Direct to consumer medical tests are offered in United States

BMJ 2006; 333 doi: (Published 29 June 2006) Cite this as: BMJ 2006;333:12
  1. Janice Hopkins Tanne
  1. New York

    “Internet companies and some hospitals in the United States are offering medical tests directly to consumers without the need for a doctor's recommendation, reports the Wall Street Journal (20 Jun, p D4).

    Although welcomed by consumers' groups, the move has sparked concerns among doctors about patients' ability to interpret results and about legal implications.

    Gene Herbek, head of the pathology centre at Methodist Hospital in Omaha, Nebraska, told the BMJ that his hospital would begin offering tests within a few weeks at two walk-in clinics. Its tests include those for blood glucose concentrations, thyroid disease, blood lipid concentrations, hepatitis B, Epstein-Barr virus, pregnancy, and prostate specific antigen, as well as screening for drug misuse. Patients will also be able to order a kit for faecal occult blood testing.

    Dr Herbek said, “It's a national trend—a service patients want.

    “The idea is to encourage patients to know their family history and to take charge of their health,” he said. Pharmacies already sell over the counter tests for blood glucose concentrations, pregnancy, and melanin concentrations (which are commonly believed to be related to sleep problems). Many also offer free blood pressure testing by machine.

    Patients will be able to ask for the tests they want, pay up front, and receive the results by post. Abnormal results will prompt a phone call advising the patient to see a doctor. Patients will be given an explanation of the test and a number to call if they have questions. The hospital can refer them to one of its staff doctors if patients don't have a doctor.

    Internet sites such as,, and offer a nationwide service by acting as online brokers, allowing users to enter their postcode and get the addresses of several nearby laboratories. Results from tests these laboratories offer are sent directly to the consumer. Patients are contacted if serious abnormalities are picked up.

    Privacy is a key factor in the growth of direct to consumer tests, said Dr Herbek. “Patients want to be the first to know,” he said. Abnormal tests can affect people's ability to get life or health insurance. Convenience is another reason. Tests are cheaper, because patients pay up front and administrative costs are less.

    But insurance companies will not reimburse patients for the cost of tests unless they have been ordered by a doctor. The College of American Pathologists says that pathology clinics offering these tests should consider whether a patient can interpret the results without the help of a doctor.

    Arthur Levin, director of the Center for Medical Consumers in New York, said that the companies were selling “worry to the worried well” and that money was being wasted. Tests might have false positive results, leading to further inappropriate testing, he added.

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