New recommendations by the US Preventive Services Task Force (USPSTF) published in JAMA1 reaffirm the USPSTF’s 2007 position that the evidence for cholesterol screening in childhood is insufficient to make recommendations regarding benefits and harms. In 2011, following an independent evidence review process, the National Heart, Lung, and Blood Institute and the American Academy of Pediatrics published integrated guidelines for cardiovascular risk reduction in children and adolescents, recommending universal screening for blood cholesterol levels at ages 9 to 11 years and 17 to 21 years.2,3 Given that the evidence evaluated by these groups was not that different, why are these conclusions disparate?