H. Gilbert Welch (MD, MPH, Professor of Medicine at Dartmouth University, author of Less Medicine, More Health, and Overdiagnosed: Making People Sick In The Pursuit Of Health) says we’re testing too much … blood tests, colonoscopies, endoscopies, mammograms, ultrasounds, MRIs, CT scans, biopsies, gene tests. He says all this testing isn’t making us any healthier. To the contrary, by digging incessantly for some tiny abnormality – abnormalities that may never harm us, abnormalities that BigPharma and BigHospital and BigMedicalEstablishment can treat – it leaves consumers with unnecessary stress and undesirable side effects, not least of which is the pain in their wallet.
Mark Cuban, owner of the Dallas Mavericks, started a firestorm with this tweet:
1)If you can afford to have your blood tested for everything available, do it quarterly so you have a baseline of your own personal health
— Mark Cuban (@mcuban) April 1, 2015
Comprehensive blood tests every 3 months. In a healthy person. Wow.
Charles Ornstein (CO), a senior editor for ProPublica, interviewed Dr. Welch about that tweet:
Mark Cuban’s Advice A ‘Recipe For Making All Of Us Sick,’ Expert Says, ProPublica, 6 April 2015
(CO) Is quarterly blood work for healthy people a good thing?
No. It’s not. This is potentially a recipe for making all of us sick.
I guess the first thing to say is that we all harbor abnormalities, and increasingly our technologies are able to detect them–be they biochemical, be they structural. We can see things down to millimeters in size; we can measure things down to parts per billion; and we can sequence the whole genome. That’s 3 billion data points.
So there’s no shortage of biometric data that people could be collecting on themselves regularly, and by the way, there’s a huge financial interest in having people do that. The market of the well is a huge, huge market.
The problem is you’ll always be catching things out of what we would say is normal. This is anticipatory medicine at its worst, where you’re really focused on what could be going wrong in the future and you’re trying to pick up [a] signal.
The problem is there’s so much noise, because the human body is a living organism. Variation is the very essence of life. People will start reacting to this data. I also think it’s really important to label it what it is: data. To me it only becomes information to the extent that it accurately predicts something will happen in the future, and it only becomes useful knowledge – a higher level piece of information – if we can do something about it.
(CO) Cuban argues that any misdiagnoses and unnecessary treatment rests with the doctors, and not with patients owning their data. Do you agree?
I think there’s a misunderstanding that diagnosis is some super clear black-white kind of distinction, when in fact there are 1,000 shades of gray in between. The time you get into that gray is when you’re dealing with people who feel fine and have some detectable abnormality. That’s how we get into it in cancer screening. We’re looking for very early signs of disease. There’s going to be great pressure to react to those abnormalities.
It’s not fair to say the pathologists have misdiagnosed. Undoubtedly there is some misdiagnosis, but their standard for what constitutes cancer is the appearance of individual cells, and how they relate to one another – the architecture of the cells. That was a perfectly good standard when you were sending them cancers that you could feel, things the size of golf balls. But when you start sending them microscopic collections of cells, expecting them to make some prediction about the dynamics of that process and how that will interact with the host – that’s you – it’s understandably going to be fraught with uncertainly. It’s all going to be probabilistic.
(CO) Cuban makes a distinction between making a diagnosis, and collecting a series of data points to benchmark yourself.
The more tests you do, and this is only the statistical process, the more likely one of them will be falsely abnormal. And the more times you do it, the more chance that something will be falsely abnormal.
There will be great pressure to take actions and that’s how people will get hurt. It’s going to distract them from the more positive things that they can do now.
It gets down to what health is. What I’m worried about is allowing health to be defined as some set of biometric measurements. … Health is about more than a bunch of physical measurements. It’s about a state of mind and we have to be careful not to undermine that state of mind. Ironically, part of health is not being too focused on it. … Much better for people to develop good relationships, have good friends, be outside, eat well, find things that produce meaning in their lives.
I agree with Dr. Welch:
- The more tests you do, the more likely one of them will be falsely abnormal.
- Treating people who are well has become a huge market.
- Health is about more than biometric measurements.
From what I can tell, not a lot of people agree with Welch. People like to test themselves. As Paul Roberts writes in Impulse Society, we have become so inside ourselves, so self-focused and narcissistic that meticulous analysis of our every cell and secretion, every bit of bile, phlegm, feces, and blood, is all that matters.
But test-chasers are playing into the hands of businesses that are more interested in making money than in making sure people live to a ripe old age with all their faculties. How do they make money? The tests may be free (covered by insurance), but the treatments aren’t. Employers have been a key player in getting people onto the testing treadmill by requiring workers to have annual screenings, penalizing them if they don’t. It’s not because they care about their employees’ health, or at least not only. It’s because insurance companies offer employers plan discounts for getting people into the system. I mean, the more people you can test for cholesterol, the more statins you can sell.
I agree that monitoring oneself so closely is not that beneficial for the majority of people. I love technology and gadgets, but I have stayed away from the Fitbits, Apple watches, and other personal monitoring devices, because I don’t want to worry about all of my daily activities (food, exercise, sleep, etc…). For world-class athletes and individuals with specific illnesses that must be monitored, these technologies are great. Otherwise, you probably aren’t getting much out of closely monitoring oneself (and as you have found, we may be harming ourselves).
Cuban is definitely investing in a new Blood testing company / definitely owns huge shares of it or Both.
I think Mark Cuban is a bright guy and I generally agree with him on many things. However, on this testing issue I don’t. I agree with Dr. Welch, “Health is about more than a bunch of physical measurements.” We cannot test our way to good health. Good health or lack of it comes from the actions we take everyday in what we eat, how much activity (exercise) we get, how much we sleep, our interactions with friends and other people, etc.
For instance, if a test shows a person has elevated cholesterol, it will remain elevated unless he make dietary changes. High cholesterol cannot be tested away. I suppose one could do more testing to see if the cholesterol level is caused by a liver problem, but I would think a person’s diet should be examined first along with other factors like age and the actually cholesterol level.
I measure my health by how I feel and what I can do. Last fall I was in Zion National Park. I hiked the Observation Point Trail to the observation point overlooking Zion Canyon. It is an 8 mile round trip hike with a 2100 foot change in elevation. I had no reservations about doing the hike because I am fit and healthy. I really didn’t think about my health before starting the hike. I had no problems doing the hike except that I was a little thirsty at the end because I didn’t bring enough water. Being able to do activities like this hike is my measure of health. Testing my blood every three months would not have helped me make this hike.
I think medicine should focus more on what keeps us healthy and less on testing for testing’s sake.