Most people who get a heart attack have serum cholesterol levels that are `OK'; they also have blood pressure levels that are `OK'. Furthermore, they are not particularly overweight or sedentary, and do not smoke heavily, if at all. If that seems contradictory in the light of contemporary concerns about cholesterol then it is time to re-examine the issue.

High serum cholesterol, high blood pressure, obesity, smoking, sedentariness, diabetes, and probably stress are important risk factors for heart disease - the quintessential disease of the end of the century. The more of these risk factors that an individual has, the more likely he (or she, after her menopause) is to get a heart attack.. But people with only one or two of these risk factors do get heart attacks, and since there are so many more of these people than there are people with many risk factors, there will be an absolutely greater number of heart attacks among them.

Let us look at it another way. Now that seat belt legislation has (finally) been passed, and assuming that most people are in fact obeying the law, it is inevitable that those people who are going to die in motor vehicle accidents will, in most cases, be wearing their seat belts. An individual who is not wearing his or her seat belt is more likely to die in an accident than an individual who is wearing it, but there will be, let us hope, relatively few such individuals.

Which brings us to the point: it is change in the behaviour of the population as a whole that will bring the results that we want, but it is up to each and every individual - more so when legislation is not possible - to make that change happen. By wearing our seat belts we are going to save the lives of a dozen or so people in the coming year. A small act by half a million people is needed in order to change the fate of a tiny minority. It is very, very unlikely that your life will be one of those that is saved, but the only way for us to save those dozen lives, is for each of you to wear your seat belt.

The same logic applies to cholesterol. If the average person whose cholesterol is `OK' reduces his or her cholesterol, we will actually prevent twice as many heart attacks as would be prevented by finding and treating those people whose cholesterol is high.

This is the "population approach" to contemporary health problems; the most meaningful, the most cost-effective way to respond to the challenge of heart disease, cancer, hypertension, diabetes, AIDS, accidents and other so-called "lifestyle diseases". The alternative is the "high risk" approach, which would mean, to continue the seat belt example, seeking out the bad drivers in our midst and asking them to wear their seat belts because they are more likely to have accidents. The latter is obviously a less effective approach, but for a number of increasingly irrelevant reasons, that is the favoured approach where our health is concerned.

The main reason is that doctors have been trained to promote health by looking for problems that need "treatment". Drug companies have spent millions to develop those treatments, and they have to turn a profit. And so it is that we have been caught up in a "testing" frenzy to see who is in need of treatment.

Millions of dollars are going down the drain every year on Stress ECGs for business executives; annual chest X-rays are routine, though they provide no benefits and are probably increasing the incidence of cancer; fat, sedentary diabetics are wasting their money on blood sugar tests, and of course, everybody is anxious to check their cholesterol to see if it is `high'.

None of this is going to make any difference to the health of the people of Trinidad and Tobago, but powerful interests are involved. The Mount Hope hospital, for example, is literally banking on thousands of executives doing annual medical check ups. No executive in his right mind would spend thousands of dollars on a procedure that brings no obvious corporate benefits, but then health has never been a matter of logic. People want reassurance that they are not about to die rather than programmes that will make them healthier and more productive.

This is not to say that "testing " is unnecessary. The problem is the reason for the tests. Every individual should know his or her cholesterol level, but only because such knowledge is one aspect of the assumption of personal responsibility for overall health (an aspect that may well change with further research).

A responsible car owner regularly checks the oil level in the engine, but he is also careful about the condition of his tyres, his brake pads, his front ends, and so on. In other words, he looks after his car. One often hears the complaint that doctors cannot make up their minds about cholesterol; at one time milk and eggs were considered good food, now we hear that they are not good for you. Such a complaint is at best a fundamental misunderstanding of what good health is about, and at worst, an excuse for inaction. Harking back to the car owner, it may well be that checking the oil level will become as unnecessary as greasing the nipples; the responsibility, however, remains the same.

Checking one's cholesterol level without looking after one's health is virtually useless. In a vast majority of people it will not be particularly high. Even if it is high and you are otherwise in very good health, then it probably does not matter. If it is normal and you are in poor condition, you will still get that heart attack, if it is due.

Do not bother to check your cholesterol, or even your blood pressure, unless you are committed to achieving a higher standard of health - in which case you will need to do a lot more than simply check your cholesterol level.