Annual Physicals May Do More Harm Than Good
By Dr. Mercola
America spends more per capita on health care than any other
developed nation, yet Americans are among the sickest citizens of the
developed world, ranking only 50th worldwide for life expectancy.
Americans also rank near the bottom for everything from infant mortality to obesity, heart disease, and disability.1 A growing number of studies suggest that part of the problem is actually excessive medical intervention.
Americans are receiving — and paying for — an enormous amount of unnecessary and/or ineffective medical tests and treatments.
According to a report by the Institute of Medicine, approximately 30
percent of all medical procedures, tests, and medications may be
unnecessary, at a cost of more than $750 billion a year.2
The worst part is that this overtreatment is making Americans sicker
rather than healthier. While most people have trouble believing it,
there's actually an inverse relationship between money spent on health care and wellness in the US.
Annual Physicals May Do More Harm Than Good, New Study Suggests
While studies have highlighted a wide variety of unnecessary treatments,
one of the most recent investigations suggests even annual physicals
may do more harm than good.
The annual physical is the number one reason for doctor's visits, and
each year one-third of Americans file into their doctor's office for
routine weighing, measuring, and more often than not, some sort of
medical testing.
The cost of annual physicals and the tests performed amount to about $10 billion each year.3 But are Americans getting enough of a return on this massive investment? As reported by CNN:4
"'This specialized visit hasn't proven anything in terms of staying
healthful,' says Dr. Ateev Mehrotra, an associate professor of health
care policy and medicine at Harvard Medical School.
Mehrotra co-wrote an editorial5 in the most recent edition of the New England Journal of Medicine
calling the physical outdated. He points out that physicals for healthy
individuals can result in a battery of unnecessary tests and visits
that aren't effective in preventing disease.
Instead of using the time for unnecessary processes and exams,
Mehrotra argues the same amount of time and money could be better spent
targeting patients who are sick and need care. He says physicals 'make
sense in theory, but it hasn't borne out in reality.'"
According to Dr. Mehrotra, the annual physical should be reserved for a
smaller subset of the population who stand to benefit the most.
As noted in Time magazine,6
previous studies in which people have been randomly assigned to get an
annual physical or not have found there is no significant difference in
health between the two groups.
One such study, featured in the following news clip, was published in
2012. At that time, few were receptive to the idea that the annual
physical might not promote health among the general population.
To Put Patients First, System-Wide Changes Are Needed
Still today, the controversy over whether or not annual physicals are
needed continues. Not everyone agrees with Dr. Mehrotra's conclusions.
Others have countered saying the annual physical is a good way to build a
relationship with your primary doctor.
Dr. Allan Goroll, professor of Medicine at Harvard Medical School, wrote an editorial7
in favor of the annual physical, saying the problem is not the physical
itself; it's that doctors don't have time to provide truly personalized
care based on health history and individual circumstances.
Dr. Goroll suggests this could be addressed by letting registered nurses
and physician assistants handle testing, freeing up primary doctors to
focus on building relationships with patients, and providing
individualized patient care.
He also argues for changing the way doctors are paid, proposing
replacing the traditional fee for service with a payment schedule that
takes into account patient outcomes.
Blood Tests I Advise Performing Annually
While the evidence is fairly clear that there is minimal benefit to
annual exams, I do strongly believe that certain annual tests can be
enormously helpful at detecting early disease. As a general rule, I
recommend getting the following six tests done on an annual basis.
Blood pressure. Ideally,
your blood pressure should be about 120/80 without medication. If
you're over 60, your systolic pressure is the most important
cardiovascular risk factor.
If you're under 60 and have no other major risk factors for cardiovascular disease, your diastolic pressure is believed to be a more important risk factor. | Weight- and waist-to-hip ratio, which can be a powerful indicator of insulin sensitivity and your risk for diabetes and heart disease |
Vitamin D. Optimizing your vitamin D is one of the easiest and least expensive things you can do for your health.
But, the only way to determine your optimal dose is to get your blood tested.
Ideally you'll want to maintain a vitamin D serum level of 50 to 70 ng/ml year-round. |
Fasting lipid panel, which includes total
cholesterol, LDL, HDL, and triglycerides. The key here is to focus on
the ratio between these lipids, not the individual measurements in
isolation.
To learn more, see "7 Factors to Consider if You're Told Your Cholesterol Is Too High." An NMR Lipoprofile can also provide a more accurate risk assessment. |
Fasting insulin and glucose. Your fasting insulin level reflects how healthy your blood glucose levels are over time.
A normal fasting blood insulin level is below 5, but ideally you'll want it below 3.
A fasting glucose level below 100 mg/dl suggests you're not insulin
resistant, while a level between 100 and 125 confirms you have
pre-diabetes.
Studies have shown that people with a fasting blood sugar level
of 100 to 125 mg/dl had a nearly 300 percent increase higher risk of
having coronary heart disease than people with a level below 79 mg/dl. |
Serum ferritin. While many are iron deficient, which can lead to problems, having too much iron is just as common, and may be even more dangerous.
Iron is potent oxidative stress, so excess amounts can increase your risk of heart disease.
Ideally, monitor your ferritin levels and make sure they are in the 60 to 80 ng/ml range.
To lower your iron level, either donate blood or get therapeutic phlebotomy. |
Seven Most Overused and Unnecessary Procedures
The American Academy of Family Physicians' (AAFP) Choosing Wisely
campaign has identified 15 routine procedures that appear to have little
value, and in many cases do more harm than good.8
According to the AAFP, you may want to consider the following
recommendations before agreeing to any of these 15 procedures, seven of
which I've included in the list below. For the remainder, please review
the AAFP's Choosing Wisely website.9
I also recently interviewed Dr. David Lewis on the dangers of routine
flexible sigmoidoscopies and colonoscopies, which are typically
recommended for those over the age of 60. Shockingly, Dr. Lewis reveals
that the scopes are rarely properly disinfected between patients and are
typically contaminated. The only way to avoid this is to make sure the
scope has been disinfected with buffered peracetic acid.
Sadly almost all scopes are currently cleaned with glutaraldehyde which
does not thoroughly disinfect the scope. I will post that interview
sometime in the near future that goes into more detail, but he also
discusses it in his new book Science for Sale.
| Dual energy X-ray absorptiometry (DEXA) screening for osteoporosis |
Avoid DEXA screening for osteoporosis in women younger than 65, or
men younger than 70 with no risk factors. It's not a cost effective form
of screening for young, low-risk patients. |
| Annual EKGs |
Annual EKGs or other cardiac screenings are not recommended for low-risk patients who are symptom-free. |
| PAP smears |
Women younger than 21 or those who have had a hysterectomy for non-cancer disease do not need an annual PAP smear. |
| Carotid artery stenosis |
Don't screen for carotid artery stenosis in asymptomatic patients.
Screenings can lead to unnecessary surgeries that could result in harms
that outweigh the benefits. |
| Cervical cancer screening |
Women under 30 should not be screened for cervical cancer with HPV
testing, alone or in combination with cytology, as this can lead to more
invasive testing and procedures. Also, don't screen women older than 65
years of age for cervical cancer who have had adequate prior screening
and are not otherwise at high risk for cervical cancer. There's little
evidence of benefit for screening after 65. |
| Elective induction of labor, and Cesarean deliveries |
Avoid elective, non-medically indicated inductions of labor between
39 and 41 weeks, unless the cervix is deemed favorable. Also avoid
elective, non-medically indicated inductions of labor or Cesarean
deliveries before 39 weeks. |
| Pelvic exam to prescribe oral contraceptives |
A pelvic exam or other physical exam is unnecessary when prescribing oral contraceptives. |
Prostate Cancer Screenings Are Essentially Meaningless
The AAFP also recommends avoiding routine screening for prostate cancer
using a prostate-specific antigen (PSA) test or digital rectal exam, as
it tends to result in over-diagnosis of prostate tumors, many of which
are benign and do not require treatment. The US spends $10 billion per
year treating prostate cancer, but studies suggest the 30 million men
who get screened annually for prostate cancer are actually put at risk
due to the ridiculously high numbers of false positives.
More than half of older men have pathologic evidence of prostate cancer.
Therefore, PSA screening makes little sense, which explains why it's
shown to have barely any impact on mortality rates. According to
Stanford University researchers, the PSA test indicates nothing more
than the size of your prostate gland, and according to Dr. Gilbert
Welch, professor at Dartmouth Medical School, "Prostate cancer screening is the poster child for overdiagnosis."
A great deal of harm results from unnecessary prostate treatments after false positive PSA tests. Estimates are that 15 prostates must be removed in order to prevent just one prostate cancer death, and these surgical procedures carry serious side effects including impotence and incontinence.
There are presently no good comparative studies to indicate which
treatments produce the best outcomes, so a physician's own personal
preference and habits are what typically dictate his recommendations,
rather than science. But, you can be proactive and make sure your
vitamin D level is between 40 and 60 ng/ml to prevent any prostate
pathology.
Do You Need an Annual Pelvic Exam?
In 2014, the American College of Physicians (ACP) issued new
recommendations urging internists to stop doing routine pelvic exams on
non-pregnant women unless they present symptoms that may indicate a
problem. As reported by The Washington Post:10
"Citing 60 years of research, the ACP found no evidence that the
screening, performed about 63 million times annually at a cost of
approximately $2.6 billion, detects cancer or other serious conditions.
The exam, researchers reported, did cause harm: One-third of women
reported discomfort, pain, embarrassment, or anxiety — leading some to
avoid care altogether. For roughly one percent of women, a suspicious
finding triggered a cascade of anxiety-provoking interventions —
including tests and surgery, which carry a risk of complications for
conditions that nearly always turned out to be benign."
The US Preventive Services Task Force is now reviewing the evidence and
is expected to make a recommendation sometime in the coming months.
While annual pelvic exams are currently covered under the Affordable
Care Act, the recommendations of the task force govern what procedures
are covered without a co-pay. Should they reach the same conclusion as
the ACP, the number of routine pelvic exams may drop anyway, as a result
of not being covered in the yearly "well woman" visit.
According to George Sawaya, a professor of Obstetrics, Gynecology, and
Reproductive Sciences and Epidemiology and Biostatistics at the San
Francisco School of Medicine, the annual pelvic exam is "more of a
ritual than an evidence-based practice."
A study11
he co-authored in 2013 found that while gynecologists tend to believe
it's an effective way to screen for ovarian cancer, this is not true. In
fact, no effective ovarian cancer screening method currently exists...
The study also concluded that many doctors perform it simply because
patients expect it, and because they want to ensure they're adequately
compensated for the visit.
Studies Refute the Value of Mammograms
Thirty-nine million American women get mammograms each year. Over their
lifetimes, 1 in 8 women will receive a breast cancer diagnosis, but FOUR
of the eight will have at least one false positive within a decade.
Unfortunately, working up false positives means many women die
unnecessarily. Treatments such as chemotherapy and surgery are risky.
Many die not from the cancer itself but from the treatment, and if a
woman doesn't actually have malignant cancer to begin with, dying from the toxic treatment is doubly tragic.
While some women benefit, most studies show that the rate at which mammography actually saves lives is extremely low — and routine screenings can have harmful consequences.
Not only are you exposed to ionizing radiation, which can raise your
chances of developing breast cancer in the future, but when you get a
false positive, you're typically steered toward a series of unnecessary
medical interventions that may result in physical and psychological
suffering, financial strain, and even cancer. The evidence is clear;
nearly all women should avoid mammograms, as they cause more harm than
good.
False positives can result in the loss of a breast or even death, in
rare cases. A cancer diagnosis may also interfere with your eligibility
for medical insurance. A growing number of studies now refute the
validity of mammography as a primary tool against breast cancer. One of the most recent, published in JAMA Internal Medicine12,13
on July 6, 2015, confirmed previous findings showing mammography
screenings lead to unnecessary treatments while having virtually no
impact on the number of deaths from breast cancer.
Previous research14 has shown that for every life saved by mammography screening, three women
will be overdiagnosed and treated with surgery, radiation, or
chemotherapy for a cancer that might never have given them trouble in
their lifetimes. Another recent study15,16,17 published in the Journal of the Royal Society of Medicine declares its conclusion right in the title, which reads: "Mammography screening is harmful and should be abandoned."
In short, decades of routine breast cancer screening using mammograms
has done nothing to decrease deaths from breast cancer, while causing more than half
(52 percent) of all women undergoing the test to be overdiagnosed and
overtreated. According to lead author Peter C. Gøtzsche, had mammograms
been a drug, " it would have been withdrawn from the market long ago."
Updated Mammography Recommendations by the American Cancer Society
Even the American Cancer Society (ACS), which has a long history of
supporting mammograms, recently revised its recommendations for women
with an average risk for breast cancer. The new recommendations are as
follows:18
- Women ages 40 to 44 should have the choice to start
annual breast cancer screening with mammograms if they wish to do so.
The risks of screening as well as the potential benefits should be
considered.
- Women age 45 to 54 should get mammograms every year.
- Women age 55 and older should switch to mammograms
every 2 years, or have the choice to continue yearly screening.
Screening should continue as long as a woman is in good health and is
expected to live 10 more years or longer.
- All women should be familiar with the known
benefits, limitations, and potential harms associated with breast cancer
screening. They should also be familiar with how their breasts normally
look, and feel and report any changes to a health care provider right
away.
Earlier this year the US Preventive Services Task Force also cut down
on the recommended amount of mammograms women should get. Their draft
recommendations for breast cancer screening now suggest:
- Biennial mammography screening for women ages 50 to 74 who are at average risk of breast cancer
- Women who place a higher value on the potential benefit than harms
of screening, may choose biennial screening between ages 40 to 49
I was actually contacted by Chicago Tonight for an interview to
discuss the new ACS guidelines on mammograms, in conjunction with the US
Preventive Task Force's recommendations, and to share preventive steps
women can take to lower their risks for breast cancer. The program aired
October 26th.19 and the the interview is online.
Avoiding Unnecessary Medical Care May Prolong Your Life...
One of the reasons I'm so passionate about sharing information about
healthy eating, exercise, and other healthy lifestyle strategies is
because it can help keep you stay out of the conventional medical loop,
which has a tendency to lead to unnecessary tests, treatments, cost, and
suffering. Keeping yourself healthy by making wise lifestyle choices is
the best way to reduce your need for medical care in the first place.
Of all the healthy lifestyle strategies I know of that can have a
significant impact on your health, normalizing your insulin and leptin
levels is probably the most important. There is no question that this is
an absolute necessity if you want to avoid disease and slow down your
aging process. That means modifying your diet to avoid excessive amounts
of fructose, grains, and other pro-inflammatory ingredients like trans
fats. You can get up to speed on how to optimize your diet by reviewing
my comprehensive Nutrition Plan. Other strategies can help you stay healthy include (but is not limited to) the following:
- Optimize your Vitamin D levels to between 50 and 70 ng/ml.
- Eat REAL food. Over 90 percent of the calories
Americans eat come from processed foods. The single biggest change you
can make to improve your health is change this immediately. Avoid all
processed foods and severely limit restaurant foods. Either you, your
spouse, or someone you know well, needs to invest some time in the
kitchen and prepare your meals from whole foods.
- Get plenty of high quality animal based omega-3 fats – Correcting the ratio of omega-3
to healthful omega-6 fats is a strong factor in helping people live
longer. This typically means increasing your intake of animal based
omega-3 fats, such as krill oil, while decreasing your intake of damaged
omega-6 fats (think processed vegetable oils and trans fats).
- Avoid as many chemicals, toxins, and pollutants as possible
– This includes tossing out your toxic household cleaners, soaps,
personal hygiene products, air fresheners, bug sprays, lawn pesticides,
and insecticides, just to name a few, and replacing them with non-toxic
alternatives.
- Avoid prescription drugs – Pharmaceutical drugs
kill thousands of people prematurely every year – as an expected side
effect of the action of the drug. And, if you adhere to a healthy
lifestyle, you most likely will never need any of them in the first
place.
- Learn how to effectively cope with stress – Stress
has a direct impact on inflammation, which in turn underlies many of the
chronic diseases that kill people prematurely every day, so developing
effective coping mechanisms is a major longevity-promoting factor.
Meditation, prayer, physical activity, and exercise are all viable
options that can help you maintain emotional and mental equilibrium. I
also strongly believe in using energy psychology tools such as the Emotional Freedom Techniques (EFT) to address deeper, oftentimes hidden emotional problems.
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