Most direct-to-consumer medical tests advertised online found not useful

Posted 30 January 2024

Australian researchers have found most direct-to-consumer (DTC) diagnostic, screening and risk-monitoring tests sold online are unlikely to benefit the average consumer.

Reference: Shih P, and others. Direct-to-consumer tests advertised online in Australia and their implications for medical overuse: Systematic online review and a typology of clinical utility. BMJ Open, 13(12):e074205, 2023

Two of the researchers independently conducted systematic searches using Google and Google Shopping in October 2020 and identified 177 home self-tests, 65 self-collected direct-access pathology tests (DAPTs), and 242 lab-collected DAPTs. Out of all 484 tests, researchers found:

  • 7% had potential clinical utility
  • 6% had limited clinical utility
  • 9% were non-evidence-based commercial ‘health checks’
  • 7% had methods and/or target conditions not recognized by the general medical community

The last category included these methods lacking clinical validity for conditions they’re intended to test for:

  • (a) hair metal and mineral analysis, and mycotoxin test for environmental toxin exposure;
  • (b) hair analysis, IgA, and IgG for food allergy;
  • (c) antigen leukocyte antibody (ALCAT) for food sensitivity and intolerance;
  • (d) hormones for hair loss;
  • (e) urine chelation for heavy-metal exposure;
  • (f) whole blood histamine for histamine intolerance;
  • (g) urine metabolites for liver detoxification;
  • (h) zinc, copper, and zinc-copper ratio for mental health nutrition (Pfeiffer test);
  • (i) naglaese in blood for cancer and autism;
  • (j) neurotransmitters in urine for mental health disorders; and
  • (k) hydrogen and methane breath test for small intestinal bacterial overgrowth (SIBO).

The last category also included tests for conditions not established and recognized by the general medical community: (a) adrenal fatigue; (b) leaky gut syndrome; (c) pediatric autoimmune neuropsychiatric disorders syndrome; and (d) pyrrole disorder as a mental health condition.

The researchers concluded:

The large offering of tests seldom recommended in a clinical setting may represent an under-recognised driver of medical overuse and consumption of low-value healthcare, particularly among healthy consumers. Unlike publicly funded pathology services and hospital data that are auditable, the harms triggered by DTC tests are not easily tracked and measured. This may mean it remains a relatively hidden problem, with consumers and the healthcare system bearing the brunt of the immediate and long-term costs. At the policy and regulation level, higher standards of test quality and regulation are needed to support informed decision-making for consumers. . . . Consumers of varying levels of health literacy must be supported to critically engage and assess the applicability and suitability of different DTC tests. To ensure test results and patient safety are adequately followed up by medical professionals, the introduction of consumer-led reporting systems such as digital registries of test outcomes. . . is recommended.

Source: Consumer Health Digest #24-04, January 28, 2024

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