What evidence is required to justify the NHS Health Check programme?

Authors of a matched cohort study claimed the NHS Health Check programme reduced total mortality 23% and liver cirrhosis incidence 44%. Such impressive results require critical scrutiny, especially as the intervention targets a large, predominantly healthy population, and as it has harms and costs. Eleven high-quality randomised trials containing varying combinations of the elements constituting the NHS Health Check assessed total mortality. They included 233,298 participants and 21,535 deaths, with a risk ratio for total mortality of 1.00 (95% CI 0.97 to 1.03) and little or no effect on mortality from targeted diseases, including cardiovascular disease. However, the observational study did not reference any of those trials. No harms, though well-known, were assessed or mentioned. While some limitations were discussed, others were not and central questions regarding the likelihood of their results were not asked. A burden of proof must be met before interventions are introduced, especially those directed towards healthy citizens that divert resources away from medical and non-medical interventions of known benefit. In our opinion, the NHS Health Check programme does not meet UK National Screening Committee requirements that high-quality randomized trials show benefits outweigh harms. Emphasizing evidence from observational studies while disregarding randomised trials that contradict their findings and failing to assess or mention harms of interventions directed at healthy citizens, are contrary to sound scientific principles, and to evidence-based medicine. This apparently guides policies which burden an already stressed health system. A review of the NHS Health Check programme by the UK National Screening Committee seems timely.