Blood letting

Blood tests are an important part of screening, diagnosing and monitoring disease. Despite being freely available on the NHS, private blood tests have become widely available in the UK, so why would anyone want to spend their money on blood tests and are there any dangers?

Of course the obvious answer is that there are delays and frustrations with an underfunded NHS, but I have found the tests I need to be easy to get after a real or electronic interaction with my own doctor, who has no bias or baggage when it comes to ordering them, and the NHS does plenty of blood tests every day. Indeed, we are doing more than ever. Why?

Testing times

He wanted us to think things through properly and also save costs. This was seen as good medicine.

I agreed. Until that is I discovered the multichannel analyser doing the tests did the whole range of tests anyway, so we might as well get the results – just in case something odd popped up – a sort of inadvertent, un-trialled screening. Since then, increasing technology has led to an explosion in range and number of blood tests, the vast majority of which are, you will be relieved to hear, within the normal range.

In the past, blood samples were taken by junior doctors or GP’s themselves, which also acted as a gentle brake on excess testing. Phlebotomists have now taken over that role and with all the brakes off, we are all being tested for more things than ever before. The UK numbers are impressive.

• 500 million biochemistry and 130 million haematology tests are carried out per year.
• 14 tests for each person in England and Wales are performed annually.
• 300,000 tests are performed every working day.
• 50 million reports are sent from labs to GPs every year

This is mainly a good thing, we are monitoring more, screening more and diagnosing more, and blood tests have become, after listening and examining, pretty much the norm. But too much?

Choosing Wisely

There is a financial cost to all this testing, but also potential harms in delayed hospital discharge, hospital acquired anaemia, waste, anxiety, false reassurance and the danger of looking at numbers rather than the whole patient. So efforts are being made to reign it in a little with the Choosing Wisely campaign leading the way to more precise use of a precious resource. At the same time, a whole new industry of unregulated private phlebotomy has taken off? So we come to the oxymoronic “Alternative” Health Industry.

“So Called Alternative Medicine”

I was interested when a friend told me of his experiences with an alternative medical practitioner selling ‘phlebotomy’ services on a high street. For one thing, I really don’t feel there is any such thing as “Alternative” medicine; there is only medicine that works and that which doesn’t, whoever the provider happens to be. Prof Edzard Ernst, (the first and only professor of complementary medicine in the UK) writes a comprehensive blog which is a treasure trove of exposes of the dangers of what he terms “So Called Alternative Medicine” (SCAM), but even he hasn’t come across this.

It seems that you can now pay a considerable amount of money for for an initial consultation, the taking of blood, analysis in private labs, interpretation of the results (non medical SCAM practitioners may pay someone else to do this) and see you to discuss the results. If there is something really amiss, they will (fingers crossed) refer you to the GP for further action – and meanwhile take considerable amounts of your cash for ‘services’ provided.

I noticed this occasionally when I was GP, but is likely to be happening more as SCAM grows. I felt forced to repeat tests I didn’t really think were needed, then reassure the patient that the results were normal, and go on the address the reasons why the person felt there were needed in the first place. Fatigue, anxiety and fear of there being something wrong are serious symptoms to live with and can be helped by various means after some blood tests to screen out significant issues or deal with them when they arise.

I personally think people are risking their health seeing SCAM practitioners before seeing qualified doctors, however difficult that might sometimes be.

At a follow up consultation SCAM practitioners explore what such results mean for you. Aside from results not leading to a referral to a GP, for most doctors the answer would be very little. For the SCAM practitioner, it is likely to mean recommendations for supplements, often their own. No bias there!

Snake Oil

They state that having a blood test in the upper range of normal will optimise your health. This is on the basis of opinion only, and even that comes from an American antivaccine activist. Of course, there is a bit of pseudoscience behind this. For many tests, there is a wide range of normal, rather like height, but it’s a huge leap of faith to assume that the more of something you have the better. With a wide distribution of normal for many tests, this means many people can become labelled as having something not right, but its rather like saying that anyone over 6ft tall or under 5ft 6in has a problem. It’s really not that simple.

But not only can some blood tests be more concerning at upper ranges of normal, but the evidence for benefits of being above average but in the normal range are frankly non-existent. All the tests need to be taken in the context of your history, your and your families past medical history, previous test results and physical examination. Context is everything.

Harms

I guess the alternative practitioner might not see the harm. He or she will see you for a long consultation, listen intently, see you again for another consultation after the blood tests. Taking the vitamins will not usually cause any harm, even if they are often little more than an expensive placebo.

However, there are some pitfalls which some alternative practitioners might love to see you jump into.

One is along the lines of “I’m afraid your serum selenium (or whatever) is still a bit low, let’s increase your supplements, do the test again in a month, and then book another consultation.”

This could lead to a harmful and expensive dependence on the practitioner. It’s nice to see someone to unload your burdens. A problem shared is a problem halved, but such unloading is so much better in the company of friends and loved ones who care for you in the real sense of the word, or those trained in psychology and the talking therapies. People who won’t take your cash and people who will be there for you in any hour of need.

Finally, there is the opportunity cost of what you might have done for yourself with the money spent on these tests – that is always worth considering, especially when the costs can add up to a holiday, or even used directly to buy better food, a decent bicycle, a gym subscription or anything else that benefits health. In the UK alone we spend £500million a year on supplements, many of which are simply not required.

Why is private phlebotomy booming…

In our high stressed, troubled world, where there is so much that can literally make us sick and tired, it’s important to get the help, including any tests you need. This can be difficult after so much underinvestment in the NHS, and so it might seem attractive to see a SCAM practitioner who will spend time with you, and who no doubt has communication skills.

Yet I really fail to see any advantage over this SCAM to the service available free at the point of use, and unbiased by the need for repeat consultations and dependence, or financial gain. Quite the opposite.

Relax

All this ‘Alternative’ phlebotomy is not far from the best comedy sketch from Mitchell and Webb which looks at the working of an ‘Alternative’ A+E. 

So get a drop of tea, mix it with a litre of water, stir vigorously, then add a drop of that to another litre of water, stir again and add a drop of that to a cup of hot water, sit back and enjoy the video.