When I first started looking into chiropractic, I read about one of their continuing medical education (CME) offerings. CME for physicians is intended to update their knowledge so they can treat patients more effectively. This chiropractic CME course didn’t try to inform chiropractors about new knowledge from recent studies (there isn’t much new chiropractic research), or to tell them which chiropractic techniques worked better than others (they don’t know and don’t care; they just want to be able to use whichever one they choose). Instead, it was all about practical business tips for practice-building.
I was intrigued by their advice for building a pediatric practice. Chiropractors were taught how to destroy the parents’ faith in their pediatrician. Good acting skills were helpful. Chiropractors were supposed to examine the child, act concerned as if they had discovered some serious problem and ask the mother which side the child had preferred for breast feeding. Whatever she answered, they were to act as if that confirmed their findings. (Of course it hadn’t, because they hadn’t found anything.) Then they were to say “Did your pediatrician ever ask you that question?” Of course he di
dn’t, because there was no reason to do so, just as there was no reason to ask if the child preferred broccoli to zucchini. The parents were led to believe chiropractors knew things that pediatricians didn’t. This cynical exercise was intended to destroy faith in the pediatrician and persuade parents to switch from pediatric care to chiropractic care.
Some providers, especially so-called “functional medicine specialists,” order a lot of non-standard tests. I read a case report of an 80-year-old woman with breast cancer who got a whopping 154 tests including putrefactive single chain fatty acids, urine representativeness index, pancreatic elastase, lignoceric acid, and other similarly esoteric tests. Some patients might lose faith in their own doctor and be led to wonder why he had not ordered those tests. The answer, of course, is that he had no earthly reason to do so. He wouldn’t have known what the results meant or what he should do to treat abnormal results when he found them, or whether the findings even required any action. The functional medicine specialist didn’t know either, but was happy to make things up, treating the patient with a laundry list of dietary supplements, a special diet, exercise with bicycle and Qigong, a sleep program, and more.
Genetic testing
In one of my early inquiries into questionable medical practices, I collaborated with Stephen Barrett on an article on Dubious Genetic Testing for Quackwatch. We looked at several organizations that offered diet and lifestyle advice based on personal genomes. Our conclusion was that “Genetic testing to identify alleged risk factors that have no proven corrective measures is simply a waste of money.” We quoted a British genetics expert who said “tailoring your diet to your genetic make-up is about as scientific as tailoring your diet to your star sign.”
An addendum to our Quackwatch article was posted in 2008 with three updates:
- An undercover investigation by the Government Accountability Office (GAO). They purchased genetic tests from four websites and submitted 12 DNA samples from a 9-month-old female and 2 samples from a 48-year-old man, providing fake descriptions of the people allegedly submitting the samples. The companies gave different advice for identical samples, and their predictions were “medically unproven, ambiguous, and provided no meaningful information for consumers.”
- A 2006 systematic survey of websites promoting nutrigenomic services found that “Organizations did not provide adequate information about nutrigenomic services and at-home genetic testing.”
- GeneWatch UK claimed that “genetic horoscopes” are a dangerous myth, for these reasons:
- They are a bad strategy for health
- They market fear
- They undermine public health
- They create a genetic underclass
- They undermine civil liberties
- They attempt to patent life
- They waste resources and erode trust.
Sad to say, tests are still being offered that go way beyond the science. GenoPalate advertises a personalized DNA analysis that will allow you to “Eat for your genes.” The unfortunate truth is that DNA analysis simply cannot inform a personalized health plan, and any company who says it can do that is not interested in your health, but just in your money.
Theranos
Then came Theranos. Elizabeth Holmes committed fraud to become the world’s youngest self-made female billionaire. Her machine was supposed to get 200 accurate blood tests in one minute from a single finger-stick. That’s simply not possible. Her downfall was epic, inspiring books, podcasts, and movies. She was tried in federal court and found guilty of four counts of fraud and is currently out on $500,000 bail, awaiting sentencing in September, which could result in her spending 20 years in prison.
Do-it-yourself
At-home tests started to spring up everywhere. The SmartJane test allows women to assess their own vaginal health by sending in a vaginal swab. They get back a report with findings for 55 components of the vaginal microbiome. There was only one clinical study and it failed to demonstrate any clinical benefits.
EverlyWell
This company is my current pet peeve. I keep seeing ads for it on TV. A bright young woman optimistically sends off her sample (“It’s easy!”) with the confidence that it will accurately identify her food sensitivities, so she won’t have to do a food elimination test.
Her confidence is badly misplaced. The test measures IgG, which is not a valid guide to food sensitivities. It has never been scientifically proven, and the American Academy of Allergy, Asthma, and Immunology calls it a myth. The Choosing Wisely campaign recommends against IgG testing for allergies.
For a higher price, they add a saliva test for just 5 genes that they think affect metabolism and absorption of certain foods and nutrients. This test is also unreliable and not indicated.
They offer a total of 34 different do-it-yourself tests. Among them: heart health, breast milk DHA, sleep and stress test, heavy metals, STD tests for males, thyroid tests, and even a COVID-19 test. Since they are sold to everyone, they are essentially screening tests. That’s a problem, because when testing an entire population, unless the prevalence of the condition is high, the number of false positives will exceed the number of true positives, making it useless as a screening test. These tests are NOT indicated for general consumption. Some of them are useful in people who have symptoms, but patients are always better off if directed testing is ordered by their own doctors.
Whole body CT screening
In the early 20th century, it was common to see ads for whole body CT scans at dedicated free-standing CT centers. They offered to examine your entire body to find everything that might be wrong. It sounded like a great idea. It wasn’t; it was a bad idea all around. Screening with whole body CT scans had no benefits for healthy people. It exposed them to dangerously high levels of radiation. It found what we call “incidentalomas,” minor anomalies that are not a health risk for patients. Doctors were inundated by worried patients who brought in their CT reports and demanded that their doctors embark on a wild goose chase to explain or eliminate the findings with further diagnostic tests or procedures that were expensive, not indicated, invasive, and potentially even life-threatening. The FDA issued a warning, and fortunately the fad now seems to have died out.
Ultrasound screening
For many years now, companies have been offering ultrasound screening to the general public. Life Line claims to have screened over 9 million patients over 25 years to determine their risk of stroke, cardiovascular disease, and other chronic illness. If normal, the tests may provide peace of mind. If abnormal, early detection may prevent problems. They quote the American Heart Association: “80% of stroke and heart disease can be preventable.” Their $159 package uses ultrasound to screen for carotid artery plaque and abdominal aortic aneurysm, and to measure bone density in the shin bone to assess the risk of osteoporosis. In addition to ultrasound, they include blood pressure readings in the extremities to detect peripheral artery disease, and a 6-lead EKG to detect atrial fibrillation. Enthusiastic testimonials claim that these screenings have saved lives.
Lifeline sets up clinics at local service organizations and churches, implying endorsements to give them extra cachet. Currently, I am offered several options within 11 miles of my home: two Baptist churches, a Bible Chapel, a VFW post, a fire station, and the Fraternal Order of Eagles.
All this is very misleading. The only way to know if Life Line screening saves lives or prevents heart attacks or strokes would be to compare outcomes in people who have been screened to people who haven’t. Life Line has never done this, but various medical organizations and the U.S. Preventive Services Task Force (USPSTF) have reviewed all the evidence about screening and have issued these recommendations for the general public:
Carotid artery screening for people without symptoms: not recommended; the harms of screening outweigh the benefits.
Abdominal aortic aneurysm: one-time screening is recommended for men aged 65 to 75 who have ever smoked. No recommendation for or against screening for AAA in men aged 65 to 75 who have never smoked. Routine screening for AAA in women is not recommended.
Osteoporosis: screening recommended for women over 65 and women under 65 who are at increased risk, but the preferred test is dual-energy x-ray absorptiometry (DEXA) of the hip and lumbar spine. No recommendation for men.
Peripheral artery disease: no recommendation; insufficient evidence.
Atrial fibrillation: insufficient evidence to make a recommendation.
Do Life Line’s customers know this? Is Life Line giving their customers the information they need to provide informed consent? I doubt it.
Blind spot mapping
A test devised by Ted Carrick was a do-it-yourself measurement of blind spots that supposedly demonstrated that brain function was normalized by chiropractic manipulation of nonexistent subluxations. It demonstrated no such thing, and the research was seriously flawed.
Conclusion: These tests should be avoided
People are easily seduced by anything that promises to tell them more about themselves. They eagerly fill out magazine questionnaires to find out how happy their marriage is or which Harry Potter character they resemble, and they avidly consume horoscopes. They jump at the chance to self-diagnose with tests they can do at home. There are two reliable evidence-based sources they should look to for guidance: the USPSTF guidelines and the Choosing Wisely Campaign.
The old adage is true: the patient who treats himself has a fool for a doctor. Tests are best ordered for valid indications by the patient’s own doctor who understands the patient’s history, can interpret the test results, can treat diseases that are detected and can provide follow-up care. There’s a reason doctors are required to go to medical school.
This article was originally published in Skeptical Inquirer.
