In a time when artificial intelligence chatbots can answer all of your medical questions, and it's possible to access laboratory testing and imaging scans without a health professional's order, who needs actual doctors?
That's the unwritten premise behind an unsettling article in STAT News that documents the growing phenomenon of empowered patients bypassing doctors and ordering direct-to-consumer tests that they think they need. The article begins with the story of a middle-aged man who shelled out $200 for dozens of lab tests that he didn't think his doctor would want to order, in the hope of obtaining more information to manage his metabolic conditions and lower his risk of developing dementia.
“This is the stuff that if I went to my doctor [with], my doctor would kind of look at me like I’m weird,” he said of the tests. ... Sidaway didn’t want to wait “20 years for the long-term studies and double-blind, placebo-controlled studies for them to say X, Y, and Z works,” he said. “Doctors are going to have to get used to this and navigate this.”Do-It-Yourself, or DIY medicine, isn't a unique phenomenon among highly trained professions. I'm sure that there are building contractors who roll their eyes at homeowners who get in over their heads with DIY renovations, or trial lawyers who wince when they see people without training try to represent themselves competently in court. Some days, I am tempted to point to the diplomas hanging on my home office wall and proclaim that if a patient believes that a chatbot or Dr. Google can equal my decades of medical training and practice, they are welcome to put their lives in DIY medicine's hands.
On the other hand, I know that the traditional medical system does not serve many people well, and I support the democratization of health information and broadening of access to care - provided that it is effective care. One example that might fall into the DIY medicine bucket is being able to self-screen for cervical cancer from the privacy of one's home. The Department of Health and Human Services (HHS) announced this week that starting in 2027, it will mandate insurance coverage of FDA-approved self-sampling tests for patients who are not at high risk for cervical cancer. That's a win for women who dread going to the doctor for a speculum exam and Pap smear, and it's based on good evidence, synthesized more than a year ago by the U.S. Preventive Services Task Force, whose work has, ironically, been suspended indefinitely by RFK Jr. and the Trump administration.
Parents who follow the new, expertise-free HHS guidance and disregard their pediatrician or family physician's advice to give their children hepatitis B vaccine at birth, or at all, will expose them to the risk of acquiring chronic viral hepatitis, which will put them on a path to developing liver cancer. (Hepatitis B is treatable with antivirals, but not curable.) And dropping the second dose of the human papillomavirus (HPV) vaccine based on promising but incomplete evidence from other countries who have done so mainly for cost reasons could put more people at risk for not only cervical, but oropharyngeal and anorectal cancers caused by HPV. (The U.S. Food and Drug Administration, which is part of HHS, has not approved a single dose HPV vaccine regimen for cancer prevention.) Finally, cutting $1.1 trillion from Medicaid in last year's budget reconciliation bill is projected to lead to "over 1 million missed [breast, lung, and colorectal] cancer screenings and hundreds of avoidable deaths within 2 years," according to a just-published analysis.
America's experiment with DIY medicine is underway, for better or for worse. Almost certainly, for worse.