In April, I awoke to the latest of many controversies in billionaire Mark Cuban’s life. Mr. Cuban, it seems, “ignited a digital firestorm on Twitter” with his seemingly out of the blue query about whether or not it would be a good idea for people to test their own blood once a quarter “for everything available.”   The hoopla surround this query was thoroughly documented in an article in Forbes magazine, HERE, which chronicled both the “pros” and “cons” of this position. One wonders if Mark Cuban (also known as one of the famous investors on Shark Tank), is weighing an investment possibility in Elizabeth Holmes’ company Theranos, which at the time of a Fortune magazine article about her June of 2014, offered more than 200 commonly ordered blood tests – all done without the need for the typical and slightly painful blood draw.   They were “ramping up to offer more than 1,000” tests. (Source: Fortune, June 2014).   The blood draw is a finger stick and requires 1/100^th to 1/1000^th the amount of blood that would ordinarily be required. As of the date of the most recent Forbes magazine article in early April, there are already a couple of dozen Walgreens pharmacies in Phoenix where you can have your Theranos blood specimen drawn.   Not surprisingly after Mr. Cuban’s Tweet, the MD allopathic medical establishment began weighing in with negative opinions about this idea, including the old saw, “We don’t know what to do with the [sure to be newly and copiously generated] results at this point.”   Here’s are two representative excerpts from the article:

• “As healthcare starts to offload more of the cost and responsibility to consumers ? it had better get used to the idea that consumers have some new ideas about their own participation and biometric data collection.”
• “Beyond the debate itself is the simple reality that Direct Access Testing (DAT) is poised to become mainstream a lot faster than many realize. DAT has been around for about 15 years now, but the technology advances are poised to fundamentally change the dynamics of both access and cost.”
• “Simply saying we shouldn’t do something because we don’t know the value ? and there is risk ? seems to be an especially weak argument at the same time as trying to engage people more directly in their health and well being.”

I actually recall a breakfast discussion in which I was engaged some thirty years ago in medical school in Galveston, Texas. I had met a group of really bright people for breakfast, and the topic came around to “order it yourself lab tests.” One member of the group asserted that it was a foregone conclusion that this would happen in the future. I asserted, on the other hand, that it was inconceivable that tests would EVER be ordered without a physician’s order and follow-up interpretation.   The basis of this was that “patients would not be educated enough to read their own tests.”   What I hadn’t counted on were the following developments:

• “The internet” – which I witnessed, up close and personal in a live display at the Evansville Rotary Club in the fall of 1993. Paul Becker, CEO of the ISP start-up Evansville Online demonstrated the Mozilla Netscape browser on a computer/video projector hook up, including virtual visits to the Library of Congress and several other locations.   I went back to my office after that meeting and immediately ordered this thing called “a dial-up internet connection” that, miracle of miracles, could go through my existing phone lines!
• Then an upstart named Google began making search on the internet ridiculously easy, becoming a verb in the process.   Any Hoosier can now go on Google, type in a blood test with “high” or “low” and begin reading the differential diagnoses
• I also had not planned on the near-destruction of medical care in this country, and the unquestioned destruction of the primary dyadic relationship between a patient and his or her PHYSICIAN.   One of my patients described her Ironman training husband’s visit to his doctor. He had on an athletic watch with lap timers, and timed his doc from his entrance to exit from the room. The total physician encounter lasted 53 seconds.
• Indeed, the annual physical exam is now considered so worthless by some medical authorities that NPR Radio ran a feature about the inadvisability of this previously unquestioned annual event.
• The destruction of the physician/patient relationship, encompassing the use of “physician extenders,” minimum appointment times, “one complaint per visit” policies, and the never ending pressure on docs and other “providers” to crunch patients through like widgets on an assembly line so that they can “make overhead” has resulted, in my opinion, in the near-total destruction of thoughtful consideration of the patient, the patient’s HEALTH, and the patient’s WELLNESS.   The notion of optimal function, of peak performance, is never considered. As long as a patient’s labs are “within normal limits,” then everything is supposedly “fine.”

This was all brought into sharp clarity for me when a patient arrived in my practice for intake recently. “I know I have problems with my thyroid and adrenals, and I can’t find any doctor to treat me,” she announced in a preemptive, definite (and correct!) manner. She also brought in a salivary hormone panel that she had ordered herself from an online company showing four distinct cortisol values taken from her saliva. The results showed a flattened cortisol curve and totally inadequate levels at two time points, plus a low DHEA-Sulfate (all of which indicate adrenal fatigue).   All of her previous physicians had focused monomaniacally on “TSH” as the presumptive end-all and be-all lab to ascertain her thyroid status – a position doomed to logical invalidation in the context of the overwhelming evidence of the peer-reviewed medical literature to the contrary.  The fact that this patient “did her own testing” and brought it in, plus reading Cuban’s provocative tweet, got me to thinking even more about the serious deficiencies in our medical care system – a system that would more properly be classified as “sick care” or “disease care.”

The patient, by the way, did have sub-optimal thyroid status, exhausted adrenals, and, if memory serves as I am writing this, some subtle sex hormone abnormalities. All have been fixed and she is definitively, vibrantly better. I consider her a beacon of self-empowerment and the vanguard of what we as physicians will be seeing in the future.   I think the tbought-provoking questions for physicians, physician extenders, and patients these days are the following:

For docs and other “HCP’s”:

• Do you want to be a healer or a technician?
• Do you honestly want to do HEALTH care or do you want to do SICKNESS care?
• Do you want to be a slave to “co-pays” and declining reimbursements resulting in having to crunch patients through your practice like widgets on an assembly line?
• Are you willing to open your mind to the peer-reviewed medical/scientific literature?
• Do you really think that the current economic and reimbursement model of sick care in this country is sustainable? What’s going to happen when the music stops?
• Do you want to fix the problem or drug the symptoms?
• Are you open to considering supplementation and hormonal replacement therapy to support the structure and function of the human body?

And, similarly, for patients, I suggest the following questions:

• What expectations do you have of your health care professionals?
• Do you want a quick fix – (“Here, take this pain pill and muscle relaxant”) – or do you want an approach which fundamentally addresses the problem?
• Can you afford to live with your previously accustomed status quo? That is, when “insurance was going to pay for everything” and your deductibles were reasonable? Or, in today’s era of steadily, inexorably increasing health care costs where your deductibles are outrageously high, your co-pays have increased, and your medications are so expensive that you feel like you need to see a psychiatrist (hey, I’m available…) don’t you really think it’s time for a new paradigm of WELLNESS rather than the increasingly and prohibitively expensive proposition of being sick, unhealthy, and unwell?
• Do you really think that the current economic and reimbursement model of sick care in this country is sustainable? What’s going to happen when the music stops?
• Do you want to fix the problem or drug the symptoms?
• Are you open to considering supplementation and hormonal replacement therapy to support the structure and function of the human body?

In my opinion, these are the questions that will fundamentally define health care in the rest of the 21^st Century. We are in for a wild and exciting ride!

Louis B. Cady, MD       Cady Wellness Institute May 12, 2015