Feb 03 2010

Biophysical250 – Neurotics-R-Us

I was recently asked my opinion about the Biophysical250 – a series of 250 blood tests offered by a commercial lab for the out-of-pocket cost of $3,400. My skeptical alarms immediately began ringing – I am familiar with the commercial labs promising diagnostic tests directly to the public – generally not a good idea.

I checked out their website, which set off more alarms. The first thing you see, in the upper left corner, is this:

Would you like to get back the vibrancy and passion you enjoyed when you were younger? Are there things you would like to be doing at work or with your family and friends that you don’t have the energy to accomplish?

Umm…yes, please. Probably like every 45 year old, I would love to feel like I did when I was 25 (although honestly I am pretty healthy, except for hypertension, some occasional lower back pain, and I probably have a small rotator cuff tear in my right shoulder).  Will these blood tests fix all that, repair 20 years of wear and tear and rejuvenate my cells? Oh!…darn.

But the implication here is that the average middle-aged “worried well” person – you know, someone with disposable income who can still remember fondly what it felt like to be a 20 something – can recapture their youth and vigor if they could just figure out what mystery ailment afflicts them. There must be something wrong, otherwise they would feel perfect.

For many people there probably are some issues that can be altered to make them feel better – even much better. I see these patients in my office every day. They require some lifestyle adjustments – lose some weight, start exercising regularly, reduce your caffeine intake, and work on your sleep habits. Most people I see do not have nutritional issues – by which I mean they are not malnourished. I do screen for certain targeted vitamin insufficiencies and will treat as needed, but most people don’t require supplements. If anything, Americans suffer from diet excess – too much salt, too much animal fat – but that’s not why they don’t feel well.

(Obligatory caveat – of course many people have real disease, and the whole point of a diagnostic evaluation is to sort out those people who do and treat them appropriately.)

However, most of my patients don’t really need me to tell them they are overweight and they need to exercise, stop smoking, and sleep more. They know it – but that’s hard work. They want me to do a blood test, diagnose syndrome X, give them a pill, and make them feel like they did when they were 20. Some patients are actually disappointed when I tell them that the workup is negative and they are healthy – except for those lifestyle things they need to work on.

That is where Biophysical250 comes in. In fact, there seems to be an entire industry catering to the middle-aged worried well  – complete with custom (and socially acceptable – even fashionable) diagnoses, tests, and treatments.

I should note at this point that I am not being critical. Staying in shape and staving off the effects of aging is hard work, and our culture does not make it easy. I am also (unfortunately) increasingly sympathetic to the tribulations of normal aging. And I am happy to help guide my patients toward feeling better. I am, however, critical of those who try to exploit people who are vulnerable because they do not feel well.

And that is my main problem with Biophsyical – their marketing seems optimized to exploit anxieties and neuroses among the worried well, rather than providing a useful medical service.

The Biophysical250 also falls, in my opinion, into the category of over-screening. Screening for disease, as counter-intuitive as this may seem, is not always a good idea. If you screen low risk groups you may be more likely to have a false positive than true positive, and false positives lead to more testing, perhaps unnecessary procedures and treatments, and anxiety. You may cause more harm than good by blanket screening of low risk groups.

Therefore the standard of science-based medicine is always to do evidence-based screening. Research is done to look at overall outcomes from screening either the entire population or targeted sub-populations for specific diseases. Some screens are good – yes, get you eye pressures checked for glaucoma. Some cause more harm than good – like frequent chest X-rays. And some are controversial – like the recent debate about mammography screening. It’s all about balancing risks and benefits to optimize outcome.

I am not even talking about cost-effectiveness, which is a separate issue. Although cost-effectiveness usually (not always) tracks well with medical effectiveness – preventing costly diseases saves money too.

With all this in mind, it seems highly unlikely that all, or even most, of the 250 blood tests offered by Biophysical meet the criteria for appropriate general population screening. Doing theses tests all at once, rather than separately, is cheaper and more convenient – but who cares if you don’t need the tests in the first place.

What there is a distinct lack of is scientific data showing that people who get the Biophysical250 screen have a net positive health outcome. The company crows about their clients who found problems they did not know were there – but were those problems really problems? What happened when they were treated or further tested? How many were false positive, or would not have caused problems in the first place. And how does the 250 screen compare to the usual tests that their primary care doctor would have run anyway.

In an unfortunately credulous Scientific American article on the topic CEO Mark Chandler was asked about the expense of the test:

Chandler says that plucking out a few of the beads would not be cost-effective, although perhaps a few dozen biomarkers might be enough to catch the most common afflictions and permit a less expensive assessment.

You mean just like is currently done as part of routine screening? That admission was surprising, as it went against all the previous hype. It makes sense to check for the most common diseases, or those that a person is particularly at risk for – not for everything possible, just because the technology exists to do so.

The bottom line is that an extensive screen like the Biophysical250 is probably a waste of time and money. The tests you really need your doctor will order anyway, and your insurance company will pay for. Massive screening like this may not only be worthless, it may cause more harm than good. We need some objective scientific data (which is currently lacking) to really know.

Potential customers should also consider what else they can do with that $3,400. Buy some exercise equipment, a new mattress, or even just take a vacation. They are likely to have more of a health benefit than a battery of unnecessary tests.

13 responses so far