An Abundance of Concern

The U.S. Preventive Services Task Force has, over the past year or so, recommended no routine prostate cancer screening for men and decreased breast cancer screening for women. Both were based on an analysis of the net benefits -- how many people are treated unnecessarily (and in some cases harmed) for each person whose life is saved by treatment.

As health journalist Gary Schwitzer has said, more is not always better when it comes to health care. It's a lesson I thought we were beginning to learn.

Then there was today's AP story on the American Academy of Pediatrics' endorsement of routine screening of all children for high cholesterol. Not just kids with family histories of high cholesterol or heart disease, or those who are obese or have diabetes. No, it's all kids. As the AP story put it,

The doctors on the expert panel that announced the new guidelines Friday concede there is little proof that testing now will prevent heart attacks decades later. But many doctors say waiting might be too late for children who have hidden risks.

 It's never too soon to be put on statin drugs for the rest of your life with dubious benefits, I guess.

The U.S. Preventive Services Task Force had recommended against this type of screening for kids in 2007. Their reasoning was because

...not enough is known about the possible benefits and risks to recommend for or against cholesterol screening for children and teens.

One of [the task force's] leaders, Dr. Michael LeFevre, a family medicine specialist at the University of Missouri, said that for the task force to declare screening beneficial there must be evidence that treatment improves health, such as preventing heart attacks, rather than just nudging down a number — the cholesterol score.

Exactly. A slightly different version of the AP story contained this sentence:

studies suggest that half of children with high cholesterol will also have it as adults, and it's one of the best-known causes of clogged arteries that can lead to heart attacks.

This oversimplification of the relationship between cholesterol and heart disease is all too common. Cholesterol is not a bad thing -- it's an essential part of the human body. There are many examples in books like The Cholesterol Myths of incoherent or contradictory data about the relationship between high cholesterol and death from heart disease.

This bothers me on a medical basis, but also because it's yet another example of trying to protect kids beyond any reasonable level. Two recent posts on Free-Range Kids are like echoes of these recommendations.

One, called The Drop Off in Drop-Offs, bemoans the fact that parents are now required to be present at every one of their kids' sports practices. "'You need to be there in case something happens.' In case what happens? Nobody knows! It’s a generic fear of a generic something." Kind of like cholesterol testing.

The other was about a recent change in Amtrak policy, upping the age for children traveling without an adult from 8 to 13. According to the Amtrak rep, "This is not in response to any incidents," but "out of an abundance of concern for the comfort and safety of all our travelers."

An abundance of concern is exactly what we have about everything related to children (and health generally) -- but it's one form of abundance that only makes our society sicker, not healthier or happier.