Protocol
General health checks (multi-organ screening of asymptomatic adults)
Cochrane 2019 update (Krogsbøll et al.; PMID PubMed ID: the permanent number the US National Library of Medicine gives a published paper. Each one links to that paper's record on PubMed. 30699470): 17 randomized trials, 251,891 participants, comparing general health checks (screening for more than one disease or risk factor across more than one organ system) against no health checks in adults unselected for disease.
Grade D, tested: a human randomized trial looked for a benefit on the endpoint The outcome a trial measures to decide whether the treatment worked, such as heart attacks, blood pressure or a symptom score. graded and did not find one. How to read a grade →
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How this letter has changedLatest: October 2026 · Corrected.
The record was named for serial multi-biomarker screening while its own scope note said the Cochrane trials tested health checks of their era; the name now says multi-organ screening of asymptomatic adults. Added: Jørgensen 2014 (PMID 24912589), Inter99, 59,616 people, null on ischemic heart disease, stroke and mortality at 10 years; Wang 2026 (PMID 42414985), a systematic review A review that searches for every study on a question using a method set in advance, then assesses them together. of 22 randomized trials through 2025 confirming no mortality or cardiovascular benefit; both beside Krogsbøll 2019 (PMID 30699470). The confidence intervals The range the true effect probably falls in. A wide interval means the estimate is uncertain. now read 'to' rather than a dash. Letter unchanged.PMID 24912589 PMID 42414985 PMID 30699470
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General health checks are routine checkups and test panels for adults who feel well. A careful review pooled 17 studies with about 250,000 people. People offered regular checkups did not live longer, and they had no fewer deaths from heart disease or cancer than people who were not offered them. That is a strong result based on very large numbers of people.
Cochrane 2019 update (Krogsbøll et al.; PMID 30699470): 17 randomized trials, 251,891 participants, comparing general health checks (screening for more than one disease or risk factor across more than one organ system) against no health checks in adults unselected for disease. All-cause mortality RR 1.00 (95% CI 0.97 to 1.03; 11 trials; 233,298 participants; 21,535 deaths; high-certainty evidence; I² = 0%). Cancer mortality RR 1.01 (0.92 to 1.12; high-certainty). Cardiovascular mortality RR 1.05 (0.94 to 1.16; moderate-certainty). Fatal and non-fatal ischemic heart disease RR 0.98 (0.94 to 1.03; high-certainty). The review authors conclude general health checks are unlikely to be beneficial. Jørgensen et al. (BMJ, 2014; PMID 24912589): Inter99, the largest single modern trial, 59,616 Danish adults randomized to screening with repeated lifestyle counseling or no invitation; at 10 years no difference in ischemic heart disease (hazard ratio How often an event happened in the treated group compared with the control group over the same period. A ratio of 0.80 means 20 percent fewer events. 1.03, 95% CI 0.94 to 1.13), stroke or total mortality (1.00, 0.91 to 1.09). Wang et al. (BMC Public Health, 2026; PMID 42414985): systematic review to July 2025, 22 randomized trials among 56 studies; most trials showed no reduction in all-cause mortality and none showed a reduction in cardiovascular events. Scope note: the trials tested health checks of their era, questionnaires, examination, a few laboratory tests and often counseling, not the 100-plus marker direct-to-consumer blood panels sold today. No randomized trial has tested a consumer advanced-biomarker panel against any clinical endpoint. Individual markers measured within such panels (ApoB Apolipoprotein B, a protein carried once on each cholesterol particle that can enter the artery wall, so it counts those particles directly., Lp(a) Lipoprotein(a), a cholesterol-carrying particle whose level is set largely by genetics., HbA1c A blood test that reflects average blood sugar over the previous two to three months.) carry their own separate evidence and their own separate grades.
Why this gradeGrade D, tested, no benefit. The reasoning, and what the grade does not cover.
Grade D on Route 2 Human randomized trials have been run and did not show benefit on the stated outcome. One of the two routes to the lowest letter on EBL's scale.: tested, no benefit demonstrated, at a level of certainty almost nothing else on this site reaches. The 2019 Cochrane review pooled 17 randomized trials and 251,891 participants comparing general health checks against no health checks in adults unselected for disease. All-cause mortality was RR 1.00 (95% CI 0.97 to 1.03, 11 trials, 233,298 participants, 21,535 deaths, high-certainty, I-squared 0%). Cancer mortality at RR 1.01 and ischemic heart disease at RR 0.98 were likewise flat. An interval that tight around 1.00 is not an underpowered null, it is a well-measured absence of effect. Inter99 (PMID 24912589), the largest single modern trial, and a 2026 systematic review through 2025 (PMID 42414985) agree.
WHAT THIS GRADE DOES NOT COVERthe pooled trials tested health checks of their era (questionnaires, examination, a few laboratory tests, often counseling), not the 100-plus marker direct-to-consumer panels sold today, and no randomized trial has tested a consumer advanced-biomarker panel against any clinical endpoint. Individual markers measured inside such panels, including ApoB, Lp(a) and HbA1c, carry their own evidence and their own separate grades. It also does not grade targeted screening in someone with a specific indication, which is a different question with different trials behind it.
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Screening moves people into diagnosis and treatment, and the Cochrane review on this record was conducted to weigh that against the benefit. More testing produces more findings to chase, and a normal panel can supply false reassurance in someone with symptoms who needs a different question asked.
The evidence, in fullThree papers, each linked to its PubMed record.
Krogsbøll et al. (Cochrane Database of Systematic Reviews, 2019; PMID 30699470): 17 randomized trials, 251,891 participants; all-cause mortality RR 1.00. Jørgensen et al. (BMJ, 2014; PMID 24912589): Inter99, 59,616 people, null on ischemic heart disease, stroke and mortality at 10 years. Wang et al. (BMC Public Health, 2026; PMID 42414985): 2026 systematic review of 22 randomized trials confirming no mortality or cardiovascular benefit.
The existing trial evidence does not support routine multi-biomarker screening panels improving outcomes in asymptomatic adults. If pursuing comprehensive panels, track changes in actionable biomarkers A measurable sign in the body, such as a blood test value, used to track a condition or the effect of a treatment. (LDL Low-density lipoprotein cholesterol, the cholesterol fraction most closely tied to plaque in the arteries., HbA1c, hsCRP High-sensitivity C-reactive protein, a blood marker of low-grade inflammation., ApoB) at baseline and 6 months, and document whether results led to protocol changes: the value is in triggering behavior change, not just collecting numbers.
Evidence notes: meta-analysis A study that pools the numbers from several trials into one combined estimate.
Endpoint graded: All-cause, cardiovascular and cancer mortality in adults unselected for disease (hard)
Last reviewed: July 2026
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