– Or just: ‘Never trust a crocodile’s smile’.
This week, in bmj Editor’s Choice, First do no Harm, editor Fiona Godlee includes a link to a piece about the UK government’s announcement that all adults aged 40-75 are to be offered regular free health checks. ‘On the face of it this sounds like a good and generous plan’ she says, but points to the article by Felicity Goodyear-Smith who asks ‘do benefits outweigh harms, do false negatives lead to inappropriate reassurance, or do false positives lead to over-investigation and over-intervention?’ (doi:10.1136/bmj.f4788. http://www.bmj.com/content/347/bmj.f4788).
Fiona Godlee also flags up an article by Ray Moynihan, part of the bmj series on overdiagnosis, in which he, along with colleagues, explain that although large numbers of people (14% of all adults) are now labelled as having chronic kidney disease, ‘the low rate of total kidney failure suggests that many of those diagnosed will never develop symptoms’. Similarly, many women diagnosed and treated for breast cancer would never have developed symptoms. (doi:10.1136/bmj.f4298. http://www.bmj.com/content/347/bmj.f4298). The authors suggest a need for ‘clinical scepticism’ about the current definition of chronic kidney disease
and ‘caution in labelling patients, especially older people’.
We certainly have enough recent research showing the harms of breast cancer screening and researched harms of other interventions are detailed in GP, Dr Margaret McCartney’s eye-opening book, ‘The Patient Paradox – why sexed-up medicine is bad for your health’. People want to trust their doctors and most will probably see only benefit from these free health checks, when the reverse is likely to be true. Why don’t more doctors speak out about these interventions – even if they do bring them more money? (See my previous post). In the case of medical interventions, ‘free’ is not likely to mean ‘without cost’.