Cholesterol Tests For Kids?

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MADELEINE BRAND, host:

Back now with Day to Day. There is an epidemic of childhood obesity that is causing more Type II Diabetes among older children and adults. And so the American Academy of Pediatrics is now recommending that some children be tested for high cholesterol. Children as young as two years old. And those who have it should be put on cholesterol-lowering drugs, or so-called statins. Dr. Sydney Spiesel is a pediatrician, and a Yale Medical School professor, and he's here now. And, first of all Syd, what did you think when you heard that recommendation?

Dr. SYDNEY SPIESEL (Professor, Yale Medical School): Well, I was, as I am about so many things, sort of skeptical. You know, I track the literature pretty closely, and I didn't remember seeing a lot of papers that would support that idea.

BRAND: And why is that?

Dr. SPIESEL: Well, I think the main reason is that it's very difficult and expensive to do research on children, so there's a tremendous amount that we don't know about kids and kids' health, and what is even the best thing to do. So we kind of, you know, we do the best we can.

BRAND: So, why wouldn't it be a good idea to put kids on statins if they do indeed have high cholesterol, if they are obese, and if they are in danger of developing Type II Diabetes?

Dr. SPIESEL: Well, there haven't been long enough studies to be absolutely certain, so what you have to do is balance. You say, well, we have some kids who have very high risk, and there we think it's a reasonable balance to try to use statins on these kids. But I'm worried about - is there going to be a lot of overflow, that people are going to misread the paper and misread the recommendations, which really are more focused on kids with significant problems, or risk of significant problems, and think, well, if its OK for them, maybe it's a good idea for everybody.

BRAND: And then a lot more kids will get tested than need to be?

Dr. SPIESEL: Well, I think a lot more kids will be tested than need to be, or at least it might be that these kids need to be tested, but we don't know whether interceding - I'm much more worried about our well-intentioned intercessions, and what effects they might have.

BRAND: Because also, children, don't they react to drugs differently than adults do?

Dr. SPIESEL: Sometimes they do, yes, and so you have to go with what you know. I mean, in the few studies that have been done it looks like the kids who have been given statins do reasonably well with them, and there are some other drugs too, which are also used for cholesterol control. But I think the issues are somehow deeper than that. You know, one problem is that cholesterol is bad for me. But, you know, cholesterol is the building block for cell membranes. And if you're making new cells, lots of new cells, especially new cells in the brain, you need cholesterol, which is why the recommendations for adults might be very different than the recommendations for kids.

BRAND: So, what will you do with this recommendation?

Dr. SPIESEL: I'll keep it in mind, and I'll certainly be actively pursuing - some of the recommendation, some aspects of the recommendation, are really pretty good. If you identify kids who are at significant risk, it probably is a good idea. You know, a strong family history of early heart disease, a strong family history of a terrible liver disorder, those are the kids that we really need to be tracking closely and paying very close attention to. Although, frankly, from my experience with kids in general, I think that trying to manipulate diet is a fairly hilarious notion. All the kids I've ever dealt with have found it so.

BRAND: Well thank you, Syd.

Dr. SPIESEL: Thank you.

BRAND: That's opinion from Dr. Sydney Spiesel. He's a pediatrician and a professor at Yale Medical School, and he comes to us via the online magazine, Slate.

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