"Is It Worth Getting Annual Health Check-Ups?"
Physicians and patients have come to expect
the annual check-up as a routine part of care.
However, considerable research has not demonstrated
it has any substantial benefits.
And so a revolt is brewing against the tradition of periodic check-ups.
Even the Society for General Internal Medicine
has advised primary care physicians
to avoid such "routine general health checks for asymptomatic adults."
Check-ups seem to make sense, but historically medical practice
has included all sorts of things that seemed to make sense,
such as hormone replacement therapy for menopause,
until it was put to the test and found to increase
the risk of breast cancer, blood clots, heart disease, and stroke.
Or like when doctors killed babies by making the so-called
"common sense" recommendation that infants sleep on their tummies,
whereas we all know now "Face Up to Wake Up."
We should always demand evidence.
We check our cars regularly though.
So why shouldn't we also check our bodies?
Well, unlike cars, our bodies have self-healing properties.
To see if the benefits outweigh the harms,
researchers decided to put it to the test.
So what are the benefits and harms
of general health checks for adult populations?
The bottom line is that check-ups were not associated
with lower rates of mortality, meaning not associated with
living longer or a lower risk of dying from heart disease, stroke, or cancer.
So general check-ups may
not reduce disease rates or death rates,
but they do increase the number of new diagnoses.
And the harmful effects of the tests and subsequent
treatments could have balanced out any benefits.
Possible harms from check-ups include overdiagnosis,
overtreatment, distress or injury from invasive follow-up tests,
distress due to false positive test results,
false reassurance due to false negative test results,
possible continuation of adverse health behaviors
due to negative test results, adverse psychosocial effects
due to labeling, and difficulties with getting insurance
now that you have a pre-existing condition,
not to mention all the associated cost.
For example, diabetes.
Wouldn't it be great if we picked up a case of diabetes earlier?
Perhaps not, if they were given the #1 diabetes drug at the time,
Avandia, which was pulled off the market because
instead of helping people, it appeared to be killing people.
Adverse drug events are now one of our leading causes of death.
When it comes to lifestyle diseases, like type 2 diabetes,
maybe we should instead focus on
creating healthier food environments,
like my new favorite organization, Balanced,
to help prevent the diabetes epidemic in the first place.
How many times have you tried to inform someone
about healthy eating, about evidence-based nutrition,
only to have them come back and say,
"No, I don't have to worry; my doctor says I'm OK.
Just had a check-up, everything's normal."
As if like having a normal cholesterol is OK
in a society where it's normal to drop dead of a heart attack—
the number one killer of men and women.
I mean, if you went to see a lifestyle medicine doctor
who spent the check-up giving you the tools
to prevent 80% of chronic disease, that's one thing,
but given the way medicine is currently practiced,
it's no wonder, perhaps, why the history of routine check-ups
"has been one of glorious failure."
But generations of well-meaning clinicians
just don't want to believe it.
Policy should be based on evidence though.
Poor diet is on par with cigarette smoking
as the most common actual cause of death;
yet, the medical profession is inadequately trained in nutrition.
Worse, nutrition education in medical school appears
to be in decline, if you can believe it.
A shrinking of nutrition education among health professionals.
So the advice you get in your annual check-up may just be
from whatever last tabloid your doctor
skimmed in the check-out line.
Screening opportunities should not be regarded as
a form of "health education," one medical journal editorial read.
"People who are obese know very well that they are,
and if we have no means of helping them,
we should just shut up."
Well, if you really have nothing to say that will help them,
maybe you should shut up, especially doctors who say
they have no idea what constitutes a "healthy" diet,
though veggies and nuts are a good start.