The BMJ Today: Lifestyle counselling and screening—great expectations and false hopes

georg_roegglaThe underlying concept of screening is that an early detection of risk factors or disease is beneficial for the clinical or public health outcome. Patients, physicians, and public health authorities have had high expectations for this concept. Unfortunately, some of the hopes for screening have turned out to be false hopes after critical, scientific assessment.

Lifestyle medicine is defined as the application of environmental, behavioural, medical, and motivational principles to the management of lifestyle related health problems in a clinical setting. It has at least as many enthusiastic supporters as screening programmess have.

Uncritical believers in screening and lifestyle medicine will probably be disappointed by a paper published in The BMJ yesterday.

Torben Jørgensen and co-authors performed a randomised controlled trial, including 59 616 people, which evaluated the effect of systematic screening for risk factors for ischaemic heart disease, followed by repeated lifestyle counselling on the 10 year development of ischaemic heart disease. They report that this individually tailored, intervention programme had no effect on ischaemic heart disease, stroke, or mortality at the population level after 10 years.

Does this mean we should stop giving lifestyle advice to our patients? Of course not. Lifestyle counselling should continue in everyday practice, but should not be implemented as a systematic programme in the general population.

In his related Editorial, Peter C Gøtzsche asks why shouldn’t we check our bodies so that we can find and treat abnormalities before they cause too much harm, just like we check our cars regularly. His answer is convincing: screening will cause harm in some people. This is why we need randomised trials to find out if screening does more good than harm before we decide whether to introduce it.

Georg Roeggla is an associate editor for The BMJ.

  • Gillian Bartlett-Esquilant

    Doesn’t this support the idea of “personalized” medicine? That good primary care prevention is based on knowing your patient and knowing who would benefit most from this intervention?