2265 North Clybourn Avenue    Chicago, IL 60614    P: 773.296.6700     F: 773.296.1131

Knowledge Base

Welcome to our extensive library of articles on health concerns and conditions, alternative therapies, nutrition, nutritional supplements, and much more. Acupuncture / Traditional Chinese Medicine Aging Allergies & Food Sensitivities Alternative Therapies Big Pharma Evils Bone Health Candida (Yeast) and Parasites Cardiovascular Health Case Studies Chiropractic & Physical Medicine Dermatology Digestion Diseases Ear, Nose & Throat Environmental Sensitivities Eye Care Fibromyalgia & Chronic Fatigue Fitness & Exercise Health Insurance Issues Healthy Lifestyle Immune System Inflammation Integrative Medicine Lyme Disease & Morgellons Men's Health Mental Health Nutrition, Nutritional Supplements, Vitamins, & Herbal Remedies Pain Management Sexual Health Thyroid, Adrenal, & Sex Hormone Issues Weight Issues Women's Health

Do I Really Need A Check-Up?

Posted 06/24/2013

You’d never guess this would be a hotly debated topic among physicians, since an affirmative answer seems so obvious. As for patients, assuming you have insurance, a doctor, and nothing’s really wrong with you, you still might like someone to look things over and ensure nothing’s amiss, no evil lurking inside that will cause you to keel over while you’re still (relatively) young.

If you want regular check-ups, you’re in luck. Many health insurance companies now offer annual wellness checks. In fact, check-ups are already written into the Affordable Care Act (ACA), which will bring a lot of people into doctor’s offices who once stayed away, basically because they had no money.

But eventually some spoilsport was going to ask if all these check-ups people were clamoring for really paid off, especially if these people were young or middle-aged, that line being arbitrarily drawn at under 65.

Determined to discover what seemed like useful information, a group of medical researchers from Denmark reviewed a total of 14 clinical trials conducted between the late 1960s and the early 2000s, tracking over a period of years nearly 200,000 patients divided equally between the “checked-up” and the “non-checked-up.” For their review, they sought trials that measured just one outcome: death.

More harm than good?
Published this week in JAMA, their conclusion is that there wasn’t any difference in death rates between those who got check-ups and those who did not. They also discovered (to no one’s surprise) that among those who had regular check-ups, there was excessive additional testing, more referrals to specialists, more prescriptions, and more diagnostic labels (not to mention more worry) than among those who’d not seen a doctor at all.

In other words, maybe all these wellness checks and disease screenings aren’t such a hot idea since they seem to be doing people more harm than good. But an accompanying editorial disagrees, saying we do need wellness checks. We’ve just not been doing them the right way.

The editorial first points out that in all 14 clinical trials, disease screenings were performed in special outpatient units designed for efficiency. Personnel collected both biometric (weight, height, blood pressure, etc.) and lab data, and when abnormal results appeared they provided medical counseling. However, the tests and counseling were all done parallel to the patient’s primary care doctor, rather than including him or her. This immediately placed a barrier to optimal coordination of care.

In other words, in these clinical trials at least, those in the regularly checked-up group may actually have been receiving substandard care.

If we extrapolate this to the future, let’s say you’re going to a Walgreen’s or CVS clinic for your wellness check and it’s discovered you have high blood pressure. They give you a brochure on high blood pressure, tell you to cut back on salt, and recommend you see your doctor. This isn’t as effective as having your high blood pressure discovered in your doctor’s office. It simply makes no sense to have two locations for measuring blood pressure and, if necessary, receiving prescriptions for treatment.

The second point in the editorial is that when data on all these patients was reviewed, there was a real disconnect between the diseases that were being screened for and what people under 65 actually die of. This is a significant point. Of the almost 12,000 deaths that occurred in both groups, the checked and the unchecked, the most common causes of death were injury, suicide, homicide, heart disease, and cancer. Since we have yet to invent effective tools for preventing the first three, when these studies were started (and to this day) the only serious screening that happens during wellness checks is for heart disease and cancer.

And maybe this is the real problem. Maybe the failure of the check-up group to be superior to the unchecked group is that the point of screening for risk was being soundly overlooked. They were being screened for disease (heart disease and breast, colon, cervical, and prostate cancers) rather than for unhealthy lifestyles.

Given that developing cancer before age 65 is a fairly rare event, consider all the trouble they endured getting screened for it. Cancer screening, especially among healthy people, is considered low-yield, averaging about one case in 1000 screenings each for breast (mammogram) and colon (testing stools for blood). My experience with the exceptionally healthy WholeHealth Chicago patient population certainly aligns with this data. In my 13 years of screening patients under 65 for cancer, I’ve had not one mammogram, Pap smear, or colonoscopy reveal an undiscovered cancer in anyone. Cysts, dysplasias, and polyps, yes, but actual cancer under 65 discovered in a screening, no.

From the point of view of the Danish investigators, the standard wellness checks they reviewed as they were performed from the late 1960s to the early 2000s were a waste of everyone’s time and money, and probably dangerous to boot.

Looking at lifestyle
But if we changed the wellness check to a lifestyle check, we could potentially make a real difference. The more data we gather about what prevents chronic illness and premature death, the more the finger points to unhealthy lifestyle choices.

Let’s update the same-old wellness check to something effective. Let’s have you arrive for your check-up with a completed questionnaire on which you’ve answered a variety of questions on topics that might include seat belt use, number of guns in your home, and your honest diaries of a week’s worth of food eaten, alcohol consumed, physical activity performed, and stresses encountered.

Having a health counselor review this with you, and giving her both the funds and authority to initiate nutritional counseling or a fitness program, we might see real progress in wellness checks. We could limit our current fixation on disease screening to individuals at special risk, such as those with strong family histories of heart disease or cancer, or to those with unhealthy lifestyles who either cannot or will not change.

Here’s one example of how such lifestyle screening could make a real difference. In a report published recently in Internal Medicine News, of 17,000 men tracked over a period of 20 years, those who were most physically fit enjoyed not only the expected low frequency of heart disease, but also 68% less lung cancer and 38% less colon cancer than men who were deemed physically unfit. With this in mind, an effective wellness check would include an assessment of exercise habits, maybe even actually measuring physical fitness, and getting the unfit into shape with a subsidized fitness program. Instead of repeatedly measuring cholesterol or testing stools for blood, we’d be measuring improvements in weight, body fat percentage, and cardiorespiratory endurance.

To the question posed in the title of this health tip, the answer is definitely yes, provided you recognize that within the current health care system much of your check-up will be a DIY project.

Be well,
David Edelberg, MD

 

 

 

Leave a Comment


  1. Addie says:

    This was an extremely interesting post. One question I had: would death as the only measured outcome give meaningful results? Wasn’t that the main problem with the study? Leaving out for a moment the points about lifestyle and the insufficiency of coordinated care, wouldn’t a better study have included debilitating illness? Because for some living isn’t an optimal outcome. I’m thinking about people vegetating on life support, or those living in constant unbearable pain as a result of infrequent or non existent check-ups. It would have been a much better (and more expensive) study had it also shown the effect of checkups on severe and potentially debilitating problems.

Join our Newsletter

Get health recommendations, delicious and time-saving recipes, medical news, supplement reviews, birthday discounts, and more!

BIRTHDAY

Health Tips

Dr. Edelberg’s Health Tips contain concise bits of advice, medical news, nutritional supplement and pharmaceutical updates, and stress relief ideas. With every Health Tip, you’ll also receive an easy, delicious, and healthful recipe.

When you sign up to receive Health Tips, you can look forward to Dr. Edelberg’s smart and very current observations arriving in your in-box weekly. They’re packed with helpful information and are often slightly irreverent. One of the most common responses to the tips is “I wish my doctor talked to me like this!”

Quick Connect

Get One Click Access to our

patient-portal

The Knowledge Base

Patient education is an integral part of our practice. Here you will find a comprehensive collection of staff articles, descriptions of therapies and nutritional supplements, information addressing your health concerns, and the latest research on nutritional supplements and alternative therapies.

Join our Newsletter

Get health recommendations, delicious and time-saving recipes, medical news, supplement reviews, birthday discounts, and more!

BIRTHDAY

Upcoming Workshops

 

*Yoga Therapy for Digestive Health
1-3 pm Saturday, April 22

In this workshop you will:

  • Discover how biological and environmental factors shape the health of your gastrointestinal system.
  • Learn specific breathing techniques to reduce stress and feel more grounded in your body.
  • Practice yoga postures that soothe, detox, and ground the entire GI system.
  • Practice a mindful eating exercise (on gluten-free, dairy-free, and sugar-free foods) to explore your relationship to food and cultivate fulfillment.

Registration
Insurance-eligible for WholeHealth Chicago patients.
$50 registration for self-pay or those new to WholeHealth Chicago.
Space is limited and registration is required. Register by calling (773) 296-6700.
More>>

Questions? Please email Renee here.

 

*Self Care for Chronic Pain with Yoga Therapy and Healing Touch
Monday May 15th and Monday May 22nd
6pm – 7:30pm
Workshop Fee $75

Are you looking for ways to manage chronic pain that doesn’t involve medication? Consider a gentle exploration in Healing Touch and Yoga Therapy that connects mind, body and spirit for overall health and wellbeing with WholeHealth Chicago’s Healing Touch practitioner Katie Oberlin and Yoga Therapist Renee Zambo.

Enrollment is limited. Register online here or by calling (773) 296-6700 to secure your spot.
Read More>>

 

*May Lyme Academy
Lyme & Lymph; A Source of Pain and Swelling
Tuesday May 16, 5:30-7:00pm

People with Lyme disease may experience pain, swelling and have decreased ability to move toxins out of their body. Karen Meier, Doctor of Physical Therapy, will be presenting information about the lymphatic system, how Lyme affects it, self care and manual techniques for treatment.

Registration:
Registration is open to patients of Dr. Kelley, and pre-registration is required. Please call WholeHealth Chicago at 773-296-6700 or see a Patient Services team member to sign up!

 

*Awakened Body, Quiet Mind
An innovative workshop series for relieving mind/body stress and tapping into your true power and natural health.

Four Group Sessions with Meghan Roekle, PsyD.

Four meetings using a unique combination of embodiment meditation and mental inquiry for deep healing.

Tuesdays from 6:00-8:00pm beginning May 23rd.  Register online or call 773-296-6700
More>>

 

*Facial Guasha Class
The Ultimate DIY Anti-Aging Facial!
With Mari Stecker, LAc
Thursday June 8, 2017, 6:30-8PM, $65 course fee

Join us and learn a traditional Chinese facial rejuvenation technique that you can do yourself! Guasha treatment is a 2,000 year old Chinese massage technique that uses a flat tool to apply pressure to the skin to increase circulation as it moves along acupuncture channels.

Facial guasha is an easy to learn technique that:
* encourages blood flow and promotes radiance
* prevents wrinkles
* activates cells to regain facial elasticity
* drains fluids to detoxify skin and reduce puffiness
* sloughs off dead skin cells
* uplifts and tones skin
* firms up facial muscles
* minimizes dark circles
* promotes a healthy, younger and more radiant look

Space is limited, pre-registration required by calling 773-296-6700 or online.
More>>

Recent Health Tips

  • Pain And How We Perceive It

    Pain And How We Perceive It

    Many people suffering chronic pain and fatigue hear far too often the dismissive “it’s all in your head.” Dr. Edelberg has written frequently on the destructive nature of this statement, which places all the blame on the patient and none on the physician to dig …Read More »
  • Stevia and Lyme Disease

    Stevia and Lyme Disease

    Patients often ask me if stevia can treat Lyme disease. The answer is both yes and no. The question stems from a study published in 2015 in the European Journal of Microbiology and Immunology on stevia and the different forms of Borrelia burgdorferi, the bacterium …Read More »

April Sale: 20% Off Metagenics Medical Foods

Metagenics pioneered the development of science-based medical foods to help manage specific health conditions. Take 20% off these products during April…
More>>