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. And if you’re going to be offered the same diet and exercise advice or be put on the same medication, does it really matter if your risk is established by one test or a dozen?So far the AMA and the FDA haven’t taken a formal position on direct-testing labs, but some physicians caution that, without having the numbers interpreted along with a medical history and a physical, you could be falsely reassured by a normal test or too anxious about one outside the normal range. Enter preventative and executive health centers, which offer a thorough physical and some pampering along with mega-testing.At the Kronos Optimal Health Centre in Scottsdale, Arizona, the standard battery includes more than 100 measures. "The tests we do have all been proven scientifically useful, but they may not be cost-effective so they usually aren’t recommended by your regular physician," says Susan Kaib, MD, who spends at least an hour performing a history and physical on each Kronos patient, then another 90 minutes going over their results.For super-achievers, Kronos offers a challenge: To pass, you have to be better than "normal," because they compare your results with a far narrower "optimal range" of values. And every patient leaves with custom-blended supplements and a new exercise and nutrition regimen. Like other facilities, such as the Mayo Clinic in Rochester, Minnesota, and the Canyon Ranch Health Resorts nationwide, Kronos also offers some serious coddling (for $4,000 or more, it had better!), with clients spending time between tests in amenity-filled private suites. A False Sense of Security?If you were offered the choice between a full-body scan and $1,000, which would you choose? According to a national telephone survey by researchers with Dartmouth Medical School and the University of Massachusetts, Boston, 73 percent of us would go for the scan, which provides a detailed look at one’s bones, muscles, organs, and blood vessels with computer-enhanced images generated by x-rays.Indeed, the popularity of full-body (or, more accurately, full-torso) CT scans has exploded in the past few years. Do a computer search under "peace of mind," and "CT scan" and you’ll find links to dozens of companies, such as Peace of Mind Scans in California and Your Peace of Mind, Inc., in Florida. It’s not that we’ve given up on traditional screening, but the idea of being able to get a quick once-over and spot potentially life-threatening problems — say, a tiny tumor or weakened blood vessel — is appealing. The possibility of getting an "all clear" is perhaps even more enticing.There is a growing body of evidence that CT scans, which have been used for years to evaluate possible tumors, vascular problems and kidney stones, can be beneficial for certain people. Specific scans are also available for those with an above-average risk of heart disease or colon or lung cancer. But an estimated 80 percent of aberrations found on full-body screening scans are harmless — old scar tissue or benign growths, for example."People need to realize that a scan may find something of unknown significance, and they may end up undergoing invasive tests that cause anxiety and carry their own risks," says Judy Illes, PhD, senior research scholar at the Stanford University Medical Center for Biomedical Ethics and Department of Radiology. It’s also possible to have a scan that doesn’t raise any red flags and suffer a stroke or be diagnosed with cancer soon after."On a public-health basis, the scans don’t even come close to making sense, but some people want it and in some cases it makes sense for them to have it," says Jeffry L. Huffman, MD, president and CEO of the University of Southern California Care Medical Group, where full-body scanning is offered as part of a new Executive Health and Imaging Center. "It doesn’t take finding too many incidental cancers in fortunate patients to make you happy they’re available."The DrawbacksOf all the health concerns of the wealthy worried well, cancer is preeminent. For years we’ve been told that getting screened is our best defense, and we’ve dutifully signed up for mammograms, colonoscopies, and the like. But if you think that a full-body scan is a good way to condense several screenings into one, think again. It’s especially important to note that full-body scans aren’t specific enough to detect the disease many women fear most: breast cancer.Although mammography is still considered the gold standard for breast cancer detection, another technique, the breast MRI, is being touted by for-profit companies as more effective. While researchers are enthusiastic about the possibility of harnessing the technology in the future to screen high-risk women, there is a high rate of false positives as well as other kinks that need to be ironed out before it’s appropriate for everyone.Unfortunately, some marketers neglect to make that clear in their reassurance-for-a-price appeals. In its promotions, the AmeriScan company disparaged mammograms as a flawed screening tool. That didn’t bother Barbara Brenner, executive director of Breast Cancer Action, a grassroots organization: "Actually, they were saying a lot of what’s true, but not often acknowledged, about mammograms." What made her group dub the company "AmeriScam" was their stating that the $2,200 breast MRIs they offered were any better. The center claimed that "AmeriScan’s revolutionary MRI Breast-Screen is so powerful that no woman should suffer or die from this terrible disease" and that it "can find early breast cancer with nearly one hundred percent accuracy." The company shut down last fall after the San Francisco District Attorney’s Office and the California Medical Board filed suit against it for making false and misleading claims. "There are all kinds of technologies coming out that try to interpret different types of physical information [such as light, sound waves, heat, and the passage of electrical currents] about breast tissue. But these are not ready for prime time and should not replace any established diagnostic test," says Nola Hylton, PhD, professor of radiology at the University of California-San Francisco.Ethicists fear that even more established breast tests are being oversold to women who can’t benefit. Myriad Genetics, creators of the test for the BRCA1 and 2 gene mutations that raise breast- and ovarian-cancer risk, initially sold the test (for up to $2,975) only to oncologists and cancer centers, but later decided to reach out directly to women concerned about their risk. In 2002, Myriad spent about $3 million on a TV and print campaign in Denver and Atlanta, urging women with a family history of gynecological cancer to ask a doctor about testing.Critics feared that doctors unsophisticated in genetics would authorize testing for anyone who inquired, without being prepared to deal with the complex risk information and powerful emotions the results might bring. They also worried that many people would not realize that prevention options lag far beyond the ability to assess genetic risk, and that only 5-10 percent of all breast cancers are caused by mutations to these genes.The ads did result in a five-fold increase in inquiries from those cities, but women tested after seeing the ads had about the same proportion of positive tests as those referred by physicians in other areas, according to Myriad vice president Bill Hockett.What’s Next?Despite reservations among the medical community, we’re likely to have even more seductive choices in the near future.In November, Brain Matters, Inc., opened in Denver, the first in a line of for-profit centers selling brain scans that purport to detect early-onset Alzheimer’s and attention deficit/hyperactivity disorder, sort out a variety of psychiatric problems, or just give you a "brain check" by analyzing blood flow in different regions of the brain. TV ads began running in February in the Denver area.The Alzheimer’s Association notes that such tests, which utilize a technology called single photon emission computed tomography (SPECT), are experimental, and scientists disagree on their value. Assuming SPECT can warn us of impending mental decline, the main avenues of intervention — eating well and exercising — are steps we should be taking anyway."Maybe these are scary, maybe they’re wonderful, but we won’t know without more dedicated work," says Stanford’s Judy Illes.And that’s the reality for many new tests on the market, and on the horizon: We simply can’t know how beneficial they truly are until they’ve been carefully scrutinized and have stood the test of time. Meanwhile, "We should be bringing critical ethical thinking to the table in parallel with any new tests as they’re being developed," Illes says. "But in the absence of quality controls and clinical trial results, we urge caution on everybody’s end."Susan Ince frequently writes for MORE magazine.Originally published in MORE magazine, May 2004.

First Published Mon, 2009-04-06 18:26

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