Several years ago, I got my genome sequenced and obtained my variant call files, the tabulation of all differences between my gene sequences and the annotated human genome. Although my primary care physician was aware, I didn’t require his intermediation to obtain or interpret my genomics data. How I might react to adverse information was up to me. I’ve referred to my variant spreadsheet many times since then, whenever I’ve read about a new variant associated with risk of, or protection from, disease.Disintermediated health care information isn’t new or exotic. Anyone can buy and use a digital thermometer, blood pressure cuff, blood sugar monitor, oxygen saturation monitor, pregnancy test kit or COVID test kit without a doctor’s approval.
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Joel Eissenberg considers the following as important: direct-to-consumer MRIs, disintermediated healthcare information, Healthcare, law
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Disintermediated health care information isn’t new or exotic. Anyone can buy and use a digital thermometer, blood pressure cuff, blood sugar monitor, oxygen saturation monitor, pregnancy test kit or COVID test kit without a doctor’s approval. Direct-to-consumer MRIs and CTs have been around for a while. CT scans involve X-rays, a form of ionizing radiation that can cause DNA damage and cancer. MRIs involve no such risk.
Direct-to-consumer marketing of whole-body MRIs is good for the health of MRI machine manufacturers and the companies that offer scanning to the public, but is it good for people who get the scans?
“MRIs are great for what they’re typically used for,” said Ernest Hawk, MD, MPH, a vice president at MD Anderson Cancer Center in Houston. “But now you’re moving them much earlier into an average-risk population, and that’s where you can run into these questions that haven’t been answered.”
“Many radiologists say the likelihood of finding a serious problem, such as a cancerous tumor or brain aneurysm, in someone with no symptoms is very low. Instead, scans are likely to flag growths that are usually harmless. Definitively ruling out a problem could require additional tests, appointments, and even surgeries.
“You’re going to end up finding a lot of incidental things,” said Mina Makary, MD, a radiologist at the Ohio State Wexner Medical Center in Columbus. “That’s going to create more psychological stress or trauma for the patient, including additional costs for tests and procedures that may have risks.”
MRIs are relatively harmless, except for the ca. $2000 damage to the patient bank account. The risk of discovering false positives—“incedentalomas”—is needless worry and unnecessary follow-up procedures, but the latter will be intermediated by healthcare professionals. In an open society, maximizing autonomy is a virtue. Direct-to-consumer MRIs, like direct-to-consumer genomics, are here to stay. Caveat emptor.