The Utility of General Health Checks in Adults Takes a Beating
In a Cochrane systematic review and meta-analysis of 14 trials (involving 182,880 participants) recently published in the British Medical Journal, the authors from the Nordic Cochrane Center conclude that general health checks, defined as “a contact between a person and a health care professional to identify signs, symptoms or risk factors for disease that were previously unrecognized,” do not improve the health of patients. Specifically, the authors report that health checks do not reduce cardiovascular deaths or cancer deaths (in an analysis of data from 8 of the 14 trials).
So based on this review, does this mean you ought to cancel your upcoming doctor’s appointment for your annual examination and wait until you detect a problem with your health to make an appointment with your doctor? Absolutely not.
If you take a careful look at the framework from which these authors made their conclusions as well as the studies included in their review, I think you will agree.
The authors set the stage for this review by challenging the notion that early detection of disease in a general health check leads to improved patient outcomes or reduction of disease or death. In their words, “Theoretically, there are many possible benefits of general health checks, through apparently intuitive mechanisms.” In other words, we think there are benefits of general health checks because that makes sense to us (so called intuition) but there is no rigorously proven scientific evidence. Furthermore, they go on to say that the detection of risk factors such as hypertension of hypercholesterolemia “may” lead to reductions in morbidity and mortality through preventive treatment.
You may be thinking that this is a crazy statement because we know that treating hypertension and hyperlipidemia in a primary prevention does reduce heart attacks and death from cardiovascular disease. Well, we know this is true if you are enrolled in a clinical trial, but do we know it is true if your hypertension or high cholesterol is detected by your primary care provider? Technically, we do not have clinical trials data to prove this, but why should we? The whole point of clinical trials is to prove that therapies are effective so they can be brought into clinical practice.
Let’s take a look at the eight studies included in the analysis of the impact of health checks on cardiovascular mortality and cancer death. Here are some features of these trials as a group:
- Seven of the eight trials were started between 1963 and 1971; one started in 1989. Many therapies that we know save lives were not available at the time of these trials. For example, the first statin was released for marketing 1987.
- Only three of the eight trials offered lifestyle interventions. Without effective drug therapies, education about healthy lifestyles is critical.
- The number of health checks ranged from just one (in three trials) to three. We know it is hard to change a health behavior in just one visit.
- The average follow up ranged from four to 22 years.
To give you a feel for what these studies were like, let me describe one. The authors included data from one study performed in Stockholm of 3,064 men and women ages 18 to 65 who underwent one health check in 1969 compared to 29,122 men and women who did not undergo a health check in 1969 and then ascertained the death status on all participants 22 years later.
Frankly, I am not surprised to find that people who had one health check in 1969 did not have a reduced risk of dying from heart disease or cancer more than two decades later compared to people who did not have one health check because there are so many potential confounders concerning how all those people lived (who smoked, who didn’t, etc.) and were treated (who had a regular doctor, who took medications) during the intervening 22 years. But I certainly do not see this as an indictment of routine health checks in 2012.
The authors of this study conclude that “our results do not support the use of general health checks aimed at a general adult population…” which is the tag line I am sure you will see on the 5:00 news.
However, the authors go on to say that physicians should not stop “clinically motivated testing and preventive activities” and that their results “do not imply that all individual components of health check are ineffective.…”
So, keep that doctor’s appointment, take your medications, watch what you eat and get some exercise. You’ll be glad you did.
Dr. Nina Radford is Director of Clinical Research and a cardiologist at Cooper Clinic. She received a Bachelor of Arts from Cornell University and a Medical Degree from Mount Sinai School of Medicine. She completed her internal medicine internship, residency and a clinical and research fellowship in cardiology at The University of Texas Southwestern Medical School Affiliated Hospitals. Dr. Radford also completed a fellowship at the American Heart Association Bugher Foundation Centers for Molecular Biology in the Cardiovascular System. She is certified in internal medicine with a subspecialty certification in cardiovascular disease by the American Board of Internal Medicine. She also is certified by the American Society of Hypertension and the Board of Nuclear Cardiology and is a Testamur of the National Board of Echocardiography. She serves on the Board of Directors of the Discovery Foundation and The Cooper Institute.