Tuesday, November 13, 2007

Health checkups not such a good idea

Britons now spend a staggering 99million pounds a year on DIY diagnostic kits (home-use tests that can 'detect' diseases such as diabetes), a rise of 30 per cent over the past five years. But it's not just the cheap end of the market that's flourishing; more people than ever are now undergoing CT and MRI scans. Once the preserve of patients with serious illnesses such as cancer, these scans can cost up to 3,000 a time, yet companies that offer them report a major surge in demand.

Some experts are worried that these health tests are causing unnecessary anxiety - a health problem in itself. They are also concerned that the tests can lead to people having further investigations they don't need, and that these tests also pose an unnecessary risk. 'It's certainly true that we are more anxious than ever about our health because we feel more vulnerable than we used to,' says Dr Michael Fitzpatrick, a London GP and author of a book on public fears about health.

Part of the blame lies with health promotion campaigns - and the growing phenomenon of 'awareness' weeks, he says. 'With last month's breast cancer month, for example, you have girls in their teens and 20s coming to see you, terrified that they have it, when there's more chance of them being struck by lightning.' The availability of information is also fuelling this anxiety, says Professor Michael Hyland, a professor of health psychology at the University of Plymouth. 'We have always been a nation of worried well, but now technology means we have a lot more access to information about disease that only medics had access to previously - and people worry about it.'

Younger patients in particular are becoming 'health obsessed', says Dr Fitzpatrick. 'In the past ten years, the number of fit and healthy 25-year-old men demanding a "full health check-up" has soared - but they need nothing of the sort,' he says. 'They should be enjoying themselves, not testing their cholesterol.'

One issue is the quality of some DIY tests - talk to most specialists and they'd argue it's always better to have a proper medical test than to spend 10 pounds on a home test with questionable results. GPs are seeing an influx of people after self-diagnosis who are worried about their results when there is no need for them to be, says Dr Vivienne Nathanson, head of science and ethics at the British Medical Association. The other concern is that home testing kits only encourage 'preoccupation with health that isn't conducive to good health,' says Dr Fitzpatrick. 'Personally, I wouldn't do any of this sort of testing or screening - it's unnecessary. These companies are feeding off people's anxieties and making a vast income from something of dubious value.'

However, the greater concern, say some experts, are body scans. Typically these use MRI (magnetic resonance imaging), although you can also have CT scans, which involve a powerful beam of X-rays over the body. These scans are used to identify health problems such as heart disease or tumours - sometimes before symptoms have developed.

Dr Sebastian Kalwij, a GP in Central London and doctor at Prescan, a private clinic where body scans are offered, says demand is rising. 'I used to see two or three patients a week at the beginning of this year but it's now around two or three a day,' he says. 'We find life-threatening health abnormalities in around two per cent of patients and, for the rest, the scan puts their mind at rest that there is nothing sinister going on inside.' Prescan's typical customer, he says, is someone who wants to take control of their own health. 'They may not like their GP, or can't face the long NHS waiting lists, or want their results quickly. Either way, they can afford not to have this frustration.'

But while it's important we take an interest in our health, these tests 'very rarely' pick up anything significant, says Dr Vivienne Nathanson. 'More often, people are just left worried by them. We must understand the limitations of these tests - MRI and CT scans are brilliant when you have some idea what is wrong with you and are looking for an abnormality which has caused a symptom. 'But these scans also pick up a lot of abnormalities which we class as unimportant and as posing no danger to your health - such as cysts and blood vessels taking an abnormal route, which would be simply regarded as not relevant. 'The danger then is that people start worrying about things which are just natural variations in how we're made up and looking for diseases and symptoms which aren't there. 'This leaves them open to physical risks - if they have further examinations such as exploratory procedures like a colonoscopy - and higher financial costs, as well as more emotional worries about their future health.'

There are risks with unnecessary exposure to radiation during CT scans, she adds. 'Radiation is like a poison - the level of risk is associated with the dose. When you expose yourself to radiation unnecessarily, you start to reduce the amount you can have safely at other times when you really need it, say, in hospital.'

GPs are often left picking up the pieces. 'Some people are told there could be something wrong with them but are then given no treatment plan or advice.' This, in turn, creates its own anxiety, suggests Professor Paul Salkovskis, the director of the Maudsley Hospital Centre for Anxiety Disorders and Trauma. 'Telling someone they are "probably okay", as these places sometimes do - because there is never any guarantee that you are 100 per cent okay - is not reassuring, so people go on to pursue their potential problem further. This is often counterproductive and makes people anxious.'


Noise just sickening

SICK to death of noisy neighbours? More than you realise, probably. Researchers have linked exposure to chronic noise with a range of serious ailments including sleep disorders, learning difficulties, high blood pressure, cardiovascular disease and depression. Griffith University School of Environment lecturer Deanna Tomerini said it was clear from the Environmental Health Council of Australia study that "unwanted sound" was as detrimental to public health as air and water pollution, and that the problem was growing. "Higher-density living, population growth, the increase in road and air traffic - it's evident noise problems are increasing. More people are being affected by noise," she said.

Ms Tomerini warned that governments could expect health problems to increase as noise problems worsened. "Noise should be given the same priority as any other health issue," she said. "Noise just has to be up there at the same level. We need to identify the extent of the problem now. Many of the things to be done to prevent noise need to be done at the planning stage."

Inner-city resident Marion Brown, 59, said there was no doubt her health had suffered after two years of enduring the "neighbours from hell". She said she regularly experienced chronic headaches and anxiety and was now set to sell her house to escape. "It's got to the point where I've been so tired from being unable to sleep because of their noise, I've slept in the car," she said. "I didn't want to sell, but I felt like I had no other choice."

Ms Tomerini said Ms Brown's case highlighted the frustration people had with noise and their reluctance to report it. "Sometimes people don't complain about noise because they think nothing will be done, or they get passed from agency to agency," she said. Ms Tomerini said it would be helpful to have a more integrated approach, including a single agency to receive complaints.



Just some problems with the "Obesity" war:

1). It tries to impose behavior change on everybody -- when most of those targeted are not obese and hence have no reason to change their behaviour. It is a form of punishing the innocent and the guilty alike. (It is also typical of Leftist thinking: Scorning the individual and capable of dealing with large groups only).

2). The longevity research all leads to the conclusion that it is people of MIDDLING weight who live longest -- not slim people. So the "epidemic" of obesity is in fact largely an "epidemic" of living longer.

3). It is total calorie intake that makes you fat -- not where you get your calories. Policies that attack only the source of the calories (e.g. "junk food") without addressing total calorie intake are hence pissing into the wind. People involuntarily deprived of their preferred calorie intake from one source are highly likely to seek and find their calories elsewhere.

4). So-called junk food is perfectly nutritious. A big Mac meal comprises meat, bread, salad and potatoes -- which is a mainstream Western diet. If that is bad then we are all in big trouble.

5). Food warriors demonize salt and fat. But we need a daily salt intake to counter salt-loss through perspiration and the research shows that people on salt-restricted diets die SOONER. And Eskimos eat huge amounts of fat with no apparent ill-effects. And the average home-cooked roast dinner has LOTS of fat. Will we ban roast dinners?

6). The foods restricted are often no more calorific than those permitted -- such as milk and fruit-juice drinks.

7). Tendency to weight is mostly genetic and is therefore not readily susceptible to voluntary behaviour change.

8). And when are we going to ban cheese? Cheese is a concentrated calorie bomb and has lots of that wicked animal fat in it too. Wouldn't we all be better off without it? And what about butter and margarine? They are just about pure fat. Surely they should be treated as contraband in kids' lunchboxes! [/sarcasm].

9). And how odd it is that we never hear of the huge American study which showed that women who eat lots of veggies have an INCREASED risk of stomach cancer? So the official recommendation to eat five lots of veggies every day might just be creating lots of cancer for the future! It's as plausible (i.e. not very) as all the other dietary "wisdom" we read about fat etc.

10). And will "this generation of Western children be the first in history to lead shorter lives than their parents did"? This is another anti-fat scare that emanates from a much-cited editorial in a prominent medical journal that said so. Yet this editorial offered no statistical basis for its opinion -- an opinion that flies directly in the face of the available evidence.

Even statistical correlations far stronger than anything found in medical research may disappear if more data is used. A remarkable example from Sociology: "The modern literature on hate crimes began with a remarkable 1933 book by Arthur Raper titled The Tragedy of Lynching. Raper assembled data on the number of lynchings each year in the South and on the price of an acre’s yield of cotton. He calculated the correla­tion coefficient between the two series at –0.532. In other words, when the economy was doing well, the number of lynchings was lower.... In 2001, Donald Green, Laurence McFalls, and Jennifer Smith published a paper that demolished the alleged connection between economic condi­tions and lynchings in Raper’s data. Raper had the misfortune of stopping his anal­ysis in 1929. After the Great Depression hit, the price of cotton plummeted and economic condi­tions deteriorated, yet lynchings continued to fall. The correlation disappeared altogether when more years of data were added." So we must be sure to base our conclusions on ALL the data. But in medical research, data selectivity and the "overlooking" of discordant research findings is epidemic.


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