Last night the celebrity billionaire Mark Cuban ignited a firestorm on Twitter with the following recommendation to his 2.7 million followers:
1)If you can afford to have your blood tested for everything available, do it quarterly so you have a baseline of your own personal health
2) create your own personal health profile and history.It will help you and create a base of knowledge for your children,their children, etc
3) a big failing of medicine = we wait till we are sick to have our blood tested and compare the results to “comparable demographics”
Led by ProPublica health reporter Charles Ornstein, a slew of doctors, healthcare experts, patient advocates and journalists tried to show Cuban the error of his ways. (You can read good summaries and perspectives on the exchange by Charles Ornstein, Dan Diamond, and Aaron Carroll.
The main problem with Cuban’s idea is that it has absolutely no evidence to support it, and if widely accepted could lead to disastrous increases in spending with almost certainly no subsequent health benefit to individuals. The argument that it should only be done by those who can afford it won’t hold water, because our health care system is almost completely incapable of taking cost into account once benefits have been widely promoted. More importantly, excessive testing inevitably leads to false positive results, turning healthy people into sick people and subjecting them to the whims and misfortunes of the health care system.
Cuban’s main defense appears to be that the backlog of test records will help him and his physicians with medical care in the future, since new test results can be compared to his old results. This is an interesting concept but I’m afraid we are nowhere near the point in the vast majority of situations where this type of comparison would be helpful. For most doctors, this sort of avalanche of earlier tests would prove a huge distraction. And Cuban doesn’t seem to realize that researchers have devoted an enormous amount of research trying to figure out how to interpret test results. It’s extremely unlikely that an individual doctor or patient will be able to immediately improve on their work in the setting of an occasion where blood test results are actually needed. In any case, even if you accept the value of baseline tests, the idea of obtaining tests every 3 months would still require additional validation. This could well be a textbook definition of TMI.
Even Eric Topol, who is probably the most famous and vocal proponent of big data and patient empowerment, didn’t endorse Cuban’s recommendation, tweeting that the recommendation is “unfounded.”
Billionaire Bucks and VIP Health Care
Cuban did emphasize that his recommendation was restricted to those who can afford the tests, but that also presents problems. How many of Cuban’s 2.7 million Twitter followers can afford these tests? How many of those who can’t afford it and who admire and respect Cuban will then feel that their current care, in this respect, is inadequate? For that matter, does Cuban feel that the best health care can and should be reserved for the wealthy?
Cuban’s proposal strikes me as a subset of VIP care, in which very famous or rich people get “exceptionable” care that often differs from the care that the rest of us get. The funny thing is that when you talk to doctors who have delivered or observed VIP care they almost universally agree that VIP care leads to substandard care. (This doesn’t mean that usual care doesn’t need to be improved– it does!– but that attempts to do so on the fly for a VIP can backfire, or worse.) Cuban may think that he can outspend and outthink everyone else and get superior care, but he may well wind up with care that’s actually a lot worse.
Cuban has a right to do what he wants with his own money and if he wants to throw it away on needless tests that’s his business. But a public recommendation to 2.7 million people is another matter entirely. Because he is very rich and very famous his words can have an enormous impact on lots of people. He doesn’t acknowledge the possibility that he’s wrong, but he should at least consider the potential damage of delivering uninformed recommendations to so many people. For now, though, we will need to think of him as a public health danger, like Jenny McCarthy and Gwyneth Paltrow.
One final point: on his Twitter profile picture Cuban is smoking a cigar. I can guarantee that the negative health effects of cigars far outweigh any potential benefits of his incessant testing. This strikes me as a perfect example of the misplaced emphasis on a very small perceived risk (missing a baseline lab value) while completely ignoring a much bigger risk. Smoking, Cuban should know, is the single biggest modifiable risk factor. Perhaps he could take the cigar out of his mouth and recommend his Twitter followers do the same.