Government defends NHS health checks for people aged 40-74 but promises evaluationBMJ 2015; 350 doi: https://doi.org/10.1136/bmj.h581 (Published 02 February 2015) Cite this as: BMJ 2015;350:h581
All rapid responses
News that the “Government defends NHS health checks for people aged 40-74 but promises evaluation” deserves more attention.(1) General health checks have already been evaluated: They do not reduce morbidity or mortality - neither overall nor for cardiovascular or cancer causes(2,3); The recently published results of the nearest equivalent to the UK health check showed no impact whatsoever on the primary endpoint of ischaemic heart disease, nor on the secondary outcomes of stroke and total mortality at 10 years.(4)
It is not as if the government was not warned. In January 2008, the then prime minister, Gordon Brown, announced “everyone in England will have access to the right preventative health check-up”. John Ashton, president of the Faculty of Public Health, stated “We are not convinced about the evidence base. There is a danger of medicalising social inequalities—in many ways health checks could be seen as playing into the pharmaceutical agenda. We should be focusing on disadvantaged communities—not finding more worried well.”(5) History has shown that health professionals’ good intentions and ‘common sense’ have killed many in the name of prevention before (e.g. the recommendation of prone sleeping position for infants (6), use of anti-arrhythmias (7) and multi-vaccines in Africa (8,9)). Thus, good-willed people should always demand and choose evidence rather than succumb to delusion (a belief held with strong conviction despite superior evidence to the contrary).
Sadly, the latest government response to the Science and Technology Committee (whose MPs recognized health checks as a screening programme) continues to fly in the face of evidence.(10) The claim that health checks are not screening is ludicrous, and would be laughable were so much money (£6bn over a decade), and people’s wellbeing not at stake. Theoretical literature on the purported distinction between screening and a ‘risk assessment and risk management’ programme has not been supplied despite repeated requests to those implementing the programme locally and nationally (Bewley S, personal communication). Medically qualified officials working for the government who are required to provide health checks by legal mandate must be uncomfortable invoking this pseudo-science for support. Our concerns are not only for their cognitive dissonance but for those frontline NHS health care professionals who are forced to engage in the endeavour. We used to prioritize the sick over the well, and doing good over pointless activity. The willingness to invest one’s effort, sense of significance, enthusiasm and pride are all below average within the NHS employees.(11) Is this surprising?
1 O'Dowd A. Government defends NHS health checks for people aged 40-74 but promises evaluation. BMJ 2015;350:h581.
2 Krogsbøll LT, Jørgensen KJ, Grønhøj Larsen C, Gøtzsche PC. General health checks in adults for reducing morbidity and mortality from disease: Cochrane systematic review and meta-analysis. BMJ. 2012;345:e7191.
3 Saquib N, Saquib J, Ioannidis JP. Does screening for disease save lives in asymptomatic adults? Systematic review of meta-analyses and randomized trials. Int J Epidemiol 2015. Online Jan 15. doi: 10.1093/ije/dyu140
4. Jørgensen T, Jacobsen RK, Toft U, Aadahl M, Glümer C, Pisinger C. Effect of screening and lifestyle counselling on incidence of ischaemic heart disease in general population: Inter99 randomised trial. BMJ 2014; 348 doi: http://dx.doi.org/10.1136/bmj.g3617
5. McCartney M. Where’s the evidence for NHS health checks? BMJ 2013;347:f5834.
6. Trier H, Helweg-larsen K, Coolidge J, Iversen L, Keiding LM. [Significance of sleeping position on the occurrence of sudden, unexplained infant death. An epidemiological review]. Ugeskr Laeger 1992; 154(49):3483-3488.7.
7. Moore T. Excess mortality estimates. Deadly medicine: Why tens of thousands of heart patients died in America’s worst drug disaster. New York (NY): Simon & Schuster;1995.
8. Fisker AB, Ravn H, Rodrigues A, Ostergaard MD, Bale C, Benn CS et al. Co-administration of live measles and yellow fever vaccines and inactivated pentavalent vaccines is associated with increased mortality compared with measles and yellow fever vaccines only. An observational study from Guinea-Bissau. Vaccine 2014; 32(5):598-605.9.
9. Aaby P, Garly ML, Nielsen J, Ravn H, Martins C, Bale C et al. Increased female-male mortality ratio associated with inactivated polio and diphtheria-tetanus-pertussis vaccines: Observations from vaccination trials in Guinea-Bissau. Pediatr Infect Dis J 2007; 26(3):247-252.
10.https://www.gov.uk/government/uploads/system/uploads/attachment_data/fil... (last accessed 13 February 2015)
11. Jeve YB, Oppenheimer C, Konje J. Employee engagement within the NHS: a cross-sectional study. Int J Health Policy Manag 2015; 4: 85–90.
Competing interests: Competing interests: We have read and understood the BMJ policy on declaration of interests and declare the following interests: SB has not had a healthcheck as her invitation leaflet did not quantify the risks or benefits and they are not recommended by the National Screening Committee. Her DOIs can be found at http://whopaysthisdoctor.org/doctor/58. CP is the principal investigator of the Inter-99 study (ref 4)
Undoing an ineffective programme after it has been set up is difficult or well-nigh impossible. Those involved – the government in this case – adopt the automatic defensive position so as not to disappoint those they have promised to help. They promise `risk assessment` to help prevent heart disease, stroke, diabetes, kidney disease and certain types of dementia.  It is extremely misleading to affix different labels of `risk awareness`, `risk assessment`, and `risk management` to such programmes. `Health checks` or `screening` - the intent and content is the same. Nor does changing the name of the NHS Breast Screening Programme`s `Age Extension Trial` from a `randomised controlled trial` to an `epidemiological study` alter what is being inflicted on unsuspecting women to no benefit and great cost both to them and the NHS coffers. [2. Paragraph 10]
The accepted scientific process is to determine what is already known about a topic by undertaking a thorough systematic review of available evidence BEFORE embarking on implementing a `good idea` to offer health checks – call it what you will! To promise `evaluation` (as proffered also for the justification for not stopping the age extension trial) AFTER having blindly set up a Programme, using people as pawns to see how much they might benefit, disregarding how much they will be harmed, and expending tax-payers resources in doing so, is breathtakingly naïve/arrogant: totally unscientific. So much for the director of public health and wellbeing`s promise that “PHE [Public Health England] is committed to bringing greater scientific oversight to this programme.” Education needed here, not just of the public, but many of those `in the business` too! 
 O`Dowd, A. Government defends NHS health checks for people aged 40-74 but promises evaluation. BMJ 2015;350:h581
 Department of Health. Government response to the House of Commons Science and Technology Committee report on national health screening. Jan 2015.https://www.gov.uk/government/uploads/system/uploads/attachment_data/fil....
 Evans I, Thornton H, Chalmers I, Glasziou P. Testing treatments: better research for better healthcare – Second Edition. Pinter and Martin, London. 2011. ISBN 978-1-905177-48-6 Free download from www.testingtreatments.org/the-book/
Competing interests: No competing interests