评论
打印
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.
我们都会制定新年计划，发誓要更健康、过更好的生活、让世界变得更美好。不去做年度体检，是我能做到的减轻医疗成本的一个微小举动——不体检还能节约我的时间、省心，而且省去一番毫无价值的周章。
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.
今年大约会有4500万美国人进行例行体检，就像他们多年来所做的那样。这里戳一下，那里听一听，抽几管血，或许再做一下X光，之后再听医生说些叮咛的话：注意饮食、锻炼身体、不要抽烟，目的只是为了确信所有机能都运转良好。多数人对体检的理解都是，让人像车一样，每跑1.5万英里就检查一下，换换机油，好发现隐藏的问题，确保引擎寿命能够延长。
There is only one problem: From a health perspective, the annual physical exam is basically worthless.
只有一个问题：从健康的角度来看，年度体检基本上毫无价值。
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，由一群医学专家组成的科克伦协作网(Cochrane Collaboration)对全球生物医学研究资料进行了系统性的调查，分析了14个随机对照试验，这些实验覆盖了逾18.2万人，跟踪年限中位数为9年，目的是评估一般性体检的作用。所谓一般性体检是指那些在没有任何特定症状，或者不适感的情况下，去医生那里做的体检。
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.
这项调查得出了明确的结论：一般性体检可能没有好处。无论采用哪些筛查和测试方式，关于年度体检的1963年至1999年期间的研究表明，它们并没有整体降低死亡率，也没有降低癌症或心脏疾病等特定病因的死亡率。体检耗费了数以十亿计的美元，但具体数字难以得出，因为无法知道，额外的筛查和后续测试又花费了多少钱。
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.
这种缺乏证据的状况，是美国预防服务工作组(United States Preventive Services Task Force)——由专家组成的独立团体，就预防措施提供有确凿证据支持的建议——没有推荐每年例行健康检查的主要原因。自1979年以来，加拿大就不推荐进行这些检查。
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.
这怎么可能？在过去的几年里，曾有报道和研究对体检的价值提出质疑，但病人和医生似乎都不想听这样的消息。一部分是心理因素；即便身体无恙，体检也给双方提供了交谈机会，重新拉近了医患关系。也有习惯方面的原因。一百多年来，医生和医疗机构推荐每年体检，这是很难改变的。再有就是大家对这些研究有所怀疑。几乎每个人，都觉得自己认识的某人，在每年体检中发现了轻微的症状，导致了癌症的早期诊断和治疗，或者听过类似的体检挽救生命的故事。
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.
每年体检在降低死亡率方面没有效果的一种解释是，对于急性原因导致的死亡或残疾，它几乎没有作用。意外伤害和自杀，在美国人的死因中分别位居第四和第十。而且每年体检对慢性病的作用很不明显，比如老年人第五大致死原因阿尔茨海默氏症。
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，研究人员很早就注意到，对于那些没有不适感的健康人，用筛查来改善健康的效果相当差。如果你筛选数千人，发现可能患有某种疾病的只有几十人，进一步测试，会发现其实只有几个人真的患了病。而在这些人中，也许一两个真正从早期诊断中受了益。
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，要么是在临床上永远不会显露症状和变得危险，要么是患上了不治之症。例如，早期发现的甲状腺癌病人中，大多数都接受了手术治疗，但在很多情况下，这种癌症不会造成严重问题，更不用说死亡了。而对于每年体检发现的食管癌或胰腺癌患者，早期诊断可以延长他们提前知道自己患癌，但不太可能延长他们的寿命。
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.
实际上，体检还给一些人造成了损失，因为健康人如果在体检中疑似有问题，就需要进行进一步筛查和验证性测试，这会他们带来并发症和疼痛感。
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.
我下这样的新年决心，并不意味着我放弃每年的流感疫苗接种，或每10年一次的结肠镜检查——或保持均衡的饮食和规律的运动。数据已经证明，这些做法确实可以减少发病率和死亡率。那些宣扬常规体检的人，必须拿出数据来，证明它为什么有益于健康。如果拿不出来，那么就像我一样下个决心：每年体检不在我的健康习惯之内。这将为医生节省出大量时间，来照顾那些确实有健康问题的病人，随着越来越多的美国人拥有了医疗保险，这样做有助于缓解医生短缺的状况。
