Abstract
<h3>To the Editor.—</h3> To the "cholesterol saga" presented in the December 19, 1990, issue ofThe Journal, we would like to add a "cost-misdeedness" analysis. The wave of enthusiasm for the beneficial effects of lowering blood cholesterol concentrations by pharmacological intervention in asymptomatic persons who are free of a history of coronary heart disease requires such an analysis. High plasma cholesterol levels are widely recognized as a major risk factor for heart disease and related mortality,<sup>1,2</sup>but no evidence has yet been found that reducing cholesterol levels by drugs and diet can, in primary prevention trials, reduce total mortality.<sup>3</sup> Since total mortality and long life expectancy are still considered nontrivial end points and since cost containment is a major public policy concern, the worrisome results of the three largest randomized primary prevention drug trials<sup>4-8</sup>seem to ask for time for us to reflect before we introduce interventions. A
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