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

 

**Join us for a demonstration of Taoist Tai Chi® internal arts of health
Saturday, August 26th at 11:00AM – 12:00PM
There is no fee for this program
WholeHealth Chicago
2265 North Clybourn Ave.
773-296-6700

This demonstration of Taoist Tai Chi® arts will give you an opportunity to learn more about this ancient path to good health of body and mind. Taoist Tai Chi® arts help to promote a healthy, balanced life style and a simple way to manage stress. Taoist Tai Chi® arts offers a chance to discover a powerful adaptable, and accessible tool for all ages, including seniors, and people with specific health concerns. These arts can be used to help people take responsibility for their health on its own or as a complement to medical treatment they may be receiving.

 

**Facial Rejuvenation Guasha Class
The Ultimate DIY Anti-Aging Facial!

With Mari Stecker, LAc
Thursday September 21, 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 and registration is required.
Register online or call WholeHealth Chicago at 773-296-6700
More>>

 

**Vaginal Rejuvenation
October 12th, 6:00pm – 8:00pm  Fee: $65
With Mari Stecker, LAc & Renee Zambo, RYT

Are you experiencing vaginal dryness? Or pain with intercourse? Have you been told you have vaginal atrophy due to menopauseAre you frustrated because you believe your sex life is overWell, it doesn’t have to be!

Come learn easy, non-pharmaceutical, non-hormonal, low cost techniques that you can do at home to help alleviate vaginal dryness, atrophy, thinning of vaginal skin and/or painful intercourse.

This class is appropriate for any woman who is experiencing discomfort during intercourse, pelvic exams or daily activities due to vaginal dryness and atrophy as well as women who are experiencing vaginal changes due to perimenopause, menopause, cancer treatments, hysterectomy or medications.

This class will include information on specific instructions for self-treatments that can be done at home as well as yoga postures and meditation that focus on the pelvic region.

Movement and breath will draw awareness to the pelvic floor, and facilitate both the full relaxation and activation of pelvic floor muscles. A short guided meditation will reconnect awareness to the feminine energy held within the pelvis.

Space is limited and registration is required.
Register on-line or by calling (773) 296-6700.

 

Recent Health Tips

  • Women and ADHD, Part 2: Can I Treat This Without Meds?

    “I lose my keys endlessly. I pay big bucks in unnecessary late fees on bills that I put down somewhere and just forget about. After I finished college, I never read another book–it was just too much work. I can cope with a magazine article, …Read More »
  • Women and ADHD, Part 1

    Already ten minutes late for her first appointment, Claire phoned from her car that she’d be in the office in five minutes. Fifteen minutes later, arriving flustered and embarrassed, she blurted “Oh my gosh, I left all the forms on my kitchen table, but I …Read More »

August Sale: 20% Off All Hyland Homeopathic Products

Hyland’s has been trusted for generations to provide safe, effective, homeopathic medicines for every member of the family.  Take 20% off these products during August.  Read more>>