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

An 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!

TAGS:  Big Pharma

About the Author

Mark Sisson is the founder of Mark’s Daily Apple, godfather to the Primal food and lifestyle movement, and the New York Times bestselling author of The Keto Reset Diet. His latest book is Keto for Life, where he discusses how he combines the keto diet with a Primal lifestyle for optimal health and longevity. Mark is the author of numerous other books as well, including The Primal Blueprint, which was credited with turbocharging the growth of the primal/paleo movement back in 2009. After spending more than three decades educating folks on why food is the key component to achieving and maintaining optimal wellness, Mark launched Primal Kitchen, a real-food company that creates flavorful and delicious kitchen staples crafted with premium ingredients like avocado oil. With over 70 condiments, sauces, oils, and dressings in their lineup, Primal Kitchen makes it easy to prep mouthwatering meals that fit into your lifestyle.

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