Posted by Phillipa on October 22, 2012, at 21:40:05
Here we go the withdrawal of medical care. Phillipa
Medscape Medical NewsGeneral Health Checks Unlikely to Benefit Patients
Elizabeth DeVita-Raeburn
Oct 22, 2012
Authors & Disclosures
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Performing general health checks and screening asymptomatic adults for diseases or their risk factors did not reduce either overall morbidity or mortality, according to a review published online October 17 in the Cochrane Database of Systematic Reviews.
The large number of participants and deaths in the studies, the long follow-up, and the absence of a reduction in cardiovascular and cancer mortality suggest that general health checks are unlikely to be beneficial, conclude Lasse T. Krogsbøll and colleagues, all from the Nordic Cochrane Centre in Denmark.
The review included data from 16 randomized studies from primary care or community settings comparing health checks or no health checks in adults "unselected" for disease or risk factors.
Fourteen studies (182,880 participants) had outcome data available for analysis. Nine trials provided data on total mortality (155,899 participants, 11,940 deaths). In those trials, the median follow-up time was 9 years, the authors note, which yielded a risk ratio of 0.99 (95% confidence interval [CI], 0.95 - 1.03) for the health check group compared with the nonhealth check group.
Eight trials provided data on cardiovascular mortality (152,435 participants, 4567 deaths; risk ratio, 1.03; 95% CI, 0.91 - 1.17), and 8 trials on cancer mortality (139,290 participants, 3663 deaths; risk ratio, 1.01; 95% CI, 0.92 - 1.12).
One trial revealed an increase in the diagnosis of hypertension and hypercholesterolemia with health checks. Another found an increase in self-reported chronic disease. Two of 4 trials found more people taking antihypertensive medication with health checks, and another found a 20% increase in the total number of new diagnoses per participant over the course of 6 years compared with the nonhealth check group.
Benefits Smaller, Harms Greater
In addition to the lack of clear benefit, general health checks potentially cause harm, the authors write. "[E]xperience from screening programmes for individual diseases have shown that the benefits may be smaller than expected and the harms greater," they note.
Among the harms they cite are the diagnosis of conditions that were never destined to cause symptoms or death and the risk for unnecessary treatment. "While we cannot be certain that screening leads to benefit, all medical interventions can lead to harm," the authors note. The study, however, did not document harm.
The researchers "make an excellent point that a well person can go in for a general check-up and have screening done that can lead to a cascade of events that can lead to more harm than good," Glen Stream, MD, MBI, chair of the board of directors at the American Academy of Family Physicians, said.
However, "some of the methodology in the studies they reviewed were not all that strong," Dr. Stream told Medscape Medical News. He also noted, among other issues, the lack of specific data on harm caused by general health checks. "It makes you wonder if there's [just not] good information out there," he said.
The authors defined general health checks as screens of the general population for more than one disease or risk factor in more than one organ system. Screening methods varied considerably from study to study, including questionnaires, physical exams, blood assays, imaging, stool testing, and the assessment of cardiovascular risk factors.
Studies that enrolled people older than 65 years were excluded. Subgroup and sensitivity analyses did not change the findings, the authors said. The results, they add, are consistent with earlier reviews.
Health Checks a Recent Phenomenon
Health checks of healthy people are a recent phenomenon, the authors noted. The evolution of medicine and new diagnostic methods in the latter half of the twentieth century, they write, has "increased expectations that many diseases can be prevented or discovered before there is irreversible damage." However, studies such as this one suggest that these expectations may not be met, they add.
The authors of the study acknowledged other problems in most of the trials, citing lack of blinding and missing outcome data as the 2 most common issues. "[D]etection bias, biased reporting of subjective outcomes, and biased drop-out were major concerns in many of the trials," they add.
Despite this, the authors of the study were emphatic about the overall significance of their findings. "Public healthcare initiatives to systematically offer general health checks should be resisted, and private suppliers of the intervention do so without the support from the best available evidence," they conclude.
Dr. Stream does not agree. "They made a stronger conclusion than the evidence the presented in their discussion section would support, because they didn't demonstrate harm," he said.
From his point of view, he said, the study raises as many questions as answers. Are doctors merely measuring the wrong things? Is there a hidden benefit in establishing a doctor-patient rapport that benefits care when problems do arise? "It's a call-out to the research community," he said.
Part of the salary for Krogsbøll was supplied by Trygfonden. The other authors and commentator have disclosed no relevant financial relationships.
Cochrane Database Syst Rev. Published online October 17, 2012
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