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One of the biggest pieces of news this past month in the cardiovascular sector came not from the device side of this industry but from the pharmaceutical side.

Attracting major headlines, and considerable controversy — controversy always the main reason for the big headlines — was the new guideline issued by the American Academy of Pediatrics (Elk Grove Village, Illinois) that children as young as 8 might be treated ("might," not "should") with cholesterol-lowering drugs.

The controversy which ensued was predictable, since these drugs, like most pharmaceuticals developed for use in adults, have not been tested for their activity or side effects in children. Thus the quotes and comments gathered from experts lined up on the opposite sides of this lack-of-clinical-evidence divide.

Critics emphasized the obvious murkiness of the risk/benefit equation: that the clinical trials were not available to demonstrate the benefit of using these kinds of drugs in young children, and the bigger problem being that the risks of use in this population also were not known and could be very large over the individual's lifetime.

Proponents lined up with the pediatrics organization issuing the guidelines. While acknowledging potential risks, they noted the benefits and general safety in large populations and, much more importantly, the severity of the problem being addressed: childhood obesity — especially being observed in younger and younger children.

This, they said, pointed to the rapidly increasing epidemic of cardiovascular and cardio-related illnesses, such as diabetes, at younger ages and the potential for an increase in combined multiple chronic pathologies into advanced age.

The controversy swirled around the cardio drug sector and also sometimes, by extension, the increasing use of pharmaceutical "solutions" to deal with otherwise preventable problems. But that focus too often failing to develop concern about the real — and really major — issue.

It is not difficult to imagine a point in time when a young person with a complicated disease progression points to the use of a cardiovascular drug prescribed to him or her at age 8 and files suit against the drug company, and also the prescribing physician, when the real problem was childhood inactivity and too many calories. That, of course, is the real issue — one that does not seem to have a foreseeable solution in sight.

Healthcare experts, even some politicians, can harangue ad nauseum concerning the need for pushing kids out of the house to be more active, but the vast luxuries of a Game Boyed, Internet-connected, computerized and real-time media-subsumed world will always be more powerful.

Ultimately, the complaints about rising healthcare costs, like the criticism of dosing children with adult drugs, if not totally silly, are, at the least, totally irrelevant.

Of course, one can hope that watching world-class Olympic athletes perform in China this month will encourage kids to get out and play. But it more likely will feed their addiction to sitting still and being entertained.

— Don Long, CD&D National Editor




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