7 ms·

I strongly disagree. We need more blood tests, and we need them badly. We need them in forms which people can self administer, outside of the prescription-and-p

I strongly disagree. We need more blood tests, and we need them badly. We need them in forms which people can self administer, outside of the prescription-and-professional-blood-draw model. The history of blood glucose testing is informative here. It used to be a hospital lab test, like most other tests: done fasting, infrequently, to diagnose diabetes. Today, that test is done with an over-the-counter test kit, and diabetics do it multiple times per day. This provides information that the infrequent, hospital version couldn't provide at all: how blood glucose responds to meals. There are many other tests which, if they could be frequent and self-administered, would enable people to make new discoveries. The common metabolic tests, for example - HDL, LDL, etc - are very closely analogous to glucose tests, in that they respond to meals and that response is probably more informative than the fasting test. But there's nothing analogous to a glucose tolerance test for cholesterol, because that requires ten tests in a row and that's too expensive. One of the more common complaints I hear from friends is about migraines. Blood tests are worthless there because it's impossible to get a blood draw during an actual migraine. Same for most mental illnesses; comparing blood tests between a bipolar person's manic and depressive phases would be fascinating, but no one does it. And that's not even mentioning micronutrient status screening. The rates of micronutrient deficiencies in the United States found by the National Health and Nutrition Examination Survey (NHANES) are shocking; it's the twenty-first century and the rate of iodine deficiency is 9%.

brianwawok 10y ago
You aren't giving false positives any credit. False positives can be DEVASTATING. If a test has 50, 75, 90% false positive rates, as many do - you are causing much panic for nothing. If tests were 100% reliable and a simple pinprick.. absolutely, everyone should take one when they wake up and drink their morning coffee. But with the accuracy of tests today? Not so sure. basically take any 100% healthy person. Run 500 tests on them. They will have 5-6 major problems via a false positive result. Run more detailed invasive tests on those. Maybe you rule them out, maybe you get another false positive. You could end up going through Chemo or some other "cure" for a disease you never had, and the "cure" could end up giving you real cancer.
- sigmar 10y ago
  >If a test has 50, 75, 90% false positive rates, as many do What tests are you referring to? I can't find a reference but I highly doubt the FDA would approve of many tests with that high of false-positive rates.
  - mikeyouse 10y ago
    Your doubt is misplaced.. At least at the high end. Pap smears have a false negative rate of ~20% and a false positive rate of ~10%. Many doctors are now recommending less frequent tests; http://www.wsj.com/articles/SB125875596169058039 http://www.wsj.com/articles/SB125875596169058039
    - sigmar 10y ago
      10% false positive rate is significantly lower than the quoted "50, 75, 90%"
      - LionessLover 10y ago
        How about you read the article the entire discussion is about? You will learn what is meant right there.
  - Falell 10y ago
    I think these statistics are claiming '50-90% of observed positives are false', not '50-90% of all tests return false positives'. Suppose 0.1% of the population has a condition and the test for the condition has a 0.5% false positive rate. If administered blindly, most positive tests will be false positives.
    - fisherjeff 10y ago
      I think this is the crux of the article's argument - more people testing more frequently and "blindly" means a whole lot more positive results, most of which will be false.
    - 10y ago
deleted 10y ago
[deleted]
KaiserPro 10y ago
Evidence is needed here. This isn't an industry where "disruption" is harmless, moving fast and breaking things in the endless pursuit of personal fortune is going to cost many innocent people years of their lives. Because there is no one single class of people, you can't just prescribe on the basis of a self administered blood test. Take liver function test, depending on what you are looking for, and when you've last eat, you can "prove" you have the beginnings of cirrhosis. Without controlled testing people will be lead to the wrong conclusions. Also, what is the half life of the compounds you are testing for? how long can they be in a vile before they start to distort? This is an actual science, and needs to be treated with some respect for the scientific process (evidence leads, actions follow.) You can draw blood during a migraine, the vein constriction is in the brain, not the rest of the body, otherwise there would be a trivially simple test for migraines vs headaches. I could go on. The point is this: theranos is basically a symptom of the wrong type of progress. snake oil dressed as science in the pursuit of personal profit. No science was shared, humanities knowledge was not expanded despite the huge amount of money waisted on something that was clearly bollocks
pak 10y ago
The history of blood glucose testing is informative here. You're conflating a diagnostic test with a test that patients need to control dosing (of insulin). To make a diagnosis of diabetes, such frequent testing is not any more informative. Better tests, such as HbA1C, have been developed to indirectly measure blood glucose levels over a 3-month timescale, which is more appropriate for diagnosis. I don't think there's any evidence yet that people being able to monitor their lipid levels while eating provides any useful medical information, unless you have some kind of (incredibly rare) inherited lipid metabolism deficiency. comparing blood tests between a bipolar person's manic and depressive phases would be fascinating, but no one does it. There in fact has been plenty of work on this, but in a research setting, where it belongs. See section 6 of http://www.ncbi.nlm.nih.gov/pubmed/27017833 http://www.ncbi.nlm.nih.gov/pubmed/27017833 it's the twenty-first century and the rate of iodine deficiency is 9%. Micronutrient deficiencies are usually a result of dietary choices. This problem is more easily solved by encouraging everyone to take a daily multivitamin, which would be completely prophylactic, than by encouraging the same population to subscribe to series of blood tests that may or may not reveal the problem, and would require follow-up action. Again, think about it from a population health perspective.
- shanusmagnus 10y ago
  The fact that you immediately jumped to the assumption that the only useful thing one could do with glucose testing is to diagnose diabetes or plan insulin doses is indicative of the failure of imagination endemic to the system. Glucose testing is useful for all kinds of things; the fact that you yourself (and most doctors) don't know that, or think that other people can't be trusted with their own data without some Credentialed Professional to interpret it for them, is both insulting and limiting. I don't want to go back to a world where AT&T had to anticipate the ways I'd want to use telecom. Although sadly in some respects we've never left it.
  - CJKinni 10y ago
    Just curious, what are the other uses for glucose testing?
gukov 10y ago
I'm a T1 and poke my finger on average 10 times a day. It's led to A1C of a nearly non-diabetic person, 5.3%.
paviva 10y ago
It is indeed a pity blood tests are regulated, and not available not anyone who wants them -- I would be making millions out of people like you'd draw bloods before, after, and during migraine, and test for who-knows-what for who-knows-why. I'm curious, though, how come is that blood tests are not possible during migraine attack, I really cannot understand why should it be so. That being said, you have no clue about human physiology, and not much more about clinical biochemistry.

brianwawok 10y ago

You aren't giving false positives any credit. False positives can be DEVASTATING. If a test has 50, 75, 90% false positive rates, as many do - you are causing much panic for nothing. If tests were 100% reliable and a simple pinprick.. absolutely, everyone should take one when they wake up and drink their morning coffee. But with the accuracy of tests today? Not so sure. basically take any 100% healthy person. Run 500 tests on them. They will have 5-6 major problems via a false positive result. Run more detailed invasive tests on those. Maybe you rule them out, maybe you get another false positive. You could end up going through Chemo or some other "cure" for a disease you never had, and the "cure" could end up giving you real cancer.

sigmar 10y ago
>If a test has 50, 75, 90% false positive rates, as many do What tests are you referring to? I can't find a reference but I highly doubt the FDA would approve of many tests with that high of false-positive rates.
- mikeyouse 10y ago
  Your doubt is misplaced.. At least at the high end. Pap smears have a false negative rate of ~20% and a false positive rate of ~10%. Many doctors are now recommending less frequent tests; http://www.wsj.com/articles/SB125875596169058039 http://www.wsj.com/articles/SB125875596169058039
  - sigmar 10y ago
    10% false positive rate is significantly lower than the quoted "50, 75, 90%"
    - LionessLover 10y ago
      How about you read the article the entire discussion is about? You will learn what is meant right there.
- Falell 10y ago
  I think these statistics are claiming '50-90% of observed positives are false', not '50-90% of all tests return false positives'. Suppose 0.1% of the population has a condition and the test for the condition has a 0.5% false positive rate. If administered blindly, most positive tests will be false positives.
  - fisherjeff 10y ago
    I think this is the crux of the article's argument - more people testing more frequently and "blindly" means a whole lot more positive results, most of which will be false.
  - 10y ago

deleted 10y ago

[deleted]

KaiserPro 10y ago

Evidence is needed here. This isn't an industry where "disruption" is harmless, moving fast and breaking things in the endless pursuit of personal fortune is going to cost many innocent people years of their lives. Because there is no one single class of people, you can't just prescribe on the basis of a self administered blood test. Take liver function test, depending on what you are looking for, and when you've last eat, you can "prove" you have the beginnings of cirrhosis. Without controlled testing people will be lead to the wrong conclusions. Also, what is the half life of the compounds you are testing for? how long can they be in a vile before they start to distort? This is an actual science, and needs to be treated with some respect for the scientific process (evidence leads, actions follow.) You can draw blood during a migraine, the vein constriction is in the brain, not the rest of the body, otherwise there would be a trivially simple test for migraines vs headaches. I could go on. The point is this: theranos is basically a symptom of the wrong type of progress. snake oil dressed as science in the pursuit of personal profit. No science was shared, humanities knowledge was not expanded despite the huge amount of money waisted on something that was clearly bollocks

pak 10y ago

The history of blood glucose testing is informative here. You're conflating a diagnostic test with a test that patients need to control dosing (of insulin). To make a diagnosis of diabetes, such frequent testing is not any more informative. Better tests, such as HbA1C, have been developed to indirectly measure blood glucose levels over a 3-month timescale, which is more appropriate for diagnosis. I don't think there's any evidence yet that people being able to monitor their lipid levels while eating provides any useful medical information, unless you have some kind of (incredibly rare) inherited lipid metabolism deficiency. comparing blood tests between a bipolar person's manic and depressive phases would be fascinating, but no one does it. There in fact has been plenty of work on this, but in a research setting, where it belongs. See section 6 of http://www.ncbi.nlm.nih.gov/pubmed/27017833 http://www.ncbi.nlm.nih.gov/pubmed/27017833 it's the twenty-first century and the rate of iodine deficiency is 9%. Micronutrient deficiencies are usually a result of dietary choices. This problem is more easily solved by encouraging everyone to take a daily multivitamin, which would be completely prophylactic, than by encouraging the same population to subscribe to series of blood tests that may or may not reveal the problem, and would require follow-up action. Again, think about it from a population health perspective.

shanusmagnus 10y ago
The fact that you immediately jumped to the assumption that the only useful thing one could do with glucose testing is to diagnose diabetes or plan insulin doses is indicative of the failure of imagination endemic to the system. Glucose testing is useful for all kinds of things; the fact that you yourself (and most doctors) don't know that, or think that other people can't be trusted with their own data without some Credentialed Professional to interpret it for them, is both insulting and limiting. I don't want to go back to a world where AT&T had to anticipate the ways I'd want to use telecom. Although sadly in some respects we've never left it.
- CJKinni 10y ago
  Just curious, what are the other uses for glucose testing?

gukov 10y ago

I'm a T1 and poke my finger on average 10 times a day. It's led to A1C of a nearly non-diabetic person, 5.3%.

paviva 10y ago

It is indeed a pity blood tests are regulated, and not available not anyone who wants them -- I would be making millions out of people like you'd draw bloods before, after, and during migraine, and test for who-knows-what for who-knows-why. I'm curious, though, how come is that blood tests are not possible during migraine attack, I really cannot understand why should it be so. That being said, you have no clue about human physiology, and not much more about clinical biochemistry.