Uh, no. Hypertension is a silent killer. Mole checks? Colonoscopies? Testicular cancer screenings? These are all worthless? Preventative medicine has a long way to go, but it's currently the best it's ever been. Thank God I don't see any of these doctors.
According to the study cited, they concede that annual checkups result in more diagnosis, but not in a decrease in morbidity. What you consider worthwhile, or worthless, is up to you I guess.
So to take this to an extreme, if the cohort that got checkups lived a healthy life until age 80, and the no-checkup cohort lived with diabetes and dialysis until 80, this study would say “checkups lead to no decrease in morbidity.”
More relevant for the insurer (which might help explain why an insurer is urging checkups) living until 80 with diabetes and on dialysis is much more expensive than living healthily until 80.
Morbidity is not mortality, it means "suffering from disease". The dictionary definition is "the condition of suffering from a disease or medical condition". So being on dialysis would not be "no decrease in morbidity", no.
Isn't that a tautology? Of course knowing you have a disease doesn't prevent you from having the disease.
The point is that knowing you have a disease allows you to treat the disease, which one would hope would reduce your chances of dying or becoming disabled.
Generally, yes; for example, routine colonoscopies are not practiced in many developed countries, and it doesn't necessarily translate into any difference in overall health outcomes. One recent study is described here: https://www.cnn.com/2022/10/09/health/colonoscopy-cancer-dea... . One explanation is that such cancers are slow-growing and tend to be discovered late in life, so treating them doesn't actually help much, and any benefits are offset by potential harms of the procedure itself, the risk of false positives, etc.
There is value in targeted screening and education, but annual checkups for otherwise healthy people aren't necessarily the way to do it. Not to mention, many of these checkups are perfunctory.
A lot of the gains in life expectancy have little to do with advanced diagnostics and treatments. Sanitation, hygiene, antibiotics, and increased standards of living do a lot of the heavy lifting here. And when the needle moves in the other direction, the causes tend to be mundane too - e.g., opioid abuse in the US.
> Generally, yes; for example, routine colonoscopies are not practiced in many developed countries, and it doesn't necessarily translate into any difference in overall health outcomes. One recent study is described here:
This overstates the impact of the Nordic study. If you go to the original article[0] you can see why, this study had very low participation and event rates which limits how strong of a conclusion we can draw from this as treatment effects may not be accurately reflected (for example in some countries the colonoscopy arm only had 32% participation). We also have historical studies looking at gFOBT and flexible sigmoidoscopy showing mortality benefits which can be extrapolated to colonoscopies. For a full picture of the evidence behind colon cancer screening I would suggest referring to the USPSTF which provides a publicly accessible summary and rationale[1].
With respect to developing countries, colorectal cancer (and living long enough to suffer its sequela) is mostly a developed country problem although this is changing.
In recent years, we have been seeing a surprising rise in colorectal cancer rates occurring at younger ages presenting with advanced disease which has led to the USPTF lowering the recommendation for screening to 45 from 50. With this trend in mind and historical data, we would really need extremely strong evidence to make the claim that screening colonoscopies are ineffective which the Nordic study does not provide.
> Similarly, while hypertension is a problem, there is scant evidence that routine treatment of it is beneficial.
This is just boldly incorrect and a VERY dangerous statement to make. The article you link to is entirely irrelevant as it looks at acute hypertension which is a very different beast, this article is describing what we call permissive hypertension in medicine. We have known for several years now that we do not need to tightly control inpatient blood pressures (which are often temporarily increased due to stress/illness) and that doing so is harmful. This says nothing about the consequences of untreated chronic hypertension in the outpatient setting.
For treatment (beyond the scope of USPSTF which does provide a grade A recommendation for hypertension screening) we can turn to the ACC[2] which also helpfully provides an evidence synthesis specifically drawing your attention to:
"In a meta-analysis of 61 prospective studies, the risk of CVD increased in a log-linear fashion from SBP levels <115 mm Hg to >180 mm Hg and from DBP levels <75 mm Hg to >105 mm Hg. In that analysis, 20 mm Hg higher SBP and 10 mm Hg higher DBP were each associated with a doubling in the risk of death from stroke, heart disease, or other vascular disease."
"This is just boldly incorrect and a VERY dangerous statement to make."
I couldn't agree more. I worry that individuals will read things like the grandparents uninformed take on hypertension and conclude "I guess I don't need to worry about my blood pressure". Be careful what medical knowledge you take away from HN. Imagine forming opinions about software engineering practices by reading a forum filled with medical doctors.
That was my worry as well, especially with how misrepresented the cited evidence was.
I’m very supportive of the intellectually curious looking at evidence for themselves, but directly evaluating primary medical research is challenging even for a trained academic physician. Like in all fields, a lot of the papers published (even in reputable journals like NEJM and JAMA) are biased/flawed.
As one example, there was a landmark trial 40 years ago that claimed screening mammography doesn’t improve outcomes which was discordant with other smaller trials and mostly ignored by the medical community. That study was recently exposed as borderline fraudulent[0][1]. Had we stopped screening undoubtedly many women would have died of breast cancer. Those of us involved in colorectal cancer screening/diagnosis are well aware of the Nordic trial, but it is not practice changing.
For the curious HN reader wondering why we do some of the things we do in medicine, my strong recommendation is to refer to the USPSTF or Google “society guideline on [disease/intervention]” where you will always find an excellent summary of the evidence, strength of recommendation, rationale and limitations written by domain experts in that specific area rather than risk misinterpreting a single study, it’s how physicians practice too.
These are different and called “preventative screening” and usually not done at a physical. Your GP isn’t going to do a colonoscopy or do a skin check. The article is taking issue with the standard physical, which for heathy people is mostly a few questions to ask if you feel alright and some routine blood tests.
Let's not kid ourselves: Americans are terrible about looking out for their health. If an annual physical is what it takes for PCPs to effectively route people to the necessary screenings, so be it. That saves lives.
Under most insurance plans you also can't see a specialist unless your primary care doctor writes you a referral. If nothing else the Free Annual Checkup is a way to get a referral without incurring additional primary care copays. (If you have a PPO, that's not a problem, but you're paying higher premiums to compensate.)
But if they're not done at the physical, the physical is where the doctor asks whether you've been screen/checked for things and when, and then schedules them.
If I didn't go in for an annual physical, I'd never get tested or screened for a single thing. I'd never have blood work done. Because when else do I go to a doctor? How else would I know?
That's what baffles me here. Your annual physical is the launching point for everything preventative. It's the only time you ever see your doctor if you're otherwise healthy. Saying no to annual physicals means saying no to literally all screening, or am I missing something?
If you can find a primary care physician near you and ask for a standard "just checking to make sure everything's good" blood test, they'll probably order you something called a Complete Blood Count panel and maybe another that measures blood glucose. The CBC panel isn't used to diagnose anything particular, it's more of a general snapshot that gives you insight into all kinds of potential issues (or, more likely, tells you everything is fine). Mine always come back saying that I'm a bit anemic, but iron supplements don't agree with me so I just live with it.
Another benefit of semi-regular blood testing (and I'm talking once every year or two) is that it provides a good baseline for what your body is like. Then if you ever start having specific medical issues that warrant more tests, you know what your Healthy Levels are and can compare accordingly. For example, my MCH tends to dip just slightly below normal thanks to the anemia, so I know not to take that as an ill omen in itself. Conversely, I've never had abnormal blood glucose levels, so if that starts wavering I'll know something's up.
The standard physical is where your GP teaches you about those things and has you schedule them as needed based on your age and the things they notice during the annual physical.
No joke, getting a colonoscopy was the best decision I've made all year. I'm incredibly grateful that my doctor twisted my arm into getting one even though I'm under 40 and wasn't thrilled about the whole prep situation.
(It was IBD, not cancer, but regardless. One of those things you'd rather catch before it lands you in the hospital.)
Yep. I will say that the doctor's visit that spurred the colonoscopy talk wasn't an annual checkup, per se, but it was almost as benign—initially went in to complain about a hemorrhoid and mild tummy problems, walked away several weeks later with a pretty serious (but treatable) diagnosis.
