6 ms·

The point about needing a doctor's order to get a blood test seems pretty irrelevant to the rest of the situation. I don't know why they included it. I'd love

The point about needing a doctor's order to get a blood test seems pretty irrelevant to the rest of the situation. I don't know why they included it. I'd love to get a simple blood test without needing to talk to my doctor (plenty of people would). I would not love to get a blood test misrepresenting its accuracy (nobody would).

timr 11y ago
The reason is the same as why you require higher standards of statistical evidence when you don't have a strictly defined hypothesis before an experiment: if you go looking for something in noisy data, you'll probably find it. Lab tests have significant margins of error. Just by chance, if you go out and get a bunch of lab tests, you'll probably find something "wrong". Unless you're knowledgable about interpreting the results -- and unless you are a practicing medical doctor, you are highly unlikely to be knowledgable, even if you think you are -- this can/does lead to catastrophically bad outcomes. (And now, for an ironic aside: the median HN user is extremely quick to attack valid science for the reason that "most results are wrong", while also complaining loudly when the medical establishment wants to restrict access to clinical tests with a large margin of error. Go figure.)
- conistonwater 11y ago
  There is another issue I've read about, which is that outside the context of a medical diagnosis, even a very accurate test would still be relatively unhelpful because it can be measuring natural variability. (E.g., testing some metric associated with prostate cancer in young men/women — prostate cancer only appears in older men, so testing young people is mostly useless.) Whereas if you're already potentially sick and go to a doctor, the relevant tests then have more predictive power.
  - deleted 11y ago
    [deleted]
- cheriot 11y ago
  For things like STD tests it raises the barrier and cost of frequent testing. We need a more fine grained policy than all blood tests require a physician.
  - timr 11y ago
    They don't. You can get cheap/free STD tests from non-physician providers. You can also buy STD tests at the drugstore, over the counter. But like it or not, anyone who collects biological samples from strangers' is going to require some training and licensing. Moreover, the interpretation of an STD test is not as straightforward as you might think. False positive rates can be high for the cheaper tests, and there's natural variability in things like antibody titers. People also neglect that timing matters -- if you test too soon after infection, even the most sensitive tests won't work. Or they fixate on one particular scary illness (e.g. HIV), and neglect testing for others that are less well-known, but more common (e.g. Chlamydia). Some of these problems can be mitigated. Others can't. Regardless, having someone trained to interpret tests is a good idea for just about everyone. Even the cheap/free/OTC tests come with that service, at a minimum. It's a bad idea to just allow people to pick and interpret their own tests, even for the "simple" ones, like STD tests.
- pkaye 11y ago
  In reality this doesn't mean much because I can order a blood test online and a doctor's approved receipt will be available in under a minute to take to a local lab. I doubt the doctor looked at anything except his bank account. And this process is legal in most US states.
  - copperx 11y ago
    What about insurance?
    - pkaye 11y ago
      I used to do this to supplement my doctor's own tests because of my own curiosity and concern. So I just paid for it myself without insurance. For example a standard panel of 26 common tests costs $55.
      - semi-extrinsic 11y ago
        I don't get it. What is the average person going to do themselves with the results of a simple blood test? Car analogy: is there any point in taking your car to a garage and having them look it over and just make a list of the status of common components on the car, without any (vehicle specific) interpretations? As in "you have 5/16 inch wear difference between the front left and right brake rotors, the steering toe-in is 1.3 degrees, and the alternator is providing 13.2 volts". If not, why is the blood test thing different?
        pkaye 11y ago
        A better question is would you drive a car without a working gas gauge? Blood tests are flagged as abnormal if they exceed the 95% confidence interval. So there is a possibility of it happening by chance. Or you may get some abnormality due to minor issues like a recent cold or injury. But then you just need to start a conversation with your doctor to get clarity. Did you know your kidney health could be down to 10-20% of capacity and you would not even feel a thing wrong? And something happened to me in 2 intervening years of tests for that exact scenario to happen. I doubt most people have tested anything other than their cholesterol and BP in the last two years. If anything, we should be checking our body health more than our car because we can always replace our car.
thieving_magpie 11y ago
This was a law passed in Arizona that likely doesn't happen without Theranos pushing for it. It certainly seems relevant that a company making illegitimate claims about their product wants to bypass the scrutiny of medical professionals.
deleted 11y ago
[deleted]
adevine 11y ago
Agreed. I thought this quote from the article was pretty lame: > Because once the patient has those test results, more likely than not, they're going to need a doctor's opinion to decipher them and to know what those results mean. So why not keep the doctor involved from the beginning so that, first of all, there is a logic for getting the blood test, and then there's an expert opinion there when the test results arrive to help you interpret them. I call BS on that. Many, if not most, tests would NOT need any doctor involved if the test came back normal, which in the majority of cases, it does. Heck, when I go to my doctor NOW and have to get a test, if everything is normal I just get a phone call: "Yep, everything was normal." Explain again why a doctor needs to be involved in that process? As another example, look at STD tests. Anyone can walk into one of thousands of clinics around the country to get a suite of STD tests, no doctor required, and only if a test comes back positive would you need to see a doctor. So why is this so different from other types of tests?
- Retric 11y ago
  If you got every blood test done you would no question get several false positives. If 1,000,000 people got every blood test possible they would on average have worse Heath outcomes than a control ground who got zero tests. This is who of he reasons mass screenings for conditions are often a bad idea.
  - jsprogrammer 11y ago
    Subsequent screenings can reduce the false positive rate. There's no reason to accept a single measurement as gospel.
    - Retric 11y ago
      The problem with false positives is they often show up because your body chemistry is X not because the test failed. So, subsequent screenings are often more invasive and involve risks. (radiation, being cut open etc.)
- neuro_imager 11y ago
dogma1138 11y ago
The need for a doctor is less about getting your blood work down and more about going over the results and analyzing them based on your medical history and general profile. You can pay to get blood work done even without a doctor in most cases but there is actually very little use for it if all you going to get is some standardized report without any good way of actually analyzing and no i don't thin theranos had a good system in place to bring that to the masses and this isn't something that needs to be brought to the masses in the first place. Instead of finding a way to allow you to get your blood tested in the same manner as you would develop film 15 years ago why not work on making doctors more accessible? Doctors and trains hemotologists is what you need scalability was never an issue.
brandonmenc 11y ago
Apparently you can get blood tests without a doctor. I've not tried this yet, but plan to: http://www.healthonelabs.com http://www.healthonelabs.com

timr 11y ago

The reason is the same as why you require higher standards of statistical evidence when you don't have a strictly defined hypothesis before an experiment: if you go looking for something in noisy data, you'll probably find it. Lab tests have significant margins of error. Just by chance, if you go out and get a bunch of lab tests, you'll probably find something "wrong". Unless you're knowledgable about interpreting the results -- and unless you are a practicing medical doctor, you are highly unlikely to be knowledgable, even if you think you are -- this can/does lead to catastrophically bad outcomes. (And now, for an ironic aside: the median HN user is extremely quick to attack valid science for the reason that "most results are wrong", while also complaining loudly when the medical establishment wants to restrict access to clinical tests with a large margin of error. Go figure.)

conistonwater 11y ago
There is another issue I've read about, which is that outside the context of a medical diagnosis, even a very accurate test would still be relatively unhelpful because it can be measuring natural variability. (E.g., testing some metric associated with prostate cancer in young men/women — prostate cancer only appears in older men, so testing young people is mostly useless.) Whereas if you're already potentially sick and go to a doctor, the relevant tests then have more predictive power.
- deleted 11y ago
  [deleted]
cheriot 11y ago
For things like STD tests it raises the barrier and cost of frequent testing. We need a more fine grained policy than all blood tests require a physician.
- timr 11y ago
  They don't. You can get cheap/free STD tests from non-physician providers. You can also buy STD tests at the drugstore, over the counter. But like it or not, anyone who collects biological samples from strangers' is going to require some training and licensing. Moreover, the interpretation of an STD test is not as straightforward as you might think. False positive rates can be high for the cheaper tests, and there's natural variability in things like antibody titers. People also neglect that timing matters -- if you test too soon after infection, even the most sensitive tests won't work. Or they fixate on one particular scary illness (e.g. HIV), and neglect testing for others that are less well-known, but more common (e.g. Chlamydia). Some of these problems can be mitigated. Others can't. Regardless, having someone trained to interpret tests is a good idea for just about everyone. Even the cheap/free/OTC tests come with that service, at a minimum. It's a bad idea to just allow people to pick and interpret their own tests, even for the "simple" ones, like STD tests.
pkaye 11y ago
In reality this doesn't mean much because I can order a blood test online and a doctor's approved receipt will be available in under a minute to take to a local lab. I doubt the doctor looked at anything except his bank account. And this process is legal in most US states.
- copperx 11y ago
  What about insurance?
  - pkaye 11y ago
    I used to do this to supplement my doctor's own tests because of my own curiosity and concern. So I just paid for it myself without insurance. For example a standard panel of 26 common tests costs $55.
    - semi-extrinsic 11y ago
      I don't get it. What is the average person going to do themselves with the results of a simple blood test? Car analogy: is there any point in taking your car to a garage and having them look it over and just make a list of the status of common components on the car, without any (vehicle specific) interpretations? As in "you have 5/16 inch wear difference between the front left and right brake rotors, the steering toe-in is 1.3 degrees, and the alternator is providing 13.2 volts". If not, why is the blood test thing different?
      - pkaye 11y ago
        A better question is would you drive a car without a working gas gauge? Blood tests are flagged as abnormal if they exceed the 95% confidence interval. So there is a possibility of it happening by chance. Or you may get some abnormality due to minor issues like a recent cold or injury. But then you just need to start a conversation with your doctor to get clarity. Did you know your kidney health could be down to 10-20% of capacity and you would not even feel a thing wrong? And something happened to me in 2 intervening years of tests for that exact scenario to happen. I doubt most people have tested anything other than their cholesterol and BP in the last two years. If anything, we should be checking our body health more than our car because we can always replace our car.

thieving_magpie 11y ago

This was a law passed in Arizona that likely doesn't happen without Theranos pushing for it. It certainly seems relevant that a company making illegitimate claims about their product wants to bypass the scrutiny of medical professionals.

deleted 11y ago

[deleted]

adevine 11y ago

Agreed. I thought this quote from the article was pretty lame: > Because once the patient has those test results, more likely than not, they're going to need a doctor's opinion to decipher them and to know what those results mean. So why not keep the doctor involved from the beginning so that, first of all, there is a logic for getting the blood test, and then there's an expert opinion there when the test results arrive to help you interpret them. I call BS on that. Many, if not most, tests would NOT need any doctor involved if the test came back normal, which in the majority of cases, it does. Heck, when I go to my doctor NOW and have to get a test, if everything is normal I just get a phone call: "Yep, everything was normal." Explain again why a doctor needs to be involved in that process? As another example, look at STD tests. Anyone can walk into one of thousands of clinics around the country to get a suite of STD tests, no doctor required, and only if a test comes back positive would you need to see a doctor. So why is this so different from other types of tests?

Retric 11y ago
If you got every blood test done you would no question get several false positives. If 1,000,000 people got every blood test possible they would on average have worse Heath outcomes than a control ground who got zero tests. This is who of he reasons mass screenings for conditions are often a bad idea.
- jsprogrammer 11y ago
  Subsequent screenings can reduce the false positive rate. There's no reason to accept a single measurement as gospel.
  - Retric 11y ago
    The problem with false positives is they often show up because your body chemistry is X not because the test failed. So, subsequent screenings are often more invasive and involve risks. (radiation, being cut open etc.)
neuro_imager 11y ago

dogma1138 11y ago

The need for a doctor is less about getting your blood work down and more about going over the results and analyzing them based on your medical history and general profile. You can pay to get blood work done even without a doctor in most cases but there is actually very little use for it if all you going to get is some standardized report without any good way of actually analyzing and no i don't thin theranos had a good system in place to bring that to the masses and this isn't something that needs to be brought to the masses in the first place. Instead of finding a way to allow you to get your blood tested in the same manner as you would develop film 15 years ago why not work on making doctors more accessible? Doctors and trains hemotologists is what you need scalability was never an issue.

brandonmenc 11y ago

Apparently you can get blood tests without a doctor. I've not tried this yet, but plan to: http://www.healthonelabs.com http://www.healthonelabs.com