How DIY medical testing is changing health care
What if receiving a medical diagnosis was as simple as shopping online? According to the growing home diagnostics industry, it can be.
At-home testing was widespread during the COVID-19 pandemic, but more health tech companies offer DIY kits that test for food allergies, fertility and thyroid function, among other things. According to some estimates, the home diagnostics market generates $5 billion a year and is expected to double in the next eight years.
Some medical experts are wary of the on-demand model, but health tech investors say it can make care more accessible. Marketplace’s Lily Jamali spoke to Chrissy Farr, author of the Second Opinion newsletter, and Anarghya Vardhana, a partner at the Maveron venture-capital firm, about the prospects of the industry and how it affects relationships between patients and doctors.
The following is an edited transcript of their conversation.
Anarghya Vardhana: We live in a world today where the health care industry is going in two directions. On one side, you have Big Health getting bigger and bigger, more and more opaque, less accessible, less transparent. And on the other hand, you have the internet, which is a complete Wild, Wild West where people have the ability to self-diagnose with the likes of Google and WebMD, and that’s changed nowadays to self-diagnosing using ChatGPT and a plethora of other online tools. And the challenge is that people want information, they deserve information. Consumers should be able to get access to health-based information and health-based care as easily as they can get an Uber or as easily as they can get their Instacart groceries delivered. Unfortunately, we aren’t there yet.
And my hypothesis on the increase in at-home testing and diagnostics and the growth in that space is exactly that. If you want to book an appointment with your doctor to get a blood test and to get this or that tested, to know your iron levels, to know if you’re allergic to gluten, whatever it might be, that could be an appointment that is six or eight weeks away versus now with an in-home testing kit. Within a week, if not less, you have the information that you need, and then you can make decisions for your lifestyle based on that information. And because of that need, because of that desire, we’re seeing an uptick in the market. And I think it’s a great thing for consumers to be able to have that opportunity.
Lily Jamali: Chrissy, how do you advise people that are interested in participating in this and maybe doing some at-home tests? How do you separate the wheat from the chaff here?
Chrissy Farr: I just find this to be such a tricky thing for consumers. There really isn’t a place where you can go and look up a specific test and just see, what is the quality of this test? What evidence is behind it? And in my former life, I was actually a health care journalist. And I looked at a lot of these companies, and many of them just seemed so scientific on the face of it, but if you go to the website, you see all these links to journal articles. And then if you actually clicked on these links, it was just kind of random articles that didn’t directly pertain to the specific tests that they were conducting. Or you might see a test done where really what physicians would advise is that the patient comes into the clinic and get ultrasounds and get other kinds of tests that you can only really get done in person.
And then there is stuff that just to me seems like a total no-brainer. Like if you have a [urinary tract infection], you should just be able to pee on a stick at home. And same thing with a pregnancy test, same thing with a COVID test. There’s so many of these types of examples that we already see that it’s just simple. It’s a yes or a no. And any patient, I think, could fathom that.
Jamali: But to your earlier point, buyer beware. And yet there are plenty of instances where there’s a real use case and a real need for this. So, Anarghya, can you talk about how this kind of testing is making health care more accessible?
Vardhana: So, at-home testing can make health care more accessible in numerous ways. I think everything from you can now go to your local Walmart, Target, and purchase a number of the tests, that Chrissy mentioned herself, COVID, pregnancy, UTI types of things. You can also go online and there’s plenty of e-commerce platforms which are doing this. I think we saw an acceleration in the comfort of in-home testing during the COVID years. I remember my daughter, who was 2 at the time, had to do a weekly COVID test before she could go to her preschool. And we just got used to it. And as a 2-year-old, she got used to it, which I find kind of mind-blowing, but this is the world that she’s growing up in. So why would we not be able to do that? And so, I think it’s really over the next 10, 20 years of her life, she will expect this level of testing for other things that she wants to know about her own health. And so, I think that the accessibility is really key because patients want answers and they have the ease of use in in-home testing in order to be able to get these tests.
The stories that I keep hearing about patients getting pushback from their primary care physicians, from their OB-GYNs, from numerous doctors around, “Hey, you don’t need that test” because the health care system might be set up in a way where there are numerous hurdles that patients have to jump through or go through before they can actually be prescribed the test.
It’s frustrating. I think patients deserve answers, but that gets to another important point, which is it’s great to have all these tests, but we also need to have the right clinical rigor and guardrails around it because at the end of the day, the right interpretation, the right changes, the right medications, the right tests, are really important versus taking a test and not really being able to know how to interpret it and to not have the proper medical guidance around it.
Jamali: Chrissy, I want to know what you’re hearing from health care professionals, people who work in the field, doctors, nurses, etc., when it comes to this issue of at-home diagnostic testing.
Farr: Some physicians are genuinely worried about it. I’ve heard a couple of them say it feels akin to, you know, being a service professional at a restaurant where a patient will just show up and demand a bunch of tests as if they’re picking food off of a menu. And there isn’t really a collaborative discussion about what the true value is of these tests and what a patient might learn from the tests that would be actionable or relevant. So, I think some physicians feel worried about that. And they also don’t trust some of the companies out there that just seem like they are trying to make a quick buck.
On the other hand, I think there is an increasing trend around supporting patients as they just seek to find out more about their health care. And as Anarghya mentioned, consumers are just taking matters into their own hands. They did a lot of that during COVID, and nothing bad happened. As it turned out, we were equipped to be able to, even 2-year-olds like Anarghya’s daughter, we are equipped to be able to do these tests at home and see the results from those tests and follow the guidelines of what we should be doing as a next step. So, I think these are very competing impulses and feelings that oftentimes we see, you know, not just kind of amongst the industry as a whole, but an individual physician might be feeling kind of conflicted — one day one thing, one day the next.
Jamali: So, one of the issues you run into here is insurance, which doesn’t always cover at-home diagnostic tests. How does that factor into making these tests accessible, Anarghya?
Vardhana: I think this is an interesting question broadly because there are so many things that consumers are trying to get that insurance is not on board with and is not going to cover for, you know, a good portion of time. And of course, people will say use your HSA, use your FSA, use all these different avenues to pay for it. But the reality is that a lot of these e-commerce companies that are selling testing, they’re working on getting the testing down to a level of affordability where the idea of purchasing the test is, you know, maybe not that different from making any other kind of purchase that you would make — a pair of shoes, a nice pair of jeans, a jacket, whatever it might be. And what we’ve seen from a consumer trend is that people see health care as this final frontier of luxury. I mean, the pandemic further showed that distinction and started to really get into the consumer psyche of saying health care is the ultimate thing that you should think about, spend your money on, spend your time on. And so, I think that consumer barrier, that mindset of, “Am I really going to pay $235 for this food intolerance test?” has shifted to, “I should know because I feel like crap and I’m not sleeping well and my digestion is off, so I should just know this answer.”
And then the last thing I’ll say is that, especially in young customers, this is Gen Z customers, we’re seeing kind of across the board that they have a huge willingness to pay out of pocket for health care things because they find traditional health, traditional insurance, very confusing, very intimidating. If there’s a cost that kind of makes sense, whether it’s a subscription model, they’ll just pay for it out of pocket and they’re fine and happy to do so.
Jamali: And finally, very eager to hear your analysis on whether at-home testing promotes healthy living, or does it, maybe these things happen together, does it also promote a harmful distrust of health care professionals?
Farr: I think it does a bit of both. I definitely think that it gives consumers a sense that increasingly they can take their health into their own hands and don’t necessarily need a relationship with the physician. And we see that bear out in a lot of the studies that many people on the millennial and Gen Z age bracket do not even have a primary care doctor. And that is increasingly a problem and getting worse. So there certainly is that element. On the other hand, I think it pushes medicine to be better. Medicine historically has been paternalistic. It has been biased against certain populations. And I think a lot of patients have rightfully felt that when they’re suffering with an unknown diagnosis or they’re suffering from a condition that isn’t well understood, that the medical system doesn’t take them seriously. And I think that is particularly true of women and people of color. And again, the research proves that that’s true. So, I think it does a bit of both. It moves us both forward in some really positive ways and backwards in some others. I think it’s really incumbent on medical professionals to engage in the discourse and try to inform patients about the tests that they should be taking and are safe to take, as well as warn them against the ones that are not. And if that means getting on TikTok, then I’m all for it. Get on TikTok. We need to meet the patients where they are.
You heard us talk about how some diagnostics companies operate in a gray area. Well, The Washington Post writes that the Food and Drug Administration has started to wade into these murky waters. In April, regulators finalized a rule aimed at holding lab-made tests accountable to the same standards as conventional tests. It’s a big change in what the Post says has historically been a “hands-off position” on the industry.
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