Annual Medical Checkup : Part 2

by Food and Drug Administration (FDA)

(Page 2 of 3)

An Ounce (or Two) of Prevention

Two major government-sponsored inquiries sparked the reassessment of the routine annual physical. In 1979, the Canadian Task Force on the Periodic Health Examination published an evaluation of the effectiveness of preventive services performed routinely by Canadian physicians. A similar effort was launched in 1984 by the U.S. Department of Health and Human Services, of which the Food and Drug Administration is a part. The U.S. Preventive Services Task Force, a 20-member panel of non-federal physicians, other health-care providers, and preventive medicine experts, closely followed the Canadian scheme for ranking preventive services.

The U.S. task force's report, Guide to Clinical Preventive Services, published in 1989, focused on 169 measures targeted at 60 different illnesses and conditions. It has been called "the bible" of preventive medicine. If it is, then the "gospel" is: Schedule and structure periodic health checkups to match an individual patient's individual health profile.

Given that point of departure, the list of preventive services the task force found appropriate for all symptomless patients is fairly short. The only components of the old "routine" physical exam recommended for every patient are measurements of height, weight, and blood pressure. On the other hand, the approach to prevention envisioned in the task force report attaches great importance to screening measures to identify patients at special risk of illness or injury.

Physicians are advised to take a full, detailed medical history, to identify occupational and behavioral factors that affect health, to find out about a patient's eating habits, use of alcohol and other drugs, use of tobacco, and sexual activity — anything that may put the patient at high risk for a specific disease or disability. The physician can then make informed choices among available preventive services, emphasizing the ones most likely to benefit an individual patient. Many of these measures involve the use of devices, tests and vaccines regulated by FDA.

For example, the task force recommends periodic blood pressure testing for everyone 3 or older. High blood pressure affects close to 60 million Americans, many of whom have no symptoms. It's a major risk factor for coronary artery disease, congestive heart failure, stroke, and kidney disease. High blood pressure is easy to detect, and it can be controlled with diet, exercise and drugs, preventing serious illness and death.

On the other hand, the Preventive Services Task Force found no scientific basis for routine urine testing of all asymptomatic patients. (See "Urinalysis: Looking into the Void" in the October 1989 issue of FDA Consumer.) Instead, the task force recommended periodic "dipstick" urinalysis for pregnant women and people with diabetes. Urine testing, the task force suggested, may also be appropriate for preschool children and people over 60.

Serious urinary tract disorders are uncommon, urinalysis is not especially reliable as a screening test for such disorders, and the effectiveness of early detection and treatment of urinary tract problems is unproved. Hence, doing a urinalysis routinely and repeatedly among symptomless people can't be justified.

By the same token, electrocardiography (ECG) to screen for unsuspected coronary artery disease is recommended only for certain high-risk groups and for people, such as airline pilots, whose sudden heart attack could endanger public safety. "High-risk" in this instance means people who have two or more risk factors for coronary artery disease — cigarette smoking, high blood pressure or high serum cholesterol levels, diabetes, or a family history of coronary disease before age 55. The task force found no basis to recommend routine ECG screening of all individuals with no hint of coronary artery disease.

Again, the reason for the recommendation is straightforward: Studies have shown that routine screening of symptomless people in whom the probability of coronary artery disease is low has been found to generate a large proportion of false-positive results. Studies of the more reliable stress ECG (or "stress test"), in which the patient is tested while exercising to raise the heart rate toward its upper limit, indicate that most symptomless people with abnormal test results don't have coronary artery disease. According to the task force report, neither the regular nor stress ECG is recommended for children, adolescents, or young adults who show no evidence of heart disease and plan to start a strenuous athletic program.

About the Author

www.fda.gov
FDA is A United States government body that oversees medical devices, including contact lenses, intraocular lenses, excimer lasers and eyedrops. In the US, these products must be approved by the FDA before they can be marketed.