No doctors needed for tests

A leading lab is selling medical tests through CVS, but some question the company's motives.

By ALICIA CALDWELL, Times Staff Writer
© St. Petersburg Times
published August 6, 2002

If you're worried about your cholesterol, sugar metabolism or liver function, a new service in the Tampa Bay area will allow you to order medical tests without visiting a doctor.

The nation's leading medical lab is selling a dozen blood or urine tests through 10 CVS drugstores in Pinellas and Hillsborough counties, one of a few test markets in the country.

For $40 to $115, patients can order tests that range from simple drug screens to a heart risk panel or a thyroid health screen. The results are sent directly to consumers.

"It's information that makes you much more knowledgeable about the state of your health," said Hughes R. Bakewell Jr., vice president of consumer health for Quest Diagnostics, the lab offering the tests.

The tests appeal to the so-called "worried well," those who want more testing than their health insurance will authorize, and to those who want to keep some tests private even from their doctors.

It's a trend some doctors and medical ethicists find troubling. The problem, they say, isn't with the information. It's the interpretation. What exactly does one do with, say, bilirubin levels, a measure of liver function?

Dan Van Durme, a family practitioner and associate professor at the University of South Florida's medical school, compared it to trying to predict the weather by looking only at a wind gauge.

"The real issue is that labs are only one aspect of somebody's health status," Van Durme said. The numbers have to be examined in light of a person's lifestyle and genetic predisposition to say anything meaningful.

An elevated bilirubin level, for instance, could be caused by medications that ought to be changed. It could mean that you have gallstones, or a minor health condition that requires no treatment. Or it could be a sign of cancer.

"They are experts at doing lab testing," Van Durme said. "They are not experts at managing people's health."

The way it works in the Tampa Bay area is this: Consumers choose one of 12 cards, each representing a test or series of tests, from a display rack and pay for it at the drugstore. Health insurance is not accepted for payment. Customers take the validated card to a Quest lab where blood or urine is collected and analyzed.

Customers can access results online in 48 hours for most tests. If requested, a written report is mailed and typically arrives within a week.

Laboratory executives say they have worked closely with doctors to develop interpretive reports for consumers. If the results are seriously out of whack, a doctor retained by Quest will call patients and urge them to seek care, Bakewell said.

The testing is one of many services offered by Quest Diagnostics, which brought in revenues of $3.6-billion last year.

Patient-directed medical testing is not new. Lab test Web sites such as HealthCheckUSA.com and CompleteBloodwork.com will connect you with a laboratory that will draw and analyze your blood without a doctor's order.

Eckerd, which has about 100 drugstores in the Tampa Bay area, does not offer the service in its stores, said Tami Alderman, a public relations manager. A spokesman for Walgreens said he had not heard anything about the chain offering such services in the Tampa Bay area.

QuesTest, as it is called, differs from the Web services by testing at its own laboratories. A year ago, the company began a similar service in Denver and Kansas. Last month, the service was started in CVS stores in the Tampa Bay area and in Columbus, Ohio, Bakewell said.

Ken Goodman, director of the University of Miami bioethics program, said people are taking more initiative in doctoring themselves. A thermometer is a basic tool that nearly everyone owns. Home glucose testing for diabetics? Wonderful, said Goodman.

But that's a far cry, he said, from attempting to interpret whether your prostate specific antigen level indicates a high probability of prostate cancer.

"What you're doing is practicing medicine without a license on a patient who is a fool -- yourself," Goodman said.

Some in the medical laboratory industry say doctors sometimes treat patients as if they are incapable of basic analysis.

"The other side of it is how patronizing is it to tell people they can't have this information," said David Sundwall, president of the American Clinical Laboratory Association, a Washington D.C.-based trade organization to which Quest Diagnostics belongs. "I think it's pretty hard to argue that people shouldn't have information if they're willing to pay for it."

The appearance of a profit motive poses another problem, said Fred Paola, assistant professor at University of South Florida's medical school.

"It takes something where your goal is to prevent, treat or diagnose disease and makes the goal into making money," Paola said. "They're pursuing the almighty dollar and they're using medicine as a pretext."

How long will it take, Paola asked, before the laboratory begins using the names and addresses they gather from those being tested to market over-the-counter drugs?

"Are they going to say "If your cholesterol is 300 you ought to buy this pill off our shelf?' " Paola asked.

Bakewell, of Quest, said the company does not have immediate plans to use the information for marketing purposes.

"Would we do it eventually?" he asked. "Maybe."

He said Quest would never sell customer names, would obey patient privacy regulations and always would ask customers whether they wanted information about products before approaching them.

The nature of some tests explains why some people would want to keep results separate from their permanent medical record. For $55, Quest will conduct a drug screen, testing urine for marijuana, amphetamines, opiates and cocaine. They also offer a $50 hepatitis C blood test and a $105 test for chlamydia and gonorrhea. HIV testing is not offered.

However, those who want the hepatitis C or sexually transmitted disease screens have to provide identification. State law requires their names be reported to health authorities if they test positive.

The idea, Bakewell said, is not to replace doctors, but to give people a way to get information complementing what they get from physicians. It's all in the name of good health.

Said Bakewell: "An educated consumer is a better patient."

Paola, of USF, had a different view.

"They're not practicing medicine," he said. "It's business."

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