So who is likely to drop dead? The important distinction that we must make is between those who are genuinely healthy, as Sharky appeared to be, and those who are only apparently healthy. The former are those who have a low risk of a heart attack as measured by several health factors discussed below, while the latter are those who have no signs or symptoms of heart disease; a "medical" conclusion that can be very misleading.

There has been a flurry of cholesterol testing in the wake of sharky's death, a common response among people who rely on a medical assessment of their health. What it amounts to is a search for something to treat in the hope of reducing the chances of a heart attack; a "fix" for a problem; a stitch in time. Well, if one's cholesterol is found to be extraordinarily high, the test could indeed be a life-saving exercise, but there are so few people with very high cholesterol levels that screening with a view to treatment and thus prevention is really not worth the bother or the expense.

Most people who get a heart attack will have cholesterol levels that are only "a little high"; say 220 to 240 mgs/dl. Even those whose cholesterol is very high will not have had a heart attack simply because of their cholesterol, but because of their poor overall health. If you really want to know your chances of a heart attack you have to assess your overall risk, not just test your cholesterol. That means an evaluation of your lifestyle, your body composition, your lipid profile, your blood sugar, your fitness level, and so on. That is a lot more than a forty-dollar cholesterol test. But more important than the testing is the commitment to a healthier lifestyle, and that is where most people fail.

Most people whose cholesterol is found to be a little high will do nothing about it. Herein lies the problem with medical "check ups": they induce complacency. Tell the average person that there is "nothing wrong" with him or her and it is only natural that he or she will carry on as usual - until something goes wrong. That is why so many doctors are themselves in poor health. They too are reassured by the absence of symptoms and signs of disease, and carry on eating and smoking and sitting around - until they fall sick.

Even among those who do try to lower their cholesterol level by changing their diet, the number who will succeed is depressingly low. If worrying about a heart attack is their reason for trying to lower their cholesterol then "depressing" is indeed the word. People who worry about their health are very unlikely to stop worrying even if they succeed in lowering their risk below average, since they will still be operating in a reactive mode. It is like a fear of flying: no statistical demonstration of the safety of commercial aircraft can get rid of that fear.

To enjoy genuine good health one has to be proactive; one has to seek good health for its own sake. A cholesterol level below 200 must be a goal to the extent that it is a measurable indicator of good health; a needle on a compass for an individual who is in search of higher standards. There is no point in testing your cholesterol unless you are engaged in such a search. Most people will get a result somewhere between 180 and 240, and by itself that is pretty useless information.

There are serious implications here for national policies on screening and health promotion. Those who are medically trained see screening as a mechanism for weeding out people at high risk in order to "treat" them. They anticipate that such an approach will lead to a reduction in the number of "cases". That is like trying to get rid of an iceberg by cutting off the tip: it will only succeed if the iceberg is not growing in size. In the case of lifestyle problems like heart disease, the iceberg is growing in size.

Those who are health oriented, on the other hand, see screening as education; that is, not really "screening" at all, but an inducement for people to take a greater interest in their health. If people are to change their habits they need information. Not that information will necessarily bring about change, but it is an essential prerequisite for change. The more an individual understands about his health, the more likely he is to do something about it.

That is the essential difference between a "wellness assessment" and a medical check up. The former is an exercise in self-development; the latter is a search for the signs and symptoms of disease. The former is always rewarding; the latter is usually temporarily reassuring. Both involve cholesterol testing, but the two are miles apart in orientation.