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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Antibiotics given in the right doses for the right infection at the right time have saved millions of lives worldwide. However they only work for bacterial infections. They are often given “just in case” an infection is bacterial and a best guess antibiotic is chosen. Sometimes the guess is right, but at other times wide of the mark.

Guidance now given is not to prescribe antibiotics for certain conditions that are likely to be viral in nature for they will not work, and doctors and patients are being discouraged in overusing this class of useful drug because this encourages antibiotic resistance.

Antibiotics have remarkable life saving properties but they are also great money spinners for drug companies, especially if they are used indiscriminately. But because they really do save vast numbers of lives, they are probably not a very good example to quote when considering disease mongering.

What if drug companies were not always altruistic? What if some of them were more interested in their stock-market performance?

Have you ever considered what is meant by the term “disease mongering?”

If not, you should.

THE FIGHT AGAINST DISEASE MONGERING : GENERATING KNOWLEDGE FOR ACTION

COUNTRY : AUSTRALIA

“The problem of disease mongering is attracting increasing attention [1–3], though an adequate working definition remains elusive. In our view, disease mongering is the selling of sickness that widens the boundaries of illness and grows the markets for those who sell and deliver treatments. It is exemplified most explicitly by many pharmaceutical industry–funded disease-awareness campaigns—more often designed to sell drugs than to illuminate or to inform or educate about the prevention of illness or the maintenance of health. In this theme issue and elsewhere, observers have described different forms of disease mongering: aspects of ordinary life, such as menopause, being medicalised; mild problems portrayed as serious illnesses, as has occurred in the drug-company-sponsored promotion of irritable bowel syndrome (see pp. 156–174 in [2]; [4]) and risk factors, such as high cholesterol and osteoporosis, being framed as diseases.”

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