"I told you I was sick"

The increasing popularity of home tests raises a
lot of questions. And they go way beyond
taking your own blood pressure

By Angela Stanley

There's nothing new about home tests; for years the public has been able to purchase pregnancy tests, blood pressure cuffs and glucose monitors at their local pharmacies. Recently, however, a new and surprising line of home tests have sparked controversy among medical professionals.

EarlyDetect TM (marketed as DetecTot TM in Quebec) tests, are produced in the US and distributed by Pharmaprix in Quebec and Shoppers Drug Mart and London Drugs in the rest of Canada. For a mere $20, your patients can pick up their own self tests for cholesterol, H. pylori, ovulation, menopause and perhaps most striking of all, for PSA and colorectal disease.

Many of these are a first in the market -- and the first of many more we can expect to see.

According to a Frost & Sullivan market study, the North American test-at-home market grew from $750 million in 1992 to close to a staggering $3 billion, 10 years later. The company's marketing tactic focuses on a perceived increase in consumers' desire to take control of their own health. Not surprisingly, given market growth, the company has many new tests in the pipeline. Coming soon, home tests for small pox, anthrax and vitamin deficiency.

While no one would argue that preventive measures (lifestyle, nutrition, exercise) are the best way to stay healthy, the fact remains that self-test popularity, in Canada at least, is bound to be fuelled by frustrations among patients who often face long waits for both tests and test results.

The dangers of self-testing, especially in sensitive areas like cancer, are obvious: what happens after you've tested positive? A Toronto oncologist expressed outrage at the idea of PSA self-screening. "It's hard enough dealing with patients who actually have cancer. PSA testing is tricky; false positives and negatives aren't uncommon. I'm already seeing panicked men running in and demanding another test immediately -- which isn't always possible or even desireable." He described a visit by a 23-year-old man who was convinced his PSA was elevated. In the end, not surprisingly, the fellow was fine. He did acknowledge, however, that in cases where men have already been diagnosed and treated, the self-test, which claims 98% accuracy, could represent an alternative means of monitoring PSA levels while reducing congestion both at the doctor's office and lab. "I still don't know how accurate these tests are, though, and until I'm convinced, I won't recommend them," he cautioned.

Toronto psychiatrist Dr Stephen J. Sibalis has a parallel worry. "My concern is that most people would not appreciate how to interpret the results of a given test in the context of their overall health." He fears, too, the tests "help people avoid getting proper health care."

It's interesting that pregnancy self-tests are now very much the norm; in fact, some obstetricians won't see patients unless they've already tested positive. "Pregnancy's one thing," insists the Toronto onc, "cancer quite another."

The other problem, according to a Montreal GP who agreed to look at samples, is that the tests can be somewhat complicated, particularly for older patients. On the other hand, he also believes most older patients wouldn't choose to use them since "they'd rather see their doctors anyway."

TOO ALARMIST?
Of more concern to this GP is the reusable breast examination pad, also available through Early Detect TM. An ingenious device, it actually increases tactile sensitivity, which should theoretically increase the efficacy of a breast exam, especially in women with larger breasts. "The problem is it's too sensitive," he said after being told of a test on the device with a grain of salt which in fact felt enormous through the pad. "They'll come running in every time they use it thinking they've got breast cancer."

The primary concern among the physicians interviewed appeared to be the belief that these self-tests, far from reducing office or ER congestion, would actually increase it as alarmed patients rush to see their GPs and specialists. They could also lead to a flurry of unnecessary re-testing.

As far as patients are concerned, it's actually unlikely that those who could most benefit from testing (i.e. individuals who don't like to see a doctor, who are at higher risk due to lifestyle or family history, etc.) would be motivated to buy self-tests. "I don't want to know," said a colleague, laughing. "Why would you even bother?" Still, he added wryly, there's no doubt the hypochondriac market is a lucrative one.

Do you have an opinion? If so, let us know by dropping a line to [email protected]