Routine Health Checks Don’t Seem to Affect Mortality

[~Zaria~]

Routine Health Checks Don’t Seem to Affect Mortality


General health checks do not reduce mortality, according to a meta-analysis conducted by the Nordic Cochrane Center, Copenhagen, Denmark. Allan V.

Prochazka, MD, from the Denver Veterans Affairs Medical Center, and Tanner Caverly, MD, from the University of Colorado School of Medicine, Denver, review these findings in an article published online January 14 in JAMA Internal Medicine (formerly Archives of Internal Medicine).

In a systematic review of 14 randomized controlled trials conducted between 1963 and 1999, researchers evaluated the effect of annual health checkups on morbidity and mortality.

The authors defined a general health check as "a visit dedicated solely to preventive counseling and screening tests," excluding visits required for the management of chronic conditions or acute care visits.

The researchers evaluated data from more than 182,000 patients and assessed primary outcomes of all-cause mortality and disease-specific mortality. "Secondary outcomes assessed included morbidity, new diagnoses, hospitalizations, disability, worry, self-reported health, referrals to specialists, and additional visits to general practitioners," the authors write.

The researchers found that general health checks had no significant effect on total mortality, even when other factors such as inclusion of lifestyle counseling, duration of follow-up, and types of testing were examined. In terms of disease-specific mortality, no significant reduction in cancer mortality (RR, 1.01; 95% CI, 0.92 - 1.12) or cardiovascular mortality (RR, 1.03; 95% CI, 0.91 - 1.17) was found.

Not all trials included data on secondary outcomes; however, the researchers noted an increase in the number of new diagnoses of hypertension, hyperlipidemia, and diabetes mellitus during the health checks.


According to the authors, patients in the United States spend an estimated $322 million a year on laboratory tests as part of general health examinations. The authors speculate that these costs are even larger if downstream testing and overtreatment are considered but note that, despite the lack of support from guideline groups over the years for general wellness visits, a change in this tradition presents a challenge. Increased use of electronic medical records to provide individualized recommendations, as well as promotion of increased discussions between physicians and patients about healthcare costs, may ultimately change this practice.

The review authors point out that during the 40-year time span in which these studies were conducted, changes in medical and therapeutic interventions may have affected the results. They note, however, that "[g]iven the finding that general health checks have never been shown to be effective across this long span of time, the burden of proof should be to demonstrate that current screening tests are more effective than past screenings."

The reviewers also note other study limitations, such as the absence of data on the harms and costs of general checkups as well as lack of discussion of the role that the physician–patient relationship may play in the recommendation and value of these visits.

"Changing beliefs about the value of general health checks — beliefs that have withstood decades of contrary evidence — will continue to be challenging," write Dr. Prochazka and Dr. Caverly.

"New initiatives...should eventually shift patients and physicians away from the non–evidence-based yet firmly entrenched practice of the general health checkup," they conclude.

The authors have disclosed no relevant financial relationships.

JAMA Intern Med. Published online January 14, 2013. Abstract



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How many of you visit your doctor, just for a 'General Check-up?' - even if you are feeling completely well?
And why? : )

Do you thinking 'screening' for potential medical problems is of any benefit?

[جوري]

Do you thinking 'screening' for potential medical problems is of any benefit?

I am probably the wrong person to ask such a Q of. Yesterday after the accident they wanted to take us to the hospital and I was like are you kidding me? Go there wait in triage for 7 hours only to be given a brief neurological exam if at all and then discharged with a $1500 bill? Thanks but no thanks.. I suspect most people don't know enough about their body and would rather the 'experts' give them a clean bill of health but I only ever go if it is something I can't do for myself.. routine physicals are a waste again unless someone needs refills on the two biggies that plague mankind and mostly because of man kind's doing.
Heart dz/DM. Even the guy who came up with the PSA test later regretted it.

[~Zaria~]

:salam:,


The above article, published earlier this year gave many of us a lot to think about.....


And now, there is certainly renewed interest in this topic following Angelina Jolies 'preventative' bilateral mastectomy:

Angelina Jolie's Mastectomy: BRCA Testing in the Spotlight

Kate Johnson
May 16, 2013

Superstar Angelina Jolie's headline revelation this week about her positive genetic test for the BRCA1 mutation and subsequent double prophylactic mastectomy has stunned the world and put the entire field of breast cancer medicine on high alert.


Her story is "the epitome" of individualized medicine, said Eric Topol, MD, editor-in-chief of Medscape.
"She took charge by getting the test done, getting the critical information about whether she would be at risk for breast cancer and how high that risk would be, and then making a key decision of preventive surgery," said Dr. Topol, who is director, Scripps Translational Science Institute Chief Academic Officer, Scripps Health Professor of Genomics, the Scripps Research Institute.


With more than 1600 comments registered for Jolie's New York Times op-ed piece, there is little doubt about the intense public interest, which is already having a ripple effect in cancer clinics across the United States.


"We already know from studies that women think they are at a higher risk of breast cancer than they actually are," said Dr. Swain, a breast cancer specialist and medical director of the Washington Cancer Institute at MedStar Washington Hospital Center.
"Hearing this, people may think, 'Oh, she's 37, maybe I also have that risk.' "


Indeed, there has already been an uptick in patient calls and emails at Moores Cancer Center at the University of California, San Diego. "People are just wondering about how to go about getting the test or more information," said Lisa Madlensky, PhD, CGC, a cancer geneticist and director of the center's Family Cancer Genetics Program, in an interview.


"I expect a lot of women are asking themselves if they should get tested or not because of a family history," said Jennifer Litton, MD, from the Department of Breast Medical Oncology, Division of Cancer Medicine, the University of Texas MD Anderson Cancer Center, in Houston.
"Overall, I think healthcare providers may expect increased questions about this testing," she told Medscape Medical News.


"With this publicity and her speaking out, I have a feeling there will be increased requests [for BRCA testing]," Sandra M. Swain, MD, president of the American Society of Clinical Oncology, told Medscape Medical News.

There are 2 groups of people to consider in this discussion:

1. Those who do not have any known 'risk factors' for a certain condtion.

2. Those who do carry demonstratable 'risk' for developing a condition - e.g. a strong family history, genetics, other associated diseases, etc - and for whom screening tests are advisable.

I guess the question that one now needs to ask is:
How far does one go, in trying to 'prevent' a certain outcome from occuring?

I may consider bilateral mastectomy to be quite a drastic decision (vs. the choice of annual screening for the development of cancer - if I fall into a 'high risk' category), whilst others may not.....

And more importantly, what are we actually trying to prevent?

Allah (subhanawataála) tells us in the Quraan:

"Wherever you are death will find you out, even if you are in the towers built up strong and high..."

(Qur'an An-Nisa 4:11)


"Nor can a soul die except by Allah’s leave, the term being fixed by writing..."
(Qur'an Al-Imran 3:145)

Certainly, we are unable to 'delay' the time of death.

And while there is merit in making efforts to take care of our health, screening for relevant conditions if we are at risk (i.e. 'Tying our camels).....are we not perhaps, losing focus in this regard?
Perhaps we are forgetting the second part to the above hadith:


Anas ibn Malik reported: A man said, “O Messenger of Allah, should I tie my camel and trust in Allah, or should I untie her and trust in Allah?” The Messenger of Allah, peace and blessings be upon him, said,

“Tie her and trust in Allah.”

Source: Sunan At-Tirmidhi 2517


Just some thoughts.....


:wasalam:

[sister herb]

:And more importantly, what are we actually trying to prevent?

Salam alaykum

By those checks we try to avoid death. If avoiding too early death would be against islam, then for what we even need doctors? Should we accept that in someones family some kind of cancer occurs - no panic, just avoid ask any cure from doctors what might make your life longer? Ok it is will of Allah if I die at the year of 30 - no need to check my risk by doctor, no need to get help to that disease?

What is real task of doctors then? Help us to avoid death? Or help us to live healthier those days what Allah has ordered to us?

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[~Zaria~]

:wasalam: sister harb,

You have made some important points.

There is benefit in screening those who are at risk for certain conditions.

However, my concern is: What do we do, once a well, asymptomatic person is found to carry a gene that confers risk for cancer/ any other serious disease?

Is it not enough that we monitor and perform regular screening tests (in this case - e.g. have annual mammograms performed)
And then leave the rest to Allah?

In the case of the BRCA gene (which was found in Angelinas case), it is said to carry ~80% risk for breast cancer (some studies, 65-70%) and ~50% risk for ovarian cancer.
There are also reports that she wants to remove her ovaries to reduce this risk as well.....

Its not an easy decision to make - and I can sympathize with the person who may have lost their mum/ close relative to cancer, and now possibly faces a similiar fate as well.

I just hope that increasing access to genetic tests, does not result in paranoia - not only in those who are at 'high risk', but for the general population as well......


:wasalam:

[Abz2000]

In the case of the BRCA gene (which was found in Angelinas case), it is said to carry ~80% risk for breast cancer (some studies, 65-70%) and ~50% risk for ovarian cancer.
There are also reports that she wants to remove her ovaries to reduce this risk as well.....

Omg!!! Reminds me of the Verse:

وَلَتَجِدَنَّهُم أَحرَصَ النّاسِ عَلىٰ حَيوٰةٍ وَمِنَ الَّذينَ أَشرَكوا ۚ يَوَدُّ أَحَدُهُم لَو يُعَمَّرُ أَلفَ سَنَةٍ وَما هُوَ بِمُزَحزِحِهِ مِنَ العَذابِ أَن يُعَمَّرَ ۗ وَاللَّهُ بَصيرٌ بِما يَعمَلونَ


Thou wilt indeed find them, of all people, most greedy of life,-even more than the idolaters: Each one of them wishes He could be given a life of a thousand years: But the grant of such life will not save him from (due) punishment. For Allah sees well all that they do.

Al Quran 2:96

Can be a good idea to be cautious but I think she's really really scared of death. Maybe coz she feels shes in paradise and doesn't expect much afterwards.

Maybe she should also cross the road with armour padding and a helmet along with a gas mask in case a car hits her or someone passes a deadly wind.

[جوري]

It's good that we've screening for some diseases strides are made!
It would be great if testing is available for pancreatic or ovarian cancers although that in and if itself might lead to false procedures and unnecessary treatments considering all the dialogue going in now about PSA testing.
We make modest strides in some areas, we're totally behind in others and many others just lead to regret.
For instance the 'gay gene' testing and the desire for many to abort fetuses that would have tested positive if that original study were true and conclusive which it isn't!
There's alot of politics and little ethics in medicine ultimately we're left to our personal finances and moral compass to decide what's right or wrong unless our decisions are of immediate harm to self or others!

Couple of things to think about

:w:

[piXie]

There's alot of politics and little ethics in medicine

Too true.

[~Zaria~]

European Society of Human Genetics urges caution over use of new genetic sequencing techniques

16 May 2013 European Society of Human Genetics (ESHG)


The use of genome-wide analysis (GWA), where the entirety of an individual’s DNA is examined to look for the genomic mutations or variants which can cause health problems is a massively useful technology for diagnosing disease.

However, it can also pose major ethical problems if used incorrectly, say new recommendations from the European Society of Human Genetics (ESHG) published on line today (16 May 2013) in the European Journal of Human Genetics.

Many services based on whole genome and on exome* sequencing and analysis are now available to patients at an affordable price, and this raises the question of how to ensure that they are provided appropriately. “Such sequencing generates huge amounts of information that needs to be processed, analysed, and stored in a responsible manner”, said Professor Martina Cornel, chair of the Professional and Public Policy Committee of ESHG. “It is preferable to use sequencing or analysis specifically targeted at a particular health problem to avoid unsolicited findings, or those that cannot yet be interpreted, which can cause considerable anxiety to patients and their families. Clear guidance on how to deal with such findings is needed.”

Targeted analysis will limit such unsolicited findings, says the ESHG, and this is particularly important at present when there are only a limited number of clinicians properly trained to inform patients on the significance of the results of GWAs and exome sequencing. While the Society believes that the duty to inform patients may outweigh their right not to know in some circumstances, the new recommendations propose that analysis should be limited to genome regions linked to the clinical problem for which the analysis is being undertaken.

“We are opposed to the type of opportunistic screening that throws up large numbers of incidental results. If such results reveal a treatable or preventable condition, then clearly it is advantageous to patients to be informed about them. But in the majority of cases it is very difficult to interpret exactly what such incidental results mean for patients and their families. The evidence currently available often comes from families with affected persons, but it is lacking on the interpretation of results in other situations. Furthermore, in genetics healthcare, autonomy is considered very important: patients should be allowed consent on what would be screened for and reported to them. We believe that it is premature today to look for such results other than the clinical problem in circumstances where there are no prior clinical indications or family history ”, said Professor Cornel.

“A sustained effort to educate clinicians in genetics is needed in order to be able to cope with advances in analysis. We also believe that the Society has an important role to play in raising awareness of genetics among the general public. Only with the benefit of a general increase in genetic literacy can society become properly involved in the debate over who has the right to know what and in which circumstances,” she said.

Professor GertJan van Ommen, Editor in Chief of the European Journal of Human Genetics, said: “The importance of this issue has been underlined by the US Government’s Bioethics Advisory Panel’s plans to report on how incidental findings encountered in genomics research should be handled. I believe that ESHG has made an important contribution to the debate, which will be further discussed at their conference in Paris in June.”

*Exomes are the short sequences of DNA representing the regions in genes that are translated into protein

http://www.nature.com/ejhg/journal/v21/n1s/index.html

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Sometimes too much information can be bad for you........?
Just my humble thoughts at were we are heading to :/