WHAT DOES THE LATEST EVIDENCE SAY ABOUT ANNUAL PHYSICALS?
HINT: THE SAME THING YESTERDAY’S EVIDENCE SAID
My brother and his wife (both M.D.’s) were visiting us about three years ago. We were sitting on the front porch when I asked them both about a piece I had recently seen on the local news. The story was about the fact that yearly physicals were no longer recommended by numerous medical organizations and groups. The story did not go into a great deal of detail as to why this was true, so I asked the medical experts themselves. Their answer — straight from the proverbial horses mouth…. They said that there is overwhelming evidence that regular physicals lead to way too many False Positives and False Negatives. False Negatives tell your doctor that you’re fine when you’re not. False Positives tell your doctor that something is wrong with you when, in fact, you are fine. It’s the False Positives that are driving this latest wave of research.
There is good reason that False Positives are the force behind the medical community’s message that many of our current ‘do-or-die’ medical tests are not good tests to have done on a yearly basis. What are some of these tests? PSA tests are not a good yearly test for detecting Prostate Cancer. Neither are yearly mammograms a good thing. Or yearly colonoscopies. In fact, in recent years, the U.S. Preventive Services Task Force has recommended against broad-based testing of any sort in the general population on a yearly (regular) basis.
You see; when a particular test tells the examining doctor you may have a certain disease or health problem, other tests are immediately ordered. Not only are these tests usually expensive, they are often invasive — sometimes very invasive. One of ‘Medicine’s’ dirty little secrets is that many of these tests are so invasive that they are a actually themselves a threat to human life and health. And because of the massive numbers of False Positives associated with all of these tests (another dirty little secret), people end up going through expensive and invasive treatments that were never needed in the first place.
Think about it; although you are perfectly fine, the test / physical exam says you are not. More tests are ordered. These tests open a whole can of worms, that once released, are impossible to get back in the can. People are frequently led do do more testing and treatment that is expensive, dangerous, and even deadly. Does this sound like a good combination? Didn’t think so. Again, when I asked them about why the newscast was recommending that people forgo yearly exams, this was the answer they gave. It seems that this (old) idea has wheels. It has to do with a phenomenon widely referred to in the medical community as ‘OVERDIAGNOSIS & OVERTREATMENT‘.
In a recently published study, the Cochrane Library (an online medical journal) released the largest study of its kind to date —- a meta-analysis of sixteen studies involving nearly 185,000 patients. What did we learn from this study? Only that those who visited their doctor for “Regular Checkups” died of CANCER, heart attacks, strokes, and other cardiovascular events at the same rates as those who did not go for yearly Checkups.
Not only that, but when looking at secondary endpoints such as decreased numbers of hospital admissions, doctor visits, disability, missed work, referrals to specialists, follow-up tests, or surgical procedures, the two groups were identical as well. In fact, the study’s authors concluded that, “general health checks did not reduce morbidity [sickness] or mortality [death], neither overall [all diseases] nor for cardiovascular or cancer causes…. considering that cardiovascular and cancer mortality were not reduced, general health checks [Checkups] are unlikely to be beneficial.” Wow! What they are saying — in a politically correct way — is that regular checkups are a waste of time and money. They are worthless.
Interestingly enough, in an editorial on this study, Dr. Stephanie Thompson and Dr. Marcello Tonelli from the University of Alberta’s (Canada) Department of Medicine agreed that “Checkups” are a waste of time, resources, and money. The two doctors wrote:
Although general health checks are popular [19 of 20 US doctors strongly recommend them], recent debate [the past decade] has focused on their unintended consequences, including overdiagnosis, which is the detection of disease that (if left undetected) would not have affected the quantity or quality of an individual’s life. Abnormal screening results can also lead to further investigations and accompanying risks: anxiety or psychological distress; lost income due to work absences; difficulties securing insurance; and increased healthcare costs.
The results of this review are consistent with a previous systematic review by Boulware et al[a government study (AHRQ) that was published in 2006, but started in 1989] that also evaluated the benefits and harms of general health checks. The Boulware review differed in its definition of the general health check, included observational studies, and analyzed fewer randomized trials. Despite these differences, the authors of both reviews reported that general health checks had no effect on mortality, disability and hospitalizations compared with usual care.