We agree with the points made by Dr Newman, and, in our article,1 we recommended against universal childhood cholesterol screening. We believe that cholesterol studies should only be performed for high-risk children. Our criteria for selecting these children are stricter than those of the 1991 National Cholesterol Education Program2 and are outlined in the Figure.
Dr Newman's important analyses, which he cited, have called attention not only to the wastefulness of some screening programs in terms of cost-effectiveness and national health care priorities but also to the detrimental effects they exert by mislabeling patients and leading to inappropriate, potentially harmful treatment. Our study, which demonstrates poor compliance with recommendations for childhood cholesterol screening and follow-up, supports his contentions.
Reprint requests to Department of Pediatrics, Kaiser Permanente Medical Center, 280 W MacArthur Blvd, Oakland, CA 94611-5693 (Dr Bachman).