A year ago, Dr. Ezekiel Emanuel wrote in a New York Times op-ed that annual doctor visits are “basically worthless,” citing a review of medical trials that he said showed the appointments fail to reduce deaths.

Saying he would skip his yearly checkup to help reduce health spending, Emanuel magnified a debate that has divided internal medicine doctors in a time of increased scrutiny of unnecessary treatment.

On Monday, two doctors published a paper in the Annals of Internal Medicine stating the review on which Emanuel based his argument falls far short of supporting the conclusions that he and others have drawn from it.

“We don't have to abandon something that has been the cornerstone of the doctor-patient relationship for generations,” Dr. David Himmelstein, a co-author of the paper and a professor of public health at City University of New York at Hunter College, said in an interview.

The review, published in the British Medical Journal in 2012, analyzed results of 14 medical trials dating to the 1960s. The review compared whether people who underwent “health checks,” consisting of screenings ranging from blood tests to pelvic exams, had better medical outcomes than those who didn't have the screenings. The review's authors found no benefit for patients of the additional screenings.

Himmelstein and co-author Dr. Russell Phillips, a Harvard University internist, point out the review did not specifically evaluate regular doctor visits, the subject of Emanuel's op-ed and of an ongoing debate within the Society of General Internal Medicine.

Most patients received the screenings in addition to their regular doctor visits, according to the paper.

Even patients in control groups, which in randomized controlled trials are meant to serve as a comparison for whatever is being tested, continued visiting their primary care physicians throughout the trials, the paper states.

Nine of the 14 trials date to the 1960s and 1970s, before advances such as medicines that regulate blood pressure, according to the paper, and eleven of the studies took place in European countries, where poor patients generally have easier access to all types of treatment than in the United States.

“The … review encompassed mostly outdated studies conducted in settings where control patients had frequent primary care visits and faced few access barriers, and the interventions assessed are not part of a 21st-century wellness visit,” Himmelstein's paper states.

Or, as Himmelstein put it: “The evidence cited is actually not evidence.”

At the same time, he acknowledged there is little evidence to support the annual visit.

“(Where) there's not very strong evidence one way or another, there you have to go on best judgment,” he said. “… We can't say that every 12 months like clockwork you need to see your doctor, but best judgment is probably that people should regularly see their doctors.”

In his own patients, he said regular visits have helped him spot things like alcohol addiction, substance abuse and obesity that he might not have learned about otherwise.

About a third of Americans get physicals every year, costing about $10 billion per year in the U.S., according to an October article in the New England Journal of Medicine.

The Society of General Internal Medicine cited the review in a September 2013 recommendation that physicians shouldn't perform routine health checks in adults without symptoms, saying the visits can promote unnecessary testing, which can sometimes harm patients.

The recommendation was part of the “Choosing Wisely” campaign of the ABIM Foundation, a nonprofit created by the American Board of Internal Medicine. The foundation asked more than 70 medical societies to identify ways to reduce tests, treatments and procedures that may be unnecessary.

Doctors have debated the value of routine visits for decades, said Dr. Zackary Berger, an assistant professor of general internal medicine at Johns Hopkins School of Medicine. An incoming chairman of the society's Evidence-Based Medicine Task Force, Berger said he is working on a new recommendation.

The society's 2013 recommendation is not meant to discourage people from calling their doctor — whether it might be to ask about cancer screening, share concerns about smoking or for any other reason, he said. But it is meant to let people know they don't need to see a doctor every year if they are feeling fine, he said.

“There are plenty of other reasons to see a doctor, to have a good relationship with a doctor … but the evidence, at least three years ago, did not indicate that seeing them on a rigid schedule was effective for reducing death and disease.”

The United States Preventive Services Task Force, an independent panel that assesses the value of treatment in adults without symptoms, makes no recommendation for or against annual physicals. A spokeswoman said the organization designs its recommendations around specific populations with risk factors, such as those who may be at risk for various cancers.

Wes Venteicher is a Tribune-Review staff writer. Reach him at 412-380-5676 or wventeicher@tribweb.com.

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