You could call Michael Brooks a supplement junkie. He pops exactly six pills a day, three times a day, not to mention powders and shakes and chews. “A multivitamin, vitamin C, omega-3s, alpha lipoic acid,” he says. “I’m taking a digestive enzyme.”
Brooks is a personal trainer in Birmingham, Ala. He’s healthy and fit, but he almost obsessively wants to know more, which is why we find him here, a few doors down from a sandwich shop and a nail salon, at a storefront lab called Any Lab Test Now.
When you get your cholesterol or blood sugar checked, chances are your doctor ordered the tests. But as insurance companies pass along more of the cost of lab work onto the consumer, retail lab owners are seeing a niche. But there are some concerns.
Brooks is having a micronutrient test done to tell him where he’s deficient. The test costs $399, but Brooks figures his nutritional supplements aren’t cheap either.
“So even though there’s a cost to this test, I feel like if I can maybe find a few things I don’t need to be taking, so in the long run I’ll save money,” he says.
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.
My, my, my. Where to begin?
Mr. Brooks seems to be the kind of fool who is eager to speed the inexorable process of parting with his money. It surprises me not at all that someone who would avail himself of nearly four hundred dollars worth of unnecessary blood tests is also devoted to worthless supplements. Without the benefit of a single test, I could tell him that he needs to be taking none of them. I would happily sell him a tincture of my own toenail clippings for a fraction of the cost of those supplements, with a guarantee that there would be no measurable difference in benefit.
But I digress…
It should come as no surprise that I take a dim view of labs like these and the services they provide. My head swims just trying to think of what worthless woo is offered in that “fatigue” panel. And the lab owner’s mention of a PSA test forces a wry smile, given the shiny new recommendations against ordering them because they lead to unnecessary further testing, treatment and side effects in otherwise asymptomatic men. Which brings us to the major reason not to order tests like these:
[T]hat’s what is dangerous, says Michael Wilkes, professor of medicine at the University of California, Davis. He says false alarms come with the turf.
“If you order enough tests, something will eventually come back positive,” Wilkes says. And without a doctor’s input, he says, that can send someone into a panic. What’s more, ordering tests can drive up health care costs. That’s because a positive result, Wilkes says, is usually followed by a doctor’s visit.
“And now a doctor most likely has to repeat the test. And then there’s a whole list of cascade of new tests to confirm or go against what the tests show,” he says.
Just so. As I was taught in medical school, the more things you look for, the more things you find. The broader the panel of tests you order, the more likely you are to detect something randomly abnormal and almost certainly meaningless. It happens often enough even during totally appropriate routine screening. The correct approach is to repeat the test to be sure the first result wasn’t erroneous. Ordering a whole pile of totally worthless tests makes it much more likely that some kind of noise will emerge, and thus require a doctor’s visit and further testing to sort out. Mr. Brooks may pay out of pocket for that first round of tests, but if he shows up in a swivet at his doctor’s office (an emotional condition for which I would have little sympathy) then suddenly he’s contributed to everyone else’s health care costs, too.
That is my only real objection to these labs. Otherwise, I don’t really care. For people who feel overburdened by blood and money, and who wish to relieve themselves of both, I don’t feel compelled to stop them. If they fly into a panic because of something (likely clinically insignificant) that they found, it’s a panic they bought and paid for themselves. I don’t see why I would mind.
The only caveat I would add to this regards children. If grown-ups want to exsanguinate themselves and pay for the privilege of doing so, I’m pleased to let them. But children should only be put through the pain of blood testing when genuinely indicated, particularly since it is often much more difficult to draw blood from a child. Repeated needle sticks for no reason create a harm with no benefit, and could potentially create even more anxiety around legitimate medical exams, which is already enough of a problem. These labs have no place in pediatrics.
But for adults? I couldn’t care less.