The democratization of blood testing

Elizabeth Holmes, the world's youngest female self-made billionaire (at age 30), is the developer and majority owner of a $9 billion company that provides ultra-cheap blood tests requiring only a couple of drops of blood.  Her company's first director was one of her former Stanford University professors, who retired from his tenured position to join her after she dropped out in her sophomore year.  Later additions to the board included George P. Shultz, former Secretary of the Treasury and Secretary of State; Dr. William H. Foege, former director of the CDC; Dr. Bill Frist, a trained cardiac surgeon and former Senate Republican Majority Leader; Henry Kissinger, former Secretary of State; Sam Nunn, former Democratic senator and chairman of the Armed Services Committee; William J. Perry, former Defense Secretary; and Richard Kovacevich, former C.E.O. and chairman of Wells Fargo.

Although Holmes' company is advancing steadily in its market, not everyone is comfortable with the idea of making blood tests so easy and cheap that patients can get them without going through a doctor.
Holmes believes that the seventy-five-billion-dollar testing marketplace could grow to two hundred billion dollars, as more people take it upon themselves to go to a pharmacy and request blood tests for pregnancy, high cholesterol, and other common medical issues. At the moment, most such blood tests require a doctor’s note; Holmes says that this would have to change, and could. “There are states in the U.S. where citizens can order tests directly,” she said. “The fact that in some states it’s illegal for someone to be able to get basic data about their body—for example, you’re pregnant or you’re not, you have an allergy or you don’t. Not a lot of sophistication has to go into the interpretation of that test.”
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Prescriptionless blood tests raise a host of questions. “Will insurance be willing to pay for patient-ordered blood tests?” Bruce Deitchman, a dermatologist and pathologist, said. Deitchman has served as an alternate member of the American Medical Association’s expert panel that recommends reimbursement rates to Medicare. “Will Theranos insist that test results be sent to physicians, and will patients want their doctors to know?” He noted that doctors are legally obligated to follow up and address abnormal blood tests with patients. In the absence of a doctor, will Theranos be held to that standard?
If blood tests become as cheap and easy as Holmes wants, however, the medical establishment will no more be able to block patients' access to them than it can prevent their taking their own temperature and blood pressure.


raven said...

I suspect the medical industry will fight to keep it's monopolies intact- after all, they have spent millions creating them.

jaed said...

Not just the industry. Quite a bit of government now is devoted to the proposition that government agencies should (directly or indirectly) control the amount of medical care permitted. Doing that effectively depends upon the control of medical information.

Deitchman's questions, however, strike me as disconnected. Why would anyone expect insurance to pay for blood tests? Why would anyone put up with a demand that the blood test company violate their privacy by sending their results to a third party? Why would anyone be interested in having a blood test company phoning them and demanding to "address" the results?

His third question foregrounds an interesting disconnection by means of the phrase "their doctors", meaning the patient's own doctor. It is increasingly unusual for someone to have a doctor, meaning a professional they regularly consult about medical diagnosis and treatment and with whom they have an ongoing relationship in which the doctor is answerable to the patient. It is far more likely for people to have, not a doctor of their own, but an HMO or organization of some kind to which their medical care has been assigned. When they "go to the doctor", they see a corporate employee who is tasked with imposing tests and treatments according to the corporate guidelines, and with keeping specialist visits to the minimum. Such a doctor is answerable to his or her employer, not the patient. (Not incidentally, all that doctor's records about you are almost certainly stored in a federal government database with your identifying information.)

So "Will patients want their doctors to know their test results?" is an interesting question. With the Model I relationship with a doctor, of course you'd inform your doctor about any relevant medical fact. With the Model II relationship, disclosing such information might lead to loss of privacy, pressure to take unnecessary drugs, and the presence of a scarlet-letter diagnosis on your charts of the sort that might limit your options and someday limit your life, if people with that diagnosis are declared ineligible for certain treatments.

William said...

I like this! There is absolutely NO reason to restrict this tech other than control of the populace in a most unconstitutional way.
Of course, that hasn't stopped them yet......

William sends

Texan99 said...

The "doctor as vet" model. If you're not paying the bills, you're not the customer.

Ymar Sakar said...

Do livestock really need to be able to take their own temperature though?

Do we let dogs and pigs do that before eating them (China perhaps)?