Wednesday, April 30, 2003

Tips and concerns with medical self-checks

By Cheryll Powell
Knight Ridder Newspapers

Want to know whether you might have colon cancer? Buy a test strip and consult your toilet for a diagnosis.

Afraid you might have a low sperm count? Test a sample yourself in the privacy of your own home.

These days, playing doctor is as easy as a trip to your local pharmacy.

Just pay anywhere from $7 to $60 and then follow the instructions inside the box to ease or confirm your fears.

"These things do liberate the patients," said Dr. Marvin Lipman, chief medical adviser for Consumers Union, a nonprofit consumer group that publishes Consumer Reports.

The home diagnostics industry is booming, with sales reaching an estimated $2.6 billion in 2002, according to Frost & Sullivan, an international marketing consultant firm. Glucose testing and monitoring alone accounted for $2.1 billion in sales.

Home-use tests can be an easy, convenient option for consumers who want a quick answer about a potential health problem.

Most involve using a blood, urine or stool sample to look for possible signs of a condition.

Some tests require a doctor's prescription, but the majority are available over the counter.

"By and large, it's a good thing because it enables a consumer to determine if a problem may exist in the confines of his or her own private dwelling," Lipman said. "It allows them to take charge."

For Janet Griffin, home monitoring of her blood-sugar levels has enabled her to keep her diabetes under control.

The 56-year-old Akron, Ohio, woman recently completed a course through Akron General Medical Center to learn how to conduct and interpret her blood-glucose tests.

Her health insurer pays for the tests and equipment, but many other home tests aren't covered.

"I feel much better," she said. "Now that I've had the training and had a lot of questions, I feel very comfortable."

Indeed, home tests can allow people to monitor their health, particularly between doctor's visits, said Charles Inlander, president of the People's Medical Society, a nonprofit health-care consumer advocacy group in Allentown, Pa.

"It also demystifies medicine and helps people take care of their own health," he said.

But some physicians say problems can arise when people take matters into their own hands by doing such things as changing medication dosages or taking
old antibiotics.

All tests can have false-positives or false-negatives, said Dr. W. Frank Peacock, director of clinical operations for the Cleveland (Ohio) Clinic's emergency department.

To put results in context with symptoms, a professional needs to be involved, he said.

"The reason medical school and training is as long as 15 years is that there are a huge amount of issues that extend way beyond the 'yes-no' of a test," Peacock said. "The reason you see a doctor is because one size does not fit all."

Even if a home test for urinary-tract infections is negative, for example, people still should consult their physician if the symptoms don't go away.

"Most of these will need professional verification," Consumers Union's Lipman said.

If patients see their doctors, they might find they don't even need to take a test, said Dr. Edward Hill, chairman of the board of the American Medical Association and a family-practice doctor in Mississippi.

"All of us in this country tend to overuse technology because of the charm of the test," Hill said.

And there are plenty of new tests from which to choose.

People can buy over-the-counter products to look for everything from the onset of menopause to infections.

The oldest home tests most notably, home pregnancy tests have been around for decades.

In recent years, improved devices such as blood-glucose tests and blood-pressure kits have made it easier for people to monitor chronic conditions such as diabetes and high blood pressure.

Tests used with a doctor's guidance to monitor chronic health conditions tend to be the most widely accepted.

"You need to have a physician as a source of support and information," said Dr. Ross R. Black, a doctor at Millpond Family Physicians in Cuyahoga Falls, Ohio. "If you don't have a physician with whom you work regularly, where do you go with the information?"

Much of the concern centers on those tests designed to detect serious conditions, particularly HIV.

People need someone to help them put the bad news in context, said Dr. Jeffrey W. Janata, director of behavioral medicine at University Hospitals in Cleveland, Ohio, and assistant professor of psychiatry at Case Western Reserve University School of Medicine.

"Medical news that's alarming can prompt a dramatic emotional response," he said. "People can become anxious and fearful if they feel as though their worst fears are confirmed. If they don't have the benefit of a sounding board, someone to help them put it into perspective, that can be a risk to them."

There's also a risk of purchasing a bogus or faulty test, particularly over the Internet.