Cholesterol screening and the Gold Effect

Abstract

This paper explores the concept of the 'Gold Effect' in relation to the use of serum cholesterol measurement as a screening test for cardiovascular disease. The Gold Effect explains the phenomenon of the process by which an idea comes to be held as a generally accepted truth. In this paper we argue that cholesterol screening is the product of the Gold Effect. Screening tests need to be sufficiently robust as an indicator of risk and thus their evidence base should be clear and uncontested. While there has been a long standing debate about the link between high cholesterol and cardiovascular disease and, in particular, the use of statins as the main approach to lowering cholesterol levels, serum cholesterol measurement and lowering levels of cholesterol are widely accepted as NHS interventions and are financially incentivised. We start by discussing what cholesterol is and how it is screened for in the UK. We then go on to examine the evidence for using cholesterol as a risk marker for cardiovascular disease. We then discuss the research on reducing cholesterol levels through diet and by using statins. We finish by discussing the implications of this analysis and questioning why cholesterol is routinely screened for and why so much emphasis is placed on cholesterol reduction arguing that at the root of this approach there is a misconception about the relationship between fat and cholesterol and about the role of cholesterol in cardiovascular disease.

Slaying sacred cows: is it time to pull the plug on water fluoridation?

“…The resulting articles and papers will show an increasing consensus of agreement and the idea will gather pace and momentum. One of the aspects of the 'Gold Effect' which is important here is that the pace at which such an idea can grow is assisted if the idea links in with preexisting beliefs or assumptions (Lyttleton 1979, Hann andPeckham 2010). For example, there is already a commonplace belief that fluoride is 'good for your teeth' and this view has attracted medical endorsement and media attention.…”

“…Well-known examples of policy flying in the face of evidence include the recent furore over drugs misuse policy in the UK and cholesterol screening and statins use (Gossop andHall 2009, Hann andPeckham 2010). While appeals to ideas and political context affecting political policy making may explain the recent controversy over the classification of drugs in the UK (Lancet 2010), of particular interest are areas such as cholesterol screening and water fluoridation where there is substantial professional medical and public health support for such measures.…”

Gypsies/Travellers and health: risk categorisation versus being ‘at risk’

“…Statistical risk models, based on prior categorisation of risks, are used to differentiate those who are diseased from those who are not and to identify disease free, but 'at risk' populations (Hann and Peckham, 2010, Holmberg and Parascandola, 2010, Heyman et al, 2012. There is evidence that Gypsies and Travellers experience an excess burden of ill health, including lifestyle related diseases, which exceeds that seen in other ethnic minorities and socially disadvantaged groups .…”

Perspectives on the ‘lens of risk’ interview series: Interview with Nick Pidgeon

“…One approach to thinking about the issue raised is to distinguish an event such as nuclear accidents which 'really' kills from its risk which references prognostic limitations. xi Many other, sometimes controversial examples can be given, for instance cheese avoidance if sceptics about the dietary fat intake-high 'bad' cholesterol-coronary heart disease linkage (Hann and Peckham, 2010) are to be believed. xii Barnett (1982) xiii Perrow (1984) xiv Failures arising from the same causal factors and therefore not statistically independent -c.f.…”