Test Thyself

Doctors don't like it when patients can do without them.

"Soy vampiro," laughed the lab technician in the storefront laboratorio that I went to more than 10 years ago when I worked in Costa Rica. I had gone to one of the scores of laboratorios that were located throughout downtown San Jose for a blood test to see if I'd been infected by some parasite or other. The test was fast and cheap and I remember thinking, "What a great idea. Why don't we have these in the United States?"

Well, the good news is that we do finally have some retail medical labs catering directly to consumers in the U.S. The bad news is that many physicians are opposed to them.

Today, lab testing companies like Quest Diagnostics and Healthcheck USA and wellness groups like the Life Extension Foundation are offering a variety of tests directly to consumers at storefront testing labs and over the Internet. In the Washington, D.C., area, for example, Quest Diagnostics has partnered with US Wellness centers located in Giant Foods Pharmacies where consumers can get a blood test for cholesterol or diabetes or many other health concerns while they pick up a loaf of bread and a gallon of milk. What could be simpler?

The range of tests offered is comprehensive. Consumers can test their cholesterol levels, thyroid and liver function, diabetes risk, and prostate cancer markers. (They can also test for various infectious diseases.) Consumers use the information to decide whether or not to see their physicians. The test results are supplied confidentially to consumers -- Healthcheck USA, for example, supplies lab results via the Internet using 128-bit encryption.

Physicians object to offering tests directly to consumers on the grounds that they are difficult to interpret and that false negatives may mislead patients into thinking that they are healthy. "Trying to interpret lab tests is a very complex and very specialized thing that requires knowledge far beyond the usual layperson's ability," said Dr. J. Edward Hill, chairman-elect of the American Medical Association in The New York Times. "It's unfathomable that people are going to order tests that take years of medical training to understand."

But how hard is it really to interpret such tests? Typically labs return results in a form that alerts clients if any of them are outside the normal ranges. "Reading lab tests is not that hard. It's not difficult to see if something is out of line," says George Vaughan, CEO of Healthcheck USA. In cases where the tests indicate that something may be really wrong, many labs will call clients directly urging them to see their doctors immediately.

The AMA's claim that test results are too complex for laypeople is also simply outdated. There is an enormous amount of good medical information on the Internet that can provide background for people with health concerns and help them understand their lab results. But clients must keep firmly in mind that the retail testing labs do not offer diagnoses. If a test is anomalous, all the labs advise clients to visit their physicians immediately.

But what about false positives (a test that suggests a person has a problem when he or she doesn't) or false negatives (a test that indicates a person is healthy when he or she is not)? "Any lab, including any that a doctor refers his patients to, can have false positives and negatives," says Vaughan. "That's a risk that is just an inherent part of all medical testing."

A more troubling reason for the AMA's opposition to retail testing labs is a desire to make sure that licensed medicos get a piece of the action. Doctors have traditionally served as testing gatekeepers. In order to get a test, a patient would first have to see a doctor -- who of course charges for the visit. Good for the doctor, not necessarily good for the patient. With doctors acting as testing gatekeepers, doctors may feel constrained to recommend only tests that are covered by a patient's health insurance. Retail lab testing allows clients to take immediate advantage of the scores of new tests that are emerging from biotech research companies, instead of waiting for insurance companies to agree to cover them. Since clients generally pay for tests out-of-pocket, they can order whatever they want or need.

Another advantage for the patient is that if you have your blood tested before going to the doctor, you can skip a pricey pre-test visit and get straight to discussing the lab results. The advent of retail medical labs is breaking down the remaining elements of paternalism and guild mentality in medicine and helping patients take more responsibility for their own health care.

By the way, the Costa Rican lab tech called me later the same day and told me that I didn't have parasites, but that my white blood cell count was high and that I should expect to come down with a bad cold in the next couple of days. I bought some cold tablets and waited. He was right.