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Wald et al do not mention the potential adverse psychological impact of child-parent screening for familial hypercholesterolaemia.1
No matter how well these issues are communicated, this test will exacerbate the cholesterol neurosis that much of the population already seems to have. General practitioners in particular are aware that a screening programme which sounds fine in theory can translate into anxiety in patients. Throw children into the mix and the anxieties will be even higher.
Telling parents that their child has high cholesterol will worry them, which makes putting things into perspective difficult. It risks casting a shadow over childhood because parents view their progeny as threatened or fragile. This will be compounded by the fact that no immediate therapeutic action can be taken. Parents will feel that their child is vulnerable and that nothing can be done in the immediate term. At best this will make them uncomfortable, at worst it could blight their years of parenthood.
Wald et al suggest delaying treatment until adulthood. At which point—after a childhood of being less “well” than their peers and overprotected by their parents—they may or may not decide to be treated and may or may not be happy that this test was imposed on them. Perhaps their thwarted efforts to obtain life insurance will help them make up their minds.
Competing interests: None declared.