Should You Get an Annual Health Check-Up?

What are the risks and benefits of getting an annual check-up from your doctor?

Physicians and patients have come to expect the annual check-up as a routine part of care. “However, considerable research has not demonstrated a substantial benefit,” so a “revolt is brewing against the tradition of periodic” check-ups. “Even the Society for General Internal Medicine advised primary care physicians to avoid ‘routine general health checks for asymptomatic adults.’”

As I discuss in my video Is It Worth Getting Annual Health Check-Ups?, routine check-ups do seem to make sense. But, historically, medical practice has included all sorts of interventions that seemed to make sense, such as hormone replacement therapy for menopause—that is, until it was put to the test and found to increase risks of breast cancer, blood clots, heart disease, and stroke. “History repeatedly shows that good intentions and ‘common sense’ kill in the name of prevention (for example, prone sleeping recommendation for infants).” Indeed, doctors killed babies by making the so-called common sense recommendation that infants sleep on their tummies, whereas we now know “Face Up to Wake Up.” “We should always demand evidence rather than succumb to delusion.”

“We check our cars regularly, so why shouldn’t we also check our bodies…?” Well, unlike cars, our bodies have self-healing properties. To see if the benefits outweigh the harms, researchers decided to put it to the test.

“What are the benefits and harms of general health checks for adult populations?” The bottom line is that check-ups were “not associated with lower rates of all-cause mortality, mortality from cardiovascular disease, or mortality from cancer,” meaning they weren’t associated with living longer or a lower risk of dying from heart disease, stroke, or cancer. So, general check-ups may not reduce disease rates or death rates, but they do increase the number of new diagnoses. And, the “[h]armful effects of some tests and subsequent treatment could have balanced out possible beneficial effects of others.”

Possible harms from check-ups include “overdiagnosis, overtreatment, distress or injury from invasive follow-up tests, distress due to false positive test results, false reassurance due to false negative test results, possible continuation of adverse health behaviours due to negative test results, adverse psychosocial effects due to labelling, and difficulties with getting insurance” (now that you have a pre-existing condition), not to mention all of the associated costs. 

Take diabetes, for example. Wouldn’t it be great if we detected cases of diabetes earlier? Perhaps not, if you were one of the people given Avandia, the number one diabetes drug that was then pulled off the market because instead of helping people, it appeared to be killing them. Adverse drug events are now one of our leading causes of death. When it comes to lifestyle diseases like type 2 diabetes, maybe we should focus instead on creating healthier food environments. This is what one of my favorite organizations, Balanced, does to help prevent the diabetes epidemic in the first place.

How many times have you tried to inform someone about healthy eating and evidence-based nutrition, only to have them say, “No, I don’t have to worry. My doctor reassured me I’m fine. I just had a check-up, and everything’s normal.” As if having a normal cholesterol is okay in a society where it’s normal to drop dead of a heart attack, the number one killer of men and women. It would be one thing if you went to see a lifestyle medicine doctor who spent the check-up giving you the tools to prevent 80 percent of chronic disease, but given the way medicine is currently practiced, it’s no wonder why the history of routine check-ups “has been one of glorious failure, but generations of well meaning clinicians and public health physicians struggle to allow themselves to believe it.” But, “policy should be based on evidence…” 

Poor diet may be “on par with tobacco smoking as the most common actual causes of death,” yet the medical profession is inadequately trained in nutrition. Worse, nutrition education in medical school appears to be declining. If you can believe it, there is actually a “shrinking of formalized nutrition education” among health professionals, so the advice you get during your annual check-up may just be from the last tabloid your doctor skimmed while in the supermarket check-out line.

“And screening appointments should not be regarded as a form of ‘health education,’” read one medical journal editorial. “People who are obese know very well that they are, and if we have no means of helping them…then we should shut up.” Well, if you really have nothing to say that will help them, maybe you should shut up, especially those doctors who say they “have no idea what constitutes a ‘healthy’ diet”—although we do know that veggies and nuts are a good start.

Won’t a check-up allow your physician to do a comprehensive physical exam and routine blood testing? I discuss that, as well as the pros and cons, in my vide Is it Worth Getting an Annual Physical Exam?.

Did I say lifestyle medicine? Yes! Learn more about this exciting growing field in Lifestyle Medicine: Treating the Causes of Disease and Convincing Doctors to Embrace Lifestyle Medicine. Make sure your doctor is a member of the American College of Lifestyle Medicine (and even better certified by the American Board of Lifestyle Medicine).

Still don’t understand how there can be risks? See Why Prevention Is Worth a Ton of Cure. Unfortunately, physicians and patients alike wildly overestimate the benefits of pills and procedures. See, for example, The Actual Benefit of Diet vs. Drugs.

The fact is Physicians May Be Missing Their Most Important Tool.


And what about mammograms? See my video series:

In health,

Michael Greger, M.D.

PS: If you haven’t yet, you can subscribe to my free videos here and watch my live presentations:

Do Cell Phones Cause Brain Tumors?

What does the world’s leading authority on carcinogens have to say about mobile phones?

Do cell phones cause cancer? That’s a question billions of people would like to have answered and one I address in my video Cell Phone Brain Tumor Risk?. That’s why we have the World Health Organization’s International Agency for Research on Cancer (IARC), the recognized authority on determining what is and is not carcinogenic. There are five categories: Group 1 carcinogens are agents that we know with the highest level of certainty do cause cancer in human beings, Group 2A probably cause cancer, Group 2B possibly cause cancer, we’re not sure about agents categorized as Group 3, and Group 4 agents probably don’t cause cancer.

In May 2011, 30 scientists from 14 countries met at the IARC to assess the carcinogenicity of the radiation emitted from cell phones and concluded that, given the limited amount of available evidence, cell phones are “‘possibly carcinogenic to humans’ (Group 2B).” So they’re not classified as a Group 1 carcinogen that’s known definitively to be cancer-causing, like plutonium, or processed meat, or as probable carcinogen, like DDT, Monsanto’s Roundup pesticide, or some regular meat, but they are classified as a possible carcinogen, ranked similarly as preserved vegetables like kimchi. 

Now, this classification was made more than five years ago. Evidence continues to mount, and the latest two 2017 systematic reviews found a 33 percent increase in odds of brain tumors with long-term use and showed 46 percent higher odds for tumors on the phone side of your head—and the reviews included the industry-funded studies that have been accused of being biased and flawed, and underestimating the risk, as opposed to independent studies free from “financial conditioning.” How’s that for a euphemism? Given this, some scientists are pushing to have the IARC reclassify cell phones as probable carcinogens or even bump them all the way up into Group 1, at least for brain cancer and acoustic neuroma, a type of inner ear tumor. 

But the IARC classification for cell phones currently remains at possible carcinogen. What does that mean? What do we do with that information? Well, given the uncertainty, we could follow “the precautionary principle” and use simple personal measures to reduce our exposure, like not putting the phone directly up to our head all the time. Indeed, the “main concern about cell phones is that they are usually held close to the head,” which is considered particularly important for children. There’s no evidence of finger cancer, though, so you can keep texting away. 

Other potential personal recommendations include waiting a moment before putting your cell phone to your ear, if you don’t have a headset, because “when the cell phone establishes a connection, the emission is high.” And don’t fall for those anti-radiation gizmos, those “so-called protection covers,” as they may make things worse by forcing the phone to boost the signal.

Not all agree, however, with this precautionary approach. Employees at two cell phone industry trade organizations emphasize “there are many aspects of human activity that are not ‘totally without adverse health effects,’—for example, transport (including aviation) and hot showers,” so they suggest we should just accept the risk as being worth it. Wait. Hot showers? As in we might scald ourselves or something? In any case, they further suggest that we shouldn’t put forth any recommendations because “such judgment should be made by parents on a personal basis for their own children,” and, if we do put out guidelines or something, people might get nervous and we all know “anxiety itself can have deleterious health consequences.” So, basically, the cell phone industry cares so much about your health that it doesn’t want you worrying your pretty little head.

Nevertheless, all of this is openly discussed in the risk analysis literature. “From a public health perspective, it might be reasonable to provide cell phone users with voluntary precautionary recommendations for their cell phone handling in order to enable them to make informed decisions”—but what if the public can’t handle the truth? We don’t want to freak people out. There’s still “scientific uncertainty” and we don’t want to “foster inappropriate fears.” For example, brain cancer is rare to begin with. You only have about a 1 in 15,000 chance a year of getting a brain tumor,  so even if cell phones double your risk, that would only take you up to a 1 in 7,500 chance. You may be more likely to get killed by a cell phone in the hands of a distracted driver than by cancer. So, whether health authorities want to inform the general public about precautionary possibilities really remains more of a political decision.


For more on cell phones and Wi-Fi, see:

What was that about meat and cancer? See my video Carcinogens in Meat. And, to learn more about the IARC’s decision and the industry’s reaction, see:

What about cancer risk of medical diagnostic radiation? See:

In health,

Michael Greger, M.D.

PS: If you haven’t yet, you can subscribe to my free videos here and watch my live presentations:

Can Cell Phone Radiation Damage Your DNA?

Do mobile phones cause brain tumors? Whenever a trillion-dollar industry is involved—whether it’s Big Food, Big Tobacco, Big Pharma, or Big Telecom—there’s so much money that the science can get manipulated.

When it comes to the potential human health effects of cell phone use, certainly, you might end up with a crick in your neck if you text excessively or even break your neck or the neck of someone you may hit if you text while driving. On the other hand, think of the countless lives that have been saved on the road, because people are now able to so quickly phone in emergencies. 

But what about cancer? Since the turn of the century, there have been studies suggesting up to double the risk of brain tumors with long-term cell phone use on the side of your head you use to talk. That’s important, because the radiation only really penetrates up to a couple of inches into your brain. At 0:48 in my video Does Cell Phone Radiation Cause Cancer?, I show views from the back of the head and the top of the head, and you can see why you might develop cancer on one side of the head over the other.

Since it’s such a local effect, you can see why there are recommendations for using the speakerphone function or a hands-free headset, which can reduce brain exposure by a factor of 100 or more—and this includes Bluetooth headsets. This may be particularly important in children, who have thinner skulls. 

Cell phone radiation isn’t like nuclear radiation, though. It doesn’t damage DNA directly, like gamma rays from an atomic bomb. Yes, but it does appear to be able to damage DNA indirectly by generating free radicals. Out of 100 studies that looked at this, 93 confirmed these oxidative effects of the kind of low-intensity radiofrequency radiation that comes out of cell phones. Okay, but does that oxidative stress translate out into DNA damage? Most studies found it did, detecting signs of genotoxicity, which is damage to our genes, DNA, or chromosomes. A lot of those studies were done in petri dishes or in lab animals, though. I’m less interested in whether Mickey or Minnie is at risk than I am concerned about brain tumors in people. Yes, some population studies found increased cancer risk, but other studies did not. 

Could the source of funding for those studies have anything to do with the different findings? Some of the studies were funded by cell phone companies. Researchers “hypothesized that studies would be less likely to show an effect of the exposure if funded by the telecommunications industry, which has a vested interest in portraying the use of mobile phones as safe.” So, they ran the numbers and—surprise, surprise—“found that the studies funded exclusively by industry were indeed substantially less likely to report statistically significant effects…” 

Indeed, most of the independently funded studies showed an effect while most of the industry-funded studies did not. In fact, industry-funded studies had about ten times fewer odds of finding an adverse effect from cell phone use. That’s even worse than the drug industry! Studies sponsored by Big Pharma about their own products only had about four times the odds of favoring the drug compared to independent researchers. Big Tobacco still reigns supreme when it comes to Big Bias, though. Why do research articles on the health effects of second-hand smoke reach different conclusions? Well, it turns out that studies funded by the tobacco industry itself had a whopping 88 times the odds of concluding it was not harmful. So about ten times more for telecom puts it more towards the drug industry end of the bias spectrum.

There are conflicts of interest on both sides of the debate, though. If it’s not financial conflict, then it may be intellectual, as it can be human nature to show bias towards evidence that supports your personal position. As such, you’ll see flimsy science published, like a study I show at 3:55 in my video that appears to find a “disturbing” and “very linear relationship” between the states with the most brain tumors and the states with the most cell phone subscriptions. Okay, but one could think of lots of reasons why states like New York and Texas might have more brain tumors and more cells phones than the Dakotas, and those reasons have nothing to do with cell phone radiation.

Sometimes, you might even see outright fraud with allegations that the academic researchers who authored two of those genotoxicity papers and the very review I mentioned earlier were involved in scientific misconduct—allegations they deny, pointing out that their lead accuser turned out to be a lawyer working for the telecom industry. 

Whenever there’s a trillion-dollar industry involved, whether it’s the food industry, tobacco industry, drug industry, or telecom industry, there’s so much money involved that the science can get manipulated. Take the nuclear energy industry for example. There were decades of “a high-level, institutional…cover up” about the health consequences of Chernobyl. The official estimates of resulting health problems were a hundred or even a thousand times lower than estimates from independent researchers. Did only 4,000 people eventually die from it or nearly a million? It depends on who you ask and who happens to be funding whomever you’re asking. That’s why, when it comes to cancer, all eyes turn to the International Agency for Research on Cancer, the IARC, which is the official World Health Organization body that independently and objectively tries to determine what is and is not carcinogenic. You can find out what the IARC concluded about cell phones in my video Cell Phone Brain Tumor Risk?.


For more on cell phones and Wi-Fi, check out these other videos:

 

I’ve talked a lot about the corrupting influence of commercial interests on science. See, for example:

In health,

Michael Greger, M.D.

PS: If you haven’t yet, you can subscribe to my free videos here and watch my live presentations: