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General health checkups find lots of new problems but don’t cut morbidity/mortality

That’s the conclusion of a paper published in the BMJ, “General health checks in adults for reducing morbidity and mortality from disease: Cochrane systematic review and meta-analysis.”

The authors reported:

We identified 16 trials, 14 of which had available outcome data (182?880 participants). Nine trials provided data on total mortality (11?940 deaths), and they gave a risk ratio of 0.99 (95% confidence interval 0.95 to 1.03). Eight trials provided data on cardiovascular mortality (4567 deaths), risk ratio 1.03 (0.91 to 1.17), and eight on cancer mortality (3663 deaths), risk ratio 1.01 (0.92 to 1.12). Subgroup and sensitivity analyses did not alter these findings. 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. One trial found that health checks led to a 20% increase in the total number of new diagnoses per participant over six years compared with the control group and an increased number of people with self reported chronic conditions, and one trial found an increased prevalence of hypertension and hypercholesterolaemia. Two out of four trials found an increased use of antihypertensives. Two out of four trials found small beneficial effects on self reported health, which could be due to bias.

Conclusions General health checks did not reduce morbidity 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.

BMJ graphic:

HealthDay reported:

In an accompanying editorial, Dr. Domhnall MacAuley, the London-based clinical primary care editor for BMJ, alluded to some unintended consequences that can stem from ineffective checkups.

“The potential downsides,” MacAuley said, “are that those who come [in for a checkup] tend to be the ‘worried well,’ who may bear a high risk for being diagnosed with false positives or negatives. Indeed, [the study authors] suggested that there was overdiagnosis — that routine checks tend to pick up conditions that were treated with no obvious benefit in terms of [illness] or mortality.”

In his published commentary, MacAuley concluded that “policy should be based on evidence of well-being, rather than on well-meant good intentions” and rejects the notion that checkups for a healthy public are a good idea simply because “they seem a socially responsible approach to caring for patients.”

That said, he suggests that “targeted” checkups may be the alternate way to go, by focusing on those patients who have already been identified as having risk factors or conditions that could benefit from routine monitoring.

Our online search didn’t turn up very many other mainstream news organizations that knew about or cared enough about this study to report it.

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