Early detection can help, but is it worth it for everybody?

Featured in the March 27, 2006 Businessweek article "Beyond the Annual Physical" is an Austin company, Biophysical Corp., that caters to Americans who want to be fully tested for everything that could be possibly wrong with their health. The B-week writer calls them "medical worriers."

The company's hallmark service is "a $3,400 blood test named the Biophysical250 that screens for 250 possible diseases, at least 150 more than most standard physicals." The vast majority of insurance plans do not cover the costs. So how does it work?

The company sends a nurse to your home to draw two tablespoons of blood, then the samples get shipped to Austin to test for everything from the mundane -- cholesterol and blood sugar levels, infection -- to the downright scary, such as dozens of proteins and enzymes that could indicate the presence of cancers, autoimmune diseases, or weird genetic anomalies. The test screens for 39 markers for heart disease alone.

Smartly perhaps, and in line with current medical thinking, the company "does not... screen for diseases about which nothing can be done -- Alzheimer's and Parkinson's, for example." And admittedly, this battery of tests isn't necessary according to the writer's own doctor and even the writer himself in the final analysis: "All in all, Biophysical250 is a nice affirmation if you're fairly certain you're in good health, and an early warning system if you're not."

Interestingly, this extremely thorough physical isn't confined to medical startups. Well-regarded institutions like Mayo Clinic offer similar services called "executive physicals," which are more costly. The added value is that the physician takes a detail history.

"We do run the standard evidence-based tests, but we also listen very carefully to the patient and pursue any clues they may give," says Dr. Deborah J. Rhodes, director of Mayo's program. She gives the example of a 37-year-old man who mentioned in passing that he recently noticed one testicle seemed smaller. This common asymmetry would have barely been noted, except that the patient said it was a recent change. As a result, Rhodes ordered a test for testicular cancer and discovered that the man had the very earliest stages of the disease, catching it long before it would have been found in a physical exam.

Is this kind of extreme physical necessary to maintain good health? Probably not, as the writer points out, for the majority of us. But as quoted in a Scientific American June 2006 article titled "Early detection can lead to better outcomes," and actually seen on Biophysical Corp's site:

Millions of adults—even those who appear healthy—live with undetected illnesses. In the U.S. alone, 1.4 million people will be diagnosed with cancer this year. Another 17 million will suffer an adverse cardiovascular event. The good news is that the sooner specific diseases and medical conditions are detected, the sooner—and more effectively—they can be treated.

There is real value in a test that could detect an early-stage cancer or new-onset (and subacute, meaning no symptoms) diabetes, as this could help a person not only increase her chances of surviving, but also of living with a better quality of life in most cases (e.g., preventing kidney and eye disease in diabetics and curing cancers by resection before it metastasizes). Still, is there value for everyone if most people do not have such disease that are in the early stages of development? I'm not so sure.

And in the end, this jury isn't convinced one way or the other quite yet about the value of these comprehensive physical lab exams.