It seems intuitive that it is a “good thing” to have regular health checks even if you are healthy. After all, you never know what beginnings of nasty diseases are lurking within you. Better detect these conditions early and so treat them early and perhaps save your life. Better to be safe than sorry. It is illegal not to have our cars MOT’d after all. And human beings are far more important than cars.

Hmmm……

A new Cochrane review published last week suggests otherwise.

GENERAL HEALTH CHECKS FOR REDUCING ILLNESS AND MORTALITY -FULL DATA

SHORTER VERSION

COUNTRY : INTERNATIONAL

General health checks involve multiple tests in a person who does not feel ill with the purpose of finding disease early, preventing disease from developing, or providing reassurance. Health checks are a common element of health care in some countries. To many people health checks intuitively make sense, but experience from screening programmes for individual diseases have shown that the benefits may be smaller than expected and the harms greater. One possible harm from health checks is the diagnosis and treatment of conditions that were not destined to cause symptoms or death. Their diagnosis will, therefore, be superfluous and carry the risk of unnecessary treatment.

We identified 16 randomised trials which had compared a group of adults offered general health checks to a group not offered health checks. Results were available from 14 trials, including 182,880 participants. Nine trials studied the risk of death and included 155,899 participants and 11,940 deaths. There was no effect on the risk of death, or on the risk of death due to cardiovascular diseases or cancer. We did not find an effect on the risk of illness but one trial found an increased number of people identified with high blood pressure and high cholesterol, and one trial found an increased number with chronic diseases. One trial reported the total number of new diagnoses per participant and found a 20% increase over six years compared to the control group. No trials compared the total number of new prescriptions but two out of four trials found an increased number of people using drugs for high blood pressure. Two out of four trials found that health checks made people feel somewhat healthier, but this result is not reliable. We did not find that health checks had an effect on the number of admissions to hospital, disability, worry, the number of referrals to specialists, additional visits to the physician, or absence from work, but most of these outcomes were poorly studied. None of the trials reported on the number of follow-up tests after positive screening results, or the amount of surgery used.

One reason for the apparent lack of effect may be that primary care physicians already identify and intervene when they suspect a patient to be at high risk of developing disease when they see them for other reasons. Also, those at high risk of developing disease may not attend general health checks when invited. Most of the trials were old, which makes the results less applicable to today’s settings because the treatments used for conditions and risk factors have changed.

With the large number of participants and deaths included, the long follow-up periods used in the trials, and considering that death from cardiovascular diseases and cancer were not reduced, general health checks are unlikely to be beneficial.

General health checks of people who are not complaining of disease is fashionable in many countries.

Even if useful, and this study suggests they are not, it is worth remembering that they make a lot of money for some and less money of others by keeping them employed. Are these good enough reasons for routine health checks (that may be associated with harms) on normal people?

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When it comes to clogging up the coronary arteries – a gradual process which in time has the potential of resulting in angina, coronary thrombosis and myocardial infarction, then prevention really is better than cure.

The Mayo Clinic gives guidance on ways to help yourself without medication.

5 MEDICATION-FREE STRATEGIES TO HELP PREVENT HEART DISEASE

COUNTRY : USA

“Heart disease may be a leading cause of death, but that doesn’t mean you have to accept it as your fate. Although you lack the power to change some risk factors — such as family history, sex or age — there are some key heart disease prevention steps you can take.

You can avoid heart problems in the future by adopting a healthy lifestyle today. Here are five heart disease prevention tips to get you started.”

The English approach is here:

CORONARY HEART DISEASE – PREVENTION

COUNTRY : UK

“There are several ways that you can help to reduce your risk of developing coronary heart disease (CHD), these include reducing your blood pressure and cholesterol levels. There are a number of ways you can do this….”

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There are always controversies in medicine.

It is one thing to:

(a) Prescribe medication to treat a diagnosed condition

But it is quite another to:

(b) Prescribe the same medication to “treat” populations of millions who are healthy by attempting to prevent a disease occurring in a proportion of that population at some time in the future.

In group (b) high numbers of the population “treated” will never develop the disease concerned or if the do will not die from it. Some of those individuals who do not benefit will suffer other harm due to side effects from the medication, some of them serious.

Today, the focus is on statins, which are used all over the world to reduce high blood cholesterol.

A Cochrane Review today reports the following:

STATINS FOR THE PRIMARY PREVENTION OF CARDIOVASCULAR DISEASE

“Although reductions in all-cause mortality, composite endpoints and revascularisations were found with no excess of adverse events, there was evidence of selective reporting of outcomes, failure to report adverse events and inclusion of people with cardiovascular disease. Only limited evidence showed that primary prevention with statins may be cost effective and improve patient quality of life. Caution should be taken in prescribing statins for primary prevention among people at low cardiovascular risk.”

In The Telegraph, a UK newspaper their report on the Cochrane Review on statins has caused quite a stir and at the time of writing this had attracted over 200 comments.

MILLIONS TAKING STATINS NEEDLESSLY

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