Live, Lab(oratory), Love: The trajectory of at-home testing

Source

At-home testing is not a new concept. More than likely you or someone you know tests their blood sugar levels regularly and needs to treat a low blood sugar at some point. Home pregnancy and ovulation tests are also ubiquitous.

What has changed over the past decade has been the skyrocketing popularity of at home DNA tests. Initially selling for the not-so-cool price of $1000 (23andMe) to $2,500 (Navigenics), the focus of these early tests was medical information that could be gleaned from DNA. However, once they linked into the growing genetic research regarding ancestry and tapped into the family genealogy market, the customer base grew and the price dropped to the much more affordable $100 or less price point.

I took advantage of such a discount in the 2012 to 2013 period, when medical data was still available to overseas consumers. Fortunately, my data did hold any surprises regarding my ancestry or high-risk for serious illness so the whole experience and ongoing updates were fun, so to speak. However, soon after I purchased my kit, the FDA cracked down on 23andMe for the lack of scientific evidence behind their risk calculations for multiple health conditions. In response, 23andMe pulled health results for all consumers before reinstating a limited health report for the US market. Overseas consumers such as myself are limited to the ancestry data but we can still access our historical health reports, they just aren't updated. This might be due to potential violations of the Fair Trading Act 1986 as identified by law student Helena Jochem as much as it is due to the high-costs of meeting regulatory requirements of such a small market that New Zealand offers. There are also considerable questions to ask about accuracy. However, it could be argued that there is a fringe benefit of familial DNA being used to identify serial killers and unidentified bodies but that is an ethical topic for another time.

Despite this, the market for at-home medical testing continues to boom in this country and abroad. On the cheaper end of the scale, many mobile and smartphone manufacturers have included proprietary software (which cleverly link with their brand's smartwatch, smart scale, or similar accessories) which monitor your weight, water intake, and heart rate. I've written earlier in the year about Femtech, in which one of the features is predictions in timings of one's menstrual cycle. Many diabetics are able to utilise smart technology to track and control blood sugars levels with a patch. On the more expensive side are at-home hormone tests, such as Hawkes Bay-based Eve Wellness' Eve Test (RP $249), that would otherwise only be available in NZ with a doctor's referral but can now be purchased next to the gluten-free cookies at your local organic food shop.

However, the same flaws and concerns that plague international behemoth 23andMe also apply to homegrown efforts. Reporting for the Consumer website, Rebecca Styles writes that the test reports provided contain contradictory results and claimed that the results were analysed by a doctor without clarifying that it wasn't an MD but rather a PhD who did the work. Even more concerning was the upselling of add-ons meant to address the less than ideal findings, be it hundreds of dollars for supplements or subscription plans. As long as these companies avoid making links to specific diseases without evidence, they are able to steer clear of the pitfalls that affected 23andMe.

There is still much for skeptics to be wary about. There are many bad actors out there who tout bogus medical services and rely on commercial or third party labs to process these unnecessary tests at a premium price. While a high distrust in the medical establishment can partially explain this, there are also populations with conditions that are unusual or have needs that surpass the knowledge of local health professionals at the time. Having already spent money and time trying to get answers from the standard health care system, these groups can be particularly vulnerable to the illusion that these companies have an answer when they are really only interested in selling a product.

It could also be said that at-home testing could ease some pressure on the healthcare system during such events by facilitating the continuation of standard medical services, i.e. cancer screening. Bastion Health in the US recently announced the release of at-home prostate and male fertility testing kits which they intend to be matched with a telemedicine consultation which will link the client with treatment and prescription options if necessary. By necessity, the COVID-19 pandemic may also influence our growing comfort with at-home testing going forward. As the doctor's office and laboratory collection centres came to engender greater risk of viral exposure, telemedicine and no-contact specimen collection was essential. As the many variations spread within the community, the 15 minutes RAT test had the power to determine our movements for weeks at a time; this is a radical change to the testing available during the swine flu scare nearly a decade ago. It may be that in future epidemics, just as much time will be devoted to the production and distribution of at-home diagnostic tests as it is to vaccine development.