That’s Not What the Doctor Ordered

IRA FLATOW: This is Science Friday. I’m Ira Flatow.

Have you used one of those new home diagnostic tests? A test that your doctor might have done in her office, but you can now order online and do at home. It is a growing industry for those curious to know more about their current testosterone or their glucose levels, for example. You can now order a blood test from a company like InsideTracker to get that information.

But without a doctor, how do you interpret the data? How useful is it, really? Sure, the internet has helped put consumers directly in touch with the products they want without having to go to a retail store to buy them. Makes things cheaper, more affordable by cutting out that middleman. But what if that middleman is your doctor? Is that a risky thing to do?

My next guest wanted to find out, so he ordered the InsideTracker test for himself and made changes to his diet and fitness routines based on that information. And he discovered that owning your own data isn’t as empowering as it appears to be. Peter Andrey Smith is a science writer and contributor to Outside Magazine, where he wrote about his experience using the InsideTracker blood test. And joining him is Shannon Haymond, associate professor of psychopathology at Northwestern University’s Feinberg School of Medicine.

Our number, 844-724-8255. Peter, so you wrote about this company, InsideTracker, which offers a direct to consumer blood test. Tell us what your experience was.

PETER ANDREY SMITH: Yeah. Well, one afternoon I was just sitting at my desk. And my editor gave me a call and said, hey, do you want to try out this new thing? And I said sure, let’s look into it. And so found out what companies offer this service in New York. There’s only a couple. And I ordered the test. And a nurse came to my apartment, drew my blood. And two days later, I had results.

IRA FLATOW: And what were the results? You don’t have to share what they were, but did you know what to do? What kinds of test did you take?

PETER ANDREY SMITH: So they have a suite of tests. So it’s like a number of blood biomarkers, things that are biological indicators of your health. And the stuff like glucose, vitamin D, testosterone. There’s a whole list of them.

And so I feel like I’m a fairly healthy person. And that the tests sort of reflected that I’m a fairly healthy person. There weren’t any big surprises.

IRA FLATOW: So you know how to interpret the results that came?

PETER ANDREY SMITH: I mean, they sort of help you. They can say this is within the range of what we expect someone of your age and your activity level to be. So they are pretty helpful in sort of interpreting the data for you as well. And they make it clear that it’s not medical advice. This is just tools for you to get healthy, essentially.

IRA FLATOW: It’s sort of like the labels they put on the commercials for taking additives. It has not been evaluated.

PETER ANDREY SMITH: Right. There’s a little asterisk next to these tests, yes.

IRA FLATOW: Dr. Haymond, you’re someone who is very familiar with medical tests. Was it a surprise to you when companies started offering blood tests direct to consumers?

SHANNON HAYMOND: I don’t think so. It’s interesting. With everyone having mobile technologies that allow us to do and take control of all of the other things in our lives, why wouldn’t this follow? And there was a lot of news of companies doing this– one of them, most notably, Theranos– and laws changing to enable people to do this. So we’ve been watching it slowly happening. And it’s clear that it’s here now.

IRA FLATOW: But there should be some kinds of tests that you can allow yourself to do. I mean people who are diabetic, they draw their own blood, a little pinprick of blood, and take a glucose test. Why can’t I do that with my cholesterol, which gives me a number that’s useful or something like that? Do you have any problem with that?

SHANNON HAYMOND: Well, so that’s right. You can go to a number of stores today and buy things like pregnancy tests, urine drug tests, for example. There are people, as you say, measuring their blood glucose who probably know much more about that and are an expert in that, probably more than I am for their own personal numbers every day. But there are other tests that I think should be probably limited. Not every test is useful in every situation. And all tests are associated with some level of error.

IRA FLATOW: Peter, you interviewed amateur athletes who used InsideTracker tests. What were they using their tests for?

PETER ANDREY SMITH: A lot of them were trying to figure out when they were overtraining or something. I actually talked to one woman, who’s an endurance athlete. And she was taking ibuprofen, I believe, to treat a bum hip. And she sort of knew that she was taking too much ibuprofen. But when she saw the numbers, she was like, whoa. This is just like really not good for my liver.

So she was– she sort of changed. So she already knew that she was engaging in problematic drug taking. But seeing the numbers was something that made her actually want to change that behavior.

IRA FLATOW: When you went to medical experts to talk about the data that you received– you’re laughing about this.

PETER ANDREY SMITH: Yes, yes.

IRA FLATOW: Were they laughing at you?

PETER ANDREY SMITH: Yes, they were. They were trying to persuade me not to take these tests. Or if I did take the tests, to basically ignore the results. They were like, don’t fall prey to actionability, they were saying. Just be very careful about something to change these numbers.

IRA FLATOW: Dr. Haymond, do you agree?

SHANNON HAYMOND: Yeah. So it’s interesting. A lot of people are critical of this area because, especially in this case, this particular case like InsideTracker, you wonder, what is the real evidence behind this? The premise that earlier detection can be detected by more testing, it seems to make sense. But the problem is that there’s actually a lack of evidence to show that that’s the case. And there can also be situations where this backfires and that more testing can actually lead to other things that are unnecessary and can cost more, lead people to angst, unnecessary angst, et cetera.

And so if you go on the, for instance, on the InsideTracker website, there’s a tab for science. And if you look at that, it’s essentially an infographic, right? There’s a lot of numbers there, large numbers, things representing thousands of things.

But when you actually really try to look at what is the evidence behind these panels, et cetera, it really doesn’t seem to be there. Versus if you go to something at a clinical laboratory, large laboratory, for instance, the Mayo Clinic, all of the tests have a tab for the utility of that test and the evidence provided is scientific literature citations and things like Professional Medical Society recommendations.

IRA FLATOW: So what harm could be done by taking these tests and getting the results? Did you feel that you had any problem with them, Peter?

PETER ANDREY SMITH: I mean, I was also sort of– I went in with a very skeptical mindset and I was not pursuing as many interventions as maybe were recommended. But one of the things that– my vitamin D levels were fairly low. And so they said basically– I actually talked to someone at InsideTracker who was saying your levels are so low that you’re not going to get out of that without taking supplements. And supplements were not something I really wanted to take.

But another sort of problem with taking supplements is that first of all, there’s all sorts of disagreements about what proper vitamin D levels are. And secondly, if you’re taking supplements on a regular basis, that means you just need to take more tests so you aren’t overdoing it, right?

IRA FLATOW: Dr. Haymond, do you think this is the future, though? Maybe apps on your cell phone or things like that you don’t even have to send the blood in somewhere.

SHANNON HAYMOND: Certainly there’s a place for it. And I think you’re right. There are more and more technologies that are coming available that allow mobile devices to perform testing.

The question will be how accurate are these things. And how reliable are they? But we can’t ignore it. It’s here. And I think it definitely has some promise in certain places.

IRA FLATOW: You’d like to have something like that, Peter?

PETER ANDREY SMITH: I mean it was a fun exercise to do. And one of the interesting things, earlier you were saying that there isn’t any sort of long-term evidence for doing this if you take– if you test your blood biomarkers for years, there’s no evidence that actually improves your health over the long-term. And as part of this, I was going to the sauna a couple of times. And I realized that there is some evidence for going to the sauna.

And there was a commentary on this sauna paper that was saying, basically, when somebody comes– this was a doctor saying if a patient comes to me and says, hey, I want to take this medical test. I basically tell them no. Just forget about it and do something you enjoy, like a sauna. So I think that that’s the kind of advice I would give to anybody. If you enjoy taking blood tests, then do it. And if you enjoy going for a run or doing a sauna, then do that.

IRA FLATOW: No harm, no foul.

PETER ANDREY SMITH: Exactly.

SHANNON HAYMOND: But I think– yeah. I think there is a point though that there can be harm in blood tests. And in fact, the whole thing is very interesting because in the hospital, so in clinical settings, there’s a tremendous effort underway to reduce the amount of tests that we’re offering and that patients are getting because we know that are unnecessary things being done. It’s wasting money and resources.

It’s actually, as I said, there are a number of false positives and negatives that can happen with certain tests. And depending on the way they’re used, those percentages can ramp up quite quickly. And so there can there can be harm. So I think that there is this idea that it’s just a test. What can the harm be done? But there can actually be harm done in certain cases.

IRA FLATOW: You know, Theranos just had to shut down their clinical operations. Do you think we should be putting more restrictions, regulations on new medical start-ups like that?

SHANNON HAYMOND: So that’s an interesting question because certainly in our laboratories, we also– we are able to develop new tests and leverage new technologies using this quote, unquote, “loophole” that Theranos used, which was this lab developed test regulation.

So I think that there is a place for modernizing that, but it needs to be done very carefully so that it does not stifle our innovation. But it also needs to be balanced with the fact that people are doing things that are inappropriate and putting patients at harm.

IRA FLATOW: Peter, would you try any other tests you’re thinking about? Any other one?

PETER ANDREY SMITH: Well, I personally don’t enjoy getting my blood drawn, so I probably won’t continue to do this. But yeah, I wouldn’t rule it out. I mean especially as it gets easier.

This is sort of like hailing a cab or taking an Uber at this point. It’s very easy to do and the results are very quick. So I think as those things become quicker and easier, I think that as the barrier to access is lowered, I think it might be something I’d consider again.

IRA FLATOW: I saw an announcement coming out next week with a telomere test to see how old supposedly the telomeres on your chromosomes are. So new ones popping up all the time. We’ll keep track of them.

Thank you both for taking time to be with us today. Shannon Haymond, associate professor of pathology at Northwestern University’s Feinberg School of Medicine. Peter Smith, science writer and contributor to Outside Magazine. Thank you both, as I say, for taking time to be with us.

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