It came again. Of course it did. It always does. What came?
The polite command to get into my doctor for what used to be called a "physical" and now most often is called something like an "annual wellness visit." Why do I have to visit a doctor to "make sure you're up-to-date on all health checks and screenings?" Simple: we patients don't care about our own health and fail to track elementary things. So we need to be told and then have our arms twisted to submit to various forms of testing. It's important -- early detection saves lives!!
What's included?
Here's what was in my annual thingy, which is probably similar to the one you got:
Draw some blood. Ask how depressed you are. Check whether you're had all the covid and other shots you're supposed to get. Colon cancer is terrible -- make sure you've had the colonoscopy you're supposed to have!
It's interesting that I also sometimes get something like this from my medical insurance company. It costs them money -- why would they send me to the doctor? I guess they really care -- or maybe they think prevention will be cheaper than cure. That seems to be what everyone thinks.
Houston, we've got a problem
Let's step back. Why this emphasis on health checking? It wasn't a big deal decades ago. Has something happened?
You bet something has happened. In spite of all the things pushed by public medicine, it's getting worse instead of better. Here are some highlights.
U.S. life expectancy fell to 76.4 years in 2021, the lowest since 1996, erasing a quarter-century of progress. By the end of 2021, the life-expectancy gap between the U.S. and Germany had widened to 4.3 years, and between the U.S. and France to six years.
...
The U.S. 2020 death rate from overdoses of 277 per million compared unfavorably with ... Germany’s 19 per million, and France’s 7 per million.
...
Between 2000 and 2020, the rate of obesity in the U.S. has risen from 30.5% to 41.9%. It is now the highest of any developed country and a stunning 10 times the rate in the lowest, Japan.
This is awful! No wonder we're getting harangued about getting to the doctor's office -- we're getting sicker and dying younger! Better do something about it!
What good does this checking do?
Has anyone run a trial to see if this massive testing and prevention actually makes anyone live a longer, healthier life? You'd think it would -- after all, doing sensible things like preventing getting too cold In the winter seems like it's better than trying to fix frost-bitten fingers and toes. It turns that many such trials have been run! And there's even a meta-analysis of all the trials, involving over 182,000 patients! Let's see what was discovered:
(NNT = Number Needed to Treat, i.e., the number of people who need to be treated in order for a single person to benefit. For more see this and this.)
Here are the highlights:
This Cochrane Collaboration review compared health checks, defined as “screening general populations for more than one disease or risk factor in more than one organ system,” to no health checks in a general, non-geriatric adult population. The authors included 14 trials of 182,880 subjects, testing three outcomes primarily: overall mortality, cardiovascular mortality, and cancer-related mortality.
Nine trials found no difference in overall mortality (7.4% in the intervention group and 7.5% in the control groups) with no observed heterogeneity across studies. Subgroups included less than or greater than five year follow up, old versus recent trials, USA versus European cohorts, and others, with no differences noted.
Health checks also failed to improve cardiovascular-specific mortality in eight trials, at 3.8% in the intervention group and 3.7% in the control group, though heterogeneity for this comparison was substantial. This was attributed to varying definitions of cardiovascular disease (myocardial infarction, stroke, etc).
For cancer-specific mortality rates were 2.1% in both intervention and control groups with moderate heterogeneity.
For secondary outcomes no difference was found in morbidity, hospitalizations, disability, physician visits, specialist referrals, absence from work, or patient worry, however there was a slight increased sense of self-health among those assigned to checkups.
You would think that an ounce of prevention is worth a pound of cure. There's no doubt that preventing getting cold is better than recovering from frostbite, but apparently it's not the same for medical testing.
What's being checked?
Everyone's list is probably a bit different, but let's check out the one I got as a typical wellness list as shown above.
First on the list was cancer screenings.
- Breast cancer. Getting a mammography seems to make sense, since catching something early sounds like a good idea. Bottom line: no one has a longer life because of the tests and lots of people are hurt by them. See this.
- Colon cancer. It's a terrible disease. you don't want to get it. Colonoscopies are supposed to not only detect it early and even help prevent it. Good idea! Sorry, not a good idea. In spite of tens of billions a year spent on prevention, the only controlled trial ever conducted, a big multi-country one, clearly shows that colonoscopies do NOT help you live longer. See this for the facts.
- Cervical cancer. According to the National Cancer Institute, cervical cancer was only 0.7% of all new cancer cases and deaths in 2022. Most women who get it survive 5 years or more. It's a tiny fraction, for example of liver cancer. And the recommended test, for HPV, has huge numbers of false positives. Why is this even on the list?
- Lung cancer if you've been a smoker. There have been lots of trials, careful tests. People have tried safer methods of testing than X-rays. They don't work. See this and this for the details.
Second was vaccinations.
- The one they mention is the "yearly flu shot." This may be the mostly highly promoted shot on the planet. Sadly, there is conclusive evidence from scientific studies, including the CDC, that flu shots do not help. The studies show that not only are flu shots useless, they are a bad idea for old people. See this for my review of the details.
- Here is a discussion of "efficacy" in vaccines and what it really means, with specific illustration of covid vaccines. Unless you go into NNT for benefits and harms, you won't understand vaccines.
Third amounts to a blood test.
- Blood pressure. Everybody seems to accept that so-called hypertension (a.k.a. high blood pressure) is a disease. A huge fraction of the population take pills to "control" it. Not only is hypertension NOT a disease, taking the pills more than doubles your chances of going blind. The more "routine" side effects of the pills can be awful.
- Diabetes. Type 2 diabetes is not a good thing. Often it can be controlled by losing weight. Drugs are often prescribed. The data shows that almost no one is helped and that a large number taking drugs are harmed.
- Cholesterol. High cholesterol in the blood is supposed to lead to heart attacks. Why not take pills to keep it down and live longer? Simple: random controlled trials conclusively show that not only doesn't reducing cholesterol help, the pills are actively harmful in serious ways. See this.
Bottom line: these things shouldn't be tested for or, worse, "cured."
Conclusion
If you've got a medical problem and need help, by all means contact your doctor! There may be preventative or screening things I haven't covered here that are valuable, particularly with inheritable conditions. But screening overall doesn't help as the study I quoted above shows, and the screening things I've covered here as examples are the most common, and the data shows they do more harm than good. Your health is ... owned by you -- own it! And get help when you need it.
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