DIY test may need a health warning

The boom in medical tests for the healthy may lead to GPs having to reassure the worried well, reports Tom Ireland.

Test on the internet could worsen teh anxiety of the worried well
Test on the internet could worsen teh anxiety of the worried well

A proliferation of privately available health tests threatens to boost anxieties among the worried well, who can now sidestep the previously obligatory visit to the GP prior to investigations.

Concerned patients can buy finger-prick DIY blood tests on the internet, book MRI and CT whole-body scans, measure their own cholesterol and go for genetic screening to pick up any lurking predispositions.

Even prime minister Gordon Brown seems keen on the idea of pre-emptive screening, making vague yet resolute announcements in January that soon anyone could walk into a GP clinic and ask to be screened for conditions ranging from cardiovascular disease (CVD) to respiratory problems.

However, the UK National Screening Committee (NSC) has not endorsed these plans, although it has published tentative guidance on CVD screening in general practice.

The GPC is concerned, saying any national screening programme requires massive investment. Add the possibility of genetic tests that identify people predisposed to certain diseases, and primary care could be overwhelmed with the worried well.

Commercially available self-testing kits are becoming commonplace. These tests are a growing industry in the UK, worth around £99 million a year.

Sense About Science, an independent body of scientists and doctors, recently published 'Making Sense of Testing', a report that argues there is little evidence that such genetic tests can be used diagnostically.

There is the possibility of false positives, false negatives, anxiety and a GP consultation for no apparent reason, according to the report.

Costly whole-body CT scans are also feared to cause fatal cancers in one in 2,000 patients.

Alongside the Science Council, Sense About Science has called for a national system to evaluate all laboratory health tests and make the results accessible for GPs and patients.

Dr Andrew Green, a GP in Hedon, East Yorkshire, and a contributor to the report, said: 'At the moment there is no responsibility for test providers to prove that their test makes a difference to the patient's health.'

'They only have to prove that the test measures what is says it measures.'

Regulation call
Currently, companies have to show the MHRA that tests work as the manufacturer claims, not whether the test is worthwhile.

Dr Green recommends GPs take the results of any tests in context. 'A core skill of a GP is to interpret test results,' he said.

So far, the growing availability of tests on the high street and from private providers does not seem to have resulted in a deluge of anxious, healthy patients to GP practices, he admitted.

A BMA spokeswoman said: 'Our worry is patients finding out test results with no medical information, and either taking them too seriously or not seriously enough.'

But despite these concerns the BMA has not yet conducted any research on the effect on the NHS or GP workload.

The spokeswoman said it was not up to the BMA to advise patients or GPs which tests to avoid.

Choosing the right tests
Private healthcare provider BUPA, which offers health assessments to its customers, agreed that some tests can 'do more harm than good'.

However, speaking about the Sense About Science report, BUPA medical director Dr Andrew Vallence-Owen, said such tests do tie in with the 2002 DoH report by Dr Derek Wanless, which called for people to engage with their own health.

'BUPA health assessments are based on good medical science and research,' he said. 'They provide people with plenty of time with a doctor to talk through test results and health concerns and discuss how to make positive lifestyle changes.'

BUPA also backed the call for a tighter national system of regulation for DIY health tests, particularly those that promise genetic screening.

Sense About Science representatives met MPs this week to argue the case of a regulatory body and public database for all health tests, in an attempt to prevent patients trusting commercial health tests over the know-how of GPs.

tom.ireland@haymarket.com

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