Do-It-Yourself Medicine Makes Inroads

New tests enhance self-screening, improve management of chronic conditions

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By Karen Pallarito
HealthDay Reporter

THURSDAY, June 22, 2006 (HealthDay News) -- Not so long ago, a woman had to visit her doctor, leave a urine sample and wait by the phone -- sometimes days -- to find out whether she was pregnant.

But over-the-counter home-pregnancy tests -- which first hit the market in the late 1970s -- make the process quick, convenient and private.

In fact, those pregnancy kits, as well as glucose-monitoring tests for diabetics, were in the vanguard of a health care revolution that continues to gain momentum. New and better tests for detecting and managing a plethora of conditions have made their way to pharmacy shelves in recent years, the fruit of both scientific advancement and consumer demand.

Diabetes is a good example of a disease for which self-testing has made enormous strides, said Dr. Barbara P. Yawn, an adjunct professor of family and community medicine at the University of Minnesota in Minneapolis, and a member of the U.S. Preventive Services Task Force.

People with diabetes used to check the sugar in their urine at home to monitor their condition. It wasn't a very useful test, she said, because a person's blood sugar might have to be 250 or even 300 mg/dL -- well above optimal levels -- for sugar to spill into their urine.

The introduction of blood-glucose meters and testing strips in the late 1960s vastly improved efforts by patients to monitor fluctuations in their blood sugar and make needed adjustments to their diet and medication. And painful finger pricks have gotten less so in recent years with the introduction of finer lancets and meters that require less blood. There's even a non-invasive watch-like device that automatically measures glucose levels up to six times an hour.

"Home monitoring (of diabetes) has been improved again and again and again," said Yawn, who credits manufacturers for heeding patients' wants and needs. "They've paid attention to what makes people use it or not use it," she said. "Pain was a big deterrent."

If you include the bathroom scale or the thermometer, home testing has been around longer than people realize.

But today, there are home-test kits that women can use to see whether they are ovulating or not. There are also kits for screening for urinary tract infections, colon cancer and even HIV.

There are home cholesterol tests that can give you a total cholesterol count. The problem with these screens is they can't break down that number into its more useful components -- like HDL (the good cholesterol), and LDL (the bad type) -- so many doctors still recommend that a health professional check your cholesterol count.

Home-health tests have to be fairly simple to perform, easy to interpret and used with some frequency to be useful to people, said Dr. Paul S. Frame, a clinical professor in the Department of Family Medicine at the University of Rochester School of Medicine in Rochester, N.Y.

Home glucose monitoring meets that definition, in his view. So does home blood pressure monitoring.

Having a blood pressure cuff handy may be a good idea for patients who have "white coat" hypertension, meaning their readings are always high when they come to the doctor's, but when they check their blood pressure at home, "it's generally quite good," he said.

Frame is also a "fairly big fan" of the fecal occult blood test, a screening test for colorectal cancer. Doctors often give patients a test kit to take home with them.

The test, which involves taking a series of stool samples, may also be purchased at pharmacies, said Elissa Passiment, executive vice president of the American Society for Clinical Laboratory Science in Bethesda, Maryland.

But are Americans anxious to self-screen for this disease? "I can promise you that they are not jumping off anybody's shelf," she said.

On the other hand, "Many patients would much rather do the fecal occult blood test than have a colonoscopy," Frame said. In fact, when patients repeatedly fail to perform the at-home test, he gives them a choice.

"I say, well, you know, if you don't want to do this, if this isn't working for you, if you can't so this, we can do a colonoscopy," he said, adding, that often spurs compliance.

For a glimpse at the future of at-home testing, look to the baby boomers, Passiment said. That generation, whose oldest members are turning 60 this year, is anxious not to age the way their parents did and eager to avoid disease.

"I think you're going to see more over-the-counter tests for prevention," including sexually transmitted diseases, she predicted, "rather than just management of the already diagnosed."

More information

For more on home health testing, visit the American Society for Clinical Laboratory Science.

SOURCES: Barbara P. Yawn, M.D., adjunct professor, Department of Family and Community Medicine, University of Minnesota, Minneapolis; Paul S. Frame, M.D., clinical professor, Department of Family Medicine, University of Rochester School of Medicine, Rochester, N.Y., and family physician, Tri-County Family Medicine, Cohocton, N.Y.; Elissa Passiment, Ed.M., CLS, executive vice president, American Society for Clinical Laboratory Science, Bethesda, Md.

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