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Beware the dark side of health checks

44 Comments
By Michael Hoffman

“The biggest lie of all,” biologist Kiyohiko Ikeda tells President magazine (Oct 13), “is the health check.”

Really? Aging Japan is awash in health checks. Turn 65 and the pressure to submit to them mounts. You feel fine? Don’t be fooled. Cancer lurks in dark corners before it bursts into the light. Heart disease bides its time. Dementia toys with us before getting down to business: you forget where you put your keys and think, “It’s nothing, happens to everyone, happened to me when I was young enough to laugh it off; I’ll laugh it off now.”

Better not, is the official stance. An annual health check reveals disease in embryo. Disease is vulnerable then; less and less so as time passes. The costs of late treatment, medical and financial, to you and the government, are high at best, prohibitive at worst. Thus the periodic notices in the mailboxes of the elderly. They come from national and local governments. Time for a health check. Your neighborhood clinic is waiting for you. There’s no charge. Included sometimes as an added inducement is an appeal to the profit motive. Get checked and receive as a reward a 1,000-yen shopping coupon.

But what if the early treatment prescribed is unnecessary? What if the cure is worse than the disease?

President’s extended feature  is titled “The Other Side of Health Checks,” suggesting a dark side. It opens with a dialogue between Ikeda, 76, and anatomist Takeshi Yoro, 86. Take high blood pressure, says Ikeda. “If your blood pressure is high they’ll give you medicine. If you hadn’t gone for a check, you’d never have known you had high blood pressure.” Does ignorance protect us from consequences? Surely not, is the first thought; the second is, maybe sometimes it does.

“There’s no such thing as perfect health,” says Ikeda, meaning some imperfection is tolerable. Nor, adds Yoro, is there any such thing as a “normal body.” The human body is not generic. One size doesn’t fit all. One person can – and maybe should be left alone to – live quite comfortably with a condition that might be dangerous in another. Moreover, Ikeda argues that doctors may have reasons other than medical to prescribe – to wit, economic. “In Japan,” he says, “a lot of people get their living from health checks. For my part, I have no desire to obstruct their livelihood. All the same, I’ve no intention of getting checked myself.”

“If nothing bothers you, leave well enough alone,” is Yoro’s advice. Doctors who pride themselves on “saving your life” flatter themselves, he says; they cure symptoms and relieve pain and more power to them to that extent, but “in fact,” says Yoro, “patients cure themselves; the best doctors can do is help them. Lately people have this idea in their heads, ‘If I don’t see a doctor, there’s no hope for me.’ That in itself,” he says, “is a problem.”

What sort of problem? One with multiple aspects. Medical checks are time-consuming and invasive. Hospitals are depressing places – how much time do we want to spend in them? No more than necessary seems the obvious answer, lest their gloomy atmosphere infect us psychologically if not (as so often in the COVID-19 crisis) biologically. How much poking and prodding can the body take, especially with the various weaknesses of age setting in and taking their toll?

More concretely, says Ikeda, medicine in Japan is narrowly specialized: “If you’ve a pain in your leg they send you to a neurologist; if your stomach hurts you must see an internist. Each doctor prescribes a different medicine, so that there are more than a few people taking seven or eight different kinds of medicine at the same time” – heightening the risk of side-effects. “The human body is a whole, and yet is treated like a machine, part by part.”

Yoro agrees – and yet surprises us: “I consult doctors,” he says, “and I take medicine daily.” Really? “Probably there’s no point to it but if I don’t, the doctors will be put out, so there’s no help for it.” Seriously? A qualified physician himself, a skeptic with regard to the hyper-medicalization of life, submits to a system whose merits he doubts simply to keep doctors in good humor?

“If doctors don’t dispense medicine they can’t eat,” he says. “Then when we really need medical attention, who will give it?” There is, besides, the high cost to society as a whole of late-stage treatment of conditions that could have been treated more cheaply earlier on. It’s a complex issue. No single answer will do, or single point of view suffice.

 First of two parts. The conclusion will appear on October 15.

© Japan Today

©2024 GPlusMedia Inc.

44 Comments
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A health check in mid-2019 revealed I had cancer, prostate. Biopsy revealed it was more than 90% but further tests revealed it had not spread. After a discussion with the doctors and experts, it was decided to remove it. That happened at the beginning of 2020 just before the covid.

Four years later I am free from cancer.

Without the initial health check, I wouldn't have known I had cancer.

I have blood checks every three months. After four years, all of my tests were normal for the first time in years.

Removal of the prostate creates its own set of problems but I'm still alive.

16 ( +19 / -3 )

I always take my health check results with a grain of salt and don't need to get an A or B on everything and base my health on my overall feeling for the most part. I have a much younger friend who got all A on his results but is tired and lethargic almost every time I see him and I feel like I'm in better health. Who knows?

10 ( +10 / -0 )

I like the medical system here 95% of the time.

6 ( +9 / -3 )

Wallace, I am delighted that everything is working out for you. My grandfather died aged 50 of it, so consequently I have been worrying about prostate cancer for some time. I really hate that I need to have a health check every year, but it did put me into contact with a rather good urologist. So far, so good.

5 ( +6 / -1 )

I've had both very good and very bad experiences with doctors in Japan.

My primary doctor (who was trained in the US) made a big point to discourage patients from scheduling medical checks unless there was a purpose for them. He argued that when doctors are searching for a problem, they will invariably find one (as the article here says: there's no such thing as a perfectly healthy body), which leads to unnecessary treatment, unnecessary referrals, unnecessary cost (for the patient), and unnecessary clogging of the doctor's schedule.

4 ( +5 / -1 )

aaronagstring

Wallace, I am delighted that everything is working out for you. My grandfather died aged 50 of it, so consequently I have been worrying about prostate cancer for some time. I really hate that I need to have a health check every year, but it did put me into contact with a rather good urologist. So far, so good.

Avoid having the prostate removed if possible. 5 high radiation doses can kill the cancer now. There are new treatments. Removal should be the final decision.

4 ( +5 / -1 )

There was a study in The Lancet a few years back saying that due to Japanese doctors ordering so many CT scans and X-rays, Japan has the highest incidence of cancers caused by radiation from the machines!

Ummhh??? I'm with Wallace on this one. I'd like to see the said report before casting my own judgement

4 ( +6 / -2 )

A biologist and an anatomist do not really seem like an authority to talk about the topic, specially with the terribly bad arguments they use to discuss it, health checks do not depend on every body being generic, being asymptomatic is a terribly bad standard to assume being healthy, medical specialists do not treat everything according to their field of expertise (and frequently direct patients to another specialist when necessary), the first step for chronic diseases are lifestyle changes instead of medicine, etc.

There is such a thing as too much testing, and a lot of research is being done to only do tests when the ratio of cost/benefits is positive. Much more dangerous than having frequent health checks are people that instead of using objective data and information to argue for a point only use personal opinions and hearsay to say people would be healthier by pretending nothing is wrong if they feel fine.

3 ( +9 / -6 )

Wallace - glad to hear you are now cancer free. Yes - a simple check can indicate a more serious underlying problem.

And as you said, having a prostatectomy has it's own issues, but being informed is crucial to making a decision.

BTW - what was your Gleason score if you don't mind?

3 ( +4 / -1 )

@Rex

Any reference for this?

I remember reading about this a couple of years ago on a reputable website, like Mayo or something. Don't remember which one exactly.

Here's a reference I just found, if you want one, on research done in Denmark:

Regular health checks can ‘do more harm than good’

https://www.nationalhealthexecutive.com/News/regular-health-checks-can-do-more-harm-than-good

3 ( +4 / -1 )

I kinda agree. The annual check is a bit annoying and overly cautious in my opinion. Especially since the cost and exams increase as you get older. Even more so doctors are everywhere in Japan so it’s not difficult to check when your feeling unwell along with Japans mentality of going to the doctor even for common colds.

It is nice to just go when your feeling unwell and getting some help usually. That said clinic quality is amazingly all over the place in Japan

2 ( +3 / -1 )

It is nice to just go when your feeling unwell and getting some help usually

Unfortunately for many diseases "feeling unwell" is already too late to take effective therapeutic measures and decades of life may be shortened to years or months by doing this.

There is a balance in medical check ups, a point where the costs, risk and complications are offset by the benefits obtained, getting full checkups yearly without need is bad, but only going to the doctor when you already have an evident health problem can be worse.

2 ( +6 / -4 )

"It opens with a dialogue between Ikeda, 76, and anatomist Takeshi Yoro, 86."

The simple fact that the two individuals, both men, have already lived well past most countries' life expectancy rates for males says a lot about the positives of the health care system in Japan.

I'd also mention that medicinal doses here in Japan are typically at a much lower level of potency, and are recommended much less frequently, than in many of the "habitually drugged up" West. Just sample, for example, American "over the counter products", then compare their potency to what's commonly offered up at Matsu-Kiyo for the same ailments, and you'll easily find this to be the case.

I'm sure there are some phony health check scams out there trying to siphon money off of the elderly, just as there are phony "treatments" that are trying to make a quick yen off the very same group. But for the most part, the fact that Japanese on average LIVE SO LONG (and that they have more health related checks of any kind in their lives, on average, than almost any other group of people) suggests that if it ain't broke, there's not a lot of need to "fix" it.

2 ( +2 / -0 )

Radiation risk from medical imaging

https://www.health.harvard.edu/cancer/radiation-risk-from-medical-imaging

That article states that CT scans present a risk. Sounds like you are agreeing with David Brent now. Certainly if x-rays and CT scans are overused, there will be an increased cancer risk. That's not even a debated point. The risk is weighed against the possible benefits, so a careful doctor will not use them without some consideration.

2 ( +4 / -2 )

I don't want to hear about people refusing lifesaving CT scans because they read on a forum they cause cancer.

It is not something so drastic, and obviously something that any patient should discuss with their doctors, there is such thing as taking too much radiation for very dubious benefits, but that of course do not apply for situations where the doctor have no doubt about the need for the test. Unfortunately there are also examples where any competent doctor can understand the test would give no useful information (for example conducting it repeatedly while in treatment at a time point where there is no realistic chance of observing any change). There are a lot of literature talking about this

https://pubmed.ncbi.nlm.nih.gov/20634104/

Any competent doctor would be more than happy to explain to his patient why a test is necessary or even just beneficial, so a patient that expresses anxiety about it is an excellent chance to have this conversation.

2 ( +3 / -1 )

TBH, quality rather than quantity, especially here.

1 ( +2 / -1 )

browny1

Wallace - glad to hear you are now cancer free. Yes - a simple check can indicate a more serious underlying problem.

> And as you said, having a prostatectomy has it's own issues, but being informed is crucial to making a decision.

> BTW - what was your Gleason score if you don't mind?

They don't use it in Japan. In 2019, my PSA was more than 50 (average 4-5). It went to zero but after three went to nearly 2, so I started hormone therapy. Now less than 0.5. It was the size of a baseball and took 10 to remove by robot.

1 ( +2 / -1 )

browny1

The Gleason would have been 8-10. I had stage 3 cancer.

1 ( +2 / -1 )

In layman terms, they are experts.

These days, losers think experts cannot be trusted. Someone on a site the other day was arguing with me that trying to say an expert is an expert, is an appeal to authority. The poster was so stupid, they totally misunderstood that logical fallacy and made themselves look dumb as a post.

1 ( +5 / -4 )

Many Western countries don't do them because their research shows no significant differences in death rates between tested populations and untested populations.

It seems Japan does them because Japan is usually slow to change on these kind of things, like public smoking policies, while a testing industry has sprouted up.

That said, I get regular checkups and I find them useful.

1 ( +3 / -2 )

I have a hard time understanding how regular health checks, at least the yearly ones compulsory in Japan, can do more harm. They don't do them in my native country, and unfortunately already some people I've known died in their 40s because they did not know they have a condition, or their cancer was discovered too late. My parents also discovered they have cancer at a relatively early stage by complete luck (unrelated check), which saved their lives.

I do health checks every year (they're compulsory at my company, and free), and I never had the experience of pushy doctors trying to sell me whatever. Just a regular check of blood, urine, fecal matter, chest Xrays, electrocardiogram, eyes/ears check, talking with a doctor, and the sort. Then the results come, and if there are some bad values, they recommend some life style improvements and in some cases a double check. Which helped me detect some nasty polyps.

1 ( +2 / -1 )

Wallace - Thanks.

With a Gleason score of 8 - 10 your cancer would certainly have been advanced and with such an enlarged prostate you made the right decision at the time. Good that it has not re-surfaced anywhere.

And as you stated the new 5 times high-dose radiation treatment out of England looks like becoming the preferred treatment for established prostate cancer cases. Lots of positive reports.

And prostate treatment has certainly evolved over the years with Japan being slow to get on the train - but now it seems doctors are changing their views.

I had a Gleason 3 + 3 = 6 diagnosis 12 years ago. My urologist wanted to remove my prostate. I researched a lot and found that watchful waiting - the normal procedure in Europe - was the best. I also took/take supplements which have cleared up all urinary difficulties. I go twice yearly for checks and my doctor now believes I chose the best way.

That makes me smile.

1 ( +2 / -1 )

Here's a reference I just found, if you want one, on research done in Denmark:

The reference concludes a very different thing, if anything that health checks should be improved to include the people more at risk but not that they are useless or that countries do not do them because of this. As one of the references I put before indicates there is evidence of value in recognizing chronic conditions by regular checks that improve how they are treated, even if for problems like cardiac disease the study found no advantage.

There is a huge difference between indiscriminate check ups for everything and anything in the general population and directed test for people that have increased risk because of their demographics. Routine annual checks for weight and blood pressure for example may not offer too drastic advantages, but neither they bring special risks. Other things like colonoscopies or mammograms do have those risks so they are only recommended to certain age groups or people with special factors of risk.

1 ( +3 / -2 )

David Brent

There was a study in The Lancet a few years back saying that due to Japanese doctors ordering so many CT scans and X-rays, Japan has the highest incidence of cancers caused by radiation from the machines!

I don't believe that. When my cancer was detected I had many full-body scans. That is a tin-foil hat story.

1 ( +5 / -4 )

The article in The Lancet is from 31 January 2004. 20 years in medical science is a long time. I am not even going to read it.

1 ( +4 / -3 )

Radiation risk from medical imaging

https://www.health.harvard.edu/cancer/radiation-risk-from-medical-imaging

1 ( +3 / -2 )

There was a study in The Lancet a few years back saying that due to Japanese doctors ordering so many CT scans and X-rays, Japan has the highest incidence of cancers caused by radiation from the machines!

Definitely something to consider, and likely to be something that can be easily improved (not enough benefits to offset the costs of that risk) the calculations of the absolute number of cancer cases attributed to this is telling.

It is also interesting to see the affiliation of one of the authors that belongs to the Epidemiological Studies Unit of the University of Oxford, hopefully this can clarify why just performing a test is not enough to also become an expert in quantifying the benefits or costs (in risk) of that test but instead something that requires preparation un public health or, as in this case, epidemiology.

1 ( +2 / -1 )

Yes, surely everyone has some issues here or there and it's in theory not bad that they often can be found during such sophisticated health checks with newest technology. But also you quickly get trapped into their business spiral of sending you to the next doctor and again back to the first and a third, then maybe some unnecessary medications, additional checks to get their expensive machinery paid off, surgeries that could also managed by other methods etc. They in fact play medical ping-pong with you and it's difficult to break out. And if you luckily break out, you can't get anymore the few real necessary check results. It's. a mess, I can tell you, and it really makes you sick, if you haven't already been sick. Otherwise it makes you even sicker, because it's easy to tell you anything if you are not an equally skilled medical expert.

1 ( +2 / -1 )

Just remember medical industry is a business first and helping people second. The doctor is the main sales person for tests and drugs.

It does not mean some Dr will not help you when you are sick, they will - but just do not believe everything and do everything they ask at face value. Interests are frequently not aligned.

0 ( +4 / -4 )

An epidemiologist, a public health expert would be an authority on the topic of how health checks should be performed, a degree on biology or anatomy by themselves do not confer any kind of expertise in the topic. And as demonstrated with references some health checks do not include an audiology determination which can be appropriate or not depending on the person, the same as every other test.

0 ( +4 / -4 )

The simple fact that the two individuals, both men, have already lived well past most countries' life expectancy rates for males says a lot about the positives of the health care system in Japan.

Exactly, unfortunately both are expressing opinions outside of their field of expertise, which can explain why they reduce themselves to hearsay and personal experience instead of discussing actual data that apparently do not support their opinions. Neither of them have demonstrable training or experience in evaluating epidemiological considerations for public health, so any appeal to their supposed authority is invalid.

the fact that Japanese on average LIVE SO LONG (and that they have more health related checks of any kind in their lives, on average, than almost any other group of people) suggests that if it ain't broke, there's not a lot of need to "fix" it.

Of course other factors are also involved, but this is a very powerful argument towards demonstrating that even if public health in Japan is not free of problems the regualr check ups are not one of them as the opinions in the article seems to suggest. Waiting until something is wrong with your health to see a doctor is a terribly bad alternative.

0 ( +2 / -2 )

From my full body scans the doctors were able to see I was free from cancer. Without those, it would have been unknown which would have been a problem to live with. Not knowing if I had cancer cells or not.

0 ( +3 / -3 )

The benefits of CT scans and others outweigh the risks in the majority of cases. They save lives.

Studies show that the risk of cancer from CT scans is extremely low. The amount of cancer attributable to ionizing radiation is difficult to estimate.

Most patients do not have many tens of scans over one year.

Doctors don't have a specific limit on the number of CT scans you can have safely.

"guidelines by the National Comprehensive Cancer Network and other cancer groups recommend computed tomography (CT) scans every three to six months for patients who have had malignant lung tumors surgically removed."

For the majority of patients, the scans are life-saving.

During my cancer treatment in several hospitals, I had scans. Most took 20 minutes or so. The waiting rooms were mostly empty of other patients.

I had MRI full body scans, which I hated, and took a full 30 minutes. One very expensive machine and 30 minutes is not going to be used for a large number of patients in a single day.

I was happy to be living in a country that could afford these expensive machines and be able to provide them to the public.

"Conclusion. Japanese people have remarkably low mortality rates from ischemic heart disease and cancer (particularly breast and prostate), and relatively high rates from cerebrovascular disease and respiratory infection."

https://www.nature.com/articles/s41430-020-0677-5#:~:text=Conclusion,cerebrovascular%20disease%20and%20respiratory%20infection.

0 ( +2 / -2 )

I don't want to hear about people refusing lifesaving CT scans because they read on a forum they cause cancer.

The radiation from one CT scan is less than 20 millisieverts, mSv.

https://www.webmd.com/cancer/radiation-doses-ct-scans

0 ( +3 / -3 )

Over three decades in Japan and I've never had a health check. No problems whatsoever.

-1 ( +0 / -1 )

Many Western countries don't do them because their research shows no significant differences in death rates between tested populations and untested populations.

Any reference for this? because current research do not support these claims,

https://pubmed.ncbi.nlm.nih.gov/34100866/

https://pubmed.ncbi.nlm.nih.gov/31361740/

-2 ( +2 / -4 )

From 2019

Computed Tomography (CT) Scans and Cancer Fact Sheet - NCI

"Standard x-ray procedures, such as routine chest x-rays and mammography, use relatively low levels of ionizing radiation. The radiation exposure from CT is higher than that from standard x-ray procedures, but the increase in cancer risk from one CT scan is still small."

https://www.cancer.gov/about-cancer/diagnosis-staging/ct-scans-fact-sheet#:~:text=Standard%20x%2Dray%20procedures%2C%20such,CT%20scan%20is%20still%20small.

-2 ( +1 / -3 )

It opens with a dialogue between Ikeda, 76, and anatomist Takeshi Yoro, 86. 

These physicians obviously have the authority to discuss health check ups in Japan.

That's what they do.

-2 ( +1 / -3 )

Happy for these health checks, where a hearing test is part of it.

A biologist and an anatomist do not really seem like an authority to talk about the topic

Considering that biology and anatomy are core subjects of a medical degree, a biologist and anatomist are authorities.

In layman terms, they are experts.

-3 ( +5 / -8 )

The medical doctor is the authority on performing health checks

This argument is refuted by the same reason, the authority that can accurately evaluate the value in public health for the health checks is an epidemiologist or someone with a degree in public health, not the person that can perform such tests. A nurse can be excellent at taking blood samples, but that would not make him an authority on whatever is found on those samples.

For example this research article

https://pubmed.ncbi.nlm.nih.gov/28880484/

Is authored by a professional specialized in public health (community health) and do not have a MD.

-3 ( +1 / -4 )

Interesting article about a biologist and anatomist, who are also medical doctors who performed these health checks and so are the authorities. I mean, if the doctors giving these exams are not qualified authorities they would not be giving these exams in highly regulated Japan.

Nice to listen to something right out of the mouths of these physicians who are the actual experts.

-4 ( +1 / -5 )

unfortunately both are expressing opinions outside of their field of expertise

Two medical doctors who perform annual health checks are expressing opinions on those health checks, but someone thinks the medical experts are speaking outside of their expertise?

-4 ( +1 / -5 )

I don't believe that. When my cancer was detected I had many full-body scans. That is a tin-foil hat story.

You can disbelieve it all you want; doesn't make it any less true. Or are you calling one of the foremost medical journals in the world a liar?

In 13 other developed countries, estimates of the attributable risk ranged from 0·6% to 1·8%, whereas in Japan, which had the highest estimated annual exposure frequency in the world, it was more than 3%.

https://www.sciencedirect.com/science/article/abs/pii/S0140673604154330?dgcid=api_sd_search-api-endpoint

-5 ( +2 / -7 )

There was a study in The Lancet a few years back saying that due to Japanese doctors ordering so many CT scans and X-rays, Japan has the highest incidence of cancers caused by radiation from the machines!

-7 ( +1 / -8 )

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