8 ms·

Uh, no. Hypertension is a silent killer. Mole checks? Colonoscopies? Testicular cancer screenings? These are all worthless? Preventative medicine has a long way

Uh, no. Hypertension is a silent killer. Mole checks? Colonoscopies? Testicular cancer screenings? These are all worthless? Preventative medicine has a long way to go, but it's currently the best it's ever been. Thank God I don't see any of these doctors.

tapland 3y ago
Those things are checked and screened for even in places where yearly checkups are unheard of.
- crazygringo 3y ago
  ...when? If you're otherwise healthy you're not visiting the doctor at all. So where are these checking and screenings happening for adults?
mbostleman 3y ago
According to the study cited, they concede that annual checkups result in more diagnosis, but not in a decrease in morbidity. What you consider worthwhile, or worthless, is up to you I guess.
- massysett 3y ago
  So to take this to an extreme, if the cohort that got checkups lived a healthy life until age 80, and the no-checkup cohort lived with diabetes and dialysis until 80, this study would say “checkups lead to no decrease in morbidity.” More relevant for the insurer (which might help explain why an insurer is urging checkups) living until 80 with diabetes and on dialysis is much more expensive than living healthily until 80.
  - apsec112 3y ago
    Morbidity is not mortality, it means "suffering from disease". The dictionary definition is "the condition of suffering from a disease or medical condition". So being on dialysis would not be "no decrease in morbidity", no.
  - 8note 3y ago
    Wouldn't the checkup crowd be on dialysis from age 60-80 while the no checkup crowd from 75-80?
- op00to 3y ago
  What about relative health while you’re still alive?
- thescriptkiddie 3y ago
  Isn't that a tautology? Of course knowing you have a disease doesn't prevent you from having the disease. The point is that knowing you have a disease allows you to treat the disease, which one would hope would reduce your chances of dying or becoming disabled.
  - pessimizer 3y ago
    > one would hope would reduce your chances of dying or becoming disabled. The point of the comment you're replying to is to explain that didn't happen.
- qgin 3y ago
  Maybe I'm missing something, but is this basically saying treating disease doesn't improve outcomes?
runtime_blues 3y ago
Generally, yes; for example, routine colonoscopies are not practiced in many developed countries, and it doesn't necessarily translate into any difference in overall health outcomes. One recent study is described here: https://www.cnn.com/2022/10/09/health/colonoscopy-cancer-death-study/index.html https://www.cnn.com/2022/10/09/health/colonoscopy-cancer-dea... . One explanation is that such cancers are slow-growing and tend to be discovered late in life, so treating them doesn't actually help much, and any benefits are offset by potential harms of the procedure itself, the risk of false positives, etc. Similarly, while hypertension is a problem, there is scant evidence that routine treatment of it is beneficial. The drugs have health risks: https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2774562 https://jamanetwork.com/journals/jamainternalmedicine/fullar... There is value in targeted screening and education, but annual checkups for otherwise healthy people aren't necessarily the way to do it. Not to mention, many of these checkups are perfunctory. A lot of the gains in life expectancy have little to do with advanced diagnostics and treatments. Sanitation, hygiene, antibiotics, and increased standards of living do a lot of the heavy lifting here. And when the needle moves in the other direction, the causes tend to be mundane too - e.g., opioid abuse in the US.
- haldujai 3y ago
  > Generally, yes; for example, routine colonoscopies are not practiced in many developed countries, and it doesn't necessarily translate into any difference in overall health outcomes. One recent study is described here: This overstates the impact of the Nordic study. If you go to the original article[0] you can see why, this study had very low participation and event rates which limits how strong of a conclusion we can draw from this as treatment effects may not be accurately reflected (for example in some countries the colonoscopy arm only had 32% participation). We also have historical studies looking at gFOBT and flexible sigmoidoscopy showing mortality benefits which can be extrapolated to colonoscopies. For a full picture of the evidence behind colon cancer screening I would suggest referring to the USPSTF which provides a publicly accessible summary and rationale[1]. With respect to developing countries, colorectal cancer (and living long enough to suffer its sequela) is mostly a developed country problem although this is changing. In recent years, we have been seeing a surprising rise in colorectal cancer rates occurring at younger ages presenting with advanced disease which has led to the USPTF lowering the recommendation for screening to 45 from 50. With this trend in mind and historical data, we would really need extremely strong evidence to make the claim that screening colonoscopies are ineffective which the Nordic study does not provide. > Similarly, while hypertension is a problem, there is scant evidence that routine treatment of it is beneficial. This is just boldly incorrect and a VERY dangerous statement to make. The article you link to is entirely irrelevant as it looks at acute hypertension which is a very different beast, this article is describing what we call permissive hypertension in medicine. We have known for several years now that we do not need to tightly control inpatient blood pressures (which are often temporarily increased due to stress/illness) and that doing so is harmful. This says nothing about the consequences of untreated chronic hypertension in the outpatient setting. For treatment (beyond the scope of USPSTF which does provide a grade A recommendation for hypertension screening) we can turn to the ACC[2] which also helpfully provides an evidence synthesis specifically drawing your attention to: "In a meta-analysis of 61 prospective studies, the risk of CVD increased in a log-linear fashion from SBP levels <115 mm Hg to >180 mm Hg and from DBP levels <75 mm Hg to >105 mm Hg. In that analysis, 20 mm Hg higher SBP and 10 mm Hg higher DBP were each associated with a doubling in the risk of death from stroke, heart disease, or other vascular disease." [0] https://www.nejm.org/doi/full/10.1056/NEJMoa2208375 https://www.nejm.org/doi/full/10.1056/NEJMoa2208375 [1] https://www.uspreventiveservicestaskforce.org/uspstf/document/RecommendationStatementFinal/colorectal-cancer-screening https://www.uspreventiveservicestaskforce.org/uspstf/documen... [2] https://www.ahajournals.org/doi/full/10.1161/HYP.0000000000000065#d1e2145 https://www.ahajournals.org/doi/full/10.1161/HYP.00000000000...
JCM9 3y ago
These are different and called “preventative screening” and usually not done at a physical. Your GP isn’t going to do a colonoscopy or do a skin check. The article is taking issue with the standard physical, which for heathy people is mostly a few questions to ask if you feel alright and some routine blood tests.
- lr4444lr 3y ago
  Let's not kid ourselves: Americans are terrible about looking out for their health. If an annual physical is what it takes for PCPs to effectively route people to the necessary screenings, so be it. That saves lives.
  - spondylosaurus 3y ago
    Under most insurance plans you also can't see a specialist unless your primary care doctor writes you a referral. If nothing else the Free Annual Checkup is a way to get a referral without incurring additional primary care copays. (If you have a PPO, that's not a problem, but you're paying higher premiums to compensate.)
    - lotsofpulp 3y ago
      See figure E, HMO and the old style plans are far in the minority in terms of population covered. https://files.kff.org/attachment/Summary-of-Findings-Employer-Health-Benefits-2022-Annual-Survey.pdf https://files.kff.org/attachment/Summary-of-Findings-Employe... I would bet most insureds in the US can see a specialist without seeing their primary care doctor (if they even have one).
- kiba 3y ago
  If that is what the annual is, then it's probably no wonder why they aren't helpful.
- deleted 3y ago
  [deleted]
- crazygringo 3y ago
spondylosaurus 3y ago
No joke, getting a colonoscopy was the best decision I've made all year. I'm incredibly grateful that my doctor twisted my arm into getting one even though I'm under 40 and wasn't thrilled about the whole prep situation. (It was IBD, not cancer, but regardless. One of those things you'd rather catch before it lands you in the hospital.)
- zouhair 3y ago
  That's different from an annual checkup.
  - simfree 3y ago
    Regular checkups give your doctor the opportunity to encourage you to seek relevant services (like OPs doctor did).
    - spondylosaurus 3y ago
      Yep. I will say that the doctor's visit that spurred the colonoscopy talk wasn't an annual checkup, per se, but it was almost as benign—initially went in to complain about a hemorrhoid and mild tummy problems, walked away several weeks later with a pretty serious (but treatable) diagnosis.
- deleted 3y ago
  [deleted]
apsec112 3y ago
Here's a review of annual physicals by Cochrane Collaboration, where they looked at 15 studies involving 250,000 people and found no effect: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6353639/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6353639/

tapland 3y ago

Those things are checked and screened for even in places where yearly checkups are unheard of.

crazygringo 3y ago
...when? If you're otherwise healthy you're not visiting the doctor at all. So where are these checking and screenings happening for adults?

mbostleman 3y ago

According to the study cited, they concede that annual checkups result in more diagnosis, but not in a decrease in morbidity. What you consider worthwhile, or worthless, is up to you I guess.

massysett 3y ago
So to take this to an extreme, if the cohort that got checkups lived a healthy life until age 80, and the no-checkup cohort lived with diabetes and dialysis until 80, this study would say “checkups lead to no decrease in morbidity.” More relevant for the insurer (which might help explain why an insurer is urging checkups) living until 80 with diabetes and on dialysis is much more expensive than living healthily until 80.
- apsec112 3y ago
  Morbidity is not mortality, it means "suffering from disease". The dictionary definition is "the condition of suffering from a disease or medical condition". So being on dialysis would not be "no decrease in morbidity", no.
- 8note 3y ago
  Wouldn't the checkup crowd be on dialysis from age 60-80 while the no checkup crowd from 75-80?
op00to 3y ago
What about relative health while you’re still alive?
thescriptkiddie 3y ago
Isn't that a tautology? Of course knowing you have a disease doesn't prevent you from having the disease. The point is that knowing you have a disease allows you to treat the disease, which one would hope would reduce your chances of dying or becoming disabled.
- pessimizer 3y ago
  > one would hope would reduce your chances of dying or becoming disabled. The point of the comment you're replying to is to explain that didn't happen.
qgin 3y ago
Maybe I'm missing something, but is this basically saying treating disease doesn't improve outcomes?

runtime_blues 3y ago

Generally, yes; for example, routine colonoscopies are not practiced in many developed countries, and it doesn't necessarily translate into any difference in overall health outcomes. One recent study is described here: https://www.cnn.com/2022/10/09/health/colonoscopy-cancer-death-study/index.html https://www.cnn.com/2022/10/09/health/colonoscopy-cancer-dea... . One explanation is that such cancers are slow-growing and tend to be discovered late in life, so treating them doesn't actually help much, and any benefits are offset by potential harms of the procedure itself, the risk of false positives, etc. Similarly, while hypertension is a problem, there is scant evidence that routine treatment of it is beneficial. The drugs have health risks: https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2774562 https://jamanetwork.com/journals/jamainternalmedicine/fullar... There is value in targeted screening and education, but annual checkups for otherwise healthy people aren't necessarily the way to do it. Not to mention, many of these checkups are perfunctory. A lot of the gains in life expectancy have little to do with advanced diagnostics and treatments. Sanitation, hygiene, antibiotics, and increased standards of living do a lot of the heavy lifting here. And when the needle moves in the other direction, the causes tend to be mundane too - e.g., opioid abuse in the US.

haldujai 3y ago
> Generally, yes; for example, routine colonoscopies are not practiced in many developed countries, and it doesn't necessarily translate into any difference in overall health outcomes. One recent study is described here: This overstates the impact of the Nordic study. If you go to the original article[0] you can see why, this study had very low participation and event rates which limits how strong of a conclusion we can draw from this as treatment effects may not be accurately reflected (for example in some countries the colonoscopy arm only had 32% participation). We also have historical studies looking at gFOBT and flexible sigmoidoscopy showing mortality benefits which can be extrapolated to colonoscopies. For a full picture of the evidence behind colon cancer screening I would suggest referring to the USPSTF which provides a publicly accessible summary and rationale[1]. With respect to developing countries, colorectal cancer (and living long enough to suffer its sequela) is mostly a developed country problem although this is changing. In recent years, we have been seeing a surprising rise in colorectal cancer rates occurring at younger ages presenting with advanced disease which has led to the USPTF lowering the recommendation for screening to 45 from 50. With this trend in mind and historical data, we would really need extremely strong evidence to make the claim that screening colonoscopies are ineffective which the Nordic study does not provide. > Similarly, while hypertension is a problem, there is scant evidence that routine treatment of it is beneficial. This is just boldly incorrect and a VERY dangerous statement to make. The article you link to is entirely irrelevant as it looks at acute hypertension which is a very different beast, this article is describing what we call permissive hypertension in medicine. We have known for several years now that we do not need to tightly control inpatient blood pressures (which are often temporarily increased due to stress/illness) and that doing so is harmful. This says nothing about the consequences of untreated chronic hypertension in the outpatient setting. For treatment (beyond the scope of USPSTF which does provide a grade A recommendation for hypertension screening) we can turn to the ACC[2] which also helpfully provides an evidence synthesis specifically drawing your attention to: "In a meta-analysis of 61 prospective studies, the risk of CVD increased in a log-linear fashion from SBP levels <115 mm Hg to >180 mm Hg and from DBP levels <75 mm Hg to >105 mm Hg. In that analysis, 20 mm Hg higher SBP and 10 mm Hg higher DBP were each associated with a doubling in the risk of death from stroke, heart disease, or other vascular disease." [0] https://www.nejm.org/doi/full/10.1056/NEJMoa2208375 https://www.nejm.org/doi/full/10.1056/NEJMoa2208375 [1] https://www.uspreventiveservicestaskforce.org/uspstf/document/RecommendationStatementFinal/colorectal-cancer-screening https://www.uspreventiveservicestaskforce.org/uspstf/documen... [2] https://www.ahajournals.org/doi/full/10.1161/HYP.0000000000000065#d1e2145 https://www.ahajournals.org/doi/full/10.1161/HYP.00000000000...

JCM9 3y ago

These are different and called “preventative screening” and usually not done at a physical. Your GP isn’t going to do a colonoscopy or do a skin check. The article is taking issue with the standard physical, which for heathy people is mostly a few questions to ask if you feel alright and some routine blood tests.

lr4444lr 3y ago
Let's not kid ourselves: Americans are terrible about looking out for their health. If an annual physical is what it takes for PCPs to effectively route people to the necessary screenings, so be it. That saves lives.
- spondylosaurus 3y ago
  Under most insurance plans you also can't see a specialist unless your primary care doctor writes you a referral. If nothing else the Free Annual Checkup is a way to get a referral without incurring additional primary care copays. (If you have a PPO, that's not a problem, but you're paying higher premiums to compensate.)
  - lotsofpulp 3y ago
    See figure E, HMO and the old style plans are far in the minority in terms of population covered. https://files.kff.org/attachment/Summary-of-Findings-Employer-Health-Benefits-2022-Annual-Survey.pdf https://files.kff.org/attachment/Summary-of-Findings-Employe... I would bet most insureds in the US can see a specialist without seeing their primary care doctor (if they even have one).
kiba 3y ago
If that is what the annual is, then it's probably no wonder why they aren't helpful.
deleted 3y ago
[deleted]
crazygringo 3y ago

spondylosaurus 3y ago

No joke, getting a colonoscopy was the best decision I've made all year. I'm incredibly grateful that my doctor twisted my arm into getting one even though I'm under 40 and wasn't thrilled about the whole prep situation. (It was IBD, not cancer, but regardless. One of those things you'd rather catch before it lands you in the hospital.)

zouhair 3y ago
That's different from an annual checkup.
- simfree 3y ago
  Regular checkups give your doctor the opportunity to encourage you to seek relevant services (like OPs doctor did).
  - spondylosaurus 3y ago
    Yep. I will say that the doctor's visit that spurred the colonoscopy talk wasn't an annual checkup, per se, but it was almost as benign—initially went in to complain about a hemorrhoid and mild tummy problems, walked away several weeks later with a pretty serious (but treatable) diagnosis.
deleted 3y ago
[deleted]

apsec112 3y ago

Here's a review of annual physicals by Cochrane Collaboration, where they looked at 15 studies involving 250,000 people and found no effect: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6353639/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6353639/