年度體檢意義不大

Skip Your Annual Physical

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(huì)制定新年計(jì)劃，發(fā)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(yī)療成本的一個(gè)微小舉動(dòng)——不體檢還能節(jié)約我的時(shí)間、省心，而且省去一番毫無價(jià)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(huì)有4500萬美國(guó)人進(jìn)行例行體檢，就像他們多年來所做的那樣。這里戳一下，那里聽一聽，抽幾管血，或許再做一下X光，之后再聽醫(yī)生說些叮嚀的話：注意飲食、鍛煉身體、不要抽煙，目的只是為了確信所有機(jī)能都運(yùn)轉(zhuǎn)良好。多數(shù)人對(duì)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(jī)油，好發(fā)現(xiàn)隱藏的問題，確保引擎壽命能夠延長(zhǎng)。

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

只有一個(gè)問題：從健康的角度來看，年度體檢基本上毫無價(jià)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，由一群醫(yī)學(xué)專家組成的科克倫協(xié)作網(wǎng)(Cochrane Collaboration)對(duì)全球生物醫(yī)學(xué)研究資料進(jìn)行了系統(tǒng)性的調(diào)查，分析了14個(gè)隨機(jī)對(duì)照試驗(yàn)，這些實(shí)驗(yàn)覆蓋了逾18.2萬人，跟蹤年限中位數(shù)為9 年，目的是評(píng)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癥狀，或者不適感的情況下，去醫(yī)生那里做的體檢。

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(xiàng)調(diào)查得出了明確的結(jié)論：一般性體檢可能沒有好處。無論采用哪些篩查和測(cè)試方式，關(guān)于年度體檢的1963年至1999年期間的研究表明，它們并沒有整體降低死亡率，也沒有降低癌癥或心臟疾病等特定病因的死亡率。體檢耗費(fèi)了數(shù)以十億計(jì)的美元，但具體數(shù)字難以得出，因?yàn)闊o法知道，額外的篩查和后續(xù)測(cè)試又花費(fèi)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(jù)的狀況，是美國(guó)預(yù)防服務(wù)工作組(United States Preventive Services Task Force)——由專家組成的獨(dú)立團(tuán)體，就預(yù)防措施提供有確鑿證據(jù)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(jìn)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.

這怎么可能?在過去的幾年里，曾有報(bào)道和研究對(duì)體檢的價(jià)值提出質(zhì)疑，但病人和醫(yī)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(jī)會(huì)，重新拉近了醫(yī)患關(guān)系。也有習(xí)慣方面的原因。一百多年來，醫(yī)生和醫(yī)療機(jī)構(gòu)推薦每年體檢，這是很難改變的。再有就是大家對(duì)這些研究有所懷疑。幾乎每個(gè)人，都覺得自己認(rèn)識(shí)的某人，在每年體檢中發(fā)現(xiàn)了輕微的癥狀，導(dǎo)致了癌癥的早期診斷和治療，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(duì)于急性原因?qū)е碌乃劳龌驓埣玻鼛缀鯖]有作用。意外傷害和自殺，在美國(guó)人的死因中分別位居第四和第十。而且每年體檢對(duì)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癥。

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(duì)于那些沒有不適感的健康人，用篩查來改善健康的效果相當(dāng)差。如果你篩選數(shù)千人，發(fā)現(xiàn)可能患有某種疾病的只有幾十人，進(jìn)一步測(cè)試，會(huì)發(fā)現(xiàn)其實(shí)只有幾個(gè)人真的患了病。而在這些人中，也許一兩個(gè)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.

至于其他人，要么是在臨床上永遠(yuǎn)不會(huì)顯露癥狀和變得危險(xiǎn)，要么是患上了不治之癥。例如，早期發(fā)現(xiàn)的甲狀腺癌病人中，大多數(shù)都接受了手術(shù)治療，但在很多情況下，這種癌癥不會(huì)造成嚴(yán)重問題，更不用說死亡了。而對(duì)于每年體檢發(fā)現(xiàn)的食管癌或胰腺癌患者，早期診斷可以延長(zhǎng)他們提前知道自己患癌，但不太可能延長(zhǎng)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(shí)際上，體檢還給一些人造成了損失，因?yàn)榻】等巳绻隗w檢中疑似有問題，就需要進(jìn)行進(jìn)一步篩查和驗(yàn)證性測(cè)試，這會(huì)他們帶來并發(fā)癥和疼痛感。