The fallacy of the routine medical check-up: part 2

Central to our belief in the “check up” is the idea that early detection must be good. The strength of construct validity of this idea has overwhelmed evidence to the contrary.

Perhaps science fiction is to blame: Doc McCoy’s pocket scanner certainly reflected that widespread belief that only if we could see inside the human body then we could pick up diseases early enough to “nip them in the bud”.

Maybe its deeper in our psyche.  The early bird gets the first worm. Nip it in the bud. 

Different cultures have the same concept. In this country, Maori (indigenous Polynesians) have a proverb which says “The first come to eat food, those who are behind swallow spittle.”

The problem is that the research on the routine medical check up usually does not focus on true outcomes, because it is too remote from this although for specific realms of medicine there are intermediate benefits e.g. cardiovascular and diabetes. However as for listening to the health y heart, palpating the asymptomatic abdomen, or inspection of the unsymptomatic urine, then the data is either lacking or unsupporting.

Microscopic haematuria is a classic. No use as a screening tool in fact probably downright dangerous for the high probability of a positive result is matched only by the high probability of an unhelpful or incurable finding following invasive investigation. And as for prostate screening, well the Americans found it didn’t save lives and the Europeans found it did but at a very significant cost in terms of adverse patient outcomes.

But we still do it and the tea leaves suggest this will not change.

That’s medicine.