Testing Testing

Writer Rob McGovern | March 13, 2018

For many people, the first step to a better, healthier you is to declare that you will improve your diet, drink less alcohol, give up smoking and finally join a gym. But beyond bulging biceps and a trim waistline, what does being healthy really mean and how can we go about making sure we are truly in top condition?

A good way to check the state of your health, and get advice to help you plan the new diet and workout regime, is to get a health check-up before embarking on your new lifestyle.

Exam Prep

“People may not think an annual check-up is necessary if they feel okay. The important thing to remember is that certain conditions like high blood pressure, cervical cancer, and breast cancer will not show symptoms until advanced stages. The idea is to pick up such conditions at treatable stages,” says Dr Bimal Ashar, clinical director, Division of General Internal Medicine at the Johns Hopkins Hospital and associate professor of Medicine, Johns Hopkins University School of Medicine.

For those who are one step away from hypochondria, a thorough and comprehensive check, known to some as executive wellness exams, may sound perfect. Offering all manner of tests from electrocardiograms to thyroid function screenings (TSH), they often appeal to business people that are ‘time poor’ and often include access to high-speed Wi-Fi, a selection of newspapers and sometimes even breakfast after the exam is finished.

Offering something in that mould is Forward, a wellness clinic that has adopted the style of a high-end gym. For US$149 a month, users get unlimited access to genetic screenings, blood testing, weight-loss planning and routine doctors’ visits.

Founded by former Google executive Adrian Aoun, the idea is to look out for signs of things to come and treat them accordingly. In addition to this more proactive approach, Forward also offers reactive medicine including unlimited generic medications without copays (a big plus in the US). 

While the price tag precludes a lot of people (they do not accept health insurance), the idea is appealing to investors and the venture has reportedly raised US$100 million in funding and has recently opened a location in LA.

Mind Field

But while (hopefully) getting a clean bill of health sounds fantastic and the perfect way to start any new year, many medical professionals aren’t convinced that many of these tests are necessary, and some think they can even be detrimental to your health.

Dr Kinnary Martin, associate director of General Practice Studies at the department of public health and primary care at Cambridge University advises caution when considering anything other than a basic check-up. He says, “There is a very real risk of overdiagnosis – the diagnosis of disease or signs which will not cause symptoms or death – which then leads to unnecessary investigation and treatment, which can result in both physical and psychological harm.”

Dr J. Hunter Young, medical director of Patient Services, Johns Hopkins Medicine International agrees: “Despite the importance of certain screening tests in detecting early problems, there are other tests that do not improve health and wellness, but rather can lead to unnecessary procedures and unintended consequences such as complications from those procedures. For example, imaging studies such as full body MRIs have not been demonstrated to enhance health and wellness. Results from these studies can lead to unnecessary procedures for benign conditions, which may result in complications.”

There are other issues with having check-ups that are either too in depth or having them too regularly. “A verdict of a ‘normal’ health check could reassure patients so much that they continue to participate in risky behaviour, such as smoking and drinking excessive alcohol, or so much that they do not present to their doctor with symptoms that require further investigation – waiting until their next health check to mention symptoms,” adds Dr Martin. “The more complex tests that you include in a health check, the more likely it is that overdiagnosis could occur.”

And this healthy scepticism of screenings isn’t new. An article in the Journal of the Royal College of Medical Practitioners in 1989 by Dr Howard Stoate set out to determine whether screening can be psychologically harmful to healthy adults. The main finding was that patients’ own assessment of their psychological distress was significantly increased three months after screening compared with that of controls, who showed a non-significant decrease. The result was that there is a real risk of causing distress by screening healthy adults.

So while there can be a cost to people’s health – both mental and physical – with this approach, there may well be another cost, a positive one for screeners. “There is a worry that providers of screenings…will do a test for anyone who is willing to pay for it,” says Dr Joe Rosenthal, honorary consultant in Primary Care at NHS North Central and East London and at the Royal Free NHS Foundation Trust. “Some private doctors will encourage people to have tests because there is a financial incentive for them and their organisation which has invested in a lot of expensive kit and need to use it. There are incentives that sometimes go beyond the individual needs of the patient.”

In addition to making sure that the appropriate screening tests and immunisations are being administered, it is a time for the doctor-patient relationship to be established
~ Dr Bimal Ashar