'You're amazing we want to keep you that way,' read the billboards of one private health insurer. 'Get your body MOT,' calls another. Employment contracts increasingly offer private health insurance, including annual 'health checks' as a perk and last month, some US firms announced that, as part of their caring approach to employees, every staff member would be asked to go through a computerised health check, which would then send encouraging reminders at intervals across their work station screens of how to improve their lifestyle. There's no doubt prevention is better than cure when it comes to the common diseases such as heart disease, stroke, diabetes and cancer. And getting early warning that we might be developing one of these conditions is medical motherhood and apple pie.
But can the battery of health checks now being encouraged by private medicine really do this? Will paying for tests Bupa's full health screen costs £340 for men and £360 for women not done routinely by your GP really keep you healthier? Not surprisingly, two of the major providers of health check services say yes.
Dr Kirstie Gibson, clinical services manager for Bupa, says: 'It's increasingly about giving people some assessment of their risk in the future. With the tests we run we are trying to pick up all the information someone would need to try to make lifestyle changes that we know from research can reduce mortality and illness.' Dr Kevin Ling, clinical director of Medicentres, adds: 'Knowing about your health in a predictive way is useful. There are so many things you can do to improve your health: you don't want to leave it until they have to cure you by cutting things out or putting you on medication.'
Few doctors would argue with this, but it doesn't take a £340 healthcheck to know you should give up smoking, take more exercise, eat more vegetables, less saturated fat, and avoid getting falling-down drunk. Surely the more technical tests done in these health checks must give an extra fillip? Very little, says Dr Muir Grey, director of the National Screening Committee, which investigates the usefulness and accuracy of clinical tests. 'Some of these tests don't have any predictive effect at all. These health check packages are more to do with attention and motivation than getting useful information. Having health checks could be useful if you are the kind of person to take advice on board only if you are getting attention. There's something about being medicalised - in general we try to demedicalise things, but for some people it's helpful. It may be that getting someone else to do it, and paying them to do it, increases motivation to do something about lifestyle problems like weight and exercise.'
But Dr Grey punctures the idea that being able to afford a regular health screen means that you'll get the jump on any life-threatening disease. 'One or two of the tests - blood pressure for example - could help with early diagnosis. But you can go to your doctor and get these for free.' The reason most GPs do not routinely do these checks, he adds, has nothing to do with cost. There is simply no evidence they have the predictive power that makes them worth doing in people with no symptoms.
Dr Gibson begs to differ: 'The cost-benefits needed to justify national screening programmes are different to the balance of risk which makes a test valuable. A screening programme may not be worth doing in a large population; perhaps the test is not accurate enough, or people don't like it, but on an individual basis it is worth it.' She agrees, though, that many tests do act as motivators rather than predictors - and are valuable for that reason alone. 'People get to spend a lot of time with our doctor or nurse talking things through. It's an education process as well. We give people the time to take information on board, to plan to do something about it and the support to do it.' The bottom line is that you may not learn anything from a health check that your GP or a few health magazines couldn't tell you, but perhaps the substantial investment will make you hear it better.
Testing time
Dr Muir Grey, National Screening Programme director, and Dr Kirstie Gibson, director of BUPA's health check service, assess screening tests.
Electrocardiogram (ECG) Grey: 'There's no evidence that ECG screening of healthy people with no symptoms is useful in preventing disease.' Gibson: 'There have been studies showing how small changes in rhythm may have predictive capacity. But even people who have a heart attack can have a normal ECG.'
Cardiorespiratory test Grey/Gibson: 'If you are promoting exercise this is sensible. It can help suggest a starting level.'
Lung function Grey: 'There is no evidence this gives any useful predictive information about asthma, emphysema or chronic bronchitis.' Gibson: 'The benefit is more feedback than prediction. Smokers could be motivated to stop.'
Body mass index/body fat Grey: 'You'd be better off taking your clothes off, looking in the mirror and being honest.' Gibson: 'Shows if your weight is reasonable for your height.'
Dietary balance analysis Grey: 'Might increase your motivation to change your diet.'
Blood pressure Grey: 'Everybody should have this. It reduces the risk of stroke. But your GP can do it easily.'
Full blood profile Grey: 'There's no evidence that kidney and liver function tests offer any predictive information. Gibson: 'We have detected leukaemia with this screen.'
Cholesterol Grey: 'Only people with other risk factors such as a family history of heart disease seem to benefit here.' Gibson: 'You don't get symptoms from high cholesterol. By the time you have symptoms it's too late.
Urinalysis Grey: 'There is no evidence that this can predict kidney problems. It is not a good test for diabetes.' Gibson: 'Can detect abnormalities which can indicate diabetes or kidney disease.'
Stool test Grey: 'Good for people aged 50-69.' Gibson: 'Detects blood loss due to colon cancer or other benign problems.
