Health Checks

Health Care Public Health

To have regular physical examinations has always been attractive because of the belief that conditions will be identified at an early stage and so be far more amenable to treatment. The first recorded “health checks” were in a brothel in Avignon in 1347 to identify and segregate women who had developed conditions as a result of their whoring and to prevent them from passing it on to other clients. Logically regular examinations sound useful, – after all our cars have to have annual MOTs. Health insurance companies and other health care providers have not been slow to see the commercial attraction of regular health checks as is evident from the proliferation of advertisements, the presence of screening caravans in supermarket car parks and using them as a “perk” in employment. But it is necessary to consider whether they are “value for money”.

Les Demoiselles d'Avignon
Les Demoiselles d’Avignon

“Health checks” (or screening) do find abnormalities, but the very great majority found are either not important or not amenable to treatment. Benefits to both individuals and populations were obvious in the regular x-ray examinations for TB, a condition which is contagious and can be treated. But the use of whole-body CAT scans or MRI in well-persons is much more dubious. When determining whether “health checks” (screening) is worth while it is essential to consider both the benefits as well as the hazards and the costs of the procedure. A prime ethical consideration must be that there is an effective, available treatment for anything found. It must not be forgotten that no examination or test is perfect, there will always be results that an individual will be shown to be free of disease, and yet have a disease or that an individual is shown to have early signs of a disease and require further tests to confirm which are shown to be negative.

This false diagnosis will require further investigation, may result in unnecessary treatment and has been shown to affect the behaviour of these individuals.

In the UK we have developed an Independent body to review the efficacy of a variety of screening procedures. Thus, for example, it recommends screening for cervical cancer, in women, in phenylketonuria in the newborn, conditions for which effective treatment is available. It has not, so far, recommended “health checks”. There have been many studies in several countries, in the past 50 years, none of which have shown any worthwhile benefit. In spite of this the Brown government introduced “health checks” for coronary heart disease, cerebrovascular disease and type II diabetes. In spite of the NHS expecting all new drugs on treatments only to be used after they have been shown as effective by properly designed evaluation the use of “health checks” was only based on a paper economic model. Only now, some years later, are evaluations of this programme being done. The introduction and use of “health checks” to reduce the burden of coronary heart disease, stroke and diabetes is particularly disappointing when it has been shown that general measures such as reducing the number of smokers or the initiation of smoking by the young, reducing the fat content of food e.g. banning the use of transfats, reducing the intake of salt e.g. by reducing it in prepared foods such as biscuits, and reducing the sale of fizzy drinks to children are far more effective in reducing the burden of heart disease and diabetes. But then these measures are commercially sensitive and affect industry profits and thus governments are far more loath to use them when it is possible to blame individuals for their unhealthy habits.

It is particularly disappointing that “Health Checks” were introduced by a Labour administration without adequate evaluation or consideration of past studies, all of which had shown a lack of benefit and an increase in the cost of the NHS if introduced. The lack of effort by the current administration to introduce general measures such as banning the use of transfats and plain cigarette packets and rely on blaming individuals for their bad habits and the use of pharmacological agents, such as statins to reduce the burden of heart disease and diabetes is not surprising. Let us hope that more sensible public health measures will be used in the future than “Health Checks”.