I have long been interested in direct access testing (DAT) and have blogged about the topic for ten years. Here's a link to an early note from 2006 (see: Four Categories of Direct Access Testing). Over this time, DAT has never gained much market share or attention until recently when the travails of Theranos have brought the topic to the level of consciousness for many. Theranos lobbied with success in Arizona for legislation to allow DAT. This was in the pursuit of its own business interests but it also allowed Sonora Quest Labs to begin accept consumer specimens in its Safeway-based patent service centers in Phoenix (see: Sonora Quest Laboratories Offers Convenient Laboratory Services to Arizona Consumers in Select Safeway).
I believe that the explanation for the lack of consumer enthusiasm for DAT over the years are numerous. Paramount in my mind, however, is the fact that the cost of most lab testing is covered for insured patients with the test results generated then easily accessible to treating physicians. However, a recent article about DAT in the New York Times hinted that the DAT business model was now undergoing a change (see: Direct-to-Consumer Lab Tests, No Doctor Visit Required). Here's the excerpt from the article that caught my attention:
Ms. Wood had her blood tested by a consumer service called InsideTracker, which analyzes 30 hormones and biomarkers, such as vitamin levels, cholesterol and inflammation. After the service told Ms. Wood she had excessive levels of vitamin D, she cut back on a supplement she had been using and said she almost immediately felt better. Now she has her blood drawn and tested by InsideTracker every four months to check everything from her blood sugar to her B12 levels which, she said, “allows me to be proactive” about her health....InsideTracker also offers customers the option to have nurses show up at their home and draw blood.....InsideTracker and another leading company, WellnessFX, said they worked with doctors who reviewed all test results. Paul Jacobson, the chief executive of WellnessFX, based in San Francisco, said the company complied with all regulations and offered customers the option of consulting with a doctor, nutritionist or registered dietitian to discuss their results. WellnessFX sells packages ranging from $78 to $988, offering analyses of 25 to 88 blood biomarkers, including vitamins, lipids, cardiovascular markers and thyroid and reproductive hormones. Depending on the results, the company also suggests supplements, foods and exercise.
Here's how one of the two DAT businesses mentioned in the article, WellnessFX, defines a portion of its target audience -- consumers who are interested in health and "performance":
Health nuts:...Being healthy is on the top of your list. You’re not afraid of that spinach smoothie to keep your body in the best shape possible.
Bad-ass athletes: You want to be on top of your game and you know that checking your inflammation, testosterone and thyroid levels can keep you there.
Diet experimenters & Biohackers: Paleo, vegetarian, gluten free? You’ve made a lot of changes to your diet, make sure those changes are working for you from the inside.
InsideTracker and WellnessFX are clearly not giving up on lab testing for clients who are interested in monitoring disease. They are just adding clients to the mix who are more interested in wellness and fitness. Many such customers are not only motivated to pay for such monitoring but can also become repeat customers since such an interest may not wane. Even more importantly, these on-line DAT vendors can offer additional services such as health coaching that don't have the medico-legal risk of offering advice to patients about a disease. Although such an approach can lapse into quackery, note in the quote above from WellnessFX that the company also recommends foods and dietary supplements.