I find this to be dubious and honestly a little insulting. Here in the UK there is a not insignificant number of people that die from cancers because their local health practice ignored or even refused to listen to a patient.
The idea of a yearly checkup is totally foreign here unless you are going private.
I think the idea is this: even accurate tests have false positives. For patients in a low-risk group, virtually all positive results in the checkup will be false positives. When the low-risk group is large (the entirety of a nation's healthy 20-30 year olds), the number of such false positives will also be large.
The positive results, regardless of whether they are true or false, will have some sort of follow-up. Maybe a second, more invasive test, maybe even starting on a drug straight away if the numbers look bad. And like for any medical procedure, there is a chance that this follow-up will harm this person's health: they will get an infection from a badly done second test, they will have an adverse reaction to the drug, etc.
And the question is whether it is ethical or worthwhile to expose patients to the risk of harming their health through the follow up, given that the chances of them having the condition (and thus of the follow-up being at all useful) are extremely low regardless of what the checkup result says.
> whether it is ethical or worthwhile to expose patients to the risk of harming their health through the follow up
So you seem to be saying that, in certain cases, if you have a positive test result, then the expected value of taking certain follow-up actions is negative. It follows that a rational actor, knowing this, would not take those actions in that situation. Then isn't the solution for doctors to update their procedures so that they don't take those follow-up actions in those situations (and explain the odds to patients who care)?
The phrasing "expose patients to the risk of harming their health through the follow up" makes it sound like the follow-up is something that automatically and unavoidably just happens, as if no one has any agency in the matter. If that's true, due to some kind of regulations or rules or liability rulings, then that sounds like a problem.
To some extent this is resolved by backpropagating: if the test is just a two-value "positive"/"negative" thing, and you plan to take the same action (i.e. nothing) regardless of the result, then there's no point in taking the test. However, I expect there are also other tests where, say, the test has a "super positive" value (or value range) where you should take action, and a "technically positive" value where you shouldn't act (plus a "negative" value); and the test is worth taking because of the likelihood of "super positive", but that means you do sometimes end up with the "technically positive" result, and must solve the problem of knowing when not to act.
If it is not worth taking the follow-up action, then it is not worth doing the screening either.
Concrete example. Younger women have firmer breasts. A chunk of relatively firm breast looks a lot like cancer. Therefore the younger a woman is, the higher the odds are of a false positive from a mammogram.
As a result a woman who is 30-40 SHOULD NOT get a mammogram UNLESS she has a variety of specific risk factors that increase the odds that a positive on the test is a true positive, and not a false positive.
On an individual case you’re right. But in aggregate is where the nuance lies.
E.g. If 99 out of 100 cases are false positives, and those 99 people are harmed by taking action, but the one true positive was helped, which is the better policy to pursue? Blanket screening or none at all?
This gets more complicated when there are limited resources available, eg treating the 100 people means someone else misses out.
And then there are diseases like cancer, which pretty much every human will get, if they live long enough. So screening for some types of cancer can have negative health implications on some target populations.
Do annual checkups involve blood tests where you are? I've only had blood taken as part of one once, and that was in direct response to a new diagnosis of a health condition in a grandparent.
Of course, blood and urine. I do them every six months, even though my insurance only covers once a year, I'm happy to pay out of pocket for the second.
The idea of a yearly checkup is totally foreign here unless you are going private.