Health checks are a common feature of conventional medical care. Here, individuals who don’t necessarily have any specific health issues are subjected to several medical tests such as blood pressure and cholesterol measurement, height and weight and standard blood tests. The idea is that ‘problems’ will be spotted earlier than they would be ordinarily, and earlier ‘intervention’ will lead to better health outcomes.
I read this week that the UK Government is pushing for more people aged 40-74 to get a health check every 5 years as, we are informed, implementation and uptake of its policies are only about half what they should be [1]. Now, those in the UK will be only too aware that we have a healthcare system (the National Health Service) that is creaking and groaning and essentially bankrupt. So, if the UK Government wants greater uptake of health checks, then you would imagine it would have good evidence that these are effective and cost-effective.
The impact of health checks on health outcomes was assessed by researchers from the so-called Cochrane Collaboration (specialising in performing ‘meta-analyses’ of health interventions) and published last year [2]. The review pooled together the results of 14 studies where the health outcomes of people who underwent a health check were compared with those of people who didn’t.
Some of the studies shows that people in the ‘health check group’ would end up with more diagnoses of, say, high blood pressure or ‘raised’ cholesterol, and there was also evidence of more medical treatment in this group too. However, what we really want to know is whether any of this led to any improvement in health. Here are the results:
Risk of death from cancer – no benefit
Risk of death from cardiovascular disease – no benefit
Overall risk of death – no benefit
The authors add:
We did not find beneficial effects of general health checks on morbidity, hospitalisation, disability, worry, additional physician visits, or absence from work, but not all trials reported on these outcomes.
They conclude:
General health checks did not reduce morbidity [illness] or mortality, neither overall nor for cardiovascular or cancer causes, although they increased the number of new diagnoses. Important harmful outcomes were often not studied or reported.
This last line is important, because when someone is subjected to a health check, there is at least some risk that they will be treated for (and suffer as a result) for something that would not have bothered them if it had just been left alone (this is termed ‘overtreatment’). Health checks, it seems, generally do no good, but that does not mean they do no harm either.
According to the BMJ article this week, the director of health and wellbeing for Public Health England (the body pushing ahead with plans to broaden screening) has acknowledged that the impact of the checks has not been properly assessed, but added: “If we are going to wait for the perfect evidence than we would never to be able to innovate.” The use of the word ‘innovate’ is very telling here, I think. Because innovation is the sort of buzzword people use in managerial positions, and it’s just the sort of thing that can divert attention away from what truly matters – outcomes.
Public Health England criticised the Cochrane review, particularly for including trials conducted “many years ago.” But, the authors of the review contend that: “There are plenty of possible explanations for the disappointing effects of health checks in the trials, and in the absence of evidence to the contrary, there is no reason to assume that the NHS Health Check is any better.”
Oddly, prior to election, the Tory party was saying it was going to scrap the health checks or at least modify them [3]. My strong sense that efforts to redouble our efforts regarding health checks was made by a committee of people who, collectively, may be more interested in ‘innovation’ and being seen to be proactive rather than focusing on what is truly important in medicine – genuinely improving the condition of the people it serves.
References:
1. Drive to boost health checks in England is criticised. BMJ 2013;347:f4675
2. Krogsbøll LT, et al. General health checks in adults for reducing morbidity and mortality from disease: Cochrane systematic review and meta-analysis. BMJ2012;345:e7191.3.
3. Krogsbøll LT, et al. Re: Government prioritises health checks for 15 million adults despite pre-election promise to scrap them. BMJ 28 May 2013.
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I was recently about to have dental work at a clinic here in Thailand. There I was almost upside down , plastic bibbed, near blinded by the inspection lamp, and surrounded by white coats. ln other words a typical stressful scenario at the dentist when the assistant produces a blood pressure monitor, “to see if my blood pressure was ok prior to commencing treatment”. Needless to say you can guess what I told them to do with their ruddy machine!
There’s word missing in your second highlighted outcome! A friend had one of these health checks last year. The stroke she’d had a couple of months earlier (and which had not been identified at the time) continued not to be identified… it was only diagnosed when she was referred to a Consultant in another speciality who picked up on the residual signs.
Sandy
Thanks for spotting that – corrected now.
One positive outcome for ‘healthy’ results of a health check is that I get a 15% reduction in the cost of my private health insurance!
Some checks in health checks are not even particularly valid , I was chatting to a doctor who had performed “health screens” on some Scottish rugby internationals & he commented that they often scored over 30 on their BMI but were obviously not obese….. just as well they scored well on other measures !
I am not sure whether others will find this a typical picture of a GP, but in my experience if you present with a tangible problem then you will almost always get an appropriate treatment since the system knows empirically the ‘correct’ procedure for making you ‘better’.
On the other hand if you present with vague symptoms the time-poor GP will struggle and typically latch onto something in your symptoms they are familiar with and treat you for that.
But if you present with no symptoms because you have been called in for an age related health check then you fall prey to the ‘tick in the box’ religious culture that is ‘perceived medical wisdom’.
Time pressures (8 minutes per consultation) mean that your chances of being treated as a patient rather than an unacceptable variation from a centrally determined subjective norm are virtually zero.
Despite having had good experiences in the past with my GP practice, now that I am being subjected to ‘health checks’ and measured against these arbitrary and – as I am learning by studying the subject – wrong norms, I am coming round to the opinion that I should remove myself from their list and in the event of future ‘tangible’ medical issues present myself to A&E.
Stephen Rhodes
Well, provided you don’t mind waiting for 4 hours to be seen, visiting the Accident and Emergency Department with something which is neither an accident nor an emergency is likely to result in someone explaining, I hope politely, the definition of those two words.
You may wish to bear in mind that, should you need the A&E for a life threatening event, it won’t help if it’s knee deep in people attending there as a protest against silly health checks.
I must declare my interests; my daughter is a Medical Registrar, aka a MedReg, who devotes her life to those admitted to hospital with serious medical problems, and I have a rather spectacular lung disease, coupled with adrenal insufficiency, which puts me on the fast track should I ever venture into an A&E.
Of course, my doctors don’t do silly health check ups on me, since, as they put it, they prefer trying to keep me alive, so I’m not exposed to the irritant…
my doc, (hard to change as my insurance sucks), withholds my prescriptions for antidepressants and hypnotics if I do not do f/u for high cholesterol. I have tried every statin and got severe raby, max dosage of fibrate and that gives me softwood problems. Is there any ethical rules that prevent physicians from withholding QoL medications if the patient does not meet their LDL management protocols? (USA)
This is sweet music to my ears! Having worked out for myself, months ago, that I was in some sort of poly pharma vortex, I have removed myself from its influence and feel 100% better. But what happens if/when I do not present for my next “health check”, or decline the flu jab in the Autumn?
As a post-war baby I was brought up to respect GPs and policemen. Am I just an embittered old fogey, now having little regard for either? Thank goodness for the Internet, because reading this report has made me realise that I have taken the correct route this year, and am medication free for the 1st time in 10 years.
I’m confused. I live in Gloucester and was already receiving an annual health check as I was over 40.
Would this mean my annual health checks will be reduced to every 5 years, or no health checks at all?
Personally I’m convinced they made me diabetic because they had me on statins from age 40 and following the supposedly heart healthy low fat official NHS dietary advice until I was diagnosed as T2.
I’ve now gone low-carb high-fat in response to reading Escape The Diet Trap and have effectively got my diabetes under control and lost over 60lbs in the process over the last 12 months.
When is the NHS going to acknowledge these statistics? We all can’t be fobbed off as anecdotal, surely.
GP practice used to be really good. Haven’t been for last 7 years. Now takes 3 weeks to get an appointment. I think they would have me on a statin, BP med, etc in a trice, (only went in to get osteo arthritic knee xray result) took BP and it was slightly elevated, mentioned it might be white coat syndrome and I left, quickly….
I’d prefer to pay and go private, get seen and get sorted out as needed.
Don’t want to partake in spurious screenings and health checks.
Have been on paleo diet for quite a while and never felt better (thanks to your book).
Thanks again for your interesting blogs and newsletters.