Does cholesterol screening result in negative labeling effects? Results of the Massachusetts Model Systems for Blood Cholesterol Screening Project

Article Abstract:

The National Institutes of Health Consensus Development Program recommended in 1984 that physicians test the blood cholesterol levels of all adults. Mass screenings were not recommended because of a lack of knowledge about their usefulness. Also, some of the research indicated that a diagnosis of high blood pressure led to a decreased sense of well-being, the ''negative labeling effect.'' Later research found that these effects could be avoided by using supportive health personnel, patient education emphasizing normal life style, and tactics to improve compliance. As a result of the conference, several portable devices were developed for mass screening of blood cholesterol, and many organizations began to use them. The National Heart, Lung, and Blood Institute funded the Model Systems for Blood Cholesterol Screening Project to test whether these new instruments measure cholesterol accurately, to evaluate screening, education and referral strategies, and to ensure that individuals at risk are evaluated. One of the questions addressed by the research is whether blood cholesterol screening has adverse effects related to a lowered sense of well-being among those whose blood cholesterol is found to be high. To test this, 1,093 adults who had a high blood cholesterol level during mass screenings in 1988 and 1989 filled out a questionnaire before the testing, and were sent a follow-up questionnaire. Eight hundred sixty-seven people completed both the initial and the follow-up questionnaires. No negative labeling effects were found; instead there was a small positive change in the average score, indicating slightly better feelings about physical and mental well-being. This may have been the result of well-trained personnel who emphasized that cholesterol level is largely under a person's control, as well as dietary recommendations and follow-up and counseling by private physicians. (Consumer Summary produced by Reliance Medical Information, Inc.)

Psychological aspects, Research, United States. National Heart, Lung and Blood Institute

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Results of the Massachusetts model systems for blood cholesterol screening project

Article Abstract:

Blood cholesterol screening has been recommended for adults, and the marketing of numerous portable cholesterol-testing devices has made large-scale testing possible. However, questions remain about the effectiveness of such programs because some studies found that only about one third of those with high cholesterol saw their physicians, and almost two thirds of those who did seek medical advice were given no dietary guidelines and told not to worry. The Model Systems for Blood Cholesterol Screening program was implemented to evaluate the effectiveness of different types of screening approaches, to ensure that evaluation and treatment would be available to those who needed it, and to test the accuracy and precision of different models of portable cholesterol analyzers. A total of 10,428 people were screened. Over half of those whose cholesterol levels were high saw their physicians within four months of testing; by six months the proportion had risen to almost two thirds. Whether a lay or professional educator provided information on cholesterol during the initial testing made no difference in whether people saw their physicians afterward. Postcard reminders encouraged more people to visit their physicians. The success of the program in having people see their physicians, and physicians' increased responsiveness, were a result of better patient education and the amount of media coverage. There were two concerns. First, minorities, the young, and the poor were underrepresented. Second, in spite of clear guidelines for managing high cholesterol by dietary measures first, physicians too often prescribe drugs, especially for the elderly. Continuing education on nutrition and nutrition training in medical schools will be required to improve physician practices. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, Evaluation, Testing, Medical care, Education, Physicians, Medical professions

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Should the elderly be screened for hypercholesterolemia?

Article Abstract:

The utility of many medical therapies is being reassessed, with attention paid to cost and effectiveness. Until recently, doctors tended to offer all services to patients that seemed to offer any benefit, without focusing on cost or likely outcome. Screening tests, which are done on all patients in order to detect disease in the absence of symptoms, carry far greater costs than those of merely administering the test. Those tests that detect disease lead to treatment and side effects, greatly increasing the ultimate cost of screening. Screening for elevated blood cholesterol levels in the elderly has been criticized because the few studies done to date do not show clear benefit from treating elderly persons with high blood cholesterol levels. Some studies suggest that the costs of identifying and then treating high cholesterol levels in the elderly do not justify the cost of screening, while other studies suggest that the number of years of life saved by treating the elderly with high cholesterol is too small to justify screening. Realizing that in general the elderly have fewer years of life to save than those who are younger weakens this argument. Measuring other endpoints, such as number of deaths from heart disease averted because of cholesterol treatment, might be of more value in assessing the costs of screening. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Aged, Elderly, Economic aspects, Ethical aspects, editorial

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