ShareThisAs Americans struggle to take charge of their health care -- and hold down their medical costs -- a growing number are bypassing the doctor and going right to the source for diagnostic tests.
Whether through arrangements made online or at one of scores of storefront testing centers around the country, patients are rolling up their sleeves to get screening results about everything from sexually transmitted diseases to cholesterol levels that in many cases leave physicians out of the loop.
Most of the time, patients pay for the testing out of pocket, with no insurance money involved. And they control who sees the results.
The concept appeals to patients like 40-year-old Deon Lawson of Abilene, Texas, who went to a new storefront lab "to tell me if my thyroid level is off." She said she had previously been diagnosed with a hyperactive thyroid, but sought the test when she felt her condition might be worsening. "That way, I know if I want to go to the doctor."
But having patients make the call based on consumer-ordered test results is a major concern for many doctors.
"There's always the worry that some consumer orders this blood screen on the Web and it comes back with a white count of 150,000 or some other big red flag, and he ignores it and dies. And everyone says consumers can't be trusted with this stuff,'' said Dr. Bruce Friedman, professor emeritus of pathology at the University of Michigan Medical School who follows consumer-direct-testing issues. "I think the majority of consumers, when given abnormal results, will take it to a physician and ask for interpretation."
For many clients, the labs are all about sex or drugs -- finding out, as privately as possible, answers about STDs, paternity, even sperm counts. Others want to know, in advance, whether they're likely to pass a pre-employment drug test. Often, the employer may send them back to the same lab for the official check.
Many of the facilities also report doing basic forensic work for private investigators, such as DNA tests of hair found on a pillow by a suspicious spouse.
The lab services also market bundles of tests recommended by various experts from diet-book authors to doctors who have researched complex medical conditions such as autism, chronic fatigue and arthritis.
Simple tests can cost as little as $25 to $49, while more complicated tests can run into hundreds or even thousands of dollars.
In all, medical testing is a $55 billion-a-year business in the United States. Industry experts say lab tests sold directly to consumers make up only about $100 million of that market, but believe the share will grow as people without insurance or with limited coverage seek lower-cost diagnostic options.
While there are about 200,000 medical-testing labs registered with the federal government, the vast majority of medical-diagnostic work in the U.S. is actually performed at the collection centers and facilities of two firms -- Quest Diagnostics and Lab Corp. of America.
So whether a test is ordered through a doctor's office, a retail outlet or online, chances are that the actual work will be done in the same mega-labs.
A patchwork of state rules covers how the diagnostic tests are done. Although there have been a number of calls to regulate tests offered over the Internet, particularly genetic tests, so far federal health officials haven't moved against consumer-requested lab tests, as long as the labs doing the tests are properly certified.
State restrictions can range from having no requirement for doctor referral, as in Texas, to a strict interpretation that lab tests have to be ordered by and results returned to a doctor, the situation in California and other states where most companies have been able to meet the requirements by having consumer requests passed through medical directors licensed to practice in those states.
Most online firms say they flag findings that appear to represent a serious medical threat and also caution patients to consult with a physician about their results. Most storefront centers offer to go over written results with customers.
Both the American Medical Association and the American Academy of Family Physicians (AAFP) have issued policies against clinical or genetic testing that leave physicians out of the loop.
"The trouble is, most of these services offer standard panels of tests from a menu, and that can mean you wind up paying for tests you don't need and may not get a test that might benefit you. That's what the discussion with your physician can avoid," said Dr. Lori Heim, a family-care physician in Laurinburg, N.C., and president of the AAFP.
But Joe Neely, chief executive officer of Any Lab Test Now, a growing franchise chain of storefront testing centers, says a patient is more likely to waste money on cholesterol screening by going through their doctor.
"You have to make an appointment through the doctor to go into their office or to a lab collection center to get the same test that direct-accessing testing can do by walking right into our center. You can have the actual report within 24 hours in many cases. And you're going to be charged as much as 80 percent less than you will if you go through the doctor and get whatever discount your insurance allows," he said.
"The physicians worry that we're going to misdiagnose, but for the most part, we don't see sick people," Neely added. "The people that we see are people who want to take care of themselves, are reasonably healthy and want to stay that way."
Neely said the franchises offer about 1,500 different tests, ranging from simple cholesterol checks and screening for sexually transmitted diseases to more elaborate wellness panels that can feature multiple tests. The centers also can arrange genetic tests, even "infidelity" tests on strands of hair as well as weight loss programs managed by part-time physicians working for the centers.
Any Lab Test Now started with several outlets in the Atlanta area nearly 20 years ago, but only started franchising in 2008. Neely said there are now about 95 stores, and he anticipates up to 200 more outlets opening in the next year.
David Clymer, head of MyMedLab.com, said his firm actually started as a "bricks and mortar" retail lab operation in the Midwest more than a decade ago, but soon found that serving as a test broker was more practical and economical.
"We don't have any hidden agenda, no lotions and potions we're trying sell, just testing and education for patients," Clymer said.
The lab, like several of the more than a dozen online testing services, packages screening that addresses more complex medical issues that are not easily diagnosed or treated, such as autism, with an extensive set of tests related to immune-system function, allergies and the presence of heavy metals in the body. The family ordering the tests on a child also buys a consultation on the results with a medical expert.
"We can put together a bundle of tests like these because we act as an umbrella organization to make arrangements with many different specialty labs,'' Clymer explained.
"People are realizing you have to be your own health advocate," he added. "The days of expecting doctors will tell you all you need to know are gone. Baby boomers are the ones driving the market, they want to be in charge of things and if their doctor doesn't want to deal with informed patients, they'll look for a new doctor."
(Jaime Adame of the Abilene Reporter-News contributed to this story. E-mail Scripps Howard News Service health and science correspondent Lee Bowman at bowmanl(at)shns.com.)
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