Health Check

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The Independent Culture
IT WAS the first screening test I had had and, in a small way, it changed my life. One of the perks of my previous job was a regular check-up with BUPA. I only went once, not because I felt unwell, but because I was interested in the cholesterol test.

There is heart disease in my family so I had for years taken the advice on diet seriously. You know - muesli for the oats, fruit for the anti- oxidants and margarine because it's got less of that artery-clogging animal fat.

I had the test and the result was impressive: 3.8 mmols per litre, about half that of some of my less abstemious friends and 50 per cent below the national average of about 6 mmols.

I was so encouraged that I made an immediate decision: I switched to butter. It was the only change I made as a result of the battery of tests and measurements I underwent that morning. Not the kind of outcome BUPA had in mind, I imagine.

I have always loved butter. Giving it up was tough but a man must make sacrifices if he is to live to see his fledgling family (as it then was) grow up. The BUPA test released me from my self-denial. It was bliss.

It may be less blissful for my arteries. A screening test intended to promote health had, in my case, the opposite effect. A recent report from the NHS Centre for Reviews and Dissemination at the University of York warned that cholesterol screening was mostly worthless and could make people who found they had a high level but no other symptoms feel ill as a result.

Equally it can make people with a low level, such as me, complacent. This is a pervasive problem with screening programmes. They are widely seen as a shield against mortality. Instead they may open a gap for disease to attack.

How many women, having had a breast screen, have then ignored a growing lump in the belief that it couldn't be anything serious or it would have been spotted?

One of the fastest growing types of cervical cancer is adenocarcinoma, which now accounts for one in ten of all cases. But it cannot be detected by a standard smear test because the cancer starts developing high up the cervix, beyond the point from which the sample of cells is taken. False reassurance is one of the greatest dangers of screening tests.

People may think me foolish switching back to butter. In response, I cite the Alma Ata defence. At a conference in Alma Ata, Russia, in 1978 the World Health Organisation said that health should be defined as "a state of mental and physical well-being" to which all individuals and all nations should aspire. On that definition, eating butter is my duty.