Incessant Testing: Experts are right, but Mark Cuban will prevail.

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The following is another perspective on the Mark Cuban Twitter barrage of personal health advice this week.  This post is submitted by one of our longtime contributors, Andrew Holtz.


Mark Cuban is old-fashioned and thinks small.

A couple of days ago, Cuban told his Twitter throngs to get quarterly blood tests, even when perfectly healthy, just because. A Twitter tussle ensured. My esteemed friend (and Pulitzer-winning journalist) Charlie Ornstein pointed out there’s no known benefit and plenty of problems with Cuban’s advice. Medical experts and others piled on.

Health cognoscenti basked in the superiority of their evidence and the righteousness of their collective response to Cuban’s “lunkheaded tweets”. Indeed, the expert response was correct: testing without a good reason rarely helps; it typically leads to anxiety at least, and too often shoves people onto a high-speed health care conveyor belt of follow-up testing and treatments, bumping and banging them with risks and harms that accumulate all down the line. Step 1: Shadow on a scan. Step 2: Biopsy. Step 3: Hospital-acquired antibiotic-resistant infection. Steps 4 and on are no fun at all.

Despite expert consensus, Cuban will prevail, though not quite as he imagines. As I said at the top, he’s old-fashioned and thinks small. Trudging across town to a lab every three months to get bled? That’s so 20th century. It’s labor intensive, time consuming, expensive and provides blips of data separated by months of darkness. Cuban said such testing would provide a baseline that would add context to test results obtained when someone is sick. But the signals would be sparse and hard to interpret. Diet, sleep, time of day or the seasons, recent activities or travel and many other factors could bounce the results around. Imagine being sent for a prostate biopsy just because you went on a long bike ride before a PSA test. (Many years ago, it almost happened to me.)

Speaking of cycling, I rarely hit the road without launching a phone app that tracks every mile, pace, climb… and could track workout intensity, power output, heart rate, cadence and more if I chose. It won’t be long before the incessant data logging that is already widespread in sports sprints past the daily-steps tracking by a Fitbit to global monitoring of every breath and heartbeat, every drop of sweat, even analyzing our blood without those pesky phlebotomists. Look, the Apple Watch already has a blood sugar monitor add-on and it’s not alone.

Our advertising streams will soon blossom with “just so you know” pitches for biometric devices and apps. Barriers of cost and effort will crumble. Data will flow. It will flow into a void of understanding, but the sad reality that we don’t know what to do with all this personal data won’t stop it from engulfing us.

That’s the future. A future it seems Cuban dimly glimpsed, while experts fight the last war, unprepared for the impending personal health data torrent. In the 1990s, docs started grumbling about uppity patients waving pages they had printed off the Internet. “Doc, what about this study?” They’re gonna be thrilled when patients start AirDropping months worth of data files from their phones on them. “Doc, what about this deviation in the trend last month?”

Quarterly blood tests and the arguments against them are so quaint.


Publisher’s note: See my earlier, related post:  “Smart social media health care comments this week…and then there was Mark Cuban.”  I’ve coined the phrase – Cuban Missive Crisis.

– Gary Schwitzer, Publisher


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Comments (3)

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Daniel Pendick

April 6, 2015 at 10:21 am

“Doc, what about this deviation in the trend last month?”

I wonder if something good could come out of this, though. But what if a doctor I (and I am not a doctor) simply replied, “These small bumps are nothing to worry about, but if you see your blood pressure (or glucose) go up 5 or 10 points and stay there, do come in for a visit so we can figure out if there is a problem with your meds.” There is a good amount of research to show that people who are actively engaged in their care tend to be healthier. Or am I naive?

    Andrew Holtz

    April 6, 2015 at 11:33 am

    To Daniel Pendick: Since the predictive value of the data reports from these new monitoring devices has not been tested with healthy people (as distinct from those with diabetes, for example, where there are many trials of the results of blood sugar monitoring), how would a doctor know what to tell a patient? And if you believe that a doctor would counsel a patient to just stand by because there is no evidence a bump in a number indicates an important health issue, then you probably believe that doctors don’t prescribe antibiotics for routine upper respiratory infections, and that doctors don’t biopsy patients because of incidental findings on scans.

    To Laurence Alter: Blood tests make sense when there is evidence that the results will inform clinical decisions… typically when diagnosing or tracking an illness or screening for certain problems (though the experience with PSA and some other common tests shows how often screening tests can do more harm than good).
    You suggest that more frequent testing is better than less testing, but where is the evidence for that in healthy people?
    It all rests on evidence… and until there are real trials of specific types of frequent health monitoring in healthy people we simply won’t know the specific benefits and harms of specific tests in people with specific health circumstances. Assuming that more testing provides a clearer picture (without causing a surge in unnecessary followup testing and treatment) is just that… an assumption.
    We don’t hand out drugs that have the potential to treat disease until after testing. Incessant health monitoring should also be tested BEFORE being recommended, not the other way around.

Laurence Alter

April 6, 2015 at 10:52 am

Dear Gary or Staff:

Considering your myriad of criticisms of quarterly testing of one’s blood, wouldn’t those same criticisms be applied to having your blood tested at all?

Secondly, you seem to feel *inconvenience* is such a high priority, to wit “trudging across town” (who said it has to be interpreted as “trudging” or necessarily “across town” for people?); labor intensive? (how long does a blood test take and what great effort is expended on patient or hospital staff?); “expensive” (a blood test is expensive? such a standard procedure? I guess so….); “separated by months of darkness” (presumably this is metaphorical and refers to being ‘left in the dark’ for three whole months; well, wouldn’t yearly blood tests leave one more in the dark?)

You give all the reasons why factors can interfere with the quality of the blood test (time of day; travel activities prior to test, ETC.) BUT this is an issue in favor of the proposal: more frequent testing would lessen the chances that these factors would have a great effect. Isn’t that obvious? Suppose – convenience aside – you had your blood tested every hour. Just suppose – forgetting the impracticality. Well, you average out the results and get a clearer picture, don’t you? You seem to think the factors that influence a correct reading will become LESS problematic with MORE intervals between tests. The longer the wait between tests, the more reliable the test results will be? So, I guess I should wait a lifetime before getting any test done. You sarcastically remark that quarterly testing is “so 20th Century”. Yes, let’s go further back in time to our grandparents, say, early 1900s: when and how often did they get tested for anything? Half (or more) Americans lived on farms then – did they ever see a doctor except for emergencies, and then, only when house calls could be performed. Going back in time will surely LESSEN the number of times one would have been tested.

Now, for one of my mottos: CON-venience: the Great Con of Life. Convenience is why people, very often, choose the hospital or clinic that is closest to them regardless of quality. Convenience is the #1 reason people choose a hospital (according to a survey, quoted by Dr. Oz, I believe, that found that “parking spaces” is the most frequent reason a hospital is chosen). Convenience is why fast food outlets are so popular. Convenience is why people rely on telecommunications instead of visiting someone face to face (lessening the chance of walking – i.e., exercising in a modest way – and lessening the chance for face-to-face communication). I should think a person serious about his/her health should not adopt convenience as a priority. An ideal would be: go to the Moon if better care is there (as an ideal to shoot for).


Laurence Alter