Marks Daily Apple
Serving up health and fitness insights (daily, of course) with a side of irreverence.
18 Jan

Doctors as Middlemen?: Direct-to-Consumer Online Testing Services and Other Consumer Health Trends

computermedicineAn alarming new health trend has medical professionals scurrying around issuing dire warnings of impending doom and death. As a recent piece in the Wall Street Journal relays, consumers are taking their health into their own hands by foregoing expensive, redundant doctor’s visits in favor of mail order lab tests. Blood lipids, A1C, vitamin D, C-reactive protein – you can get just about any lab value tested online, no insurance required. Lipids run between $30 and $50, A1c between $25 and $40. Even people with (overpriced) insurance and high deductibles are skipping the doctor. This is part of an overall larger worldwide trend toward going it alone. The home blood glucose monitoring industry, for example, grew from $3.8 billion worldwide in 2000 to $8.8 billion in 2008.

What should we make of it?

Now, I like the sentiment – after all, this blog’s readership is comprised of hundreds of thousands of readers who set out to take control of their own health, and I’m quite fond of you guys – but I’m wary of the execution. People taking their health into their hands, realizing that the system isn’t set up with their best interest in mind? Good. I like it. We need it. People are realizing that you can’t look to physicians as deities with all the answers or to insurance companies as pure-hearted benefactors. If you do, you’ll end up disappointed and penniless.

But what happens from there, once the test results come in?

The average person that gets online lab results showing “elevated” cholesterol might do a couple things. They’ll try to modify their lifestyle and get more “heart healthy,” which usually entails eating whole grains, switching to low-fat dairy, jogging every day, and eating rabbit food. This isn’t very sustainable, it’s boring, and unless they follow the entire Ornish-esque plan (which includes exercise, stress relief therapy, meditation, cessation of smoking, and other proven interventions that I wholeheartedly support), it probably won’t do much to improve the health of their hearts. Or they might take the easy way out and wrangle for a Lipitor prescription, either by paying the co-pay to visit the doctor, who will, of course, have to order another lipid test before prescribing anything, or by ordering some statins from a sketchy online site and hoping that they actually receive what they ordered.

They might also venture into the world of complementary and alternative medicine, or CAM, in lieu of, or in addition to, conventional medicine. In fact, that’s another growing health trend that fills me with mixed feelings. On one hand, people’s hearts are in the right place: wresting control of their own health. But CAM is a tricky subject. Much of it is hogwash and pure malarky, like homeopathy and colon cleansing, which are rightfully dismissed by anyone with a sound head on his or her shoulders. If people try to take control of their health by submitting to ridiculous, unproven, illogical practices like those, is that a good thing? No; they mean well, and their intent reflects a positive mindset and a growing trend, but the resultant treatment might be useless at best and dangerous at worst.

Then there’s stuff like vitamin supplementation, massage, bodywork, joint mobility work, nutrition, and meditation – all proven to be beneficial to both mind and body (as if the two were different) and all firmly in the “alternative” camp. If folks opt for that type of “CAM,” they’re doing it right. And the latest trends seem to indicate that they are doing it right. The increase in people using complementary and alternative medicine (38.3% of adults in 2007, up from 36% in 2002) may not seem like much, but the types of CAM treatments they’re favoring have changed. In 2007, the most popular CAM treatment was use of “natural products,” which includes vitamins, herbs, and other supplements, followed by deep breathing, meditation, chiropractic, massage, yoga, diet, progressive relaxation, guided imagery, and, finally, at a measly 1.8% of CAM users, homeopathy. I can get behind most of those. In 2002, the most popular natural product among adults was echinacea, followed by ginseng and gingko biloba; in 2007, fish oil had jumped to the top of list with over 38% of adults, followed by glucosamine, echinacea, and flaxseed. CoQ10 also made its way into the top 10 in 2007, nudging out “soy supplements.” Nice. So it’s not just enchanted snake oil being used by greasy, non-vaccinating hippies. Much of this stuff is proven. I also like the diseases/afflictions that people target with CAM. Back in 2002, a lot of people used it for “head and chest colds.” Pretty dubious, right? As of 2007, the top five diseases/conditions for which CAM was used were, in order, back pain, neck pain, joint pain, arthritis, and anxiety – all conditions for which things like diet, supplements, massage, yoga, and meditation are viable therapies. It seems that even as CAM use increases, the use of frivolous, misguided CAM therapies like homeopathy are decreasing in favor of beneficial therapies that jibe with conventional medicine (that is, they work!). This is, then, a bittersweet trend, with the idiocy tainting the legit therapies.

What About the Tests?

I’m kind of biased against numbers on a piece of paper that supposedly represent your current state of health. I don’t doubt that they reflect something going on internally, but I wonder how important it is to keep careful, steady track of the numbers and react wildly to their fluctuation. An obsession with lab values is kinda like when people weigh themselves once, twice, even thrice a day. They start focusing on numbers and numbers alone only to ignore subjective, real values, like “How am I feeling?” or “How do I look in the mirror?” And don’t even get me started on those increasingly popular but expensive DNA tests. As of now there’s almost nothing valuable to be gleaned from them. Numbers are ultimately an abstraction, and if you pay too much attention to the numbers game, you’ll start forgetting why you’re here. What’s important? Weight lost or inches lost? Numbers on the scale, or strength gained, joint health improved, and energy levels regained?

These are just numbers, albeit numbers that represent something tangible. And some of them are definitely useful. Testing your vitamin D levels is a good move, especially if you’re starting out and plan to supplement. You get tested, figure out where you’re at, start a supplement regimen, and retest in a few months to get your bearings. Diabetics should probably monitor their A1Cs, and a pre-Primal blood lipid test followed up three months later is a good way to keep skeptical loved ones off your back, but monthly tests? What’s the point? Are you gonna start eating whole grains if your LDL goes up a bit? What if it’s just your body curing itself of fatty liver? What if the number was just an aberration, a fluke?

In the end, you have to ask yourself if the numbers are going to change your behavior. I’m entirely unconvinced that I need to test my cholesterol, because whatever values come back are not going to change the way I eat, work out, sleep, or live. I’m still going to eat lots of animal fat, lift heavy things, sprint once in awhile, get plenty of sleep, and try not to take life too seriously. As long as those things are going well, as long as I feel good, wake up without an alarm clock full of energy, hold my own on the Ultimate field and in the bedroom, I’m good. Those are my health markers. If they’re in order, I’m doing things right.

So – take advantage of these tests, if you truly think they’re relevant to your situation. And if you want to engage in the Primal pastime of self-experimentation with a bit of statistical, objective rigor, go right ahead and monitor your numbers. Just don’t become wedded to the numbers and forget the bigger picture. I mean, let’s face it: when it comes to lifestyle interventions, dietary changes, activity habits, and all the rest, you know exactly what to do. It’s always pretty much the same. You know you should get more sleep, play more often, spend quality time with friends and loved ones, stimulate your mind on a regular basis, avoid industrial foods and grains, and the results of some test are not going to change those basic truths.

Overall, though? Things are getting better. The movement is growing. The trend toward taking charge of one’s own health is ultimately a good thing. All those people who are sick of wasting  money on tests and visits are that much more likely to happen upon the importance of laying a strong foundation for health through nutrition, exercise, and lifestyle. They may wind their way through veganism, raw foodism, Mediterranean diets, and whatever else, but even a single step away from the Standard American Industrial Diet – in any direction – is a positive move.

What do you think, readers? Stats are cool and worldwide trends are nice, but I also find value in anecdote; are the people around you beginning to take responsibility for their own health? If so, how are they going about it? Are they doing it wrong? Making things worse? Let me know in the comments!

You want comments? We got comments:

Imagine you’re George Clooney. Take a moment to admire your grooming and wit. Okay, now imagine someone walks up to you and asks, “What’s your name?” You say, “I’m George Clooney.” Or maybe you say, “I’m the Clooninator!” You don’t say “I’m George of George Clooney Sells Movies Blog” and you certainly don’t say, “I’m Clooney Weight Loss Plan”. So while spam is technically meat, it ain’t anywhere near Primal. Please nickname yourself something your friends would call you.

  1. There’s a hilarious skit on homeopathy at:

    http://www.youtube.com/watch?v=HMGIbOGu8q0

    John wrote on January 18th, 2011
  2. Personally, I’ve never had any blood work, lipids, A1c’s, etc. done. I switched over to a Primal/paleo lifestyle over 1 year ago, and have never felt better. Anytime I feel compelled to get blood-work done, it’s usually to PROVE to others that this lifestyle really works. I know going purely off of anecdotal evidence is a potentially slippery slope, but it really would be nice to be able to get some of my friends/family to try it without putting me through an inquisition. Guess you just gotta keep pluggin’ away.

    Matthew Myers wrote on January 18th, 2011
  3. Great post, as usual. But I’m not ready to I assume that all homeopathy is bunk on its face. Its remedies should stand up to the same kind of testing that other interventions do, however. As a retired environmental wonk, I can testify that some toxic substances have serious effects at concentrations of a few parts per billion. It is not beyond reason then that some substances have therapeutic doses in similar concentrations.

    slacker wrote on January 19th, 2011
    • That’s the thing, though. No homeopathic remedy has EVER passed properly controlled scientific trials as being any more effective than a placebo, and in any case, you aren’t getting “a few parts per billion” with homeopathic remedies. Most of them are marked “30C” which means you get one part active ingredient to 100^30 parts water (or, one drop of active substance in 100 drops of water, thirty times). So, in other words, to get one molecule of the active ingredient, you’d need to consume all the molecules in the solar system. Even homeopaths agree that there’s nothing but water in the bottle they’re selling you. They claim (without science to back it up, of course) that water has “memory”, and that this is how the remedies “work”. This would be REALLY cool if they could provide evidence for it, but they can’t.

      If you want to drink expensive water and claim it works better than scientifically tested medicine, fine. If you want to stay away from doctors and pray that you’ll get better, fine. You’re an adult, you can make your own decisions, but please keep your woo away from kids who can’t. That’s all I ask.

      Alison wrote on January 19th, 2011
  4. Wow! Imagine assuming that we have a reasoned, intelligent populace that knows how to read, research and put two and two together. I have done the above, and my doc, who is a doc of functional medicine, looked the test results over, WE came up with a plan of action, and the world is now all peachy! My ORIGINAL doc, who thought his name was God, and who is now history, was indignant that I would dare think for myself. Go for it!

    Cj wrote on January 19th, 2011
  5. I am firmly in the pro-homeopathy camp.

    A lot of people think my belief in the claims of Christianity is “malarky” as well.

    I can’t prove either of them scientifically, but then again, I don’t see the need to.

    honeybee wrote on January 19th, 2011
  6. Regardless of the subject – food, health, raising children, vaccines . . . I firmly believe more information and options are better than less. It is each person’s responsibility to do their own research, seek out the right professionals and ultimately make their own decisions about their health (and take responsibility for the consequences). I have conquered several health conditions (cancer, dermographism, hypotyroid, pulmonary fibrosis, fatigue, IBS and more things that some told me were incurable) and have used several resources who have guided my journey like my doctor, herbalist, chiropractor, and Mark (of course!) along with tons and tons of reading and discussions. You have to make smart prudent decisions and don’t follow anyone source or person blindly. Sadly some people just don’t want to put in the effort. Well . . . that’s their choice.

    Jen wrote on January 19th, 2011
  7. I have had one instance when a naturopath gave me a homeopathic remedy that I think really helped. However, mostly I find that my body doesn’t seem to respond. Maybe I don’t have really good homeopathic doctors?

    My cats, though. Well they respond. I had a cat diagnosed by a traditional veterinarian and all the testing money could buy with mid-range cardiomyapathy. In cats this means living about five years. I took him to an alternative vet thinking about Chinese herbal medicine which I would then use. However, she used a homeopathic remedy. He seemed fine. The next year I took him in for his annual exam and the regular vet couldn’t find the heart murmur that she had been hearing for a couple of years. In fact, he lived for another 10 and only in the last year did the murmur start showing up again.

    Since that time I have taken other cats in for homeopathic remedies and I find the results amazing. Perhaps my cats just believe that getting something nasty tasting in their mouth will help them. My current vet uses homeopathy for the first treatment choice and moves on to more conventional medicine if necessary.

    Does homeopathy work? Well whatever my vet does, seems to. I’ve working in a veterinary clinic and have volunteered at shelters since leaving so I know cats. I know when they are well and when they aren’t.

    Homeopathy is not my first choice for most of my health conditions but I wouldn’t say it’s hogwash. But then I’m an acupuncturist–we work with energy not matter to begin with. Who would think that pressing certain points on a shoulder could help heartburn? But it works.

    Bonnie wrote on January 19th, 2011
    • Bonnie,

      I think it is always a mistake to take homeopathic medications that are prescribed from someone who is not a rigorously trained homeopath — and one who *only* practices homeopathy.

      This is where a lot of people have disappointing results from homeopathy. They take remedies prescribed by other alternative medicine practitioners who do not have a clear idea of the theory and art and science of homeopathy — they think it’s just another tool and they don’t understand it well.

      Find yourself a true homeopath and see if you don’t have better results.

      honeybee wrote on January 19th, 2011
      • My naturopaths who work with homeopathy are trained in homeopathy. They are not classical homeopaths but the remedy that worked so well was not a classical remedy either.

        My vet is classically trained they use only one remedy. As my issues are merely colds, some allergies and perhaps the flu, I generally work with the medicine I practice, which is acupuncture and Chinese herbal medicine along with some supplements for which I work with a naturopath.

        However I think that the fact that homeopathy does work with pets shows that there is something more than a placebo effect going on. The fact that I do not get results for my body does not trouble me at all. I think that different bodies respond to different medicines and some people need a gentle suggestion and others need a sledgehammer. I do not think that those who need a sledgehammer to heal should say that the gentle suggestion has nothing to offer.

        Bonnie wrote on January 19th, 2011
  8. In my family we have both a vac reaction and polio. So this is a sensitive subject.

    What we’ve chosen, for the most part, is to vaccinate but separately rather than the stacked variety.

    My dad had polio when he was 8. He died of post polio syndrome. So, yes, we all vaccinate for it. No discussion. We all saw how his entire life was effected.

    We have chosen not to vaccinate for chicken pox, etc and never seasonal stuff, (although I vaccinate peop).

    jem wrote on January 19th, 2011
  9. When I got married almost 30 years ago I had a very tough time convincing my wife she doesn’t have to go to the Witch Doctor for every little ailment. (She still looks to the doctors for problems I think are insignificant but there you go.) I did not, and still do not, go to the doctor unless I am truly I am truly in trouble.

    Now, having said that, I will tell you my medical bills in the past averaged about $2000 per year due to high blood pressure, a “pre-” diabetic diagnosis, a twenty year battle with gout, and all the various medicines, blood tests, etc.

    Two years ago my blood pressure got completely out of hand resulting in another blood pressure medicine at a high cost, both economic and physical — I felt like shit — and I finally decided to do something about it.

    I got into “barefoot” running and while researching the subject I bumped into Sisson’s blog and wound up buying his book. Holy shit, what an epiphany. Archeology was part of my education and the whole “Paleo” concept — barefoot running and Sisson’s ideas — hit me like a ton of bricks. Cool.

    Beginning in about April 2009 I went into the concept whole hog, no pun intended, and have since completely turned my health around. My blood pressure is now low normal, my blood glucose stays below 95 mg/dL, and I haven’t had a gout attack in over a year even though I no longer take ANY meds. (As a side note, I’ve lost 30 pounds.)

    The really nice part of all this? In the year 2010 I did not spend one dime on the medical profession. From $2000 to $0 in the space of about nine months. My last visit to the Witch Doctor was a blood test to determine my uric acid level (a predictor of gout). It was low. My blood pressure went from a high of something like 140/100 down to today’s 80/65. It really felt good waving bye-bye to the doctor.

    I don’t care about measuring anything except my weight. I haven’t been sick in the past year, not even a cold, and I am now convinced, after reading and researching for the past year, that if I eat the proper foods and exercise properly, my body will take care of itself. Except for a dire emergency, I do not intend to ever step foot in doctor’s office again.

    Phocion Timone wrote on January 19th, 2011
  10. Mark, just keep in mind that most people find greasy, unvaccinated homeopathic hippies MUCH, MUCH more normal than us primal lard-loving, wheat-averse, whole-grain hating health nuts! Some of us might even be all of the above….

    fitmom wrote on January 19th, 2011
  11. Looks like I’m late to this party. Too bad, as it certainly seems to have been a humdinger.

    My two cents? There are some “homeopathic” practices and remedies that have been shown, anecdotally, to be beneficial to people who have tried them. The reason they are being referred to as “homeopathic” is that nobody has subjected them to the classic double-blind, empirical testing that is the mainstay of Western medicine (a mainstay which, I would say, is a VERY good thing). Once that happens – and REGARDLESS of whether the majority of the Western medical community “accepts” the results – if the practice is shown to be effective and safe, then we can rightly regard it as a proper medical remedy. If not, then it’s exactly as Mark says: hogwash.

    Don’t get confused by the fact that there are many Western medical practices and remedies that are considered to be effective and safe which are NOT, and which have, unfortunately, been subjected only to the most circumspect of empirical scientific testing (Ancel Keys, anyone?). This inconvenient fact blurs the lines between “Conventional” and homeopathic medicines, because clearly, both categories accommodate age-old practices that a few unbiased tests would show to be complete and absolute bunk.

    Nobody’s word is gospel. Seek out the facts, and let the facts speak for themselves.

    Alhaddadin wrote on January 19th, 2011
    • As an addendum: much of homeopathic medicine is, by my estimation, based upon a very powerful application of the placebo effect combined with an extremely low, unrefined dosage of the more powerful variety that might be prescribed by a conventional physician. We already know that the placebo effect works – that’s the reason for the double blind – so it’s conceivable that the whole category of homeopathy might be more rightly regarded as “Paraplacebic Medicine.”

      …which sounds a lot less desirable than actual medicine, scientifically AND anecdotally verified, such as the kind Mark advocates (and has been consistently advocating) here.

      Alhaddadin wrote on January 19th, 2011
  12. To whom it may concern:
    If I am of sound body and mind then why do you care if I take homeopathic remedies? If they are, as you say, innefective plecebos then let me spend my own hard earned money on them. My body, my choice. Don’t try to regulate or dictate other’s choices.

    Kristen wrote on January 19th, 2011
  13. If homeopathy works for you, it works for you.

    Using “homeopathic principles”, if your boss suddenly started paying you 1/1000th of your previous salary, and said that they are only doing so because you are an excellent employee and deserve recognition, would you accept the “homeopathic promotion”?

    I guess homeopathy never made sense to me because the underlying rationale (that administering something in vanishingly tiny {read ZERO} amounts will bring about a cure) is about as logical as saying to a child “the less time you practice playing the piano the greater the chance you will be a world-class piano player.

    Maybe they should change the name to “Placebeopathy.”

    Bottom line: What works, works.”

    Mark hit it on the head when he said the only reason homeopathy has not been outlawed is because it causes no harm (unless you consider that by using homeopathic methods you are possibly foregoing valid treatment that might actually help.)

    Great discourse, as always!

    Rob

    Rob wrote on January 19th, 2011
  14. I’ve beaten this topic to the ground but I’m assuming many discredit music therapy, art therapy, sound therapy, light therapy? Though studied and implemented by hospitals worldwide, it’s utilising an ‘energetic’ principle to heal the ill in a similar way to homeopathy. Overmedication in the States is way out of control. If more people were open minded to alternative therapies and tried some of this malarky, say after Prozac doesn’t cure depression, the world might be a better place. Many big pharma drugs don’t work though the science is behind it! Okay, I think I’ve said enough :)

    Cara wrote on January 20th, 2011
  15. For anyone interested in monitoring their glucose levels Walmart now sells an A1c test for $9 (postage included). They also sell glucose monitors and test strips under their house brand (Reli-on) for way cheaper than I’ve seen elsewhere. Not sure if they have rolled this out in every US store yet, much less outside of the US.

    Mojo Yugen wrote on January 20th, 2011
  16. Here’s the funny thing about homeopathy: 1. very few studies have been done (that i can find) that are empirical; and 2. animals aren’t subject to placebo effect (and from what we can tell, neither are infants and small children — the under 3/4 set).

    now, a couple of us here have asserted that our little children (under two at the time) or our pets have had positive changes due to homeopathic remedies.

    this isn’t placebo effect in my brain. my kid went from panicking when i would drink a class of water (literally, freaking out, crying, screaming, the panic-attack style breathing that sounds like “huffing”) to jumping into the shower with me and playing happily in the tub the next day with NO fear of water. It wasn’t my placebo effect? Can a less than 2 yr old have a placebo effect? Science says no. So, did it work, or did my son just magically get over a months-old, trauma-based anxiety about water for which a child psychiatrist wanted to medicate him? Because that psychiatrist has “science” behind him, but that is a dark road.

    I found the amazing randi very entertaining. i didn’t find him absolutely convincing. i have already heard his argument against homeopathy, and i have read the underlying ideology behind homeopathy (which is energetic, NOT about chemical substance which herbalism is, and drug therapy, etc — but it’s a whole different conversation).

    I thought that, from an energy standpoint, it’s plausible. But, from a physical/science stand point, there’s no way to prove it, because you cannot prove — through science — that the “energy body” exists or functions in any specific way. You can look at the nervous system, but that is *not* the “energy body” as described in yoga, TCM, etc.

    Science cannot study the energy body any more than science can study god. it doesn’t invalidate the use of energy healing modalities (from yoga to acupuncture to the various other forms, including homeopathy). it simply cannot study it.

    So why would i say “there are no scientific studies!” to invalidate it, when science — by the way it is designed — can’t study it? it can study the effects (and usually sees it as “mysterious” “inconclusive” and “placebo.” but it cannot actually study the mechanism. Why? because the energy body cannot be isolated.

    Zoebird wrote on January 20th, 2011
    • Er… kinda.

      http://www.amazon.com/Phantoms-Brain-Probing-Mysteries-Human/dp/0688172172

      and

      http://www.youtube.com/watch?v=jTWmTJALe1w

      The placebo problem is a qualia problem, not a problem of self; and if you believe Rama, above, you can technically measure it. We get little boosts of dopamine when we people comment back to our posts on comment boards; that’s measurable, chemically, and it’s also measurable as an experience.

      Alhaddadin wrote on January 21st, 2011
    • If science can’t study the “energy body,” what’s the difference between the “energy body” and an invisible pink unicorn? Or a green vampire flamingo that phases in between dimensions and is therefore undetectable by any modern technology. These exist. I know, because they both protect me when I cross the street. I have yet to be hit by a car–even when I cross against the trafic signal. See, evidence.

      I can go on making stuff up, and science can’t test it.

      I’m not saying an “energy body” doesn’t exist. I’m just saying extraordinary claims require extraoridinary evidence. Without that, they are just claims that sound a lot like made-up B.S.

      fritzy wrote on January 22nd, 2011
  17. I just came across this article today, http://www.fastcompany.com/1719084/can-sams-club-lead-healthcare-reform, along the same lines of DIY-healthcare, but with coaching and a focus on prevention. Of course, the coaching will probably be along the lines of “less artery-clogging saturated fat, more healthy whole grains”…

    Mountain wrote on January 24th, 2011

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