In plain English, Theranos does not anticipate requiring physician referrals for their tests. Some lab testing may evolve as a direct-to-consumer activity.
Holmes is not alone in her thinking. Delos M. Cosgrove, MD, president and chief operating officer of the Cleveland Clinic in Ohio and a noted expert on U.S. healthcare, predicts that blood tests for many common health issues, including high cholesterol and diabetes, will soon be initiated by patients, as well as by doctors.
“The CVSs and the Walgreens and the Walmarts of the world are going to be taking a lot of things that currently go to primary care physicians,” Dr. Cosgrove said. “The impact of that on our industry will be enormous.”2
Will the Food and Drug Administration sanction consumer-directed testing? Recently, it has approved DIY genetic testing for certain autosomal recessive genes, but it has yet to issue its final ruling on tests for which the results can have immediate effects on patient healthcare choices.4 Stay tuned.
A Trip Abroad
Joint replacement surgery has been one of the truly great advances in medical care over the past 50 years. Paradoxically, despite the more skillful surgical techniques, shorter hospital stays, better-designed implants and rising volumes of patients undergoing these procedures (1 million annually), the cost of joint arthroplasty continues to rise. Why? Orthopedic procedures have been plagued by the common medical malady of “sticky” pricing, where costs remain high or increase over time instead of dropping. For example, the list price of a total hip implant rose nearly threefold from 1998 to 2011.5 This spurs some patients to seek care in fairly exotic locales, such as Thailand, Hungary, India, Singapore and Malaysia, countries that happen to be the most sought-after destinations for Americans looking for less costly options for joint arthroplasty, spinal fusion, bariatric surgery and cosmetic procedures.
Such organizations as Patients Beyond Borders tout the virtues of medical tourism, especially the ability to receive excellent care at substantial cost markdowns compared with American prices.6
Oh yes, getting some travel time is a nice additional perk. But how patients deal with delayed post-operative complications is not easily addressed.
Medical tourism has its limits, but the concept of seeking quality orthopedic care at reasonable cost has spurred some interesting innovations. It may have persuaded several major hospitals to set fixed, discounted prices for joint arthroplasty procedures for some of the nation’s largest employers. Walmart, Pepsico and Lowe’s have created an alliance with four hospitals that will offer no-cost knee- and hip-replacement surgeries for more than 1.5 million employees and their dependents. But wait! Not only will employees receive consultations and treatment without deductibles or co-insurance, their travel, lodging and living expenses, as well as those of their companion, will also be covered.7 Pack your bags. You may soon be traveling to Baltimore or Springfield, Mo., for that total knee replacement.
Does the Crowd Know Best?
Errors in navigation can have fatal consequences. This was especially true in earlier times, when ships were lost at sea at an alarming rate due to an inability of sailors to track a ship’s correct longitude. For this reason, in 1714 the British Parliament passed the Longitude Act, which offered a substantial prize to anyone who could solve the problem of identifying a ship’s longitudinal position.8 Many proposals were submitted from all parts of Europe, and over the years, the prize was awarded to several individuals for their creative solutions. Some consider this nautical challenge to be one of the first examples of effective crowdsourcing.
Crowdsourcing works because it draws on the curiosity & the altruistic impulses of the human spirit. This creative approach will likely cultivate the growth of open source science, allowing investigators to share ideas & resolve many challenging research issues relatively quickly & at low cost.
Nowadays, crowdsourcing research has enabled investigators to engage thousands of people to provide data or perform data analysis. It has been highly effective in solving some critical problems in molecular biology, comparative genomics, pathology and radiology. In one study, trained participants were able to outperform computer-generated algorithms in solving complex protein-structure prediction problems.8 On the clinical side, another study found that participants were able to correctly classify colonic polyps on computed tomography imaging studies and accurately identify red blood cells infected with malaria parasites over 99% of the time.8
