The Brave New World of Health Testing

The "worried well" are doing whatever they can to uncover disease before it takes its toll. But does their detective work yield more questions than answers?

By Susan Ince

Doing It Ourselves"Give us your worried, your wealthy, your hordes of baby boomers yearning to breathe a sigh of relief about the state of their middle-aged bodies." This could be the motto for a growing number of entrepreneurs who are tapping into our fears about aging by offering us more direct-to-consumer medical tests than ever before. If you’re waiting for your doctor to tell you it’s time for a lipid panel or to order you an MRI, well, that’s so last century. Today you can head to a private testing center — or even a mall or grocery store — and pay for a peek at your insides.Assuming you have the cash, selecting your own screening tests buys you access to the latest, most extensive high-tech exams that are currently on the market. What the results mean isn’t always clear, but just having them can provide a feeling that, no matter what our genes have in store, we’re doing everything we can to protect ourselves. And so, demand is rising.Milk, Bread…and Blood TestsWhen doctors order blood work, the samples often end up at Quest Diagnostics, the nation’s largest clinical lab. In 2001, the company introduced QuestTest, which gives consumers the option of buying some tests directly at centers in 11 states. "Our customers are mostly in their 40s and 50s; they’re conscious of their health status and family medical history, and wonder what it means for them," says Kate Langevin, Quest’s director of strategic development.Another testing company, HealthcheckUSA, is affiliated with thousands of centers where you can have your blood drawn and evaluated; for an extra $49, a technician will come to your home or office. If even making an appointment is too troublesome, you can buy a range of screening tests while shopping at one of 3,000 groceries in Texas: Four to six times a year, a HealthcheckUSA representative sets up shop in the pharmacy section of the store. Blood samples are collected and sent to a major laboratory, where they can be tested for hundreds of ailments, from allergies to sexually transmitted diseases.Why are we choosing to select and pay for our own tests? For people who don’t have insurance, tests ordered through a discount provider can save money. Even if you are insured, it can make costs more predictable. "If you pay up front, you know your out-of-pocket costs," says Holt Vaughan, president of HealthcheckUSA. Money aside, people like to get private, written information, says Quest’s Kate Langevin, particularly as employers change insurers. Legally, you can request a copy of your medical records from your physician at any time, but most of us leave our doctors’ offices with nothing more than the vague reassurance that everything’s okay unless a receptionist calls to tell us otherwise.Ordering the WorksMaybe you are perfectly healthy. Or maybe you have a slight health problem — say, moderately high cholesterol. Your physician can administer the standard tests — panel, blood-pressure exam — but you’ve probably heard about new tests for factors like homocysteine (an amino acid) and C-reactive protein (a marker for systemic inflammation) that might shed additional light on the status of your cardiovascular health. Your doctor may not recommend (or offer) these exams. The answer? Seek out a center that provides "advanced lipid testing," which can screen for 10 or more risk factors. Clearly, one advantage of taking matters into your own hands is that you can get access to a test as soon as it hits the market. Physicians may be reluctant to advocate a new test "because insurance won’t cover it," but many times its value is still unproved. For someone with borderline high cholesterol, the results of a small LDL test (measuring "bad" cholesterol particles, with the smallest carrying the highest risk), for example, could help determine whether it’s time to start taking a lipid-lowering drug. But for those at average risk, the meaning of the results of many of these cutting-edge tests is still unclear.

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