Most people are familiar with the concept of undergoing general health checks. This might mean that your doctor talks to you about your medical history and lifestyle including diet, physical activity, alcohol intake and smoking history. This is part of providing holistic care to identify and address risk factors to prevent disease. Health checks are also performed as part of national screening programs, such as the national cervical cancer screening program, which aim to detect and treat disease early.
However, a less familiar form is the general or full body health check that not only involves a comprehensive clinical assessment, but also includes performing a whole battery of laboratory, genetic and imaging tests in a person who does not feel ill and has not sought care. General health checks are a common element of health care in some countries and purport to be able to detect disease early, prevent disease from developing, and provide reassurance. In Australia this type of comprehensive full body health check-up may be offered to company executives or directly advertised to the general public, targeting the worried well.
But do these full body check-ups truly deliver on their stated aims and are there any potential downsides?
In the article below, Dr Romi Haas and Professor Rachelle Buchbinder describe how testing asymptomatic people to screen for a range of diseases as part of these types of general health checks can be dangerous. They outline what people need to know before consenting to such checks and suggest improved regulation of public advertising could help in ensuring the judicious and informed use of screening.
This article is published as part of theTOO MUCH of a Good Thingseries, which is investigating how to reduce overdiagnosis and overtreatment in Australia and globally, and is published as a collaboration betweenWiser HealthcareandCroakey.
To follow the series, bookmarkthis link, and follow#WiserHealthcareon Twitter.
One-page advertorials are appearing in Australian and regional newspapers for something called HealthScreen, with the headline The future of medicine is here now. HealthScreen is a direct-to-consumer service that conducts a variety of assessments that search or screen for signs of disease in people who are not displaying any signs or symptoms (asymptomatic).
These general health checks offered by HealthScreen cost AU$2,000 and include Magnetic Resonance Imaging (MRI) scans for 20 of the most common cancers, coronary heart disease and stroke risk assessments, genetic screening, laboratory tests and sleep health evaluation. The $2,000 cost is not covered by Medicare or private health insurance. It is also only an initial cost: it does not include the associated cost of the inevitable additional tests as well as treatments that will follow for many people.
A quick Google search has revealed that HealthScreen is not alone in offering comprehensive general health checks. In Melbourne alone, similar services are also offered by Epworth HealthCheck, Life First, Mens Health Melbourne and National Institute of Integrative Medicine.
HealthScreens promotions say they aim to identify medical conditions that are likely to reduce life expectancy before the onset of symptoms or any indication of a problem. They promise their clients will know they are doing everything possible to take control of your health and longevity. Framed this way, parting with $2,000 to future-proof your life might sound quite appealing to those who can afford the cost. But can it truly be this easy or is it too good to be true?
This type of screening is highly likely to lead to further tests. This is because screening tests like these are not designed to be diagnostic, but rather to identify people who are at higher risk of developing a disease so they can have further diagnostic testing. Positive screening tests require confirmatory tests to definitively rule in or rule out disease.
In fact, in December 2019, HealthScreen reported that so far the doctors have found hidden problems in every patient.
So what is the evidence that finding hidden problems is beneficial in future-proofing your life?
This is not simply a question of cost. Before consenting to undergo such general health checks, it is important to be fully informed about both the potential benefits and the potential harms of undergoing such a comprehensive check-up.
The best available evidence evaluating the benefits and harms of these types of health checks indicates they are unlikely to be beneficial. A recent update of a Cochrane review included 17 trials, 15 of which reported outcome data from more than 250,000 people in total. As well as a comprehensive clinical assessment, the trials assessed various combinations of blood, urine and lung function tests, electrocardiograms, cancer screening, and vision and hearing assessments.
It found high-certainty evidence that general health checks have little or no effect on either overall mortality or death from cancer, and moderate-certainty evidence that they probably have little or no effect on fatal or non-fatal heart attacks or strokes. General health checks offered by various organisations are therefore not evidence-based; they have not been shown to increase life expectancy.
As well as being unlikely to be beneficial, full body general health checks in asymptomatic people can potentially be harmful. The main harms are overdiagnosis, detrimental psychological effects, negative effects on health behaviours (for example, failure to quit smoking due to reassurance of good health), complications related to follow-up tests, and unnecessary treatments.
No screening test is one hundred percent accurate. There is always a trade-off between sensitivity (correctly identifying when you do have a problem) and specificity (correctly identifying when you dont have a problem). Tests with high sensitivity but low specificity have a higher chance of false positive results (saying you have the disease when you dont).
A positive screening test always requires further confirmatory or diagnostic tests. A false positive result cannot help you because you do not have the disease but it can harm you from unfounded worry and stress. Tests with high specificity but low sensitivity have a higher chance of false negative results (missing people who have the disease). False negative results can provide false reassurance, delay detection of disease, lead to legal action and reduce public confidence in screening programs.
Overdiagnosis is another harm that should be considered when weighing up the potential harms and benefits of full body general health checks. This occurs when a test leads to a diagnosis that would never have caused any symptoms or problems within a persons lifetime.
In cancer testing, for example, this can happen because a tumour may grow so slowly that a person dies of something else before it starts to cause symptoms, a tumour may not grow at all or a tumour may even disappear without treatment. In each of these cases the diagnosis has no direct benefit since no treatment is needed.
However, the diagnosis can cause harm through unnecessary psychological distress, adverse effects associated with unnecessary further testing (overtesting) and unnecessary treatment including surgery (overtreatment), and unnecessary medical costs. A recent study has estimated that in Australia nearly one in five cancers diagnosed in men and one in four cancers diagnosed in women are overdiagnosed cancers.
HealthScreen uses state-of-the-art medical imaging such as MRI and CT scans to look for hidden problems in people. While these types of tests were not evaluated in the trials included in the Cochrane review, paradoxically, the use of such sensitive testing technology has been identified as a major source of overdiagnosis.
Because they are so sensitive, they can detect minute tissue changes that may not ever cause any symptoms. For example, there is evidence to suggest that very small thyroid papillary tumours are being overdiagnosed and overtreated in people who have no symptoms but have been tested for some other reason with a CT scan, MRI scan or ultrasound.
These scans also detect degenerative findings that commonly occur with age. For example, degenerative changes in the low back, knee and shoulder are seen with ageing in people with and without symptoms, and are mostly benign. If full body checks find these changes in people without symptoms, it can lead to unwarranted diagnoses, cause worry and lead to unnecessary treatment.
There is also concern that screening the genes of healthy people may cause a whole new wave of unnecessary diagnoses. This is because genetic testing is often unable to determine if a person will show symptoms or whether the condition will progress over time.
One example of harm that may arise from full body general health checks is treating high levels of uric acid detected in the blood in people without symptoms. While allopurinol is the mainstay of treatment for gout (a form of arthritis causing painful joints), prescribing this treatment solely on the basis of a high uric acid is not recommended.
In a large population-based study, people taking allopurinol were 10 times more likely to end up in hospital because of a severe skin reaction than in those who did not take allopurinol. And two out of every 10,000 of these people died from the reaction.
It seems HealthScreen is not alone in advertising the benefits of their services without adequate consideration of the potential harms.
A recent project by Professor Ken Harvey at the Monash University School of Public Health and Preventive Medicine known as the whack-a-mole project has resulted in a considerable number of individual complaints against claims made about therapeutic goods and services being upheld. This means that the manufacturer or service provider had made claims for a product or service which were not supported by evidence.
Greater regulation of direct-to-the-public advertising for whole body health checks in Australia may be needed. At the very least, companies such as HealthScreen should ensure their advertising includes outline of the potential harms as well as the potential benefits of participating in their services.
Healthscreens Medical Director, Dr David Badov, was invited to address the concerns laid out in this article. His response can be found here.
Dr Romi Haas is a Postdoctoral Research Fellow at the Monash Department of Clinical Epidemiology, Cabrini Institute, part of the Monash University Department of Epidemiology and Preventive Medicine. Her research focuses on understanding and developing ways to reduce overdiagnosis and overtreatment of musculoskeletal conditions.
Prof Rachelle Buchbinder AO is an Australian NHMRC Senior Principal Research Fellow and Director of the Monash Department of Clinical Epidemiology at Cabrini Institute and Monash University. She is a rheumatologist and clinical epidemiologist who combines clinical practice with research in a wide range of multidisciplinary projects relating to arthritis and musculoskeletal conditions.
This article is part of an ongoing series that is published as a collaboration between Wiser Healthcare andCroakey.org.
The series investigates how to reduce overdiagnosis and overtreatment in Australia and globally. The articles are also available for republication by public interest organisations, upon request.
Bookmark this link and follow #WiserHealthcare on Twitter.
Here is the original post:
Weighing up the potential benefits and harms of comprehensive full body health checks - Croakey
- The Ethical, Legal, and Social Issues Impacted by Modern ... - Hindawi - November 25th, 2022
- BSGM - The British Society for Genetic Medicine - November 25th, 2022
- Feasibility and ethics of using data from the Scottish newborn blood spot archive for research | Communications Medicine - Nature.com - October 7th, 2022
- Closing your health care practice: What you need to know - Medical Economics - October 7th, 2022
- Is the doctor's office heading for extinction? - Medical Economics - October 7th, 2022
- Abortion Access in the U.S.: What to Know on a State-By-State Level - Healthline - October 7th, 2022
- Students can create their own path with new ASU Online biology degree - ASU News Now - October 7th, 2022
- U.S. Releases an AI Bill Of Rights That Though Encouraging Won't Yet Move the Needle - JURIST - October 7th, 2022
- California Funds Research On Blocking Marijuana Monopolies And Protecting 'Legacy' Cannabis Strains - Marijuana Moment - October 7th, 2022
- Tips For Your Virtual Meetings With The FDA - Med Device Online - October 7th, 2022
- Bragar Eagel & Squire, P.C. Reminds Investors That Class Action Lawsuits Have Been Filed ... - The Bakersfield Californian - October 7th, 2022
- MeiraGTx Announces the Upcoming Presentation of 15 Abstracts at the European Society of Gene and Cell Therapy (ESGCT) 2022 Annual Congress -... - October 7th, 2022
- Neighborhood deprivation and coronary heart disease in patients with bipolar disorder | Scientific Reports - Nature.com - October 7th, 2022
- Have Insurers Paid Too Much for Asbestos and Other Toxic Torts? - Claims Journal - August 19th, 2022
- Restrictive abortion laws are limiting the options parents have after receiving genetic test results, experts say - Yahoo Singapore News - August 19th, 2022
- Neurologists Discuss the Impact of Roe v. Wade Reversal on... : Neurology Today - LWW Journals - August 19th, 2022
- Abortion ruling prompts variety of reactions from states - ABC News - August 19th, 2022
- Is pregnancy possible after multiple failed IVF attempts? Can your frozen eggs and sperm be as healthy later? - The Indian Express - August 19th, 2022
- Meet the Expert: Focus on orthopaedics and VTE - Hospital Healthcare Europe - August 19th, 2022
- Egg Donation Process: From Application to Recovery - Healthline - July 6th, 2021
- Patent protection of mRNA vaccines and regulatory authorization - Lexology - July 6th, 2021
- EAPM: Presidency bridging conference a great success, HTA compromise agreed and data on the agenda - EU Reporter - July 6th, 2021
- Cell and Gene Therapy Drug Delivery Devices Market, 2030 - Market Opportunities in the Strong Pipeline of Cell and Gene Therapies - PRNewswire - April 4th, 2021
- Legally blind Great Falls filmmakers share their vision in national challenge - Yahoo News - April 4th, 2021
- Pfizer Announces Vaccine Is 100% Protective Against Coronavirus In Kids As Young As 12 - Yahoo News - April 4th, 2021
- How the law will change in 2021 - Lexology - February 11th, 2021
- Writing is the best medicine - The London Economic - February 11th, 2021
- Misleading glyphosate-cancer study Part 2: 'Symptom of a widespread problem'Concerns about ideological activism in science research and communications... - February 11th, 2021
- The Error of Fighting a Public Health War With Medical Weapons - WIRED - January 2nd, 2021
- Moderna, Pfizer vaccine trials were the highest of quality: vaccine expert - Yahoo Money - January 2nd, 2021
- Celebrate the new year with this New Year's Eve fireworks show in SF - Yahoo News - January 2nd, 2021
- The movie industry will strengthen again around April or May: Screenvision CEO - Yahoo Money - January 2nd, 2021
- Congress overrides Donald Trump's veto of a defense policy bill in the first such rebuke of his presidency - Yahoo News - January 2nd, 2021
- How the pandemic enabled a robot revolution - Politico - December 4th, 2020
- The mink link: How COVID-19 mutations in animals affect human health and vaccine effectiveness - The Conversation CA - November 24th, 2020
- How vaccines get made and approved in the US - The Albany Herald - November 24th, 2020
- Legalization votes bring worries of increased youth marijuana use, but evidence remains murky - AberdeenNews.com - November 24th, 2020
- Your daily 6: Third vaccine looks effective, no single 'word of the year' and Trump team called 'a national embarrassment' - Ravalli Republic - November 24th, 2020
- Cybersecurity depends on the user - Modern Diplomacy - November 20th, 2020
- It's Been Exactly One Year Since the First Case of COVID Was Found in China - Newsweek - November 20th, 2020
- Risks and benefits of an AI revolution in medicine - Harvard Gazette - November 12th, 2020
- HHS eased oversight of Covid-19 tests though it knew of problems - STAT - November 3rd, 2020
- Who won this years Nobel science prizes? - The Economist - October 8th, 2020
- Patent and Patient Rights in COVID-19: Is the Right to Exclusivity a Hamlet Question? - The Leaflet - October 8th, 2020
- FDA Oversight of Laboratory-Developed Tests Continues To Evolve - JD Supra - October 8th, 2020
- One Sperm Donor. 36 Children. A Mess of Lawsuits. - The Atlantic - September 15th, 2020
- Nebraska Medical Bill initiative blocked from entering the November ballots - Cannabis Health Insider - September 15th, 2020
- Poaching pressure mounts on jaguars, the Americas' iconic big cat - Mongabay.com - September 15th, 2020
- 'There is a sense of being robbed': Olympian Caster Semenya loses appeal on testosterone rule - The World - September 15th, 2020
- Global Microbiome Sequencing Market Growth Drivers, Demands, Business Opportunities and Demand Forecast to 2026|Clinical-Microbiomics A/S; Diversigen;... - September 5th, 2020
- Legal and Regulatory Issues in Genetic Information ... - August 31st, 2020
- The legal aspects of genetic testing - Medical Defence Union - August 31st, 2020
- Their view: Now is not the time to legalize marijuana - Wilkes Barre Times-Leader - August 31st, 2020
- Soon, India will have its dedicated vaccine portal: ICMR - ETHealthworld.com - August 24th, 2020
- Two Families, Two Fates: When the Misdiagnosis is Child Abuse - The Marshall Project - August 22nd, 2020
- Ron Evans steals a trick from I/O, and points the way to a transformational diabetes therapy - Endpoints News - August 22nd, 2020
- Contact tracing apps may be ineffective for reducing Covid-19 spread: Study - ETHealthworld.com - August 22nd, 2020
- Global Microbiome Sequencing Market Size 2020 Review, Growth Strategy, Developing Technologies And Forecast By 2026|Charles River; CoreBiome, Inc.;... - August 19th, 2020
- Bill Jones: Working to create a culture of education - Wilkes Barre Times-Leader - August 19th, 2020
- Whats next for abortion legislation in the U.S.? - PBS NewsHour - July 10th, 2020
- No ethics when it comes to US enemies, even in the middle of a deadly pandemic - IOL - July 10th, 2020
- IML conducts the 5th National Convention on Medicine and Law - ETHealthworld.com - July 10th, 2020
- Wayne Medicine and Wayne Law professors team up to explore legal and ethical issues of wastewater monitoring for COVID-19 - The South End - June 28th, 2020
- Challenge trials aren't the answer to a speedy Covid-19 vaccine - STAT - June 28th, 2020
- Trump Suspends H-1B and Other Visas That Allow Foreigners to Work in the U.S. - The New York Times - June 24th, 2020
- Could the Montreal Neuro herald a paradigm shift in scientific research? - University Affairs - June 24th, 2020
- Next-Generation Sequencing Market: Understanding The Key Product Segments And Their Future During 2020 -2025 - 3rd Watch News - June 24th, 2020
- Meet 'Gastruloid': The First Human Embryo-like Model From Stem Cells That Could Soon Save Many Babie - Science Times - June 12th, 2020
- Could these senolytic drugs halt the spread of COVID-19? - Health Europa - June 12th, 2020
- The coronavirus vaccine frontrunners have emerged. Here's where they stand - BioPharma Dive - June 12th, 2020
- Regulating marine genetic resources in areas beyond national jurisdiction - The Daily Star - June 12th, 2020
- Vaccines have saved millions of lives, but history shows missteps can prove deadly - The Boston Globe - June 12th, 2020
- Quitting smoking might reduce severe coronavirus infection risk: Study - ETHealthworld.com - May 23rd, 2020
- Where Taiwan Can Make the Most of AI - Taiwan - Taiwan Business TOPICS - May 23rd, 2020
- WHO and IOC team up to improve health through sport - ETHealthworld.com - May 18th, 2020
- The Cell Therapy Industry to 2028: Global Market & Technology Analysis, Company Profiles of 309 Players (170 Involved in Stem Cells) -... - May 15th, 2020
- Medical School: Who gets in and why - Stuff.co.nz - May 15th, 2020
- Wilson Ighodalo: Addressing Substance Abuse as a Public Health Problem - THISDAY Newspapers - May 15th, 2020
- The Falsehoods of the 'Plandemic' Video - FactCheck.org - May 14th, 2020
- Robert Youngjohns, Chairman of the Board, ABBYY - Interview Series - Unite.AI - May 14th, 2020