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May 8, 1981

Cholesterol, Children, and Heart Disease: An Analysis of Alternatives

Author Affiliations

Boston University Medical Center


by Donald M. Berwick, Shan Cretin, and Emmett B. Keeler, 399 pp, with illus, $32.95, New York, Oxford University Press, 1980.

JAMA. 1981;245(18):1871. doi:10.1001/jama.1981.03310430061034

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The authors set out to evaluate the cost-effectiveness of screening children for high blood cholesterol levels and making the desired dietary changes as a means of preventing atherosclerotic disease. The benefit of dietary change is considered still uncertain, as is the ability to select persons at high risk in early life, when the changes would be most useful.

In effect, this book is an introduction to the analytic approach to determining the cost-effectiveness of programs aimed at preventing disease. The authors point out the limited benefit of new expensive technologies in increasing life expectancy and accept the thesis that preventive practices that appear reasonable offer more hope of this than do sophisticated therapeutic efforts.

A reasonably complete general review of our knowledge of the relationship of blood cholesterol level and dietary intake to development of coronary heart disease is presented. There is general acceptance of our ability to determine relative