One step into the future, and two steps back
By Judith Garber, MPP
About a week ago, I hurt my back during a team sports practice (ultimate frisbee, if you must know). I’ve had several sports injuries but never back problems, so this new painful injury filled me with anxiety. Was it just a pulled muscle? Did I slip a disc? Was this the end of my frisbee career? Fortunately for me, my worrying was misplaced; my back felt better with just a few days of rest.
When I get a familiar injury or the common cold, it’s never fun, but at least I feel as though I know what’s going on with my body and how to take care of it. When it’s a completely new ailment, however, I feel lost. I want more than anything to know what’s wrong, how bad it is, and how I can make it better.
I’m not the only one who thinks like this. The desire to “know our bodies,” to understand everything about our health and what could go wrong, is common. And, as new health care initiatives show, this desire is also lucrative. Genetic tests like 23AndMe, at-home tests for food sensitivity and vitamin deficiency (as seen on “Shark Tank”!) and other direct-to-consumer testing products are hugely popular.
And now, hospitals are jumping on the bandwagon. This fall, Mount Sinai hospital in New York City is launching a program called “Lab 100,” a “hybrid clinic and research lab” that gives patients “the most comprehensive health assessment currently available” while making this longitudinal health data available for research purposes.
CNBC reporter Christina Farr visited the lab and logged her experience, describing high-tech tests that measured everything from body composition and balance to cognition. From Farr’s visit, the “clinic visit of the future” sounds as much like a carnival as a medical visit – “Test your strength!” “Virtual reality headset!” “How fast can you put the pegs in the holes?”
Having years of sophisticated health data seems like a valuable research tool in the long run. But in the short run, will this program be helpful for patients? Or could there be potential for these tests to trigger additional tests and procedures that aren’t needed?
Dr. Alan Roth, chairman of family medicine at Jamaica Hospital, thinks the latter is more likely. “Lab 100 looks like sophisticated, useless information that will do nothing to improve patient care,” he said, “We should be focusing on making primary care accessible to all, not providing rich people with unnecessary testing and treatment.”
Right Care Alliance member Lila O’Connell agrees. “How about this model for the annual physical? Arrive at the doctor’s office, both doctor and patient put on walking shoes and take a 30-minute walk, and discuss the patient’s lifestyle and health concerns with input from the doctor.” O’Connell points out that although the annual physical has become ritualized in American health care, there is little evidence to show that these check-ups actually improve health.
Offering expensive health care programs for the wealthy is nothing new — see “executive health programs” and “concierge medicine,” for example. However, researchers warn that competition to bring wealthy patients to hospitals and clinics can result in them receiving unnecessary care that can lead to harmful overtreatment, such as cardiac stress tests, skin and prostate cancer screening, and screening for carotid artery stenosis.
The leaders of Lab 100 acknowledge the possibility of overtreatment from testing. Farr writes that when faced with incidental findings from tests, doctors at Lab 100 will “closely integrate with the traditional medical system so that they can deliver the right follow-up care.” That begs the question, what is the “right follow-up care” for incidental findings? Once you find something that looks suspicious, it’s difficult not to conduct further tests and procedures, even for doctors who understand the potential harms of overtreatment. And it’s likely that patients who seek treatment at Lab 100 are people who want to know as much as they can about their health – which means more follow-up.
Lab 100 does offer an undeniably valuable service — time with the doctor. Each visit takes 90 minutes, much of which is spent consulting with the physician about ways patients can improve their lifestyle and well-being. The doctor is also unencumbered by the electronic medical record, because the patient data is automatically recorded. However, patients shouldn’t have to spend an inordinate amount of money on clinics like Lab 100 or concierge medicine to be able to have a strong and trusting relationship with their physician.
Lab 100 plays into a worrying cultural trend that we all fall prey to, by promising to end our anxiety about not knowing. Farr reports that she left the clinic visit feeling “reassured” about her good health. Isn’t that what we all want? But our discomfort with uncertainty is leading to more harm than we realize. As difficult as it is, we have to accept that we can’t know everything about our bodies, no matter how many high-tech check-ups we get.