Too many check-ups could be bad for your health
SECOND OPINION:Only two weeks into 2013 and many people have failed to keep their new year’s resolutions. Research shows that most of us forget our resolutions within 48 hours and only about 12 per cent stick to their life change plans for more than a few weeks.
Local shops are full of self-help books encouraging us to keep on trying. Some of this year’s publications include: The Top Five Regrets of the Dying, one of which is, unsurprisingly, spending too much time working; The Procrastination Equation, containing advice on doing things now not later; and Hypnotic Gastric Band, which advises on how to lose weight without surgery.
Another way people strive to be healthier at this time of year is to have a general health check-up before starting on programmes of self-improvement and lifestyle change. Like most self-help books it seems that these health checks have no beneficial effects and may do more harm than good.
General Health Checks in Adults for Reducing Morbidity and Mortality from Disease, published by the UK-based Cochrane Library, shows that general health check-ups do not reduce diseases or death rates, either overall, or for cardiovascular disease or cancer.
After between four and 22 years follow-up, mortality risks for all causes of death, heart disease and cancers were almost identical for those who had general health check interventions and those who did not. Health checks had no effect on hospital admission rates, disability, worry or absence from work.
The study, which involved a review of 16 randomised trials and nearly 200,000 participants, concluded that “general health checks are unlikely to be beneficial”.
Health checks are defined as screening healthy adults for more than one disease and involve multiple medical tests in a person who feels well.
Health checks are usually carried out by a doctor or nurse and typically include measuring blood pressure, cholesterol levels, height and weight, an electrocardiogram, urine analysis and a clinical examination.
All health insurance companies operating in Ireland offer a range of health screening packages to individuals and employers at high cost and without any medical evidence of effectiveness to support these interventions.
More harm than good
In reality, health checks do more harm than good. False positive results lead to unnecessary worry and invasive diagnostic tests that may cause harm. False negative results lead to a false sense of security.
A “clean bill of health” encourages people to continue with an unhealthy lifestyle. Being labelled as having a disease or even being at increased risk of developing a disease has a negative impact on self- confidence and self-esteem in otherwise healthy people. They go from seeing themselves as fully functional human beings to feeling inadequate and needing unnecessary medication, such as for high blood pressure.
A November 2012 study, also from the Cochrane Library, found that using anti-hypertensive drugs for mild high blood pressure (systolic BP of 140-159mmHg and diastolic BP of 90-99mmHg) is not beneficial and does not reduce diseases, disabilities and deaths. Lifestyle changes are more effective.
The history of promoting health through routine check-ups has been, according to a recent editorial in the BMJ, “one of glorious failure, but generations of well-meaning clinicians and public health physicians struggle to allow themselves to believe it”.
Most lay people also struggle to believe health check-ups don’t work. Intuitively we think the human body is a bit like a machine which, if given a yearly service, will continue to function well.
These checks have been called MOT tests for humans, and Fine Gael promised National Body Tests (NBTs), based on the same idea as National Car Tests (NCTs), as part of its plans for universal health insurance at the last general election. Luckily for taxpayers, there is no funding for NBTs and the Cochrane study means they should never be provided.
In 2013, the health sector must concentrate on public policies that control the use of alcohol and tobacco and the consumption of high fat, high sugar foods. An individual who wants to make lifestyle changes should forget about health checks and buying self-help books.
The latter have been around since the publication in 1859 of Self-Help by Samuel Smiles. These books would have changed human behaviour for the better by now if they were ever going to, instead of which obesity and chronic health problems are more prevalent than ever.
A better idea is to invest in rain gear, walk four to five miles every day and eat real food. Problem solved.
Dr JACKY JONESis a former HSE regional manager of health promotion