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What’s Driving the Boom in At-Home Medical Tests?
Some say direct-to-consumer diagnostic kits, currently available for everything from food sensitivity to Lyme disease, offer the convenience and low cost that a doctor’s visit lacks. Others argue they’re more harmful than helpful.
In 2017, Julia Cheek broke a record on ABC’s Shark Tank: The show’s judges awarded her a $1 million deal for her company, EverlyWell, marking the largest investment a solo female entrepreneur had received in the show’s history.
EverlyWell, an at-home medical testing business, currently offers testing panels for conditions as varied as food sensitivity, menopause, and HPV. Cheek stresses that it’s a middleman service, not a diagnostic company: Customers collect their swabs and samples privately, then send them to a lab for analysis. “The tests offered through EverlyWell and those ordered in a physician’s office and processed at traditional brick-and-mortar labs are the same,” she says.
According to Cheek, less than three years into its operation, EverlyWell has seen 300% year-over-year customer growth, making it a powerful player in the rapidly growing category of direct-to-consumer testing companies and products. Others include Thorne, which, among other things, sells urine tests to monitor sleep patterns and saliva tests to assess stress; LetsGetChecked, which offers tests for diseases like Lyme and diabetes; OraQuick for diagnosing HIV; and home kits for thyroid problems, cholesterol, and urinary tract infections.
Not everyone agrees that home testing is a good idea. Some health care experts are skeptical of these tests in general, and some tests from EverlyWell in particular. Last year, for example, the medical website STAT News called EverlyWell’s food sensitivity test “medically dubious” and noted that the European Academy of Allergy and Clinical Immunology had recently recommended against the same specific food-allergy test that EverlyWell sells, arguing that it is “irrelevant for the laboratory work-up of food allergy or intolerance and should not be performed in case of food-related complaints.”
Nevertheless, consumers continue to seek out these tests in ever-larger numbers: Some experts predict that the market for at-home medical and genetic testing will reach $350 million by 2020. And as a growing number of patients skip the doctor’s office in favor of the privacy of their own bathroom, physicians also have conflicting opinions about what’s driving the migration.
“I think the phenomena is fueled by distrust,” says Arthur Caplan, the founding director of New York University’s Division of Medical Ethics. For patients who, for whatever reason, don’t believe the medical establishment prioritizes their best interests, taking back this small measure of control — you, not the doctor, are the one administering the test — can feel both comforting and empowering.
It’s true that skepticism of the medical profession is on the rise in the United States. In 1966, roughly three-quarters of Americans said they had “great confidence” in their doctors, according to a paper published last year in the New England Journal of Medicine. By 2012, however, that number had tumbled to 34%.
Of course, that mistrust is much older than Shark Tank. Measles outbreaks around the United States have been drawing increased attention to the growing anti-vaccination movement. And mistrust — as well as abuse of trust — between doctors and the African American community stretches far back into the country’s past.
“Health care has a long history of mistreatment of African Americans,” says Jennifer Taber, assistant professor of psychological sciences at Kent State University. Scholars and journalists often point to the infamous Tuskegee experiment — in which researchers neglected to treat African American men who had syphilis and misled them about their condition — as a key point in the fractured relationship. More broadly, Taber adds, “the experience of discrimination and devaluation faced by African Americans fosters an environment of skepticism and mistrust for large health care systems or organizations.”
In 2015, Taber published a paper in the Journal of General Internal Medicine examining why people avoid medical care, even when they suspect it might be necessary. Roughly a third of study participants said they were held back by negative opinions of doctors or other elements of the health care industry. And nearly twice that number said they didn’t seek care because of structural barriers like cost or time constraints.
Many experts think it’s that second reason, not distrust, that’s primarily driving the at-home medical testing boom.
“That phenomena has nothing to do with trust issues,” says Robert Blendon, professor of health policy and political analysis at the Harvard T.H. Chan School of Public Health. “It has to do with the public’s preference for convenience in health care. There is a revolution going on where people are making health care decisions based on convenience concerns.”
And cost concerns: For a large number of Americans, an unplanned medical expense can be financially ruinous. A report issued last year by the Federal Reserve found that four in 10 Americans wouldn’t be able to cover a $400 emergency. For many patients, Caplan notes, “[home testing] is seen as both convenient and as a way to save money by avoiding a visit to the doctor.”
Unclear information about how much medical tests at the doctor’s office may cost, Cheek adds, can cause some patients skip testing altogether: “Lack of transparency, at no fault of the doctor, often exacerbates the problem and leads patients to avoid testing.” Pricing for at-home tests can vary widely: EverlyWell kits range from $49 for a cholesterol or folic acid test to $399 for a “women’s health test” to check hormone levels. Thorne’s tests are similarly priced, starting at $100 for testosterone and going up to $390 for fertility, while OraQuick, the HIV test, costs somewhere in the $30 to $40 range.
Regardless of what the appeal is for the individual patient, Caplan cautions consumers against thinking of the doctor as an expendable part of the medical testing process. (Although EverlyWell recommends that patients share their test results with their primary health care provider, Cheek estimates that about 20% of EveryWell’s customers do not have a primary care physician.)
“Tests are about risk and have error rates. Someone has to interpret them,” Cheek says. “Otherwise, people will be unnecessarily frightened by a positive finding or overly blasé about a negative result.”
Without counseling, he says, at-home testing “is not a prudent way to pursue one’s health.”