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The perils of the health check-up

There are strong voices that decry the complete health-checks.

There are strong voices that decry the complete health-checks.   | Photo Credit: Special Arrangement

A spree of investigations could well find diseases where there are none

My good friend, a rising executive, is a worried man these days. The company he works for decided to sponsor an executive health check-up for him so he stays healthy. But today we have but a broken man with completely chewed-up nails. He now spends his valuable time Googling and deeply worrying about the numbers and graphs provided by the hospital. The hospital belongs to the company itself; and I suspect a malicious intent to break down rising stars so they stop all kinds of corporate warfare! And focus on their health numbers instead.

His health report ran to a full thirty-four pages. There was an odd consultation here and there, but most the pages were stuffed with numbers and graphs of all kinds. There were some niggling changes in the lipid profile and an age-related prostatic enlargement on the ultrasound system. And now he stays up all night with wide glassy eyes, worrying about the future of his family.

I wonder about the real usefulness of the complete health-check. If you run a person through a significantly large number of tests, then every person is bound to be diseased. An abnormal lipid profile is almost a rule in any person now. In fact, we have reached a stage in lipid profiles that abnormal is the new normal.  

An audiology test, an eye check, an ENT examination and a dental consultation happened. Then there were some consultations with the physician and the cardiologist. He was luckily not a she, and hence could avoid a gynaecologist, a mammogram, and a PAP smear.

The laboratory tests and radiological investigations included a complete blood picture (which comprises some 20 parameters), blood group, ESR, fasting sugar, post-prandial sugar, lipid profile, serum proteins, renal function, liver function, prostate-specific antigen, complete urine and stool examination, thyroid function, a chest X-ray, an ultrasound of the abdomen and pelvis, a stress ECG test, pulmonary function tests, and a bone densitometry too. Whew! The latest fad is trend depiction. The previous reports are compared with the new reports (along with the normal ranges) in the form of graphs and line-diagrams, which can be understood by a nursery student. There would be a line going north with the individual value printed brightly at the north pole. The normal would be at the equator. It simply declares that you have been a bad person with your lifestyle. Hercules becomes jelly.

The less said about lipid profile, the better. Hypertensives and diabetics grapple with few values only. However, the lipid profile has almost 10 values, and not to contend with plain numbers there are ratios of all kinds, the HDL/cholesterol ratio, for example. Now these values are like frogs in a well and can never ever be contained at one single go. The problem — for the patient, that is — is that there is a medicine for each of those parameters and for each of those ratios. ‘OK, you have cholesterol up, let me give you this drug, which will reduce your cholesterol values and your life time earnings.’ The next time around, ‘Buddy, your cholesterol is down, but your triglycerides are up. Stop this and we will give you this other medicine.’ You know what, the next time around, the triglycerides are down, but the cholesterol is up. ‘Well, let us put both medicines together.’ Two medicines for those numbers becomes very upsetting. So, the good doctor offers a new medicine that combines both the drugs, a little more expensive. So, you end up taking two medicines and feeling good about taking one pill only. The ratios now go haywire, with possibly drugs for that.

There are strong voices that decry the complete health-checks. Maybe the intention is good, but the consequences are decidedly not so. Technology is overtaking clinical experience now. Getting tested in the absence of symptoms may not be always a prudent decision in matters of health. Screening programmes have had a very chequered and sometimes controversial place in the history of medicine. 

It is not only doctors who are to blame for this but the patients. Laypersons are increasingly demanding objective evidence for monitoring health and starting treatments. The general practitioner with the stethoscope and blood pressure machine is not around any longer. The computer-holding young specialist surrounded by the digital machines with access to all the investigations is the new trustworthy partner in health needs.

A cynic commented that the progress of medicine is bringing more people into the ambit of sickness. If one is feeling healthy and is ready to face the world physically and mentally when the sun rises, a health check is perhaps not required. There are always exceptions of course; which only prove the rule.  

pingaligopi@gmail.com   

 

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Printable version | Feb 23, 2020 12:58:33 PM | https://www.thehindu.com/opinion/open-page/the-perils-of-the-health-check-up/article18956251.ece

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