Saturday, September 25, 2010

Health Check

Can't remember when I had my last health check. "It's long overdue", my lovely wife has been constantly complaining.

I don't believe in health check.

Numerous researches have proved that "self-rated health" outperforms complicated procedures by medical doctors. In such researches, doctors typically go through the medical history, conduct tests, see the results of the tests, and carry out detailed examination for each persons concerned. Independently of the doctors' prediction, the persons are asked to answer a simple, multiple-choice question such as the following:
In general, how would you say your health is: (a) Excellent (b) Very good (c) Good (d) Fair (e) Poor?
It may sound a bit surprising but the results are always the same: self-rated health scores provide more accurate indications of how much longer people will live than the doctors' predictions.

There is nothing modern about modern medicine. In Dance with Chance, the authors gave a vivid description of the then most advanced treatment given to King Charles II by fourteen of the best doctors.
The King was bled... to the extent of a pint from his right arm. Next [the doctor] drew eight ounces of blood from his left shoulder ... gave an emetic to make the King vomit, to physics, and a enema containing antimony rock salt, marsh-mallow leaves, violets, beet roots, camomile flowers, fennel seed, linseed, cardamon seed, cinnamon, saffron cochineal, and aloes. The King's head was then shaved and a blister raised on his scalp. A sneezing powder of hellebore root was give to purge his brain, and a powder of cowslip administered to strengthen it... A plaster of pitch and pigeon dung was put on the King's feet. Next there was more bleeding followed by the administration of melon seeds, manna, slippery elm, black cheery water... To this mixture were added forty drops of the extract of human skull. Finally, in desperation a bezoar stone was tried. The King died.
I am not trying to belittle doctors and medical researchers. No, not at all. But, thank goodness, the study of medicine is evolving and will continue to evolve.  I am a hopelessly optimistic person. I am confident that two hundred years from now people will consider MRI, CT Scan, PSA test (prostate-specific antigen test) etc. the like of extract of human skull and pigeon dung. Why then should I be obsessed with the magical effect of MRI, CT Scan and PSA test?

There is an interesting study about prostate cancer and PSA tests. In his excellent book Calculated Risks: How to Know When the Numbers Deceive You, psychologist Gigerenzer said the following about PSA test:
People who take PSA tests die equally early and equally often from prostate cancer compared with those who do not. One cannot confuse early detection with mortality reduction. PSA tests can detect cancer, but because there is as yet no effective treatment, it is not proven that early detection increases life expectancy...The test produces a substantial number of false positives, and therefore, when there is a suspiciously high PSA level, in most of these cases there is no cancer. That means many men without prostate cancer may go through unnecessary anxieties and often painful follow-up exams. Men with prostate cancer are more likely to pay more substantial costs. Many of these men undergo surgery or radiation treatment that can result in serious, lifelong harm such as incontinence and impotence. Most prostate cancer are so slow growing that they might never have been noticed except for the screening (out of 154 people with prostate caner only twenty four die of the disease). Autopsies of men older than fifty who die of natural causes indicate that about one in three of them has some form of prostate cancer...
In other words, a lot of men die with prostate cancer than from prostate cancer.

Speaking of PSA test I have a personal encounter with the test. Not exactly mine but my father's. Devastated by the death of my mother, he looked like a dead man. We took him to a doctor and he was given some tests. One of them was the PSA test. The result was positive, so positive that the doctor, reading from the most authoritative texts, was almost certain my father had prostate cancer. It turned out to be a false positive. The exceptionally high PSA reading, as the doctor was trying to explain with hindsight, was due to emotional stress. Any lesson to learn? Well, there is much truth in conventional wisdom - if you want good health, try to be happy. If you doctor tells you there is a high cancer risk, take a vacation, relax and have a second opinion.

There is a downside to health check: it promotes an illusion of control. It makes people believe that if they follow certain guidelines and have early symptoms detected, they'll live a longer and healthier life.  I don't see any real difference between this health related illusion of control and the illusion shared by a great number of parents: the belief that if they can get their kids into the most famous schools and colleges, their kids will live a happy and successful life. Is there such certainly in life? Let's see what people will say about our medicine and schooling two hundred years from now.

P.S. I will make an appointment for a health check after posting this. You know, what I think doesn't matter; I have to obey the Almighty in our house.


Gweipo said...

I find it interesting that the emphasis has always been on physical health. As I was reading my post I was wondering what the questions would be if one had to do a regular mental health check:

* do you ever have the desire to harm yourself or anyone else?
* do you ever feel out of control or anxious?
* are you prone to irrational outbursts of emotion either positive or negative
* do you have trouble falling asleep or wake up in the middle of the night?
* what do you fear and does it interfere with your daily life?

etc. etc.

Perhaps confronting those issues would be far more scary than any health check.

But having said that, men are notorious for ignoring symptoms and delaying health checks with disasterous consequences.

W said...

I'm sure my wife will agree with everything you say about men delaying health check.

ulaca said...

It's one thing to ask those questions, GP, and quite another to have any answers for them. If I were interested in medicine, I'd be a vet. Much less aggro.

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