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Health

At-Home Medical Tests Have Pitfalls

MedicineConsumersDiabetesColleges and UniversitiesDuke University

Arkansas homemaker Amy Grimes stops short of saying her at-home glucose tests are a lifesaver, but at the same time she can't live without them. In fact, the tests free her to live largely as she wants, rather than being a prisoner of diabetes.

"It's peace of mind," she said. "I know if I'm within (proper) range, I feel great and go ahead and do what I want. It just assures you you're OK. When it's too high, glucose damages blood vessels, and I don't think the general public has a clue to the damage that can occur."

Her husband, Dr. David Grimes, a board-certified preventive-medicine specialist and University of Kentucky professor, attests to the usefulness of the four daily finger pricks to check blood glucose levels. Formerly a practicing obstetrics- gynecology specialist, he also is confident that pregnancy tests are accurate and useful. "Unfortunately, the utility of home tests to the consumer drops off dramatically after pregnancy and diabetic testing," he added.

Nevertheless, home medical test sales increased from $736 million in 1989 to $4.5 billion in 2008, according to New York market research firm Frost and Sullivan. Pregnancy and diabetes tests make up about 80 percent of the home medical test market, Grimes said.

The remaining 20 percent represents an explosion in the availability of newer tests. There are more than 100 distinct home health tests available on the Internet. Top sellers include tests for illicit drugs, cholesterol levels and fecal occult blood, which checks for some intestinal conditions and colorectal cancer.

Others relatively new to the market include tests for paternity, thyroid activity, cortisol (depression assessment), prostate screening, sexually transmitted infections, hemoglobin (for anemia), nicotine metabolites, ovulation, sperm counts (infertility), blood thinning and clotting, menopause, urinary tract infection, antioxidant levels, hormones, melatonin levels (to assess sleep), blood typing, hepatitis, even HIV. Most employ blood or urine. Increasingly, they use saliva.

Walgreens, one of the nation's largest drugstore chains, stocks blood glucose tests, blood pressure meters, drug tests, breath-alcohol testers and mail-in paternity tests, said spokesman Robert Elfinger.

"As health care costs continue to rise, the population ages and patients continue to seek out more information about their health, this area has a very strong future," he said. "New and unique tests beyond what is currently available will continue to be released into the marketplace."

Consumers, however, should do their homework. The U.S. Food and Drug Administration recommends knowing exactly what the test is for, how to store it properly before use, how to store and collect the sample, when and how to conduct the test, how to interpret the results and involving the manufacturer when there are concerns and questions.

It all sounds like common sense, but even physicians using similar tests in hospitals sometimes fail to follow proper testing procedures, said Dr. Bruce Lobaugh, director of the Duke University clinical pathology laboratories. "Physicians keep vials of test strips and remove the desiccant from vials, which then take on moisture," he said. "There are many things they just don't think about."

The upside to this home-test trend, experts agree, is that it encourages consumers to take ownership of their health maintenance and establishes a foundation for a healthy relationship with their physicians. The downside is that consumers may act alone on home-test results without involving their physicians, which could have devastating results.

"A good example is a cholesterol test," Grimes said. "If a smoker did a home cholesterol test that was 150 (normal), he or she might believe they are not at risk for a heart attack. They could be dead wrong. Eighty percent of people having a heart attack have normal cholesterol levels. A physician would always recommend you stop smoking."

Added Lobaugh: "These tests can be great ‘rule outs,' but when you have a ‘rule in' you need a good way to follow up. It's important to recognize the limitations you're accepting for that immediacy."

Amy Grimes would never give up her home glucose tests, but she is married to a preventive-medicine specialist. And she has heard her husband's mantra too many times to count: "Not smoking, exercise, increased fruit in the diet and keeping vaccines current is 100 times more important than home testing."

Before you test at home

Consider these advantages and disadvantages to at-home medical tests:

Advantages


  • Confidentiality/privacy

  • Convenience - no physician appointment, available 24/7

  • Low cost - no office or hospital charges

  • Accuracy - always use an FDA-approved test; go to fda.gov to check on individual tests.

  • Speed - most give immediate results unless mail-in is required

  • Motivation - being involved with your health care team in preventing disease and/or improving your health

Disadvantages


  • Incorrect readings can lead to false-positives and false-negatives, even with an FDA-approved test

  • "Bad" tests - not FDA-approved and/or poor quality control by test manufacturer

  • Lack of clinical, professional involvement. Testing is a complex process, and results often need to be interpreted or ordered depending on your clinical big picture.

  • May not be covered by your health insurance
Copyright © 2014, The Baltimore Sun
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