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Docs at odds over kids' cholesterol test guidance

CHICAGO :Should all U.S. children get tested for high cholesterol? Doctors are still debating that question months after a government-appointed panel recommended widespread screening that would lead to prescribing medicine for some kids.

Fresh criticism was published online Monday in Pediatrics by researchers at one university who say the guidelines are too aggressive and were influenced by panel members' financial ties to drugmakers.

Eight of the 14 guidelines panel members reported industry ties and disclosed that when their advice was published in December. They contend in a rebuttal article in Pediatrics that company payments covered costs of evaluating whether the drugs are safe and effective but did not influence the recommendations.

It also is not uncommon for experts in their fields to have received some consulting fees from drug companies.

Even so, the ties pose a conflict of interest that "undermines the credibility of both the guidelines and the process through which they were produced," says the commentary by researchers at the University of California at San Francisco. The authors are Dr. Thomas Newman, a researcher and former member of a Food and Drug Administration pediatrics advisory committee, and two heart disease researchers, Drs. Mark Pletcher and Stephen Hulley.

Pletcher has received research funding from drug and device makers; the other authors said they had no relevant industry ties.

Other criticism was published earlier this year in the Journal of the American Medical Association. That critique raised concerns about putting children on cholesterol drugs called statins, noting the medicine has been linked with a rare muscle-damaging condition in adults. Those authors were heart specialist Bruce Psaty and pediatrician Frederick Rivara, both of the University of Washington in Seattle.

JAMA included additional criticism from a dissenting member of the panel that produced the kids' cholesterol guidelines, Dr. Matthew Gillman of Harvard Medical School. He recommends more narrow screening based on family history of cholesterol problems.

The guidelines are endorsed by the Academy of Pediatrics, which publishes the journal that carried the critical commentary Monday. The panel recommends that all U.S. children should get blood tests for high cholesterol as early as age 9 and that testing should begin much earlier for kids at risk of future heart disease, including those with diabetes or a family history of heart problems. Treatment should generally begin with lifestyle changes including diet and exercise, the guidelines say.

Cholesterol drugs would be recommended for some kids, but probably less than 1 percent of those tested. But the advice says those drugs, including statins, shouldn't be used at all in children younger than 10 unless they have severe problems.

The guidelines aim to help prevent and treat conditions in children that put them at risk for later heart-related problems. At least 10 percent of U.S. children have unhealthy cholesterol levels and one-third are overweight or obese.

The dispute may leave parents wondering whether to have their kids screened.

Dr. Sarah De Ferranti, an American Academy of Pediatrics spokeswoman and director of preventive cardiology at Boston Children's Hospital, said the question should be part of a conversation parents should have with their pediatrician about heart disease risks, including weight, blood pressure and lifestyle.

"Almost all of us could do better in that area," she said.

"My kids are about to turn 9 and I'm going to have them screened," said De Ferranti, who has a family history of heart disease risks.

Experts on panels that create screening and treatment recommendations for various diseases frequently have at least some financial ties to industry.

"The problem is the people who care about this issue are doing research on it and there's no way to get research done without some involvement of industry," said De Ferranti, who has done industry-funded research herself.

The critics say there's little evidence that widespread cholesterol testing and treatment in children will reduce their chances of having later heart problems. They argue that widespread testing is costly and could cause anxiety in healthy children who don't need treatment.

The National Heart, Lung and Blood Institute appointed the guidelines panel. Dr. Susan Shurin, the institute's acting director, said there are few qualified specialists who have no industry relationships, and that panel members were selected for their expertise.

"We got the best people in the country to do this," Shurin said.

Dr. Stephen Daniels, chairman of the guidelines panel, is pediatrics chief at the University of Colorado School of Medicine. He has worked as a consultant or advisory board member for Abbott Laboratories, Merck and Schering-Plough, now part of Merck, and co-authored the Pediatrics rebuttal.

Daniels said industry ties "were vetted during the discussions of the panel and I think really did not influence the debate."

The other rebuttal authors Drs. Brian McCrindle of the University of Toronto, whose industry ties include consulting or serving as advisory board member for Merck and Abbott; Peter Kwiterovich of Johns Hopkins, consulting or advisory board member for Merck and LipoScience; Patrick McBride, University of Wisconsin, who says he has had no relevant industry ties since 2007; and Rae-Ellen Kavey, University of Rochester, who listed no relevant financial ties.

 

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