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Comment by ultim8k | Hacker News Reader

That’s BS if I may. How would I know I have higher cholesterol if I didn’t do blood tests?

Interestingly, the scenario is somewhat discussed in the article:

"...Rivero used as an example a request he receives frequently: to check the cholesterol of young people with no risk factors. “Checking a 32-year-old man with no history of sudden death or hypercholesterolemia in the family is pointless,” and can result in prescriptions for medication of questionable usefulness and that is not without risk in the event of minor changes..."

Cholesterol numbers are but guides/risk factors on your health risk. They do not necessarily mean that you will suffer from atherosclerosis the precursor to heart disease.

That was my argument to my primary care doctor. He then arranged for a CT scan of my arteries that showed there was significant blockage. I'm now on statins for the rest of my life to keep cholesterol in the blood down and hopefully keep the arteries from getting completely blocked.

And your primary care physician did the correct thing which was to scan your arteries for damage. Also statins work by helping over a long period of time - so chances are if you are good with the sides (if you have sides) and you have a bunch of risk factors makes a lot of sense. Not a physician FWIW.

I get the logic, but … isn’t this failure mode the fault of the doctor, for overreacting to a minor issue/non-issue, rather than the patient for getting yearly checkups?

It may be a failure of the doctor, but we want to measure mortality in our world, not a magical one where doctors are perfect.

The takeaway here can and should be that interventions are started too soon, but that's a more difficult change than for healthy people to just reduce testing.

Doctors are generally instructed to aim for optimal outcomes.

Suppose 98% of people taking a drug as prescribed live longer, but 2% don’t use as described and they offset the gains. Should the drug be prescribed or not?

Similarly, what if people who do annual checkups and get good numbers take worse care of themselves because their numbers are healthy?

The issue is that doctors are biased to seeing a biased sample of human who are encountering problems. So in a way, they have to overreact always since the number of patients NOT having issues and seeing them due to the yearly checkups are way less than the number of people who are having problems.

The problem might go away if somehow we got a significant percentage of the general population to do health checkup, balancing out the unhealthy population (in meeting doctors). But that is nigh impossible, and might just overwhelm the whole doctor system altogether

I'm a bit mind boggled there is even a human involved here.

Lab results + Patient data = Diagnosis + Prescription

Why is there a Physician deciding if medicine is needed? The patient data from the original visit + lab should be enough, not sure why a second visit is needed. (This is only a problem because Physicians make somewhere between $250-$500/hr, if we had a market drive supply of Physicians, I don't think this question would be important)

I think that in that case, the issue is not that patient had checkup, but that standard reaction to high cholesterol is wrong. Having it checked up less often may help the patient, but real fix for healthcare system would be to not prescribe this medication in this situation.

You are right but such is the state of checkups and that is reflected in this study.

But how does the statin market stay rich and how do doctors get those marketing dollars

The vast majority of common statins are off patent and extremely inexpensive. Pharmacies often offer them at around $5/month, without insurance, usually free with.

The 'better' cholesterol drugs like the PCSK9s are expensive, but insurance almost always demands a first-line (cheap) drug be tried first for typical hypercholesterolemia.

I had my family test their blood sugar because we had a test kit sitting around. That's how we found out my youngest was at the beginning states of type 1 diabetes. If we hadn't checked her sugars, she would have undoubtedly been admitted to the hospital under DKA and had a traumatic introduction to her condition.

As it was, nobody, not the local doctors nor the children's hospital in the local metro center, had any idea of what to do with her. We had to repeat our story numerous times and she was admitted for no reason for three days because that was their protocol.

So i think the whole idea is bullshit. Test early, test often and let the practices catch up to the new amount of information.

But this thought process begs the question: what if this person is the one who STARTS the history of high cholesterol, and subsequent increased heart-related mortality. Or following it the other way, only people with a history of this are at risk? It is statistical: there could be a person with no history who is at risk, the probability is lower, but nonzero.

As others are pointing out, cholesterol is a lab indicator not a symptom or disease out right. Cholesterol numbers are a proxy for risk for a negative event, but only a weak proxy. If you're otherwise healthy and don't have a family history of cardiac events then your cholesterol numbers probably don't matter. Trying to control those numbers in the absence of other risk factors presents other risks. Cholesterol medicines aren't without side effects, so you're best off not taking them if you don't need them.

That's the key: you don't need to know it.

Cholesterol is a prime example; The leading medications deteriorate muscle and reduce mobility; where increased mobility decreases the risk of cholesterol illness via inreased arterial plasticity.

And where dietary cholesterol has been proven to not be directly related, you're fighting your liver and genetics.

Higher compared to what? Have you established what your healthy baseline cholesterol level is, or are you just assuming that whatever the literature uses as its favourite test demographic accurately captures your age/metabolism/lifestyle?

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