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On 15/10/2022 at 09:29, ICTChris said:

A colleague of mine goes for a physical every year, I think he pays for it to be done privately. I have never done this, does anyone else on P&B do it? 

I have a family history of heart disease and diabetes so I wonder if it will be worthwhile doing. It seems like something people in American TV shows do though.

The US push the "annual physical" as it's a money spinner. There's no evidence that routine "health checks" and random screening improve outcomes, outwith a few specific conditions for which we have validated screening programmes. If you've got specific concerns, as you mention, then reasonable to go and see your GP, but these whole-body scans, blood tests, etc you see advertised are a waste of money and more likely to cause you unnecessary worry than anything else.

Wikipedia has a decent enough article on what makes a good screening programme and why we don't do blanket screening: risk of doing more harm than good.

https://en.wikipedia.org/wiki/Screening_(medicine)

Edited by Cyclizine
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20 minutes ago, Cyclizine said:

The US push the "annual physical" as it's a money spinner. There's no evidence that routine "health checks" and random screening improve outcomes, outwith a few specific conditions for which we have validated screening programmes. If you've got specific concerns, as you mention, then reasonable to go and see your GP, but these whole-body scans, blood tests, etc you see advertised are a waste of money and more likely to cause you unnecessary worry than anything else.

Wikipedia has a decent enough article on what makes a good screening programme and why we don't do blanket screening: risk of doing more harm than good.

https://en.wikipedia.org/wiki/Screening_(medicine)

I always thought a kind of MOT on the body would be a good thing so that's interesting, however are there wider benefits like intervening on someone who is drifting into obesity and probably wouldn't make an appointment to discuss their weight, or someone who wants to discuss depression.

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43 minutes ago, 101 said:

I always thought a kind of MOT on the body would be a good thing so that's interesting, however are there wider benefits like intervening on someone who is drifting into obesity and probably wouldn't make an appointment to discuss their weight, or someone who wants to discuss depression.

 

1 hour ago, Cyclizine said:

The US push the "annual physical" as it's a money spinner. There's no evidence that routine "health checks" and random screening improve outcomes, outwith a few specific conditions for which we have validated screening programmes. If you've got specific concerns, as you mention, then reasonable to go and see your GP, but these whole-body scans, blood tests, etc you see advertised are a waste of money and more likely to cause you unnecessary worry than anything else.

Wikipedia has a decent enough article on what makes a good screening programme and why we don't do blanket screening: risk of doing more harm than good.

https://en.wikipedia.org/wiki/Screening_(medicine)

But surely if we focus purely on specific screening things may fall through the cracks?  Also, relying on folk going to the Doctor with specific concerns assumes people are aware of issues?  In Japan many companies offer(insist on) annual health checks and the decrease in cancer deaths is attributed, at least in part, to this.

I do agree that a scatter gun approach to tests is not necessarily beneficial but would imagine a key set of general tests would be worth having.  

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1 hour ago, hk blues said:

 

But surely if we focus purely on specific screening things may fall through the cracks?  Also, relying on folk going to the Doctor with specific concerns assumes people are aware of issues?  In Japan many companies offer(insist on) annual health checks and the decrease in cancer deaths is attributed, at least in part, to this.

I do agree that a scatter gun approach to tests is not necessarily beneficial but would imagine a key set of general tests would be worth having.  

Absolutely no evidence for this and actually evidence that random blanket screening can lead to harm. If you do twenty tests, one will be abnormal purely by chance. A "simple" set of bloods has many times that number. An incidental finding that may never have caused you any problems all of a sudden can lead to invasive and unnecessary tests and procedures with their own complications.

We already have validated screening programmes (bowel cancer, cervical cancer, diabetes eye screening etc), because there's evidence that they're beneficial. I'm not saying that we should not promote evidence based public health interventions, but that although it seems to make logical sense that "catching things early" is better, that's not demonstrated by the evidence for many conditions and may in fact be harmful.

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13 minutes ago, Cyclizine said:

Absolutely no evidence for this and actually evidence that random blanket screening can lead to harm. If you do twenty tests, one will be abnormal purely by chance. A "simple" set of bloods has many times that number. An incidental finding that may never have caused you any problems all of a sudden can lead to invasive and unnecessary tests and procedures with their own complications.

We already have validated screening programmes (bowel cancer, cervical cancer, diabetes eye screening etc), because there's evidence that they're beneficial. I'm not saying that we should not promote evidence based public health interventions, but that although it seems to make logical sense that "catching things early" is better, that's not demonstrated by the evidence for many conditions and may in fact be harmful.

So you're saying more harm can come from health screening than good? 

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1 hour ago, hk blues said:

So you're saying more harm can come from health screening than good? 

Yes. It is counterintuitive, but the Wikipedia article I linked explains this well.

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1 minute ago, Cyclizine said:

Yes. It is counterintuitive, but the Wikipedia article I linked explains this well.

I read the article.  I didn't read it as being so conclusive as you though.  It seemed to suggest that there are undoubtedly downsides to testing but I didn't see anything saying those downsides outweighed any positives.  

 

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20 minutes ago, hk blues said:

I read the article.  I didn't read it as being so conclusive as you though.  It seemed to suggest that there are undoubtedly downsides to testing but I didn't see anything saying those downsides outweighed any positives.  

 

As I said, there are screening programmes that have been shown to be of benefit and others that have not. Random screening as advertised by many private clinics is not evidence based and not shown to improve outcomes. If there are specific concerns, then focused investigations can be done, rather than a blunderbuss approach. Despite popular opinion, there are very few medical tests that give definitive answers one way or the other, they merely indicate the likelihood or not of having a condition, which itself is influenced by the prevalence of that condition.

Even some of the efficacy of recognised programmes can be in question. There are some cancer screening programmes that do indeed, reduce deaths from that cancer. However, they do not reduce overall deaths in those patients, the implication being that there are conditions that you may have but are unlikely to cause you harm, but the treatments for these conditions may be harmful in themselves.

I agree it is difficult to conceptualise. Screening programmes are designed on populations levels, you can't really boil things down to individuals. Although we can say a treatment improves outcomes by, x% overall you can't say that any particular patient will have benefit (the may in fact not have any benefit or even harm). Prostate cancer is the classic example, it's almost inevitable that as men age they will get areas of abnormality in their prostates. However, most men will not run into any problems from this and will die of something else unrelated. However, some men will develop aggressive disease. We have no way of telling, which is why we don't routinely screen all men for prostate cancer - the changes are so common and the tests so poorly able to differentiate, that we would subject many, many more men to invasive and potentially life-changing interventions, who may never have gone on to develop any significant disease. We do offer screening tests to men, but only after a proper discussion about risks and benefits so that an informed decision can be taken. Note that this is asymptomatic screening - it's a different situation when patients have symptoms as this changes the probabilities.

There are many public health and experts who are far more knowledgeable than me about evidence based screening, the NHS is generally pretty decent at screening (there are loads of programmes).

Edited by Cyclizine
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2 minutes ago, Cyclizine said:

As I said, there are screening programmes that have been shown to be of benefit and others that have not. Random screening as advertised by many private clinics is not evidence based and not shown to improve outcomes. If there are specific concerns, then focused investigations can be done, rather than a blunderbuss approach. Despite popular opinion, there are very few medical tests that give definitive answers one way or the other, they merely indicate the likelihood or not of having a condition, which itself is influenced by the prevalence of that condition.

Even some of the efficacy of recognised programmes can be in question. There are some cancer screening programmes that do indeed, reduce deaths from that cancer. However, they do not reduce overall deaths in those patients, the implication being that there are conditions that you may have but are unlikely to cause you harm, but the treatments for these conditions may be harmful in themselves.

I agree it is difficult to conceptualise. Screening programmes are designed on populations levels, you can't really boil things down to individuals. Although we can say a treatment improves outcomes by, x% overall you can't say that any particular patient will have benefit (the may in fact not have any benefit or even harm). Prostate cancer is the classic example, it's almost inevitable that as men age they will get areas of abnormality in their prostates. However, most men will not run into any problems from this and will die of something else unrelated. However, some men will develop aggressive disease. We have no way of telling, which is why we don't routinely screen all men for prostate cancer - the changes are so common and the tests so poorly able to differentiate, that we would subject many, many more men to invasive and potentially life-changing interventions, who may never have gone on to develop any significant disease.

Re. your 2nd sentence -  I already stated that several posts ago.  If you're basing your argument purely on that then we are in agreement and have been for the past while.

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Just now, 101 said:

And it's likely that people who wouldnt get something checked out would also probably skip their routine check up.

That's why many Japanese companies make it compulsory and the results are shared with employers.

I AM NOT suggesting that's a road we should be going down.

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15 minutes ago, scottsdad said:

I wouldn't argue any case with wikipedia as my source. 

It's an accessible article at an appropriate level. I'm sure others are available. Plenty of peer-reviewed sources available too, but not aimed at the general public.

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Had an out of the blue seizure after work on Friday, proper convulsing on the ground, in trying to hold myself up, I've dislocated my left shoulder and done some serious damage to my right. Had surgery on the left shoulder 16 years ago to stabilise it, so I'm guessing that's undone. Got fracture clinic about shoulders tomorrow and seizure clinic when I can get an appointment. Also took a substantial chunk out of my tongue during the seizure. 

Currently in a sling for the left shoulder, signed off for god knows how long and just generally terrified about the whole thing. Never had an episode like this before and the seizure on its own would've been bad enough without the physical damage it's caused. 

Anyway, fingers crossed for good news at the fracture clinic tomorrow. 

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