專家披露: 年度體檢意義不大

WE all make resolutions and promises to live healthier and better lives, to make the world a better place. Not having my annual physical is one small way I can help reduce health care costs — and save myself time, worry and a worthless exam.

我們都會制定新年計劃，發誓要更健康、過更好的生活、讓世界變得更美好。不去做年度體檢，是我能做到的減輕醫療成本的一個微小舉動——不體檢還能節約我的時間、省心，而且省去一番毫無價值的周章。

Around 45 million Americans are likely to have a routine physical this year — just as they have for many years running. A poke here, a listen there, a few tubes of blood, maybe an X-ray, a few reassuring words about diet, exercise and not smoking from the doctor, all just to be sure everything is in good working order. Most think of it as the human equivalent of a 15,000-mile checkup and fluid change, which can uncover hidden problems and ensure longer engine life.

今年大約會有4500萬美國人進行例行體檢，就像他們多年來所做的那樣。這裏戳一下，那裏聽一聽，抽幾管血，或許再做一下X光，之後再聽醫生說些叮嚀的話：注意飲食、鍛鍊身體、不要抽菸，目的只是爲了確信所有機能都運轉良好。多數人對體檢的理解都是，讓人像車一樣，每跑1.5萬英里就檢查一下，換換機油，好發現隱藏的問題，確保引擎壽命能夠延長。

There is only one problem: From a health perspective, the annual physical exam is basically worthless.

只有一個問題：從健康的角度來看，年度體檢基本上毫無價值。

In 2012, the Cochrane Collaboration, an international group of medical researchers who systematically review the world’s biomedical research, analyzed 14 randomized controlled trials with over 182,000 people followed for a median of nine years that sought to evaluate the benefits of routine, general health checkups — that is, visits to the physician for general health and not prompted by any particular symptom or complaint.

2012年，由一羣醫學專家組成的科克倫協作網(Cochrane Collaboration)對全球生物醫學研究資料進行了系統性的調查，分析了14個隨機對照試驗，這些實驗覆蓋了逾18.2萬人，跟蹤年限中位數爲9年，目的是評估一般性體檢的作用。所謂一般性體檢是指那些在沒有任何特定症狀，或者不適感的情況下，去醫生那裏做的體檢。

The unequivocal conclusion: the appointments are unlikely to be beneficial. Regardless of which screenings and tests were administered, studies of annual health exams dating from 1963 to 1999 show that the annual physicals did not reduce mortality overall or for specific causes of death from cancer or heart disease. And the checkups consume billions, although no one is sure exactly how many billions because of the challenge of measuring the additional screenings and follow-up tests.

這項調查得出了明確的結論：一般性體檢可能沒有好處。無論採用哪些篩查和測試方式，關於年度體檢的1963年至1999年期間的研究表明，它們並沒有整體降低死亡率，也沒有降低癌症或心臟疾病等特定病因的死亡率。體檢耗費了數以十億計的美元，但具體數字難以得出，因爲無法知道，額外的篩查和後續測試又花費了多少錢。

This lack of evidence is the main reason the United States Preventive Services Task Force — an independent group of experts making evidence-based recommendations about the use of preventive services — does not have a recommendation on routine annual health checkups. The Canadian guidelines have recommended against these exams since 1979.

這種缺乏證據的狀況，是美國預防服務工作組(United States Preventive Services Task Force)——由專家組成的獨立團體，就預防措施提供有確鑿證據支持的建議——沒有推薦每年例行健康檢查的主要原因。自1979年以來，加拿大就不推薦進行這些檢查。

How can this be? There have been stories and studies in the past few years questioning the value of the physical, but neither patients nor doctors seem to want to hear the message. Part of the reason is psychological; the exam provides an opportunity to talk and reaffirm the physician-patient relationship even if there is no specific complaint. There is also habit. It’s hard to change something that’s been recommended by physicians and medical organizations for more than 100 years. And then there is skepticism about the research. Almost everyone thinks they know someone whose annual exam detected a minor symptom that led to the early diagnosis and treatment of cancer, or some similar lifesaving story.

這怎麼可能？在過去的幾年裏，曾有報道和研究對體檢的價值提出質疑，但病人和醫生似乎都不想聽這樣的消息。一部分是心理因素；即便身體無恙，體檢也給雙方提供了交談機會，重新拉近了醫患關係。也有習慣方面的原因。一百多年來，醫生和醫療機構推薦每年體檢，這是很難改變的。再有就是大家對這些研究有所懷疑。幾乎每個人，都覺得自己認識的某人，在每年體檢中發現了輕微的症狀，導致了癌症的早期診斷和治療，或者聽過類似的體檢挽救生命的故事。

One explanation for the ineffectiveness of the annual exam in reducing the death rate is that it does little to avert death or disability from acute problems. Unintentional injuries and suicides are, respectively, the fourth and 10th leading causes of death among Americans. And it does little for chronic conditions without significantly useful interventions such as Alzheimer’s, the fifth leading cause of death among older people.

每年體檢在降低死亡率方面沒有效果的一種解釋是，對於急性原因導致的死亡或殘疾，它幾乎沒有作用。意外傷害和自殺，在美國人的死因中分別位居第四和第十。而且每年體檢對慢性病的作用很不明顯，比如老年人第五大致死原因阿爾茨海默氏症。

Further, researchers have long noted that screening healthy people who have no complaints is a pretty ineffective way to improve people’s health. If you screen thousands of people, maybe you’ll find tens whose exams suggest they might have a disease. And then upon further tests, you’ll find it is really only a few individuals who truly have something. And of those individuals, maybe one or two actually gain a health benefit from an early diagnosis.

此外，研究人員很早就注意到，對於那些沒有不適感的健康人，用篩查來改善健康的效果相當差。如果你篩選數千人，發現可能患有某種疾病的只有幾十人，進一步測試，會發現其實只有幾個人真的患了病。而在這些人中，也許一兩個真正從早期診斷中受了益。

The others may have discovered a disease, but one that either would never have become clinically evident and dangerous, or one that is already too advanced to treat effectively. For instance, early detection of most thyroid cancers leads to surgery, but in many cases those cancers would not have caused serious problems, much less death. Conversely, for individuals whose annual exams lead to the diagnosis of esophageal or pancreatic cancer, the early diagnosis might extend the time they know they have cancer but is unlikely to extend their lives.

至於其他人，要麼是在臨牀上永遠不會顯露症狀和變得危險，要麼是患上了不治之症。例如，早期發現的甲狀腺癌病人中，大多數都接受了手術治療，但在很多情況下，這種癌症不會造成嚴重問題，更不用說死亡了。而對於每年體檢發現的食管癌或胰腺癌患者，早期診斷可以延長他們提前知道自己患癌，但不太可能延長他們的壽命。

Some are actually hurt by physicals, because healthy patients who undergo an exam sometimes end up with complications and pain from further screening or confirmatory tests.

實際上，體檢還給一些人造成了損失，因爲健康人如果在體檢中疑似有問題，就需要進行進一步篩查和驗證性測試，這會他們帶來併發症和疼痛感。

My New Year’s resolution does not mean I won’t get my annual flu shot or a colonoscopy every 10 years — or eat a balanced diet and get regular exercise. These are proven to reduce morbidity and mortality. Those who preach the gospel of the routine physical have to produce the data to show why these physician visits are beneficial. If they cannot, join me and make a new resolution: My medical routine won’t include an annual exam. That will free up countless hours of doctors’ time for patients who really do have a medical problem, helping to ensure there is no doctor shortage as more Americans get health insurance.

我下這樣的新年決心，並不意味着我放棄每年的流感疫苗接種，或每10年一次的結腸鏡檢查——或保持均衡的飲食和規律的運動。數據已經證明，這些做法確實可以減少發病率和死亡率。那些宣揚常規體檢的人，必須拿出數據來，證明它爲什麼有益於健康。如果拿不出來，那麼就像我一樣下個決心：每年體檢不在我的健康習慣之內。這將爲醫生節省出大量時間，來照顧那些確實有健康問題的病人，隨着越來越多的美國人擁有了醫療保險，這樣做有助於緩解醫生短缺的狀況。