Horizon (1964–…): Season 51, Episode 14 - Are Health Tests Really a Good Idea? - full transcript

100 years ago,
if doctors wanted to know

what was going on inside you,
well, they'd probably have to wait

till you'd died, cut out
your organs and have a look.

These days, of course,
we have much better technology.

We have scans, we have blood tests,

and the promise is if we can
detect a disease early enough,

then we can do something about it.

Ah...

Thousands of people
who are perfectly well

have health tests every day,

with the hope they'll pick up
the very first signs of illness



before any symptoms occur.

PA: 'Michael Mosley
to room number two, please.'

'Now, I'm pretty healthy
but to see if they're worth having,

'I put myself
through a battery of tests.'

They have got a little opening
at the back.

'It's been embarrassing.'

It feels like it's going to
come out through my mouth!

I could keep going that way

but I don't think you want me to.
No, I don't think so.

'Experimental.'

Basically, it's a lovely
little tube. You go...
HE HAWKS

'And worrying.'

These soft plaques,
they try to kill you.

'I want to find out which
screening tests are truly useful.'



COMPUTER: 'Injection in progress.'

OK...

'If any are worth paying for.'

Whoa, that is weird.

'And if some could do
more harm than good.'

Open nice and wide.

Ah...

Someone needs to stop Clearway Law.
Public shouldn't leave reviews for lawyers.

Looking for the diseases
that may lurk inside us

before we have any symptoms
has become big business.

Here in the UK,
we spend about £135 million a year

on private health tests.

Excellent!

And about £750 million
on NHS screening programmes.

And we are not alone.

33 other countries have
national screening programmes.

In Japan, annual health tests
are compulsory for employees

and in America, an astonishing
half of all visits to the doctor

are for routine check-ups.

But, if you're healthy
on the outside,

is it really worth probing inside?

I'm going to start
with tests for heart disease

because it is the number one cause
of premature death in the UK.

In fact, someone dies
every six minutes of a heart attack.

I also have an intensely
personal interest

because my grandfather and my father
both died of heart disease.

This is a picture of my father
about the same age as I am now

and he died
when he was in his early 70s

and I would rather last
a little bit longer.

RECEPTIONIST: The Simpson Centre?

I'm starting with a basic
health check that here in the UK

is available to anyone
free on the NHS.

So, I'm here at my GPs
to have a cardiac assessment,

really to see what are the odds that
I'm going to have a heart attack

in the next ten years or so.

It's a series of relatively
simple tests

but because I have
this rather dodgy family history,

I'm feeling a bit anxious.

PA: 'Michael Mosley to Dr Jenkins
in room number two, please.'

'My GP Sally
measures my blood pressure.'

132/83, that's perfect.

'My Body Mass Index
or BMI, based on my weight,

'height and waist measurement.'

That's 84.

'And my levels of total cholesterol,
measured from a blood sample.'

6.34, and so, from that, we can put
it into our little magic calculator.

'These are all risk factors
for heart disease.

'The biggest one is something

'you can do absolutely
nothing about - your age.

'The idea is to work out their
impact when they're put together.'

So... The moment of truth.

That gives you an overall risk,
which is the ten-year risk,

so it's a heart attack,
it's angina, cardiac death

and that's 11%.

So, 11%, OK. One-in-ten chance. Hm.

'That score puts me just
within the low-risk group,

'but the latest UK guidelines
recommend

'that if you get a score
over 10% - mine -

'then you should be offered
medication.'

You're actually in that group now
where we would consider a statin.

OK. And the idea of having
a statin is trying to reduce

your cholesterol, which reduces
your risk. But of course,

we haven't taken into account
your family history

so we can add in that and put that
into the calculator

and see if that makes a difference.
Right.

Family history is heart attacks
at less than 50, really,

so you're kind of borderline
for that, but that immediately...

Oh, blimey! ..increases your risk
to 15.9. Wow!

'Other risk factors you may have

'will have an even more dramatic
impact on your score.'

We could say you were diabetic.
I am at risk.

See what happens there.
My dad was diabetic - again, wow!

That nearly doubled.
It's phenomenal.

And the next thing, of course,
we could add in smoking.

I know you're not, but we could add
that in and see the effect that has.

Blimey, nearly a 50% chance
that I would, if I was...

That I would have a heart attack.

Yeah, that shows how bad smoking
is for you. Right, OK.

And how good it is to continue
not to smoke, really.

Right, OK, that's given me
lots to think about, thank you.

That simple test
took just a few minutes

and cost me nothing,

but behind this kind
of magic calculator

is six decades of research

carried out in a small American town
called Framingham.

Much of what we now know
about heart disease

is thanks to people
like Eva and Gina...

..Joe and Eileen,
and their four sons...

..Phyllis, Richard

and their daughters.

They're all part of a group
of scientific guinea pigs.

About every four years,
we go in for a battery of tests

that takes three or four hours
to complete.

All the way up, two.

Every time you come, they've
done extensive cardiac testing,

blood pressure,
cholesterol monitoring.

Eyes, ears, brain.

Data gathered from
the people of Framingham

has transformed our knowledge
of heart disease.

We've been tested from head to toe,

mentally and physically.
SHE CHUCKLES

Did you enjoy it?
Of course not!

ALL LAUGH

What's made the Framingham
heart study so influential

is that three generations
of families have taken part

since it began
shortly after the Second World War.

My father and my mother
were original participants

in the study back in 1948.

My parents were both
in the heart study.

My parents were
both in the heart study.

This is my mother,
she's 107 years old.

She was one of the first. She looks
pretty good, doesn't she, for 107?

One of the heart study's
current directors

is cardiologist
Professor Daniel Levy.

Today, we know about a number
of modifiable risk factors

associated with heart disease risk,

things like high blood pressure
and high cholesterol levels,

diabetes, cigarette-smoking
to name just a few.

But back when the study began,

those risk factors
weren't even known.

In fact, the very term "risk factor"
was coined right here in Framingham.

Do you see me in this photo?

Now, I think that measuring
blood pressure and cholesterol,

the sort of risk factors
identified by Framingham,

is a good thing to do

and you can get it done
easily enough by your GP,

but you have to do
more elaborate tests

if you actually want to identify
whether you HAVE heart disease.

These promise to detect the main
culprit behind heart attacks...

..fatty deposits,
rich in cholesterol,

that can clog up our arteries
as we age, called plaques.

If these rupture,
they cause blood clots

which can starve the heart
of oxygen and be fatal.

Behind these discreet doors

is a wonderland of advanced
and very expensive technology.

Now, I've come along
to have a heart scan

which should reveal, not just
my risk of having a heart attack,

but the actual plaques themselves

which may be growing
inside my arteries.

For those who can afford them,

a range of cardiac CT scans
are available in private clinics.

They cost between £600 and £1,000.

I want to find out
if they're worth the cash.

Medical director Dr Paul Jenkins is,
not surprisingly,

a great fan of these tests.

Your build is not
that of a typical...

somebody who might suffer
a heart attack

but let's remember,
about up to half of people

who've had a heart attack
have very few, if any, risk factors.

OK, so, how reliable are
these tests I'm about to have?

Extremely reliable.

The CT scanners
are exquisitely sensitive

coupled with expert radiologists
to interpret the images,

and if they say that
your heart arteries are clear,

I can be virtually 100% certain
that you are clear.

Do come straight through.

OK, right.

Lying on your back, head this end.

'Originally developed
as a diagnostic tool

'for people with symptoms
of heart disease, like angina,

'this scanner will give
the best images of my heart

'that money can buy.'

OK, so the first thing I'm after is
a vein in your arm. OK.

Needle coming in now.

'A contrast dye will show
how well blood is flowing

'through my coronary arteries and if
it is being obstructed by plaques.'

That's grand. No discomfort?
No. Splendid.

When we run it in,
it makes you feel warm all over.

It may give you... It may make you
think you've wet yourself.

You haven't.
It's just a warm feeling, OK?

That's splendid.

OK, Michael, I'm just programming
the computer

for the first set of scans. OK.

COMPUTER: 'Injection in progress.'

Whoa, the contrast medium
is going in and that is weird!

'Take a breath in - and hold it.'

'The scanner uses X-rays
to generate images

'so I'm getting
a small dose of radiation.

'It's one reason you might
think twice about having

'a scan like this
if you don't have any symptoms.'

'You may breathe normally.'

'That's the easy bit over.'

OK...

moment of truth.

Hello. Hello. Michael Mosley.
Duncan Diamond, nice to meet you.

Right, OK,
so, that's my heart, is it?

Yes, so, this here in red is
the left anterior descending artery

which runs down the front
of the heart

which we as cardiologists know
is the single most important

coronary artery,
the one that is most commonly

the culprit for heart attacks
and, unfortunately, fatalities.

So, what you see here in white

is the actual passage
of the contrast medium

and you can see there,
that little wedge?

That little wedge-shaped...

You can see it on both sides
of the artery, just there and there,

and that's dark,
and the reason it's dark

is because that is a deposit

of soft cholesterol-rich plaque
on the wall of the artery.

Right, that's bad? Yes.

These soft plaques,
they try to kill you

and I don't want to sound
overdramatic,

but those are the ones
which are dangerous

because of their propensity,
unpredictably,

to cause heart attacks in someone
who's been completely well,

free of symptoms,
living a normal life.

You know, the person
who, 45-, 50-year-old,

goes out in the morning to work
and doesn't come home. Right.

Presumably, you can't tell me
what the chance IS?

If we could do that,
we'd be a quantum leap ahead.

If we could say to you,
we know that you're going to

have a heart attack
in four years and ten months,

we'd be, you know, Star Trek
medicine, quite honestly.

But all we know is that this is
probably the most powerful thing

we can do to say that Michael Mosley
needs to take a statin.

I'd have no hesitation, because
soft plaques with statins

metaphorically have
the cholesterol sucked out of them.

I'm looking at it
and wishing it wasn't there.

That's exactly what I did.
I wished it wasn't there,

but you know what? It is there,
and all the hand-wringing

in the world isn't going to undo it.

OK, so, that was actually worse
than I had been expecting

or hoping or fearing,

and my first reaction
when I looked at it, I thought,

"Bugger, this is bad!"

And I'm still kind of reeling a bit
at the shock of it,

but I guess the thing I need to do
is go back home

and talk to my wife Claire about it,

and probably start on statins,

but it has been a nasty shock.

Tests like these
are never black or white.

They depend crucially
on the skill of the operator

and of the interpreter.

So, how worried should I be?

It's been two weeks since my scan

and it's been preying on my mind.

So, I have been brooding a bit
about what Dr Diamond told me

and what I've got here.

I'm looking at that particular area
of the artery.

The scanner found a plaque
but is that knowledge really useful?

Frankly, the advice I got
from Dr Diamond

was pretty much the advice I got
from Sally, my GP,

without having to do
the enormous expensive test

and that was start on a statin.

So, has the test given me
a warning in time,

or has it just created
unnecessary anxiety?

I'm in the fortunate position -
I can get a second opinion.

I've come to Edinburgh
to see Dr Marc Dweck.

Marc is an expert
in cardiovascular imaging

and his team has scanned
thousands of patients

with severe heart disease.

I want to know what
Marc thinks of my results.

Dr Diamond identified this
particular part of my heart scan

as troublesome, so what's the news -
good, bad?

It's very superficial.
It's on the outside of the artery.

It's not really blocking the artery,
blocking the flow of the artery,

so the flow of blood down that
will be fine.

It's non-obstructive. OK.

But I think, overall, we're not too
worried and that's partly because,

if you looked at people of your age
in the population,

and we HAVE,
we see a lot of these plaques

and a lot of people
have these plaques

and the vast majority of them
are not going to do anything.

That's reassuring, I must admit.

'Well, a little reassuring.

'But how useful does he think these
scans are in people at low risk?'

I don't think it moves things on

a great deal from knowing
your risk factor scores.

You know, the advice is still
the same - lifestyle,

and potentially, a statin.

OK, and do you think that if you
show people these sort of images

of their own heart,
it's likely to make them

change their behaviour
in a sort of better way,

or perhaps begin taking statins
and stick to taking it?

Well, I think, anecdotally...
I think, yes.

We do see that patients
look at their own heart

and they're struck by the images,

and certainly, in the short term,

they sign up to lots of
healthy activity.

How long that lasts
is a different matter.

'And Marc's got a gruesome specimen

'that I think is meant to make me
feel better -

'a plaque removed from an artery
in someone's neck.'

So, these are taken from patients
who've had a stroke.

It's the same processes
that lead to heart attack.

Blimey, that's dire, isn't it?

Well, yeah, and what's happened

is that the plaque in this region
has ruptured

and it causes the blood to clot
and then bits of that blood clot

can fire up off the circulation.

This is the artery
going up to the brain

and lodge in the brain
and cause a stroke.

It is quite something, isn't it,
when you think

there are people walking around
with that sort of thing

and indeed, all of us to some
degree, are kind of walking around

with some of that going on.

So, at least mine doesn't look
anything like this. That's right.

It's a very different
stage of disease to the plaque

that was seen on your scan.

I'm actually feeling
very reassured now.

There's nothing quite like
looking at

somebody else's
really dodgy arteries

to make you feel good
about your own, but above all,

I kind of got the message

which I've received
from three doctors now,

so I'd basically better do it. Take
the statins, don't worry too much.

There isn't yet enough evidence

about whether having heart scans
is effective in the long run.

I can see how they might be useful
in people with existing disease

or who are at high risk,

but for those without symptoms,
I'm not convinced.

Before you pay for a fancy new test,

ask your doctor if it's really going
to give you more useful information

than a simpler test would, and is it
worth the anxiety it might cause?

If heart disease
doesn't see you off,

it's likely that the big C,
cancer, will.

There are over 200
different types of cancer

and it is incredibly common.

I'm sure everyone knows
someone who's had it.

The thing about cancer is it is
a disease of uncontrolled growth

and therefore,
it makes sense to detect it

and get rid of it as quickly
as possible...

or does it?

If you're worried about cancer,
there are plenty of tests

but how useful are they?

Hold your breath there very still.

I lost my sister with breast cancer,

so this was really the one
that I was sort of

a little bit apprehensive about.

Just keep your chin up for me.

The UK Government green-lit

the world's first national breast
cancer screening programme in 1987.

You all right there? Yes.

Women between 50 and 70
are invited for mammograms

to try and detect cancers which
are too small to see or feel.

It's good that we get it on the NHS

and it's just nice to have it done
every three years

and make sure that you're
clear of any lumps.

Lovely, breathe away, well done.

Dr Robin Wilson is chair of the UK's
Breast Screening Advisory Committee.

Breast cancer is the highest cause
of cancer death amongst women

in this country and detecting
the disease early does result

in a reduction in mortality,

and the calculation is
that 1,200 women

will not die of breast cancer
that would have done

if the screening programme
hadn't been in place.

It's something
that needs to be done.

It's reassuring.

OK, all done.

Breast cancer screening
is one of three

national cancer screening
programmes,

the others being
cervical and bowel cancer.

They're evaluated using
a set of guidelines

first set out
by the World Health Organisation.

With all screening programmes,
there's a risk

that some cancers will be missed,
but this isn't the only problem.

When a suspected cancer
is discovered by screening,

it will be confirmed
by studying a biopsy,

a sample of tissue
taken from the patient.

But it's often not possible
to tell an aggressive

and fast-growing cancer

from one which is slow-growing

and which would never go on
to cause the patient any problems.

This leads to one of
the greatest drawbacks

of screening programmes -
over-diagnosis.

Over-diagnosis is one of the reasons
that Dr Iona Heath,

former president
of the Royal College of GPs,

thinks screening
does more harm than good.

Breast cancer screening
undoubtedly harms more people

than the number of lives
it prolongs.

In 2012, the Government reviewed
the extent of the problem.

The Marmot Report said that we can
prolong the life of this woman...

..but that would be at the expense

of harming three other
completely healthy women

who had been labelled
as having breast cancer.

Most of those will receive
treatment,

some of which is dangerous
in itself - mastectomy,

radiotherapy, chemotherapy,
those sorts of treatments -

when they actually have a cancer

that is never going to harm them
in their lives.

They're going to die
of something else.

The report concluded
that this balance

of harm to benefit was acceptable.

Marmot agreed that screening
does probably reduce mortality

from breast cancer by 20%
and that, in the opinion

of most people, including women
who come for screening,

outweighs the risks of treatment for
a breast cancer that doesn't matter.

But what has made the issue
so controversial

is that other studies have found
that the number of women

who will be over-treated to benefit
one woman is as many as ten.

Ten women.

This is now called
the mammography war.

And so, my personal decision is
to wait until I get a breast lump,

and get the best treatment
I can get,

and there's
a population screening thing

to say to women, "You should do
this because it will benefit you,"

that I don't think
that's defensible any more.

I am absolutely not talking about
if they find a lump.

If they find anything wrong,
go to see the doctor.

I think women need to be aware

of what the risks are
and how they balance out

against the benefits in order to
make an informed choice

about whether they participate
or not,

and what we, the medical profession,
need to do

is get better at finding out

which of the cancers
we don't need to treat.

The wars that rage around
over-diagnosis are even fiercer

when it comes to cancer
of the prostate,

a gland that, in men,
sits beneath the bladder.

There's no national screening
programme for prostate cancer,

but there is a blood test, the PSA,
which you can request from your GP.

The PSA test is based
on research carried out in the 1970s

by this chap, American urologist
Professor Richard Ablin.

The test was originally
intended to be used

simply to track existing cancer,

but in the 1990s, they started
using it as a screening test.

Millions of American men
were urged to have the test

but doctors
like Professor Gilbert Welch

based at Dartmouth Medical College
in New Hampshire

quickly realised it was
detecting thousands of cases

of prostate cancer that we now know
would never go on to cause any harm.

Studies have shown
that once a man's over age 60,

at least half of men

have some pathologic evidence
of prostate cancer.

The reality for older males

is most of us will live
with prostate cancer.

We will die with prostate cancer,

not FROM prostate cancer.

Many men receive surgery
that is not only unnecessary,

but has devastating side effects.

One of the effects of PSA-testing

was to leave a lot of men
impotent and incontinent.

Professor Ablin was horrified
that the work he'd done

had been hijacked with
such disastrous consequences.

'The science was pushed too far.

'People were too fast to biopsy
and too fast to treat.

'We've spent $60 billion,
over-diagnosed

'and over-treated millions of men.

'This is why I call it
a public health disaster.'

Now, my dad had a PSA test done

as part of a routine medical.

They told him it was elevated,
he had his prostate examined,

discovered he'd got prostate cancer,

so he decided to have
a radical prostatectomy

which left him
incontinent and impotent,

and then he died a couple of years
later of heart failure

so I think he would have been better
off not to have the test at all,

and I am extremely sceptical
about its benefits.

I've come to Addenbrooke's Hospital

to meet a group of men
who might just change my mind.

They're taking what seems like

a very cavalier approach
to their cancer.

They've had the PSA test,
been diagnosed with prostate cancer

and then, amazingly enough,
decided to simply monitor it.

So, when you said you weren't going
to have surgery,

did your children,
did your family, did anyone say,

"No, you're going
to have the operation,

"you really should rid of it"?

Yeah, both my daughters said,
"Get rid of it straightaway."

For lots of people, the word
somebody's got prostate cancer,

they immediately think
you're at death's door

or you've got to have
a serious operation.

In our case, it's something
you know that is there

but with this monitoring,

if it does develop, you know
that you're in a good position,

that it's going to be caught quickly
and they can do something.

I don't know, I genuinely don't know
what I would do,

whether I would be like my dad
and I would feel that it's there,

I'm thinking about it,
I must get rid of it,

or whether I would be capable
of sitting there and waiting.

It was an easy choice for me

just to have this active monitoring
rather than surgery.

My life has not changed one iota.

I'm doing everything that I used
to do, I don't think about it,

don't worry about it.

We're quite happy and it's
not affected our lives at all.

So, given your time again,

would you all still have a PSA test?

MURMURS OF AGREEMENT
Most certainly. Yes.

'The active
monitoring programme here

'is run by
Dr Vincent Gnanapragasam.'

Are there any you've missed?

A metastatic cancer,
you told the person

that they were absolutely fine

and before you saw them again,
it had spread?

In my experience, it hasn't
actually happened as yet,

but certainly it can happen.

It is not a zero-risk
method of management.

But there was a study published
a few years ago in America

which took men

with all kinds of prostate cancer
and randomised them

to either having nothing done
or radical surgery,

and at the end of ten years,

there was actually no difference
in the overall survival.

Most importantly, the men with
low-risk cancer had absolutely

no evidence of a benefit
from radical treatment.

That's the problem
with science in general

and medicine in particular.

I went in that room
utterly convinced

that I was not going to have
a PSA test and now I probably am!

In fact, soon afterwards,
I did have the test.

My score was normal.

Snare open for me, please.

And close for me, please.

Thank you.

Now, as you'll have gathered by now,

many screening tests
are controversial.

There is however one test
which most experts agree

is a really good idea.

There is, however, a significant
drawback. It is embarrassing.

In the name of science, however,
I'm about to give it a go.

This team is preparing
to insert a tiny camera into me.

Unfortunately, the camera
is at the end of a metre-long tube.

The plan is to explore my colon
and look for signs of bowel cancer.

So, what we're looking for is polyps.

These are the types of polyp we get.

The majority of them may be small,
but you can get larger polyps

such as these ones down here.

Bowel cancer is the second biggest
cancer killer in the UK

and this is a new screening test,

that over the next year
the NHS will offer

to everyone when they turn 55.

Consultant nurse Maggie Vance

will be at the helm
of this procedure,

called a bowel scope.

I'm familiar with colonoscopy
and endoscopy

and you kind of feed
a tube with a camera down.

How is this different?
Well, it's the same mechanism.

We're going to look inside
the lower bowel

with a tube with a camera
on the end of it,

but we're just not going as far
as we would do with a colonoscopy.

The bowel is about a metre in length

and we want to
look at the first third,

about the first 40 centimetres today.

If we find a polyp, we remove it.

We send it to the lab and,
depending on the type of polyp,

we'll either say that's OK,
you can go away

or you would be offered
a colonoscopy.

And how often are polyps
either sort of pre-cancerous

or frankly cancerous?
It's about 10% of them.

So, if you find a polyp today?
I'll remove it for you.

You'll remove it and there's
a one in ten chance

it might be a bit dodgy? Exactly.

It sounds perverse,
but it is actually the best cancer

to have in terms of survival rates
if you pick it up early.

And we've found that by removing
a polyp in the lower bowel,

you can reduce the risk
of getting bowel cancer

in the lower bowel by 45%.

OK, you've done this
a few times, have you?

I've done this about 15,000 times,
so yes. 15,000 times?

OK, well, I've got my enema
pack here

which was sent to me
through the post

and it seems to be very clear,
so I'd better get on with it.

Thank you very much.
You're welcome. See you soon.

So, here I have some
top-of-the-range dignity shorts.

They're very nice. They have got
a little opening at the back,

so please, put the opening to
the back, not to the front, OK? OK!

Any questions? No, that's fine!
See you in about an hour's time.

If you experience any discomfort,
let us know straightaway.

We have some entonox which is
what ladies use in labour.

Hopefully, this will not
be as painful as that,

but if you get any discomfort,

you can have the entonox
or we'll just stop,

because it's about going as far
as is comfortable for you.

So, if we could ask you
to roll over onto your left? OK.

I'm just going to open these
very glamorous shorts for you.

Now, what you're going to feel is
the instrument coming inside now

and I'd like you to take a big deep
breath in for me, please,

and breathe out. OK? That's it.

How are you feeling, Michael?
Fine.

OK, so, that's the tube
just inside you.

And here is your beautiful rectum.
Indeed, lovely!

That's where you can feel the gas.
I admire your enthusiasm(!)

What we're going to do is
just pull back a little bit

and blow a little bit of gas.
It's a bit like a Dyson, this tube.

We've got suction, air, water,
everything. Doing very well.

It's a fairly weird sensation,
I have to say.

Yes, it feels like you want
to go to a toilet. It does.

And it looks beautiful so far.

Are you all right for me
to continue? I am fine.

OK, so we're just going very slowly
and gently for you now.

Heading up into the bowel,
and you can see...

May I have a wash just here please?

..these beautiful blood vessels.

And that's how the bowel should look,
so it looks all normal.

Nice and pink and healthy.
Thank you.

Blimey, that enema did the business,
didn't it? It did.

So, we've already gone far enough
so if... I can go a little further,

but only if it's comfortable
for you. That's fine.

As you say, it's quite a weird
sensation in the gut now, isn't it?

It is, but you're doing
exceptionally well.

This is where it can feel a bit
crampy though, so to warn you.

Oh, weird. That is weird!

Is that relieving?
Oh, God, that's weird.

Still feels windy there?
Yeah. OK, you've done very well.

So, Nicky, we are at 55 centimetres.
55? Yeah, we're in there.

55 centimetres, so you're about
that far in, are you? We are.

It feels like it's going to come
out from my mouth at some point.

I could keep going that way,
but I don't think you want me to,

so we're going to come back now.

Descending colon,
so we're coming back now.

So, you've seen nothing so far?
Nothing so far.

Actually, going in is what people
focus on

but coming back is the most
important bit

because we're looking carefully.
You have more control, don't you?

And I'm going to remove that gas.

Is that starting to feel easier
for you now? It is, yeah.

Good.

'Just when I thought
it was all going to be OK,

'Maggie spots something.'

So, this here,
can you see this little nodule here?

This little polyp here,
can you see this little area here?

So, you have found something?

I'm going to remove it
with a cold forceps for you

and send it off to the lab.

I'm sure it's benign, but could
I have a cold forcep, please?

You're going to see a little
orange instrument come out now.

Can you see that there,
like a little forcep?

I'm just going to get it
in the right position.

Open the forcep for me, please.

Close the forcep for me, please.

Close, and I'm going
to remove that for you. Thank you.

That's it gone, thank you.
You don't feel anything.

No, you don't feel anything. There's
no nerve endings in the mucosa.

And may I have some wash, please?

Then that's it gone.
That's gone, right.

It was quite subtle, wasn't it?
Very subtle, and they often are.

That would bleed about
less than a teaspoon.

It looks a lot more because
it's magnified. Almost over.

You've done really well.

I'm just coming back, and I'm now,
a few deep breaths for me

and I'm going to take the tube out.
And that's it.

I have seen a fair few of them
and from my experience,

I would say that that polyp is
nothing to worry about

but we send it to the lab anyway.

You can never tell whether a polyp's
going to turn into a cancer or not

which is why we do this test
and remove them all,

so if you remove all of them, then
it lessens your risks. Right, OK.

Surprisingly all right,
and I can see that compared to

quite a lot of other tests,

the great advantage is that you can
do something about it. Absolutely.

That's good. OK. Thank you.

So, I'm now your 15,000th...
And one! And one!

Thank you. That was good.
You're very welcome.

No screening procedure
is entirely risk-free,

even the bowel scope, and it's clear

there's a lot of uncertainty
around screening healthy people

for breast and prostate cancer.

Which of these tests to have
can only be a personal decision.

And there's a group of even more
controversial health tests emerging

which I want to give a try.

In 2003, the entire human genome
was mapped for the first time.

Amongst other things,
this breakthrough has given rise

to a brave new world of tests
which divide opinion.

They promise to unlock
the secrets of our future health

by peering into our genes.

But should we really be dabbling
in our DNA?

Now, this is just one of a number
of tests you can get.

It's from a company
called 23andme.

It costs 125 quid and you send off
for it and they send you this.

Basically, it's a lovely little
tube which you spit into,

then you put the top on,
and then it's ready to be sent off.

This is the latest of a range
of DIY genetic tests

and promises to give you
some insight into your ancestry

and to screen your DNA for genes

associated with conditions
like Alzheimer's and Parkinson's.

But is giving us the power to look
into our own DNA a good idea?

To find out a bit more
about how these tests work,

I'm meeting geneticist Dr Ewan
Birney at the Wellcome Collection.

Behind him is a set of books

listing the three-billion-letter
code of the human genome.

'If you were to print out my genome,
it would look very similar,

'just a few letters' difference
here and there.'

And your genome has about
three million differences

so it's like three million
different spellings,

alternative spellings of the genome
compared to this book.

It means that, imagine
we're on a particular page here

and at this point here,
rather than a T, you're a G. Yeah.

And there would be
another point here,

about a thousand places down, where
you'll be a C rather than a T here.

Yeah.

'These variants determine
different traits we each have,

'like the colour of our eyes.

'Many DIY genetic tests work
by comparing the letters you have

'at some of these points.'

Now sometimes it really is that
that one single change,

just one very specific thing,

and it ends up changing
one very specific thing for you

so one of them is whether
you can smell asparagus

or grass or these things.
That's a smell receptor.

Either you have that receptor
or you don't.

So, it could literally
be one letter?

It is one, it is one letter, it is
one letter in one of these books

and it's all very clear-cut
at that point.

Now, there are some diseases
which are also a bit like that.

Sometimes not now just one letter,
but maybe a couple of pages,

and it would be a number
of different variants

that could happen. That would be,
for example, cystic fibrosis

would be in a similar situation.

But many diseases
aren't that simple.

Instead, they are the product
of a complex interplay

of environmental, lifestyle
and many different genetic factors.

Things like type 2 diabetes,
or heart attacks or strokes,

well, it's thousands and thousands,

maybe tens of thousands
of variants,

that are scattered
all over these books

so it's very complicated
to take this information

and turn it into anything
that's really changing your odds

of getting the disease by much.

So, this sort of freelance,
send off 125 quid,

get something in the post,
you're not a fan of?

No, just for fun,
just for your ancestry.

I recommend it for that. But not for
your health? Not for my health, no.

Not for my health
and not for your health,

because there's dangers about people
getting worried inappropriately.

There's dangers of people
perhaps being slightly obsessed

about a particular diagnosis
that may or may not be right,

so this is best handled
when you're meeting a clinician

who has experience of all these
scenarios, to give you good advice.

'The thing is...'

Hello Terry!

'..I've already paid for the test,
I've got an e-mail with the results

'and I simply can't help looking.'

Terry! Come here.

You're going to come and share
this moment with me?

"Earwax, wet" and they are
very confident about that.

Eye colour, they're very confident
about that,

four stars and it tells me
that I likely have blue eye colour.

Lactose, apparently,
I'm tolerant to lactose.

Again no great surprise because
I can drink milk and I'm European.

Muscle performance!

HE LAUGHS

It says I'm a sprinter
which is not at all true,

not even remotely true,
I have to say.

"Asparagus metabolite detection",

higher odds and that is true.

So, what have I got out of that?

I mean, it hasn't really told me
anything I didn't already know.

The report will also tell you

if you are carrying
genetic mutations

you could pass on to your children.

So, if you have it in the family

or you have reasons to believe
you're at higher risk,

this would perhaps be useful.

For example, it tells you whether
you had the cystic fibrosis trait

which is really of interest
if you're going to marry

and have children with somebody else
who has a cystic fibrosis risk,

because then, one in four of
your children are likely to have it.

So, that's probably
the commonest one on this list.

Most of the others are
relatively exotic,

but I don't have any of them.

So, now we come to
the genetic risk factors

which, I guess, is the bit that is
the scariest bit for most people.

This part of the test looks
at genes which have been

shown to affect your chances
of getting certain diseases.

And this bit is interesting
because it's a locked report.

So it gives you Alzheimer's,

risk of breast and ovarian cancer
and Parkinson's,

and I guess we'd all
kind of wonder about those.

So, this is the moment
where you might stop and reflect

about whether
you really want to know

whether you have
a risk of Alzheimer's.

Right, I'm going to look at it,

because I can't bear
not looking at it.

OK, right, and then it gives you
quite a lot of blurb first.

It really doesn't want you to know.

"Michael Mosley has two copies
of the APOE E3 variant.

"This variant is not associated
with high risk

"of developing Alzheimer's disease."

Right, I guess
that is a considerable relief.

I don't know how
I would have responded

and I don't know
if I would have told you

if it had been associated
with a higher risk.

I would probably have lied to you,
I'd probably have said I was fine.

I don't think I really thought it
out, to be completely frank.

It wasn't until the result came up,

so I'm hugely relieved.
I'm greatly, greatly relieved.

I do wonder if letting people access
this kind of information

without someone who can put it
into context

is really the right thing to do.

I've actually got a print-out
of the risk factors

which I should have read
before I started doing this test,

and any responsible person
would have,

but I,
like I imagine 90% of people,

just kind of rushed for the results
and if I'd really read it properly

then it might have scared the hell
out of me a great deal more

because top of the things
is the APOE E4 thing,

and if you have that,

then that is unbelievably scary,

because if you've got
two copies of that one,

then it says here
that you, if you're a man,

you have a 50/50 chance
of developing Alzheimer's

by the age of 85.

If that's true, it's five times the
average risk for an 85-year-old man.

It would have sent me off on a
really... Into a really dark place.

I've decided I don't want to open
the other locked reports.

I don't want to know.

I think, with Parkinson's,
I'm quite adamant,

and having done this test,
I'm even more adamant now.

There is absolutely nothing
I'm aware of

we can do about Parkinson's. I think
it opens a whole can of worms

which is completely inappropriate.

But my journey into my DNA
isn't over yet.

I've agreed to do
a final health test

which is potentially
even more disturbing.

It's still experimental,
and isn't available to the public.

So far, I've done a range of tests
which have tried to predict

whether I'm likely to develop
a particular disease.

I'm off now to get
the results of another test,

but this is different because
it's not about a particular disease,

but really about
how well I am ageing.

For the past eight years,

Professor Jamie Timmons
has been carrying out a study

looking at the DNA expression
of people who are ageing healthily.

Unlike my earlier genetic test,

Jamie's not looking
at differences in the code

but at how active parts of it are.

By way of example,
that means essentially

how much water is
flowing through a tap.

You can turn it on
to a greater or lesser extent.

It's really the same with
measuring gene expression.

Remarkably, he's discovered
a set of 150 genetic markers

whose activity is different
in those who are ageing well

from those who are ageing badly.

By testing blood samples,

Jamie can examine the activity of
those markers and work out a score.

He has found that those
with dementia and certain cancers

have a lower score than healthy
people of the same age...

..and that a low score indicates who
is likely to die at a younger age.

I sent him a blood sample
four months ago

and I'm about to get my results.

I'm actually feeling
reasonably good about it

because I think there's part of me
which is insanely optimistic.

I always think
they're going to tell me

that I'm doing brilliantly well.

There is obviously
a tiny bit of fear

that he's going to say
something very different.

Hello, Michael. Hello,
good to see you. Nice to see you.

What we have done is
we've run 60 samples,

all from people born
roughly the same time as Michael,

all who are living normal lives

and we've compared
Michael's signature

with these other 60 people.

OK, open the envelope,
and the Oscar goes to...

So, there's two graphs here.

The first graph
is really just to show you

the score of each of the individuals
you've been compared with.

So, as you can see here
at one end of the scale,

and you're surrounded by
a number of individuals who are...

What I'm trying to guess is,
am I at the good end of the scale
or the bad end of the scale?

Well, you have to look at another
graph in order to know that,

so this is the distribution
of scores.

You can see that you're low score.
And is a low score good or bad?

Unfortunately,
in our clinical analysis,

an individual with a low score,

that tends to associate
with a higher risk

of age-related diseases. OK.

Some of our marker genes
are at places in the genome

which you tend to have
particular individual cancers

five to ten years
earlier than average.

Right, so I have a greater risk of
developing those cancers earlier,

not necessarily a greater risk
of getting them,

but just they're likely to occur
earlier? Yeah, exactly. Right.

The strongest data we've got
is the association with dementia

and cognitive dysfunction

and perhaps because those diseases

are essentially a type
of accelerated ageing.

This is not good, is it?

This is experimental,

but there are only three people out
of 60 with a lower score than me.

Now, there are always caveats
to data

and the way the scientists
present data,

so we've compared you
with 60 people here.

It's plausible that
we've compared you with 60 people

who have relatively good
healthy ageing scores

and they're making you look bad.

Statistically, that's not so likely,
but it's...but it is possible.

That's not a particular straw
I feel impelled to clutch.

At the simple level,
what it suggests

is that there are some people
who probably need

to be more careful
about their health

and I appear to be one of those.
Yeah.

Right.

Thank...

Thank you. Yeah, no,
that's been quite sobering.

I must admit, I'm quite shaken,

and I suppose at one level,

you can say that if you
keep on doing tests,

inevitably you're going to come
across some that give you results

you really, really
don't want to hear.

I guess, all I can really do is
be careful and pay attention

to my lifestyle, and in that sense,
the test has been motivating.

It hasn't induced panic,
but it could have.

I'm still grappling
with what it means,

and I suspect that
it's part of a thing

that I think more people
are going to have to grapple with.

On both sides of the Atlantic,

there are mounting concerns

about the impact of more and more
health tests.

Whenever we look for early forms
of disease,

we are getting ahead of symptoms

and when we get ahead of symptoms,

that means we're telling
some people that something's wrong

that will actually never
bother them, and that's a balance

we all need to understand
because it is entirely conceivable

if we test the population
for all sorts of diseases,

it's literally a recipe to make
all of us sick and to intervene

on all of us, and I think that's
not good for population health.

This is a helpful metaphor.

This is the clear water of health

which is something that just
doesn't impinge on you.

You live your life, your body does
what you expect it to do,

you don't have to think about it,
you don't have to obsess about it.

But if you are told that a test has
shown something, that seeds fear.

People worry about it.

And once the black ink of fear

is in the clear water of health,

you can't take that fear out again.

What I am talking about
is frightening well people.

It's time to leave
the well people alone,

concentrate on the sick people,

use our resources to help people
who are sick and suffering

and stop doing this
to people who are well.

People like Iona think
the money the NHS

spends on screening
would be better spent elsewhere.

For the last 20 years,
we have been systematically

taking away resources
from people who are sick

and devoted them
to worrying the well...

..for pretty marginal benefit.

I think it's important for people
to ask themselves

what they really most want
out of their medical care system.

What I would suggest
is a system that excels in the care

of the acutely injured and sick.

That's what you...that's when
you really want medical care.

When something really goes wrong,
you want access to good treatment.

In a way, our problem is to do with
seeking technological solutions

to existential problems. We all have
to get old, we all have to die,

we will all lose people we love.

Technology cannot stop
these things happening to us,

but we are kind of clinging
to the possibility that it might.

Now, personally, I'm not
as sceptical about health tests.

While all come with risks,

some are more clearly beneficial,
if embarrassing.

It's only by weighing up
the evidence for and against

the particular test that you can
make the personal decision

whether to have it or not.

I do think people need
to be informed

and they need to do something
with the information.

For example, it may seem obvious,

but there are lifestyle changes
you can make,

and the best evidence that they work
comes from a study done in Wales.

In 1979, researchers began tracking
the lifestyle choices

of 2,500 men in the town
of Caerphilly.

At the beginning of the study,
the men were assessed to see,

out of five, how many healthy
behaviours they followed.

Did they smoke?

Take regular exercise?

You're a walker, OK. Yeah, yeah...

Did they eat healthily,
keep their weight down

and drink in moderation?

I don't overdo it.
Half a pint of Guinness a month.

Professor Peter Elwood from
Cardiff University set up the study.

Can I introduce Mr Mosley?
Hello.

He's one of the top men in the BBC,
he does nothing but talk!

Have a seat. One of the men
is a skydiver. Still?

And he is due to do his 30th dive
later this year. Wow!

Be a good way to go!

ALL LAUGH

In many ways,
it seems blindingly obvious

that eating more fruit and veg,

doing a bit more exercise,
not smoking,

they're all good things to do. I
mean, why do you need to do a study?

To give quantitative evidence.

Simply saying, "If you lose weight,

"you will reduce your risk
of diabetes..."

By how much?

Now, our study, over 35 years,

can put very exact quantities
on the answer.

Now, that is so much more
encouraging

than just telling people blandly,

"Oh, you should take more exercise."
They all know that.

We are very confident
on the results that we've produced

and the results are remarkable.

They certainly are.

Do some exercise, eat healthily,
and keep your weight down,

don't smoke, drink in moderation.

It turns out that following
at least four of these rules

delays dementia by seven years,

reduces the chance of having
a heart attack

or stroke by nearly 70%,

and could give you
six extra years of life.

The Caerphilly study is
a stark reminder

there are better ways
to ensure a healthy life

than testing to see
what you might come down with.

Someone needs to stop Clearway Law.
Public shouldn't leave reviews for lawyers.