Let's (Not) Get Physicals - NYTimes.com FOR decades, scientific research has shown that annual physical exams - and many of the screening tests that routinely accompany them - are in many ways pointless or (worse) dangerous, because they can lead to unneeded procedures. The last few years have produced a steady stream of new evidence against the utility of popular tests: Prostate specific antigen blood tests to detect prostate cancer? No longer recommended by the United States Preventive Services Task Force. Routine EKGs? No use. Yearly Pap smears? Nope. Every three years. So why do Americans, nearly alone on the planet, remain so devoted to the ritual physical exam and to all of these tests, and why do so many doctors continue to provide them? Indeed, the last decade has seen a boom in what hospitals and health care companies call "executive physicals" - batteries of screening exams for apparently healthy people, purporting to ferret out hidden disease with the zeal of Homeland Security officers searching for terrorists. In 1979, a Canadian government task force officially recommended giving up the standard head-to-toe annual physical based on studies showing it to be "nonspecific," "inefficient" and "potentially harmful," replacing it instead with a small number of periodic screening tests, which depend in part on a patient's risk factors for illness. Faced with such evidence, I have not gotten an annual physical since around the time I finished my medical training in 1989. I respect my doctors, but I see them only when I'm sick. I religiously follow schedules for the limited number of screening tests recommended for women my age - like mammograms every two years and blood pressure checks - but most of those do not require a special office visit. "There's a lot of inertia and unwillingness to let things go - it's hard for doctors and patients," said Alan Brett, professor of clinical internal medicine at the University of South Carolina, who tells well patients there is no need to see him annually. I've rolled back the frequency and intensity of screening over the years, absolutely. I'm not doing lots of things now, because there's no evidence that they help. There is, of course, economic impetus for American medicine's "more is better" mode - at least when patients have insurance. In the United States, most doctors and hospitals profit more by doing more, and prices are particularly high for tests and scans. Also, we are one of the few countries where drug makers and hospitals advertise products and treatments directly to patients, creating demand from consumers who don't actually pay their full costs. But there are sociological reasons for America's enthusiasm as well: an abundance of specialists, who are more likely to deploy tests and procedures, as well as malpractice fears, which leave hurried doctors inclined to order a test rather than explain why it is not necessary. And then there's habit, said Dr. Brett, who writes extensively on the scientific basis of medical practice, adding: "If you ask gynecologists why they still do yearly Pap smears they'll say things like: Patients expect it; It keeps patients coming back; It's what we do in an OB-GYN visit." With health care costs spiraling out of control and insurance companies asking patients to pay a greater portion of bills, America may be poised to rethink its rituals. This year the American Board of Internal Medicine Foundation joined forces with Consumer Reports to compile a list of basic medical tests and procedures that are often performed but that don't add value. The project - called Choosing Wisely - already has a list with dozens of entries, and more will be added in the fall. "This is the right message from the right messengers - not insurance companies and government, but doctors and patients," said Dr. Christine Cassell, president of the foundation. The issue of confronting waste in the American health care system has grown increasingly important. But when this issue comes up in the political arena it becomes about rationing and death panels. The United States spends about twice as much per person as other developed countries on health care, generally without better results. A 2009 study of waste in the United States health care system pointed to "unwarranted use of medical care" - unneeded, unproven or redundant diagnosis or treatment - as the biggest single component, accounting for $250 billion to $325 billion a year. A medical doctor and an environmental reporter for The New York Times.