“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