Health checks are a common feature of conventional medical care. Here, individuals who don’t necessarily have any specific health issues are subjected to several medical tests such as blood pressure and cholesterol measurement, height and weight and standard blood tests. The idea is that ‘problems’ will be spotted earlier than they would be ordinarily, and earlier ‘intervention’ will lead to better health outcomes.
I read this week that the UK Government is pushing for more people aged 40-74 to get a health check every 5 years as, we are informed, implementation and uptake of its policies are only about half what they should be [1]. Now, those in the UK will be only too aware that we have a healthcare system (the National Health Service) that is creaking and groaning and essentially bankrupt. So, if the UK Government wants greater uptake of health checks, then you would imagine it would have good evidence that these are effective and cost-effective.
The impact of health checks on health outcomes was assessed by researchers from the so-called Cochrane Collaboration (specialising in performing ‘meta-analyses’ of health interventions) and published last year [2]. The review pooled together the results of 14 studies where the health outcomes of people who underwent a health check were compared with those of people who didn’t.
Some of the studies shows that people in the ‘health check group’ would end up with more diagnoses of, say, high blood pressure or ‘raised’ cholesterol, and there was also evidence of more medical treatment in this group too. However, what we really want to know is whether any of this led to any improvement in health. Here are the results:
Risk of death from cancer – no benefit
Risk of death from cardiovascular disease – no benefit
Overall risk of death – no benefit
The authors add:
We did not find beneficial effects of general health checks on morbidity, hospitalisation, disability, worry, additional physician visits, or absence from work, but not all trials reported on these outcomes.
They conclude:
General health checks did not reduce morbidity [illness] or mortality, neither overall nor for cardiovascular or cancer causes, although they increased the number of new diagnoses. Important harmful outcomes were often not studied or reported.
This last line is important, because when someone is subjected to a health check, there is at least some risk that they will be treated for (and suffer as a result) for something that would not have bothered them if it had just been left alone (this is termed ‘overtreatment’). Health checks, it seems, generally do no good, but that does not mean they do no harm either.
According to the BMJ article this week, the director of health and wellbeing for Public Health England (the body pushing ahead with plans to broaden screening) has acknowledged that the impact of the checks has not been properly assessed, but added: “If we are going to wait for the perfect evidence than we would never to be able to innovate.” The use of the word ‘innovate’ is very telling here, I think. Because innovation is the sort of buzzword people use in managerial positions, and it’s just the sort of thing that can divert attention away from what truly matters – outcomes.
Public Health England criticised the Cochrane review, particularly for including trials conducted “many years ago.” But, the authors of the review contend that: “There are plenty of possible explanations for the disappointing effects of health checks in the trials, and in the absence of evidence to the contrary, there is no reason to assume that the NHS Health Check is any better.”
Oddly, prior to election, the Tory party was saying it was going to scrap the health checks or at least modify them [3]. My strong sense that efforts to redouble our efforts regarding health checks was made by a committee of people who, collectively, may be more interested in ‘innovation’ and being seen to be proactive rather than focusing on what is truly important in medicine – genuinely improving the condition of the people it serves.
References:
1. Drive to boost health checks in England is criticised. BMJ 2013;347:f4675
2. Krogsbøll LT, et al. General health checks in adults for reducing morbidity and mortality from disease: Cochrane systematic review and meta-analysis. BMJ2012;345:e7191.3.
3. Krogsbøll LT, et al. Re: Government prioritises health checks for 15 million adults despite pre-election promise to scrap them. BMJ 28 May 2013.[hr]
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