Medical Tests, Sans Prescriptions

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Patients who don't want to go to the doctor — or are unable to go — have an alternate resource for medical tests. Commercial testing companies provide exams for cholesterol, HIV or DNA without a prescription.

STEVE INSKEEP, host:

This is MORNING EDITION from NPR News. I'm Steve Inskeep.

LINDA WERTHEIMER, host:

And I'm Linda Wertheimer.

Now our consumer health segment.

Americans spend more than a trillion dollars a year on health care. That's more than any other country. Health experts say that should be enough to have an easy-to-use system that provides peace of mind, but two new trends show the exact opposite is happening. This morning, we'll examine people going outside traditional health facilities to get sophisticated medical tests on the cheap, and we'll look at care managers, people you can hire to navigate the often byzantine world called health care. NPR's Allison Aubrey has the first report on a company called HealthFair USA and its high-tech mobile testing labs.

ALLISON AUBREY reporting:

Kenneth Fee(ph) is 75 and, as far as he knows, he's pretty healthy, but what he's looking for is assurance. So when he spotted an ad in his local paper for HealthFair USA's mobile screening lab, the made an appointment.

Mr. KENNETH FEE (Patient): I'm getting checked for the whole ball of wax, whatever that is.

AUBREY: Nurse Levina Confield(ph) signs him in and explains the tests.

Ms. LEVINA CONFIELD (Nurse): You're getting an EKG test, a circulation test, the abdominal aorta, check you for aneurysms, the echocardiogram to check you for problems with the heart, the bone density test and the ASI to check for hardening of the arteries.

Mr. FEE: I'll take that. I like that. And the price is cheap, you know. If got all this in the hospital, a couple of thousand, at least.

AUBREY: But today's bill is only $179 for all seven tests.

Ms. ANGIE NICHOLS(ph) (Technician): I just need you to remove your shirt for me and your shoes and socks, please.

AUBREY: Fee's first test is a sonogram of his carotid artery. Technician Angie Nichols presses a microphonelike probe gently against his neck. She's looking for blockages that could put Fee at risk of a stroke.

Ms. NICHOLS: Let me have you turn your head towards me, like that. We'll start with your right side here.

AUBREY: The probe sends an image that pops up on a computer screen, so as Fee lies on his back he can see and hear the sound of blood running through his artery.

Ms. NICHOLS: So far, so good.

Mr. Fee: I'm going to live, huh?

AUBREY: The images taken here will be handed over to a company doctor for analysis and results will be mailed in a few weeks. The way Fee sees this testing, he's spending a little money to buy a whole lot of peace of mind. But many physicians warn this may not be the result.

Dr. JOE SCHERGER (UC San Diego): We have things inside our bodies we're better off not knowing about.

AUBREY: Joe Scherger is a doctor who specializes in preventive medicine at UC San Diego.

Dr. SCHERGER: I think people believe that these tests are black and white, but every one of these tests have a large gray area. They will have findings that may mean something or may not and will require follow-up testing, which is usually invasive testing.

AUBREY: Take, for instance, the case of a woman that Angie Nichols screened last year. During a neck scan, Nichols spotted something suspicious on the woman's thyroid and she was sent for a biopsy.

Ms. NICHOLS: And she came back and told me that, you know, `You found this. My physician didn't have any idea.' And she came to tell me that it was benign. She says she never would have known if it weren't for our testing.

AUBREY: Even though it was benign, Nichols sees this case as evidence of the benefits of preventive screening, helping people discover irregularities that might hurt them. But experts who have studied the risks and benefits of screening say the woman with the thyroid scare may have been better off without the scan.

Dr. MARY FRANK (President, American Academy of Family Physicians): There are far more people who have benign things found, but when you find those benign processes, you are compelled to follow up to prove that they're benign.

AUBREY: Mary Frank is president of the American Academy of Family Physicians. She says the woman with the thyroid issue may have invited more risk into her life by undergoing the biopsy.

Dr. FRANK: Bleeding, infection. What if a nerve had been hit? For what? Ninety-nine point 999 percent were benign cysts in a patient with no symptoms of thyroid disease.

AUBREY: There are instances when scans performed in the absence of symptoms do turn up life-threatening conditions that can be treated. This is perhaps why doctors are divided on the issue. Bruce Friedman is a pathologist at the University of Michigan.

Dr. BRUCE FRIEDMAN (University of Michigan): My own view is that this is a positive development and that any time that you can draw consumers into taking greater responsibility for their care, and particularly paying for some of these services out of pocket, I see that as an advantage.

AUBREY: Doctors may not be able to convince their patients to resist the opportunity to peer inside their bodies, particularly now that it's so affordable and convenient. But Joe Scherger says what patients should know is that they may be left feeling as if they've opened Pandora's box.

Allison Aubrey, NPR News, Washington.

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