Allow me to play devil’s advocate.
I’m concerned about medical testing, almost all of it. Some recent discussions about ALCAT allergy tests have me thinking more about what I think might be the 800 pound gorilla in the room. Testing is becoming more ubiquitous and it seems related to a belief system that everything important in life can be quantified. Reflecting on this belief, though, we soon realize that that isn’t true.
Science has serious limits, yet we all seem to ignore them in deference to our beliefs.
Allow me to focus on the ALCAT testing. It is a costly process, not outrageous, but there is a significant cost. The premise of this test, like most others, is that science can take a snapshot of our bodies and determine all sorts of things about how we can be healthier and maybe even “cure” one of our diseases. While this is a noble goal, I seriously doubt that it is attainable.
Nobody knows enough about how we “work” to be able to look at a sample of our systems and zero-in on specific causes of our problems. We have a vague understanding that all of our “parts” are interconnected, but we still operate as if each part is unique, distinct, and not intimately intertwined with all the other “parts”. This unfounded belief system has given rise to all the medical specialties – as if treating the heart doesn’t also have a impact on the liver or the big toe on the left foot. We believe the body can be divided into distinct pieces but our experience proclaims otherwise. Yet, we continue to look at parts instead of wholes.
Test samples are finite pieces of material collected at a specific point in time. The information contained in any sample is different from what would be found in a similar sample taken at a different time.
Here’s a report of a simple test issue I experienced:
I attended a health conference and was interested in buying a cholesterol test setup (I still believed in the cholesterol myth at the time). I subjected myself to a test three times in one day – right after breakfast, after lunch, and before supper. The results were wildly different. The breakfast values were in the higher range and fell below 200 after lunch. After not eating anything all afternoon, the total cholesterol level rose to over 220 before dinner. Which of the levels accurately described my cholesterol? Given a choice, I would have picked the one drawn after lunch. I don’t know what factors influenced the results, but it is clear that the testing process had significant holes in it.
Testing appears to be scientific, and I can understand why so many health practitioners are drawn to it. The general consensus is that science is good, testing is science, therefore testing is good. There is a flaw in this logic. On the other hand, the “goodness” of science and testing seems to translate well into protection and economics. The testing can be used to lift professional liability from the practitioner and it is possible to test far more people, more quickly, thus moving more patients through a medical practice in a shorter period of time.
My intent today is to raise the question about what seems to be an over use and over dependence on testing in health environments. Medical tests have a place – verifying a diagnosis. It is often inappropriate to use test results to make a diagnosis.
One other perspective about repeat testing results from the field of quantum physics. Werner Heisenberg demonstrated a principle that the more precisely one property is measured, the less precisely the other can be controlled, determined, or known.
Yes, his work was focused on position and momentum, but the idea can be applied to the realm of medical testing: The more we focus on one element, or one set of results, the more we can miss (ignore) the other elements. In systems as vast and complex as the human body, the missed elements can easily have far greater impact than the ones we look at.
In addition to the physics of observation we must not ignore the influence of the persons making the observations – and those about whom the observations are being made.
Consider a situation where a woman has a mammogram test every year or so, starting around age 40. After a few years someone “reads” a report that shows a tumor, a very small one. In fact, it is so small that it probably will be of no consequence for several years. The test shows a tumor and the person reading it feels obligated to report his/her findings. Hearing the results immediately changes the woman’s life – and the lives of all the people she is in contact with.
There is evidence that tiny tumors come and go all the time. But, in this case, a diagnosis is made and many lives are changed, nay harmed. Is it valid to inform a woman of age 50 that she has a tumor that may cause her a problem when she’s 60 or 65? Is it possible that her worry could have an onerous effect on her body? Might she want to start some form of toxic treatment?
Will she be happy for the next decade or two, knowing that she HAS cancer?
Mammograms are tests that have no place in routine health exams.
Let’s turn our attention to hormone testing (saliva or blood). After large numbers of hormone balance consults, I can state that the vast majority of all people I’ve talked to have the same thing; estrogen dominance. There was a time when I tried to help adjust balance according to one protocol or another and I followed up with repeat testing. The results were usually confusing, not predictive, and a real pain in the wallet. Not to mention that the people didn’t feel much better. I observed that while we were focusing on individual hormones (estrogens in particular), the standards for their normal levels kept changing. We went from TriEst to BiEst, to individual hormones, to 90/10, to 80/20, to 70/30, to 50/50 – and practically everything in between. Regardless of the manipulations in formulas – and the follow up test results – we weren’t seeing significant changes. Sure, some things were better, but the overall picture wasn’t changing. All the testing added confusion and cost and I think it was not very useful because we were looking at pieces of the picture, not the whole thing.
What, then, caused my clients to feel poorly? Estrogen dominance was a general catch-all and it was impacted by an almost infinite set of factors, some of which were; pesticides, birth control pills, plastics, soy, beer, flame retardants, prescription drugs, household chemicals, fertilizers, phosphates in dish soap, chlorine in the shower water, fluoride in the drinking water, sodium laurel sulfate, artificial sweeteners, MSG, and so on. The specifics are endless and infinitely intertwined. Not one of them alone could be identified as THE cause of a problem. When it comes to hormone imbalance and estrogen dominance, it seems that the most reliable agent for improvement is transdermal progesterone, used according to a cycling schedule.
I suggest that ALCAT is plagued with problems similar to the hormone testing ideology, but in a far larger manner. The testing proclaims accuracy in identifying a myriad of issues by identifying deficiencies or excesses. Nice idea, but fraught with inaccuracy, not to mention the errors inherent to the actual collection of sample (mentioned above) and the interconnections between each of the items being evaluated in the test sample.
Personally, I long for a return to a time where health practitioners approached their tasks more clinically. No, reading a test is not a clinical activity. It is a mechanical response to a set of numbers that may not have any specific bearing on how the person feels. In its worst sense, a lab test (liek TSH) will show that nothing is wrong. “Well, Mrs. Jones, your TSH is normal, so we won’t be needing to treat your thyroid – its fine.”
I am advocating a health system that depends far less on test numbers and far more on connections between people who have problems and people who can work with them to resolve them. If the current approach to health persists, I can foresee a time when all health concerns will be handled at home with a test kit received in the mail. The test machines will spit out answers that I can almost guarantee will cause more problems than they fix.
I prefer doctors who feel my forehead with their wrist and tell my mother that I have a slight fever – and that it will be better in a couple of days. Keep the digital probe out of my ears. What’s the difference between 101 degrees and 101.8 degrees – and why should I care? I prefer the eye doctor who looks at an injury and tells me it will be fine in ten days, because its always ten days.
- Maybe I’m an ideologue.
- Maybe I’m a visionary.
- Maybe I’m just nuts.
Regardless, I think we’re all on a health/wellness path that will probably not turn out as well as we hope.
Just as health is not a commodity, it is not a business that can be run with automated systems controlled by test results.