High-tech Care with Old-Fashioned Values

Kids and Statins

OK, so those of you who know me already know where this is going. Today the American Academy of Pediatrics released and expert panel statement recommending more aggressive screening of cholesterol in kids AND selective use of statin drugs in kids as young as 8 years old AND a move away from whole milk in children after the age of 12 months especially if they are overweight. The first is in an effort to identify those with risk of heart disease who may benefit from intervention. The second is based on some small studies that did not show harm if children used the meds for a short term (long term followup does not exist yet). The last is a major deviation from long held belief that for younger kids a certain amount of fat in the diet is crucial for brain development.

My take is mixed: Obesity in children is rampant in America. The causes are not that complex. We eat too many calories, too many calories as rapidly absorbed sugars and too little good protein and fiber. Parents eat poorly so their children follow suit. We have used sweet sports drinks to satiate our kids growing sweet teeth and as a society we “do exercise” rather that “live active”. Our schools and social institutions feed our kids poorly and cheaply and exercise them rarely. Our kids sleep too little (which in the < 8 year old crowd has been linked with obesity.

As health professionals we have also failed. We reach for pills because we don’t want/cannot spend time with patients trying to educate and change lifestyles. We have not been out front in advocating for healthy local school food and against corporate takeover of the lunchroom. We have reached for pills to correct ignorance or sloth from parents who seem not to understand that they are killing their kids and we have gone away from common sense approaches.

Medicine has not lead the way in nutrution even for the youngest amoung us (unless they have an illness). Did you know that nearly 1/3 of our baby boys in some surveys are drinking SOY forumla. At the same time we promote soy as a phytoestrogen to help with the sympotms of menopause. THINK ABOUT THOSE TWO STATEMENTS. Although obesity < 2 years of age has not been as strongly linked to adult obesity as in kids 3-8 we now seem poised to recommend against fats that nearly all science says may be cruicial for brain development in a toddler. (Oh, well, there’s always Ritalin for the consequences).

If you think that the pharmaceutical industry is not licking its lips anticipating a new group of “patients” who will take meds FOR LIFE you are kidding yourselves. Doctors will not want to be “behind the times” and will start screening (not a bad thing) and given meds. My experience over the years especially when I was teaching was that given a choice between educating and prescribing a medication, the Rx always won. Just look how quickly marginally effective drugs spread through our society. So do not be decieved, these recommendations will largely increase testing costs, prescriptions to younger kids and side effects from those meds.

My suggestions? Work on the parents with new kids. Obese parents who eat poorly and do not exercise may wish their children were fit and active but, in my experience, the children quickly adopt the parent’s livestyle. We must as a nation make obesity as high a priority as smoking. Sugars must become public enemy number one with high fructose corn syrup becoming our number one bad guy. We need to have health care integrate nutrition and exercise eduation for children. We need to insist on good independent sources of research on nutrition rather than relying of data compiled by manufactuers of medications. We need to see that consuming is not healthy when it comes to medications and that the hard road of personal discipline and long term view is far better for society than the short term gratification of our taste buds. We need to put patients back on the hot seat as active in their own health. We need to do it now.