I am one of those people fortunate to be covered by an employer-based health insurance plan that pays for an annual physical exam and I regularly schedule one because it seems like a good preventative way of detecting early problems. So I was surprised by this article by Ezekiel J. Emanuel, an oncologist and a vice provost at the University of Pennsylvania, who says that large longitudinal studies show that routine annual physicals are of little value and his new year’s resolution is to stop having them.
The unequivocal conclusion: the appointments are unlikely to be beneficial. Regardless of which screenings and tests were administered, studies of annual health exams dating from 1963 to 1999 show that the annual physicals did not reduce mortality overall or for specific causes of death from cancer or heart disease. And the checkups consume billions, although no one is sure exactly how many billions because of the challenge of measuring the additional screenings and follow-up tests.
This lack of evidence is the main reason the United States Preventive Services Task Force — an independent group of experts making evidence-based recommendations about the use of preventive services — does not have a recommendation on routine annual health checkups. The Canadian guidelines have recommended against these exams since 1979.
Emanuel says that screening everyone is not an effective way of treating disease.
If you screen thousands of people, maybe you’ll find tens whose exams suggest they might have a disease. And then upon further tests, you’ll find it is really only a few individuals who truly have something. And of those individuals, maybe one or two actually gain a health benefit from an early diagnosis.
The others may have discovered a disease, but one that either would never have become clinically evident and dangerous, or one that is already too advanced to treat effectively.
Emanuel says that not all preventative measures are of no value.
My New Year’s resolution does not mean I won’t get my annual flu shot or a colonoscopy every 10 years — or eat a balanced diet and get regular exercise. These are proven to reduce morbidity and mortality.
Kevin Drum says that he never went for routine physicals and none of the many primary care physicians he has had over the years has ever recommended that he do so. Come to think of it, my primary care doctor’s have never done so either, though they have not discouraged it, and if I delay scheduling one, I never get a reminder from them the way I get from (say) my optometrist.
Is the routine annual physical like drinking eight glasses of water per day, something that has gripped the imagination of most of the public even though its purported benefits are non-existent?