Mind & Body, September 2006

Do-It-Yourself Medical Testing Makes Inroads

Not so long ago, a woman had to visit her physician, leave a urine sample and wait by the phone, sometimes for days, to find out whether she was pregnant.

But over-the-counter home-pregnancy tests - which first hit the market in the late 1970s - make the process quick, convenient, and private.

In fact, those pregnancy kits, as well as glucose-monitoring tests for persons with diabetes, were in the vanguard of a health care revolution that continues to gain momentum.

New and better tests for detecting and managing a plethora of conditions have made their way to pharmacy shelves in recent years, the fruit of both scientific advancement and consumer demand.

Diabetes, Pregnancy Testing Leads

Diabetes is a good example of a disease for which self-testing has made enormous strides, says Dr. Barbara P. Yawn, at the University of Minnesota in Minneapolis.

People with diabetes used to check the sugar in their urine at home to monitor their condition. It was not a very useful test, she says, because a person's blood sugar might have to be 250 or even 300 mg/dL - well above optimal levels - for sugar to be present in the urine.

The introduction of blood-glucose meters and testing strips in the late 1960s vastly improved efforts by patients to monitor fluctuations in their blood sugar and make needed adjustments to their diet and medication.

And painful finger pricks have gotten less so in recent years with the introduction of finer lancets and meters that require less blood.

There is even a non-invasive watch-like device that automatically measures blood glucose levels up to six times an hour.

"Home monitoring [of diabetes] has been improved again and again and again," says Dr. Yawn, who credits manufacturers for heeding patients' wants and needs. "They've paid attention to what makes people use it or not use it. Pain was a big deterrent."

Colon Cancer, Cholesterol Tests Key

If you include the bathroom scale or the thermometer, home testing has been around longer than people realize.

But today, there are home-test kits that women can use to see whether they are ovulating or not. There are also kits for screening for urinary tract infections, colon cancer, and even HIV.

There are home cholesterol tests that can give you a total cholesterol count. The problem with these screens is they cannot break down that number into its more useful components - like HDL (the good cholesterol), and LDL (the bad type) - so many physicians still recommend that a health professional check your cholesterol count.

Home health tests have to be fairly simple to perform, easy to interpret, and used with some frequency to be useful to people, says Dr. Paul S. Frame, at the University of Rochester School of Medicine.

Home glucose monitoring meets that definition, in his view. So does home blood pressure monitoring.

Having a blood pressure cuff handy may be a good idea for patients who have "white coat" hypertension, meaning their readings are always high when they come to the physician’s office, but when they check their blood pressure at home, "it's generally quite good," he says.

Dr. Frame is also a "fairly big fan" of the fecal occult blood test, a screening test for colorectal cancer. Physicians often give patients a test kit to take home with them.

The test, which involves taking a series of stool samples, may also be purchased at pharmacies, says Elissa Passiment, of the American Society for Clinical Laboratory Science.

But are Americans anxious to self-screen for this disease? "I can promise you that they are not jumping off anybody's shelf," she says.

On the other hand, "Many patients would much rather do the fecal occult blood test than have a colonoscopy," says Dr. Frame. In fact, when patients repeatedly fail to perform the at-home test, he gives them a choice.

"I say, well, you know, if you don't want to do this, if this isn't working for you..., we can do a colonoscopy," he says.

For a glimpse at the future of at-home testing, look to the baby boomers, notes Passiment. That generation, whose oldest members are turning 60 this year, is anxious not to age the way their parents did and eager to avoid disease.

"I think you're going to see more over-the-counter tests for prevention," including sexually transmitted diseases, she predicts, "rather than just management of the already diagnosed."

Always consult your physician for more information.

Online Resources

(These links are provided for the education and convenience of our Neighbors. AAMC is not responsible for the content of Internet sites.)

American Academy of Family Physicians

American Society for Clinical Laboratory Science

Centers for Disease Control and Prevention (CDC)

Lab Tests Online

National Institutes of Health (NIH)

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Taking Charge of Your Health

You can reap the benefits of home testing, convenience, privacy, and control, as long as you educate yourself about the potential tradeoffs, according to consumer information provided by Lab Tests Online.

Anyone who has been in a drugstore lately has seen an increase in the number of medical tests for use at home.

Advances in testing technology, and changing attitudes towards patients’ responsibility for their own health care, have made home testing a worldwide, billion-dollar-and-growing market, states Lab Tests Online.

In fact, according to Lab Tests Online, the word “patient” itself is gradually disappearing as people who used to think of themselves as patients, are now hearing themselves called “consumers” who are taking charge of their own health care.

Dr. Jim Nichols of the Clinical Chemistry Laboratory and Point-of-Care Testing at Baystate Medical Center in Springfield, Mass., says that recent market surveys indicate at least 25 percent of all medical tests are conducted outside the hospital lab.

Dr. Nichols is concerned that some tests bought at the supermarket can be of similar quality, but not necessarily similar to the quality of testing performed in the lab.

In the lab or at the bedside, for example, nurses, EMTs, and laboratorians must be trained and certified in the testing procedure, the instrumentation used to perform the test, and quality control practices.

Some tests are work well for home such as glucose testing. This allows a person to monitor blood sugar level and adjust diet or medication accordingly, without having to make frequent lab visits or risking precarious highs and lows in energy levels, states Dr. Nichols.

Dr. Nichols offers caution that it is important to recognize the potential tradeoffs between quality and convenience and take steps to protect oneself against bogus tests, the possibility of false results, and one's own lack of training.

Lab Tests Online has been designed to help individuals, as a patient or caregiver, to better understand the many clinical lab tests that are part of routine care as well as diagnosis and treatment of a broad range of conditions and diseases.

Always consult your physician for more information.