Map of life expectancy at birth from Global Education Project.

Thursday, September 25, 2008

Well, if George W. Bush says we have to do it

then I guess that settles it.

Meanwhile, back in the real world, Sarah de Ferranti and David Ludwig in NEJM discuss the recommendation by the American Academy of Pediatrics to give statins to children as young as 8 if they have elevated serum LDL. They seem reluctant to offend their colleagues in AAP, so they lay out issues without bluntly coming to conclusions. Allow me then.

Cholesterol is an essential component of cell membranes, and an essential compound in the pathway that synthesizes the steroid hormones, which include the sex hormones and others which have major importance in the development of children into adults. Cholesterol is particularly important in the central nervous system, and plays a key role in its development as well as its functioning.

There is zero -- zip, zilch, nada, nothing, bupkis, the null set, boy and bull are gone -- evidence regarding the long-term effects of giving statins to children. On the other hand, one can certainly hypothesize that drugs which inhibit the synthesis of cholesterol would have effects on sexual development and the development of the brain in children which cannot be assessed in any way based on experience with adults.

Now, why do children have elevated LDL? With the rare exception of genetic disorders, it's because they are physically inactive, overweight, and eat too much saturated and trans-fat. What do we do about it? Throw up our hands and start giving them pills, that might just be very dangerous, because actually fixing the problem would require a fundamental reorganization of how we do the business of health in this country. We have money to pay doctors and buy pills to try to fix the damage from the way we live -- although we might just be making it worse -- but we don't have the resources or the political will to fix the way we live.

And if we allow the Bush administration to complete its 8 year project of looting the treasury on behalf of the obscenely rich greedheads who control the Republican Party, we'll have no chance at all. You knew they were going to try to find a way to clean out the last dollar, but the audacity of this scheme is breathtaking. Check this link, you might find a rally tonight near your home to stop it. Good luck to us all.

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