Do Routine Physical Examinations Save Lives?

Lasse T. Krogboll, of the Cochrane Nordic Center in Copenhagen, Denmark and coauthors published an article in the online edition of the Database of Systematic Reviews that suggests that routine examinations do not save lives.  The material was reviewed in the University of Pennsylvania Medical Center online periodical Medpage Today and was critiqued by a physician at the Harvard Medical School.

The study was a systematic review of 16 clinical trials involving 183,000 patients followed for a median of 9 years. The review concluded the risk of mortality in individuals who had regular checkups, compared to those who did not, was not statistically different.  “General health checkups did not reduce morbidity or mortality, neither overall nor for cardiovascular or cancer causes, although the number of new diagnoses was increased.”  “With the large number of participants and deaths included, the long follow-up periods used and, considering that cardiovascular and cancer mortality was not reduced, general health checkups are unlikely to be beneficial.”

In commenting upon the study, Doris F. Zaleznik, MD, Associate Clinical Professor of Medicine at Harvard Medical School and Dorothy Caputo, MA BSN RN admitted that “most of the trials were old, which makes the results less applicable to today’s settings because the treatments used for conditions and risk factors have changed.”  They additionally noted that one reason for the lack of efficacy of routine general checkups might be that “primary care physicians already identify and intervene when they suspect a patient to be at high risk of developing disease when they see them for other reasons.” They additionally suspect that “those at high risk of developing disease may not attend general and health checks when invited.”

The release of this online study was dramatically promoted. One must embrace evidence based data but keep in mind that there is a strong push in the USA to reduce health care spending overall as a percentage of the gross national product.  Anything that seems to say, “Do not seek evaluation “seems to garner more attention than it is due these days.

The study did not clearly define what a general health checkup includes.  I still believe that finding a good doctor and seeing that doctor annually for a benchmarking session to review your health wellness and habits by performing a thorough history and physical examination and, comparing your habits and findings to current recommended guidelines and treatments, is a worthwhile endeavor.  The general health exam does not need to include numerous and expensive laboratory and imaging studies unless the history and examination suggest the need to pursue those options.

As medical science identifies genetic and molecular mechanisms of disease, I am sure the next long-term Cochrane Review will show the efficacy of these annual general physical examination sessions in limiting disease and extending life.

 

Multivitamins in the Prevention of Cancer in Men

Vitamin, mineral and supplement use in the United States is a multi-billion dollar industry. Despite many testimonials extolling the benefits of supplemental vitamins, there has been very little research that actually provides evidence that these supplements are beneficial. However, there is abundant evidence that over consumption of the fat soluble vitamins, A, E, D and K results in accumulation of the substances and eventual toxicity.  The 2010 Dietary Guidelines for Americans says, “For the general, healthy population, there is no evidence to support a recommendation for the uses of multivitamin or mineral supplements in the primary prevention of chronic disease.”

The Physicians Health Study II (PHS II), a randomized controlled study, followed 14,641 male U.S. patients initially aged 50 or older for a median of 11.2 years. Their results showed that “daily multivitamin supplementation modestly but significantly reduced the risk of total cancer.”  The study could not clarify or specifically define which nutrient or nutrients in their supplemental multivitamin were responsible for the effect in reducing cancer.

The study used the multivitamin Centrum Silver.  However, it did not examine the effect of multivitamins in women.  Nor, did it did allow participants to consume additional vitamins, minerals, supplements or herbs.

The message to individuals is clear. Eat a healthy and balanced diet that is prepared in a manner that does not destroy the nutrients.  A multivitamin such as Centrum Silver will reduce your risk of cancer minimally. There is no proof that taking additional products with the multivitamin will have a more positive effect.