Thursday, 12 June 2014

General Health Checks

A thoughtful editorial in the BMJ - General Health Checks Don't Work (my emphasis):
  • We check our cars regularly, so why shouldn’t we also check our bodies so that we can find and treat abnormalities before they cause too much harm? It seems so easy, but the human body is not a car, and, in contrast to a car, it has self healing properties. Actually, the first thing we know about screening is that it will cause harm in some people. This is why we need randomised trials to find out whether screening does more good than harm before we decide whether to introduce it.
The medicalisation of each part of our life leads us to focus on numbers and simple solutions; focus on a metric (often something we measure because we CAN, rather than because we SHOULD), sell pill or lifestyle to shift this metric towards the (currently) 'approved' value.  As we move to the age of the quantified self, this nonsense will get worse.  We end up chasing numbers and lose the bigger picture.

What drives this medicalisation is money.  Lots of it.  The most obvious manifestation of which is the marketing arm of pharma, and the BEHAVIOURS thusly generated:
  • Our drug regulators approve diabetes drugs solely on the basis of their glucose lowering effect without knowing what they do to patients. The only large trial of tolbutamide was stopped prematurely because the drug increased cardiovascular mortality, but nothing material happened with its regulatory status and people continued to use it. More recently, rosiglitazone, which was the most sold diabetes drug in the world, was taken off the market in Europe, as it causes myocardial infarction and cardiovascular death and pioglitazone could also face trouble, as it has been linked to heart failure and bladder cancer.
There are good reasons to go to your doctor and to get an issue seen.  But there is a line to be drawn - if you eat well, exercise appropriately, address stress, get your sleep and generally feel 'well', then you are probably fine and you don't want to create an issue for yourself from the side effects of an unneeded treatment.

Even if a single metric (whatever that may be) is outside of 'normal' (whatever THAT may be), you should still exercise some cation before sucking up the pills.  Put diagnosis in to the context of lifestyle.  Lifestyle should be the first line of any non-urgent intervention.

Health is a moving target.  Our 'numbers' will change as the body adapts. As I said in Polypharmacy & the Inverse Care Law, the 'worried well' seem to be complicit in much over diagnosis (see Inverse Care Law).  Let's not make it easy for pharma's marketing arm eh?

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