If you live in England, you might have received a leaflet in the post or seen the adverts on a bus. People between the ages of 40 and 74 should apparently be having a “midlife MOT” every five years. It’s a series of tests for high blood pressure, high cholesterol or diabetes, so you can be started on medication or advised to change your lifestyle.
This kind of general health check is also popular in the US, where people are supposed to have an annual “physical”. It sounds like preventive medicine at its best. Yet, last week, a study showed that the health benefits of such check-ups are so small as to be meaningless.
Public Health England, which is running the testing programme, said that other estimates have found larger benefits. That’s true, but these evaluated the tests’ usefulness just by counting the number of new diagnoses made. Last week’s study was the first to estimate falls in disease risk based on measured reductions in people’s cholesterol and other factors.
Yet neither was the most reliable kind of evidence – a randomised trial. A trial of a similar scheme in Denmark found no reduction in heart attacks, strokes or death rates. An analysis of six trials actually found the checks slightly raised deaths from heart disease.
One of the Danish researchers, Torben Jørgensen of the University of Copenhagen, says the counter-intuitive result is probably because so few people benefit that any gain is outweighed by harms from overtreatment – giving drugs to people who are borderline cases for needing them. Cholesterol-lowering statins, for instance, can cause diabetes and muscle pain that stops people exercising, while blood pressure drugs can cause dizziness that leads to falls.
The battery of tests and lifestyle warnings might also make people unhappy and stressed (a known contributor to heart attacks). The information leaflets that encourage people to take part gloss over any such risks – but the golden rule in medicine is that no intervention should be offered without fully explaining its pros and cons.
But the UK government is ignoring the criticisms and is ploughing on with the health-check programme, which is estimated to cost £363 million a year. Doctors initially resisted, so in 2013 the government made local authorities pay for the checks from public health funds.
Whichever budget is used, though, it’s all UK tax money. The waste is hard to understand at a time when the health service apparently can’t afford HIV prevention drugs or a meningitis vaccine. Local authorities, too, are facing great austerity; they’d be better spending their public health funds on more cycle paths, or even free e-cigarettes – which are a better way of stopping people smoking than lectures.
Doctors usually follow research evidence, so earlier this year I went to a Public Health England conference on health checks to see if I was missing something. But all I heard was a rehash of the positive data, with no mention of possible harms. We heard how at least one council is persuading waste collectors to attend by providing check-ups in the workplace and in work time.
With the audience pumped up by motivational music and patient testimonies, it was like being in a cult that blocks its ears to criticisms. One audience member called for refusenik doctors to be referred to the General Medical Council, the body that can strike them off.
That’s unlikely to happen, but the government is certainly keeping tabs on how many people have their check-up within each local authority. Those with high attendance figures will no doubt be cheered at the next conference. In such a potentially wasteful endeavour that goes against the best evidence, perhaps the region with the lowest figures will be the one that really deserves praise.
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