Annual Physicals May Do More Harm Than Good

November 04, 2015 |

WoBy 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 aninverse 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Mehrotra co-wrote an editorial5 in the most recent edition of the New England Journal of Medicine calling the physical outdated.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, yourdiastolic 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 areiron 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, soexcess 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, andCesarean 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.