Coleman’s 4th Law of Medicine: Health Screening and Check-ups Do More Harm than Good
Dr Vernon Coleman
My fourth law of medicine is that screening examinations and check-ups are more profitable for doctors than for patients – and do more harm than good.
I have been a stern critic of screening examinations and check-ups for several decades and have, in the distant past, pointed out that well-known (and extremely profitable) forms of testing such as the cervical smear, the mammogram and the prostate specific antigen (psa) test for prostate cancer may, over the years, have done considerably more harm than good.
Naturally, my criticisms have been met with a barrage of angry and very defensive comments from doctors who earn their living providing screening tests, and from companies which make money out of producing screening equipment. Today, the industry promoting health checks continues to promote (and profit from) them though, I am pleased to say, that a growing number of doctors now share my fear that such tests may, in the long run, do far more harm than good.
As long ago as 2004, a study by experts at Stanford University Medical School in the USA suggested that the psa test could not be relied upon to produce accurate results. And in recent years more and more doctors have come to accept that routine mammograms (in which the breast tissue is X-rayed) are far too dangerous and should be avoided.
It was in 1988 that I first warned about the danger of mammograms. My criticism was, of course, greeted with howls of outrage from the medical establishment. Back then I wrote: ‘There are, of course, risks in having regular X-ray examinations. No one knows yet exactly what those risks are. We will probably find out in another ten or twenty years’ time.’
In fact it was in 2006 that doctors finally issued a warning about mammograms, coming to precisely the conclusion I had warned about eighteen years earlier. Mammographic screening may help prevent breast cancer. But it may also cause breast cancer. Just how many women die because of the radiation they have received through mammography isn’t known but it seems that the risks for younger women (women in their 30’s for example) are higher than the risks for older women. (Radiation-induced cancer typically takes up to 20 years to develop, so for a woman in her 80’s the risks of mammography are probably somewhere between slight and negligible.) According to some estimates, out of every 10,000 women who have mammograms from the age of 40 onwards between two and four will develop radiation-induced breast cancer. One of them will die as a result of this. The precise figures are unknown and depend upon the quality and amount of the radiation, the skill of the technician and other factors — probably including the general health of the woman concerned.
Patients are frequently invited to their doctor’s surgery for a screening test or a health check. Don’t make the mistake of thinking that your doctor suddenly cares for you. In Britain, family doctors are paid huge bonuses if they perform routine health checks on their elderly patients.
The principle of screening is a simple one: the patient trots along to the doctor and the doctor (for a chunky, great fee, of course) does tests which are designed to spot early signs of disease. The tests which are offered are done because the medical establishment has managed to convince NHS bureaucrats that screening is worth paying for.
Doctors are enthusiastic about screening because it’s enormously profitable. And they’re very lukewarm about encouraging their patients to follow healthier lifestyles because there is no money in it.
For decades now, just about every attempt to show that medical screening programmes save lives has proved that they are a waste of time, energy and money. Indeed, surveys have proved that, because of the risk of false positives, medical screening programmes do far more harm than good.
Medical screening programmes go back a long way.
The first recorded screening took place at a public brothel in Avignon in 1347 when a local Abbess and a surgeon examined all the working women every Saturday to see whether or not they were fit to carry on serving the local population.
Then, in 1917 large corporations in the U.S. thought it might be a good idea to have their employees examined regularly. When half of four million American men called up for military service during the First World War proved to be unfit for military service, insurance companies started screening the general population.
Since then, the medical screening business has grown virtually unchecked and those promoting screening (or health checks) merrily ignore the inconvenient fact that since the 1970s there has been ample evidence to show that medical screening programmes are not just a waste of time and money but can also be a serious health hazard.
Back in 1979, the World Health Organisation published a report which showed that people who were subjected to regular medical screenings needed to go to hospital more often but were not as healthy as people who did not undergo regular medical screenings. The conclusion was that health screening is expensive and ineffective.
In the same year, the results of a Canadian Task Force report on Periodic Health Examination came to the conclusion that annual medical check-ups should be abandoned since they were both inefficient and potentially harmful.
Health checks are harmful for many reasons.
First, when people are taught to put their faith in medical check-ups they tend to abandon responsibility for their own health and enjoy a false sense of security. Patients forget that a medical check-up is no more a sign of long-term health than an encouraging bank statement is a sign of permanent financial security. A patient who is given a clean bill of health is likely to ignore strange symptoms which develop a week or two later. And there is a danger that he (or she) may feel that it is unnecessary to eat wisely or to take regular exercise.
Second, screening examinations may frighten people. They can result in cancer phobias, neuroses and depression. And they can result in so much stress that the immune system is damaged – leading to a greater susceptibility to disease.
Third, the procedures involved in screening programmes may do physical harm. There are, for example, some doctors who perform coronary angiographs as part of their check-up procedures. As many as two patients per 100 may die during this procedure.
Fourth, when a screening examination results in a false positive the patient may be given a treatment which may damage his or health. A major Swedish report on breast screening (a type of screening which has been shown to be particularly useless and dangerous but enormously profitable) showed that out of 600,000 women screened, there had been 100,000 false positives. This means that 100,000 healthy women were told that they had breast cancer when they didn’t have anything wrong with them. They were terrified and treated unnecessarily.
Fifth, screening is expensive.
Sixth it is a proven fact that screening doesn’t work. It is dangerous and does far more harm than good.
Every independent survey I have found has concluded that screening (whether general or specific) is costly and useless. The reality is that the only people who benefit from screening programmes are doctors – and other parts of the health industry. Screening programmes are extremely profitable.
The problems, and hazards, with screening programmes seem boundless. For example, you have a one in three chance of a false positive result if you have a full body CT scan. There is also a one in 20 chance that the scan will miss signs of disease – and give you a false sense of complacency and encourage you to ignore important physical signs.
I’ve been screaming about the dangers of screening programmes for 50 years and was delighted when, in November 2009, the American Cancer Society finally accepted that screening for breast and prostate cancer is inefficient, inaccurate and alarmist and can do damage by detecting cancers that either don’t exist or wouldn’t kill if they did.
Naturally, however, such programmes are still promoted within the NHS where staff favour screening programmes because it is easy to measure the results. They can say: ‘We screened 10,000 people and found 10 people with possible cancer. We, have, therefore, saved 10 lives.’ In medical and statistical terms, such claims are nonsensical. But in political terms they are invaluable.
Offering sensible advice is much cheaper and safer but the results cannot be measured and it is difficult for doctors or health authorities to claim the credit for saving lives.
Copyright Vernon Coleman July 2021
Vernon Coleman’s book `Coleman’s Laws: The Twelve Medical Truths You Must Know to Survive’ is available as a paperback and an eBook on Amazon.