On the face of it, health checks can seem like a bit of ‘no brainer’. If you accept an invite from your doctor to attend for a ‘health MOT’ (the MOT is the annual test of car road-worthiness in the UK), then the thought is this will help ‘catch something early’, and allow earlier and more effective management. It sounds good in theory, but do health checks actually do any good?
This week saw the publication of a study that aimed to assess the impact of NHS health checks [1]. The researchers compared in outcomes general practices that undertook screening, with those in patients from practices where health checks were not routine. The researchers focused on five conditions: high blood pressure, heart disease, kidney disease atrial fibrillation (a type of heart rhythm disturbance) and diabetes.
This 3-year study found that the rates of these conditions was no higher in screened patients than in those who received normal care. In other words, health checks did not pick up an additional health issues that would not have been picked up in the normal course of events. By the way, in this study the total number of screens performed was 16,669. Think of all the time, effort and resources that went into these screening endeavours, only for them to prove to be a complete dud.
More important than this finding, I think, is the impact of health checks not on the apparent prevalence of a condition, but on actual health. Do health checks translate into a reduced risk of disease or death?
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) [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.
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 concluded that:
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.
Yet, despite this, the NHS Choices website continues to promote health checks and makes quite grand claims about the ‘expected’ benefits in terms of lives saved and cases of disease prevented. The NHS Choices does not provide the evidence that backs up these claims (which, remember, run counter to the evidence presented here).
Should you get an invite for a health check, it’s perfectly legitimate to attend. It’s also perfectly legitimate, though, to ask your doctor for the evidence that supports this initiative. It’s high time we doctors were made more accountable for the recommendations we make and services we offer, including those sanctioned by our Government.
References:
- Caley M, et al. The impact of NHS Health Checks on the prevalence of disease in general practices: a controlled study. BJGP 2014;64:625 e516-e521
- Krogsbøll LT, et al. General health checks in adults for reducing morbidity and mortality from disease: Cochrane systematic review and meta-analysis. BMJ 2012;345:e7191.3
