Practice Guidelines and Cholesterol Policy

Abstract

One of the most striking pieces of medical news in the 1980s revealed the connection between high blood cholesterol and a persons likelihood of developing coronary artery disease. In 1985, the National Heart, Lung, and Blood Institute of the National Institutes of Health began the National Cholesterol Education Program, whose goal was to develop a national policy for reducing serum cholesterol. However, the panel that convened to formulate recommendations for screening and treatment was instructed not to consider cost in its deliberations. As Alan Garber and Judy Wagner point out in this article, failure to include costs in the development of guidelines such as these can have “far-reaching, unanticipated effects.” This point is especially relevant to the new Agency for Health Care Policy and Research (AHCPR), which was formed as part of the 1989 budget reconciliation law. One of AHCPR's express mandates is to develop condition-specific treatment guidelines for nationwide use. “If the AHCPR guidelines show the same disregard for costs' that the cholesterol guidelines showed, the authors state, “they cannot be expected to guide health dollars to their most effective use.'' Garber, a general internist, received his medical degree from Stanford and a doctoral degree in economics from Harvard. He is an assistant professor of medicine at the Stanford Medical School, a staff physician for the Department of Veterans Affairs, and a research associate at the National Bureau of Economic Research in Stanford, California. Garber's research interests include technology assessment, evaluation of screening programs, and health care financing. Wagner is a senior associate at the U.S. Office of Technology Assessment, where she has been since 1982. She holds a doctorate in environmental systems engineering and public finance from Cornell University. Her last published article in Health Affairs was a commentary on well-child care.