Saturday, November 12, 2011


An Associated Press news piece yesterday ( announced that we’ll soon be screening kids as young as nine years for high serum cholesterol. The new guidelines emerged from an expert panel appointed by the National Heart, Lung and Blood Institute and endorsed by the American Academy of Pediatrics.
The guidelines are based on facts everyone agrees on:
— By the fourth grade, one of every eight U.S. children has high cholesterol, defined as a score of 200 or more.
— Half of children with high cholesterol will also have it as adults, raising their risk of heart disease.
— One third of U.S. children and teens are obese or overweight, which makes high cholesterol and diabetes more likely.

I agree, too. But why is this happening now? One micro-reason is genes: one out of every five hundred people has high cholesterol because of genetic makeup. All the rest, though, comes from—you guessed it—toxic diet and inadequate exercise.
In other words, we’ve discovered we’re developing serious disease earlier and earlier in our lives because of unhealthy behavior. We’re going to identify it by large-scale testing, and treat it, of course, with medications.

I have a few problems with this strategy. First, it redefines voluntary behavior as a medical diagnosis; second, it creates an entire new class of “patients” who will consume expensive medications and endure their side effects; and third, it legitimizes and even enables disease-causing behavior.

What amazes me about these guidelines is the degree to which the medical establishment docilely accepts them. We docs should instead be demanding  effective plans for steering kids into healthier behaviors, emphasizing education and parenting.

Oh, my. I get so worked up about these things. Maybe I'm suffering from Inadequate Idiocy Tolerance Disorder (IITD, the silent killer). I need to calm down. A friend advised that I might increase my patience by remembering that we are the distant ancestors of an advanced civilization.


  1. Hopefully most physicians will attempt to make lifestyle changes the foundation of the treatment for these children (and their families)! OK, I'm a dreamer, but then as a surgeon, I don't know much :-)

  2. Dr. J actually knows a great deal despite being a surgeon. His website,, touts his "...irreverent, slightly irrelevant, but possibly useful opinions on health and fitness." Definitely an entertaining and original read.

  3. The NHLBI report is clear in its recommendation that the first line treatment for high cholesterol in kids is behavioral intervention- diet and exercise, not drugs.

  4. True. But here’s my beef, so to speak: American medicine’s modus operandi is to wait for illness to show itself, then attack it. When it comes to cause, we're far from proactive. Even though we know dismal family lifestyles are promoting kid obesity and its unhappy consequences, we make treating that secondary to screening. And let’s not kid ourselves: behavioral intervention and exercise will have some effect until this issue has had its fifteen minutes of limelight, and then it’s back to drugs. Unless we face these lifestyle disease sources as wholeheartedly as we treat emerging disease, we are Sisyphus, rolling the stone uphill forever.