a well person how to stay healthy, the insurance company will not pay at all. It’s not surprising that doctors tend to spend time on what is reimbursed, especially since we do not learn much in medical school about nutrition or how to motivate patients to change their lifestyles. We are not taught skills for coping with stress in our own lives or for teaching these skills to our patients.”
This is precisely why not only are these new recommendations missing the mark on preventing heart disease, they illuminate the fact that we are relying on entirely the wrong people to advise us on the matter. Medical doctors’ training, expertise, orientation and education are all focused on treating illness and disease. Achieving the true health potential for our nation will require an integrated paradigm in which the vast skills of allopathic medicine in detecting and treating illness, disease and trauma are balanced by the proactive, preventive agencies of other, non-allopathic, wellness-based models for care such as naturopathy, exercise science, chiropractic, Chinese medicine, herbology, and many others.