"HEART CHECK" , "SKIN CHECK" , "BONE DENSITY CHECK" ...The newspapers are bulging with invitations for vital medical checks - "Your life could depend on it..." they trumpet.

You might ask why medical services need to be advertised directly to the public. Could it be because the normal system of referral does not generate enough business?

Your family doctor is free to refer you for any valid investigation which will help you avoid illness. You must ask yourself why there are not sufficient referrals from cautious general prctitioners to keep these screening clinics in business.

Should you have a blood test? It may show some disease which would have been overlooked. If the test is OK today ...Should you do another one next week...next month...next year? How often is reasonable and justified? Where is the best place to find out: From an advertisement?

Did you know that Leukaemia may begin with a fever and a sore throat? Does this mean that you should have an urgent blood test to check that you do not have leukaemia every time you have a sore throat?

Should you have a computer scan of your brain every time to have a headache, in case it is a brain tumour? MRI scans are more accurate should you have one of those? There are entrepreneurs who can convert your every headache to dollars.

Decisions about your health should be made with the help of your trusted family doctor, so that you can have the necessary investigations and avoid hazard and expense.

If you walk in off the street and ask a car salesman; "Should I buy that car?" -- He can only say: "Yes!! ...buy two." He would never say...."Well, do you need a car? After all you live next to the bus station. There is no parking in the street and you are legally blind!!" Equally if you walk in off the street to a skin cancer clinic, they will advise your regular attendance for checking. Every mole and freckle on your body is a potential cancer. It is very easy to justify removal and pathology testing of any "suspicious" skin spot. This is a goldmine. Every day I see new and larger advertisements in the newspaper for skin cancer clinics. Where were they 5 years ago? Not surprisingly they usually "bulk bill" so the service is "free of cost" to the patient.

Ask yourself why they do not charge a fee? Do they not feel their service is worth paying for?

The fact that this is costing the government and our nation a fortune is of no immediate concern.

There are experts in the area of skin cancer. Oncologists, dermatologists and plastic surgeons specialise in this important field. The advertised skin cancer clinics I have seen, have no doctors with these specialist qualifications. Any doctor, myself included, can open a "Cancer clinic" tomorrow. A clinic near my practice declared an association with the prestigious "Melanoma Clinic" at the Royal Prince Alfred Hospital. The doctor who ran this clinic had to publish an apologetic retraction when it was revealed there was no such association.

So what is the appropriate way for you to take rational steps to avoid skin cancer? You know what I will say next: SEE YOUR FAMILY DOCTOR! Your GP is well qualified to check a spot which is worrying you and to advise about cancer screening. If I am worried about a spot on your skin (We use a dermatoscope - an illuminated magnifier) I will either refer you to a respected specialist or if practical, remove the skin lesion for testing. My own practice is to train my patients to check their own skin. It is not difficult to learn the simple features which may herald a skin cancer. The most important skin cancer which demands urgent attention is MELANOMA. Even the most experienced experts can misdiagnose these dangerous lesions. That being said, the most important eyes which should be checking for Melanoma are yours!! A proper skin check for melanoma should start with the scalp and finish with the soles of your feet. (few doctors are this thorough!). Melanoma often occurs in areas not touched by the sun, so you should check EVERYWHERE. I teach husbands and wives to check each other. Because a freckle may become malignant and spread within a few months, the "annual" skin check is not really an adequate process.

The only way to prove a spot on your skin is not dangerous, is to cut it out and look at it under a microscope.

On that basis you could be relieved of many little pieces of your skin and the contents of your bank account. Your family doctor is best placed to help you decide what to do.

What about other cancers? Breast cancer. Bowel cancer. Lung cancer. Prostate Cancer ...there is a long list. Is it possible to pick who will get cancer? If you have a cancer, is it possible to identify it early and remove it before it kills you? If you do identify a cancer years before it grows will that definitely alter the outcome? Sadly there are no good answers to these questions. I will give examples.

Lives are saved if a cancer of the cervix is identified early and removed ... but the same is probably not true of lung cancer and possibly even breast cancer. It is generally agreed that we should be screening for breast lumps with self-checking and mammography in women over 50. It seems logical that finding a lump early and removing it should be a good thing ... there are some respected experts who believe there is no change in the outcome. The consensus remains that we should keeps screening for breast cancer. Chest X rays to screen for lung cancer do not show benefit. Lung cancer is almost always fatal irrespective of when it is identified. If we screened everyone for lung cancer the X rays would cause more cancer than they found! The best screening test for bowel cancer is colonoscopy. Our nation does not have the resources to colonoscope every citizen. The next best thing is to check for blood in the stools. Many people have blood in their stools due to haemorrhoids or other causes besides cancer ...nevertheless, research has shown that early detection of bowel cancer does save lives.

The best way to avoid a heart attack is to chose your parents carefully. If they lived to be a hundred and so did your grandparents ...then your chances are pretty good! If both your parents and all your bothers and sisters died of a heart attack before they turned 50 ... then things look bleak for you too! The odds of suffering a heart attack can be swung in your favour by controlling those risk factors which can be modified - such as: Smoking, Blood pressure, cholesterol, weight, diet and exercise.

Once again the newspapers carry advertisements offering to screen hopeful people (at considerable expense) for risk of coronary events. Expert cardiologists and radiologists do not recommend screening healthy people in this way. The best person to ask about rational screening for heart attack is .... wait for it ....YOUR FAMILY DOCTOR!

In conclusion; It is possible to screen for many preventable or controllable illnesses including:

Diabetes, hypertension, vascular disease and some cancers. Unexpected death from many causes is still unavoidable. The best that you can do is live a healthy lifestyle. There is no point in stressing over things which you cannot control. Especially do not be trapped into an endless round of expensive and unnecessary medical or naturopathic tests and treatments of nil or questionable value.