January 21st, 2012

More Medical Testing! No, Less! You Decide

Fascinating Yin-Yang this week on the issue of medical testing. Want more? Want less?

First, this remarkable piece on retail medical labs, including a description of a company called ANY LAB TEST NOW:

Labs where folks can just walk in and order tests on themselves are popping up in retail centers across the country… At Any Lab Test Now, co-owner Anthony Richey pulls out a long sheet of paper with all the different tests his lab offers. There’s everything from an HIV screening to a “fatigue” panel. It looks like a sushi menu. “You say, ‘Well I want to check my diabetes, I want to get a hemoglobin A1C, and maybe I’ll check my lipid panel. And I’m a male over 40 so I’ll get my PSA checked,’ ” Richey says.

On the company’s web site, there are plenty of smiling, healthy people, plus these appealing claims:  “No Doctor’s order needed … No appointment necessary … No insurance needed …  Most results available in 24-48 hours.”

No doubt this is excellent customer service. But care to guess what that “Fatigue Panel” will set you back? That will be $499, thank you very much. But maybe they offer Gift Cards, that should help.

And if anything comes back abnormal?

If your results are ‘abnormal’ or ‘out-of-range’ from the normal, please contact your physician.


It’s a poorly appreciated fact that the lower the likelihood of a disease being present, the greater the chance of a false-positive result.

Which is why no sensible physician would order all the components in the “Fatigue Panel” — which of course includes Lyme and EBV testing — without first taking a thorough history to determine if these diseases are even worth considering.

Meanwhile, over in the Annals of Internal Medicine, a group from the American College of Physicians this week argues for less testing:

The overuse of some screening and diagnostic tests is an important component of unnecessary health care costs… Efforts to control expenditures should focus not only on benefits, harms, and costs but on the value of diagnostic tests—meaning an assessment of whether a test provides health benefits that are worth its costs or harms.

What follows is an entirely sensible view of medical testing, with certain problematic, “low-value” tests called out for being wasteful — including the Lyme test mentioned in that “Fatigue Panel.”

And those false-positive tests, which retail labs must be generating by the crateload every day?

False-positive results are of concern because they often lead to further testing, which may be expensive and potentially harmful. They may also create anxiety for the patient and may lead to inappropriate treatment.

Which brings us back to the primary motivation of ANY LAB TEST NOW, which must be obvious by now:

“From a marketing standpoint it’s a good position to be in where you create a service, create a demand,” says Rodney Forsman, president of the Clinical Laboratory Management Association. “It becomes a consumable like Starbucks or bottled water.”

My advice? I strongly recommend that someone from ANY LAB TEST NOW contact the guys running GNC and explore co-franchising options.

They completely deserve each other.

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HIV Information: Author Paul Sax, M.D.

Paul E. Sax, MD

Contributing Editor

NEJM Journal Watch
Infectious Diseases

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