Businessman and maverick, Mark Cuban recently opined, “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.” I’m unsure why he said quarterly, not weekly, daily or hourly. ‘
He further opined that this must be done to “create your own personal health profile and history. It will help you and create a base of knowledge for your children, their children, etc.” I assume etc. refers to grandchildren’s children.
I’m unclear what my grandchildren would gain from knowing my serum free testosterone levels in 2014. That’s a lot of data to enter in Ancestry.com. For that matter, the size of my grandfather’s spleen in 1956 probably doesn’t affect the way I think about my mortality. That year he had a bout of Leishmaniasis, which, thankfully, isn’t a problem in Philadelphia.
Cuban further explained “a big failing of medicine = we wait till we are sick to have our blood tested and compare the results to comparable demographics.”
Which is to say that if your serum potassium is 7.2 mM/L (dangerously high) that could just be you; you know the unique happy-bubbly, loves chocolate cinnamon latte, likes Calvin Klein not Giorgio Armani, you. Hell with demographics. Demographics, mean and standard deviation make me less of me. I’m unique. My serum potassium is, therefore, unique.
(P.S. If your serum potassium is 7.2 mM/L, please go to your nearest emergency department and don’t eat any bananas.)
Cuban’s Tweets led to some disquiet in the health care Twitterverse. Tweeps explained overdiagnosis and false positives, to which he asked a delightfully simple question “false positive compared to who?” Tweeps explained science and evidence. He remained resolute. He emphasized that his advice, canonical as it may seem, was only for those who “could afford it.” That’s the key point and has inspired a business idea which could reduce inequality and stimulate the economy.
Mr. Cuban should open centers for whole body testing all over the country. Let’s call it “Test All the Time for Total Information Tracking” (TAT 4 TIT). Neither the test nor downstream tests should be covered by insurance. TAT 4 TIT should be taxed differently — for every test performed, and for all businesses in the centers, such as Holistic Zen Trapezius Massage or Confucian Colonic Irrigation, 20 percent of the earnings should go to public education and 20 percent to the National Institutes of Health. I would very much like TAT 4 TIT to be a monopoly and to price gouge mercilessly.
This would be a fine exemplar of trickle-down economics. Let the money flow voluntarily from those in fear to those in need. If you’re 1 percent, rich and have more money than common sense, have your zinc levels tested weekly. Remember to check your selenium after eating chicken dopiaza. Chicken dopiaza gives the breath a garlic odor but so does a high level of selenium, and you can never know for sure that it’s not selenium toxicity without knowing your unique, personalized, baseline selenium and the annual trends.
Have your spleen measured monthly to understand its natural variation. Have your bile duct imaged bi-monthly. Apple can create apps, such as Angry Bile Duct Tracker, which will alert at 3 a.m. when the duct exceeds 6.12 mm.
Imagine the scintillating cocktail conversations this would inspire.
“Hi, I’m Richard Head, a contract lawyer from Boston. My spleen is 14.3 cm.”
“Pleasure to meet you. I’m Rick Mave from Atlanta. I’m a financial strategist. My potassium is 4.76, but I’d love to hear more about your spleen.”
Imagine the empowerment with such information.
According to Cuban’s Twitter profile he is a maverick. When I think of mavericks I think of those who haven’t confessed to being a maverick, such as George Mallory, who wanted to climb Everest “because it’s there” or Indiana Jones who would fall in to a snake pit “for fortune and glory.” It will take time to adjust to present day mavericks. Perhaps Mallory might have viewed a colonoscopy with courageous indifference.
“Why am I having a colonoscopy? Why? Because it’s there.”
When asked why testing shouldn’t be more frequent, Cuban answered “how did a quarterly blood test turn into testing all the time?” The point was comprehensively missed. Why not weekly, daily or hourly or continuous DNA error tracking? Any higher frequency is just as arbitrary as quarterly.
John Maynard Keynes warned us about the remorseless logician. Cuban’s prescription is a corollary to extreme individualism. To be fair, he doesn’t wish to diffuse costs to society. It’s his personal decision, and he has a right to fret and lose sleep over what he wishes to lose sleep over.
And it would be unfair to blame Cuban. He has taken the fads of modern health care, personalized medicine, big data and early diagnosis, and extrapolated it to nonsensical proportions. He is guilty of extrapolation, and of extrapolation only. It is the medical profession which is to blame for planting this in his mind: “A big failing of medicine = we wait till we are sick to have our blood tested.”
Failing? Isn’t the whole idea of medicine to treat the sick? How and when did that calculus change?
Saurabh Jha is a radiologist and can be reached on Twitter @RogueRad. This article originally appeared in the Health Care Blog.
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