dimarts, d’agost 27, 2013

Health Checks between the ages of 40 and 74?

In April 2013 NHS England implemented the NHS Health Checks for adults between the ages of 40 and 74. The programme is aimed to help preventing heart disease, stroke, diabetes, kidney disease and certain types of dementia. Everyone between the ages of 40 and 74, who has not already been diagnosed with one of these conditions or have certain risk factors, will be invited (once every five years) to have a check to assess their risk of  having those conditions and will be given support and advice to help them reduce or manage that risk (1, 2). Public Health England (PHE) took over responsibility for overseeing implementation of this programme in April 2013 with local authorities being given the task of rolling out the programme to 20% of their eligible population each year over the next 5 years (3). According to the Health Secretary Hundreds of lives could be saved every year if more people took advantage of NHS health checks as a new review has found that checking 40 to 74-year-olds' blood pressure, cholesterol, weight and lifestyle could identify problems earlier and prevent 650 deaths, 1,600 heart attacks and 4,000 cases of diabetes a year (4).

On the other hand, recently from different sectors the effectiveness of the NHS Health Check programme has been called into question. Is the evidence strong enough to justify the implementation of this ambitious programme? It seems that evidence is weak as even Public Health England recognises that “the programme is being implemented in the absence of direct randomised controlled trial evidence to guide it” and that “as one of the first programmes of its kind internationally it is perhaps inevitable that empirical evidence of direct relevance to the programme is lacking”. Public Health England defends its position arguing that “the level of investment in high-quality research has been relatively low for primary prevention for many years and as a result the number of good-quality randomised controlled trials in this area is correspondingly small” and even stating that “in the absence of scientific certainty it is necessary to make a decision on the basis of minimising harm, by comparing likely risks and harms of action with likely risk and harms of not acting” (5).

However, implementing a costly screening programme like this that will lead to the diagnoses and potential treatment of hundreds of thousands of people with no such a risk free drugs with weak evidence seems to be a dangerous step and precedent to take.