15 September 2025
In last week’s post, Who says you’re depressed or anxious? Pfizer does, I referred to a post by a Twitter user who, during what she described as “a regular checkup”, had been given a PHQ-9 – a screening questionnaire to recruit customers for antidepressants identify people suffering from ‘depression’. (The PHQ-9, as I noted in that post, was developed by academics funded entirely by the pharmaceutical giant Pfizer, which, by complete coincidence, just happens to make some of the top-selling antidepressant drugs in the world.)
Now, I know nothing whatsoever about this Twitter user’s health status, or why she might have been attending “a regular checkup”. But her use of this term reminded me of a topic that I frequently discuss with clients and members of my EmpowerEd health education program. The conversations generally go something like this: the client or member asks me which blood tests he or she should request when having an annual checkup. This leads into a broader discussion of whether attending an annual checkup is a good idea in the first place.
To summarise my answer, the general consensus among multiple advisory panels and medical researchers who have reviewed the evidence, is ‘no’.
But how could this be? Surely an annual check-up would help to identify health problems in their early stages, facilitating more effective treatment and prevention of serious complications of the disease. (This is what doctors call ‘secondary prevention’ – managing an illness so as to reduce its impact on the sufferer; ‘primary prevention’ means stopping the disease from ever developing in the first place.)
It’s an appealing idea, but unfortunately the facts don’t support it. Let’s take a look at some of the major research teams and medical associations that recommend against an annual medical check-up:
1) Cochrane Review, 2019: ‘General health checks in adults for reducing morbidity and mortality from disease’
Cochrane (formerly known as the Cochrane Collaboration) is an international, not-for-profit organisation comprised of independent authors who follow a specific methodology for reviewing published studies, in order to facilitate evidence-based decision-making in medical care and public health policy.
Cochrane’s reputation as the pre-eminent voice for evidence-based medicine was seriously tarnished by their governing board’s expulsion of founding member, Peter Gøtzsche in late 2018, over his outspoken criticism of the increasingly cosy relationship between Cochrane and the pharmaceutical industry. Cochrane reviews written after 2016, when the organisation began accepting funding from the Bill & Melinda Gates Foundation, need to be considered with a far more sceptical eye than their earlier work.
Interestingly, Cochrane’s 2019 update on general health checks was one of the last that Peter Gøtzsche worked on. He and his coauthors reviewed 15 randomised controlled trials which compared outcomes in a total of 251,891 adult participants who were not selected for disease or risk factors, and who were randomly assigned to either receive general health checks or not. A general health check is defined as conducting screening tests for more than one disease or risk factor in more than one organ system, in a person who does not currently feel ill. General health checks are also described, in various localities, as general medical examinations, periodic health evaluations, routine visits, wellness visits, multiphasic screening, annual physicals, and preventive health checks.
Outcomes assessed included illness, hospitalisation, absence from work, and death. 11 trials (with a total of 233,298 participants) included risk of death as an outcome; 21,535 deaths were assessed.
The Cochrane reviewers concluded that
“Health checks have little or no effect on the risk of death from any cause (high‐certainty evidence), or on the risk of death from cancer (high‐certainty evidence), and probably have little or no effect on the risk of death from cardiovascular causes (moderate‐certainty evidence). Likewise, health checks have little or no effect on heart disease (high‐certainty evidence) and probably have little or no effect on stroke (moderate‐certainty evidence).”
General health checks in adults for reducing morbidity and mortality from disease
In other words, if you’re diagnosed with some kind of disease as a result of attending a checkup, you’re just as likely to die of that disease, or to die of anything at all, as if you never went for the checkup and therefore didn’t even know you had the disease.
2) Systematic review of randomised trials and observational studies with control groups
Two years after the Cochrane review was published, NIH-funded researchers conducted a review of studies on general health checks, including 19 randomised controlled trials and 13 observational studies with control groups. Participants who received general health checks were more likely to have a chronic disease diagnosed, to be screened for colorectal and cervical cancer, to have moderate improvements in risk factors such as blood pressure and cholesterol, and to report higher quality of life and self-rated health. Participants in the Danish Check-In Study who were randomised to receive a single health check were also more than twice as likely to receive a new antidepressant prescription. Despite all this,
“General health checks were generally not associated with decreased mortality, cardiovascular events, or cardiovascular disease incidence.”
General Health Checks in Adult Primary Care: A Review
Gee, it’s almost as if increased medical attention, diagnosis and treatment don’t actually make people any healthier.
3) Agency for Healthcare Research and Quality
The AHRQ reviewed 21 papers on “periodic health evaluations” (PHE), assessing 17 health outcomes, and concluded that PHE
“had a consistently beneficial association with patient receipt of gynecological examinations and PAP smears, cholesterol screening, and fecal occult blood testing” (Boulware 2007, p.289). One trial found that the PHE was associated with less patient worry. There were no consistent associations between the PHE and any of the other 13 outcomes evaluated (counseling, immunizations, mammography, disease detection, health habits, health status, blood pressure, body mass index, cholesterol levels, costs, disability, hospitalization and mortality).”
Evidence Brief: Role of the Annual Comprehensive Physical Examination in the Asymptomatic Adult
Put simply, patients were more likely to get poked, prodded and tested, and they felt relieved by all that attention, but once again, it didn’t lead to better health outcomes. As a consequence, AHRQ firmly advised that
“Comprehensive routine physical examinations are not recommended for the asymptomatic adult, although many patients and physicians continue to endorse the practice.”
Evidence Brief: Role of the Annual Comprehensive Physical Examination in the Asymptomatic Adult
4) The Society of General Internal Medicine
SGIM, a global association of over 3,300 leading academic general internists (roughly equivalent to GPs), recommends against routine annual examinations for all, and instead suggests customisation informed by individual risk factors and health status. Their recommendation is based on evidence that while checkups increase the chances of being diagnosed with a chronic condition such as diabetes, hypertension, or stage 3-5 kidney disease, and of being prescribed medication aimed at disease prevention, such as statins, they do not reduce cardiovascular events, cardiovascular disease incidence or overall mortality.
Despite the evidence against the annual checkup, this medical zombie just won’t die. And it’s not just being kept alive by doctors; SGIM frets that many patients continue to demand pointless medical overservicing:
“Checkups are often erroneously called ‘annual physicals,’ and patients often expect ‘routine blood work.’ However, checkups need not happen every year, they do not need to include a comprehensive physical examination, and no organization recommends ‘routine blood work’. For asymptomatic patients, beyond blood pressure measurement, body mass index (BMI) assessment, and cervical cancer screening for women, a regular screening physical examination has not been shown to improve health. For laboratory testing, current recommendations for patients with previously normal results range from every 3 to 5 years for common tests such as blood glucose and lipid levels.”
Choosing Wisely – Five Things Physicians & Patients Should Question
5) European Federation of Internal Medicine
The Choosing Wisely Working Group of the EFIM conducted a review of the available evidence for general health checkups in 2023, and reached the same conclusion as the SGIM: clinically meaningful patient outcomes are not improved, despite some studies finding that patients who attend checkups feel better about their health. However, the EFIM working group was less inclined to blame patients for perpetuating the practice, instead urging doctors to become better informed about the risks and benefits of screening, so they can educate their patients to be wiser consumers:
“Although international guidelines recommend that PCP [primary care providers] should no longer follow the tradition of the annual general check-ups, data show that the frequency of these exams hasn’t diminished. Important reasons for not following the recommendations include – among others – perceived pressure to yield to the patient requests [8]. However, such expectations are probably overestimated by PCP, who tend to convey their inaccurate risk perceptions to patients, leading to overstatements about intervention benefits and minimization of risks.”
General health check-ups: To check or not to check? A question of choosing wisely
6) US Preventive Services Task Force
The USPSTF, an independent panel of experts in primary care and prevention that systematically reviews the evidence of effectiveness and develops recommendations for clinical preventive services, does not endorse routine annual comprehensive physical exams, instead providing targeted recommendations based on age, sex and risk factors.
I could cite more reviews and expert recommendations, but I think I’ve made my point.
Why don’t health checks promote better health?
The Cochrane team had some ideas about why routine checkups don’t make people healthier:
“We propose that one reason for the apparent lack of effect may be that primary care physicians already identify and intervene when they suspect a patient to be at high risk of developing disease when they see them for other reasons. Also, those at high risk of developing disease may not attend general health checks when invited or may not follow suggested tests and treatments.”
General health checks in adults for reducing morbidity and mortality from disease
In other words, if someone presents for treatment of an acute condition, such as a sinus infection or skin rash, and the doctor observes that the patient is overweight, reeks of cigarette smoke, or has swollen ankles, the doctor will likely grab the opportunity to initiate testing for cardiometabolic risk factors or screen them for problematic substance use.
Furthermore, the people most likely to attend an invitation for a general health check are those with the lowest likelihood of benefiting from it, because they’re already better educated, more health conscious, and more likely to be practising good health habits. Conversely, those with the worst diet and lifestyle practices are the least likely to turn up for screening, let alone to change their bad habits.
If you think this is an overly dismal view, allow me to acquaint you with the large body of research on personality – specifically, the trait of conscientiousness, which is moderately heritable (that is, attributable to individual variation in genes) and relatively stable over time (that is, a person who exhibits high conscientiousness in early adulthood is likely to still be highly conscientious in midlife and old age). Conscientious people smoke less; exercise more; eat healthier diets; are slimmer; have fewer chronic diseases and when they do have them, manage them better because they have an internal health locus of control (that is, they believe their actions can change their outcomes); and live longer. And they’re the most likely to respond to an invitation to attend a health checkup, despite having the lowest chance of benefiting from it.
The 2019 Cochrane review on general health checks was the latest update in a series on the subject, with all previous iterations having reached the same conclusion – this s#*t doesn’t work. The authors’ frustration that previous reviews have not altered research priorities or health policy, was quite evident:
“Implications for research
We see no reason to do more trials of general health checks, as it seems futile based on the large amount of available data and the fact that the results of previous trials have now been confirmed by a recent large trial. Further research in health checks should be limited to studying the effect of one component at a time, and should include harmful effects. We also suggest that surrogate outcomes such as changes in risk factors are not used for assessing benefits since they do not capture harmful effects and since their relation to meaningful outcomes is usually in doubt. The required large randomised trials with long follow‐up are expensive but not nearly as expensive as the implementation of ineffective or harmful screening programmes. We suggest more focus on the effects of structural interventions to reduce disease, for example, higher taxes on tobacco and alcohol, or restricting corporate advertising for harmful products.”
General health checks in adults for reducing morbidity and mortality from disease
In other words, governments should stop flushing taxpayers’ money down the toilet on clinical trials of general health checks, and on programs that foist them onto the uninformed public.
I would add that those taxpayer dollars would be better spent on identifying strategies to increase conscientiousness. If an effective methodology for increasing conscientiousness was developed, I could get behind a public screening campaign to identify low-conscientious individuals and recruit them into such a program.
Yeah, in my dreams, right? I don’t see the health screening gravy train going off the rails any time soon; there are too many individuals, organisations and corporations who are heavily invested in it, both financially and ideologically.
Salutogenesis vs pathogenesis
At a deeper level of analysis, the reason that general health checks don’t improve health, is that they’re delivered by individuals and institutions that have no idea what health actually is, or how to nurture it. The medical model revolves around pathogenesis – the study of the development of disease. Hence, so-called health checks are actually focused on identifying markers of illness, such as high blood pressure or elevated LDL-cholesterol or an overly-large waistline. And once those biomarkers are identified in an individual – now classified as a patient – he or she will be hoisted onto the medical conveyor belt of prescriptions and interventions and specialist referrals and further testing that identifies new pathologies to treat with more prescriptions and interventions.
By contrast, salutogenesis focuses on the factors that promote health and wellbeing and, in particular, cultivating the capacity of the individual to mobilise their own resources and capabilities in order to respond to life challenges, including illness.
When viewed through the lens of salutogenesis, the concept of the health checkup may actually have some value. When I do a periodic checkup with clients, I:
- Review their food journal and make suggestions for improvement, focusing on addressing practical considerations such as their level of cooking skills and the time they have available to prepare food;
- Discuss their exercise routine and propose modifications based on their goals and life stage;
- Investigate their sleep patterns and develop a plan to address sleep problems if they become evident; and
- Help them develop a practical stress management plan, or tweak the one they already have to increase its effectiveness.
I also encourage clients who follow a plant-based diet, and all those aged over 65, to get a blood test for serum vitamin B12 every one to two years, in order to prevent development of deficiency and to fine-tune their B12 supplement dosage. And I advise those with a strong family history of cardiovascular disease and/or type 2 diabetes to get their cardiometabolic risk biomarkers measured, including a lipid panel, apolipoprotein B, lipoprotein (a), and HbA1c.
Other blood tests are simply not necessary if no new symptoms have developed. ‘Getting everything tested’ puts you at high risk of having one or more results outside the ‘normal’ range, which can then lead to further investigation, unnecessary treatment, and escalating health anxiety. Reviewing the test results of thousands of patients over thirty years of clinical practice has taught me that perfectly healthy people live outside those ‘normal’ ranges, while people who are profoundly ill often have completely ‘normal’ test results.
Obviously, you should seek medical attention if you develop a new symptom that is severe or persists for more than a couple of days. Well-chosen tests can facilitate correct diagnosis, and inform effective treatment plans. But we can add an extra clause to the old adage, ‘If it ain’t broke, don’t fix it’ – namely, ‘if it ain’t bothering you, don’t test for it’.
