Recently Mark Cuban created a firestorm with his suggestion to have consumer driven blood testing performed every three months. The immediate pushback from medical professionals boiled down to the question of blood testing being a screening process for disease detection, and not one of health and performance that should be available to any layperson, or a generally available tool for the individual with curiosity.
According to common and dated thought processes, blood analysis confirms a disease and should be a reactive approach in the treatment process. Mr. Cuban’s idea of blood testing quarterly stems more from the opportunity to look at trends, primarily for prediction and prevention, the exact direction he feels we need to be moving to as a society.
Obviously testing in isolation, i.e., without some guidance or frame of reference, is probably not a good idea. The argument that frequent blood testing is drawing the wrong conclusion is not about what can go wrong, it should be about what can go right if done properly with good guidance and basis of reason. False positives do occur and any screening has its limits, but waiting for disease management to solve the obesity crisis is like expecting those that do autopsy analysis to lead corporate wellness programs.
The health insurance industry should, and likely will, learn a lesson from the life insurance industry regarding blood testing. Actuaries appreciate objective numbers that have validity. Specifically not if, but when, someone is likely to die. Big data and behavior patterns are great for a small term life insurance policy, but when money is on the line, blood testing is still mandatory to get that coverage.
The current medical disease model is never going to succeed in improving overall health, fitness or increasing sports performance. Treating disease or illness is in reality a zero sum game. Getting a metabolically sick population back to their “normal baseline” of unhealthiness is hardly a sign of optimal health and is a game that nobody really wins in the long run. Sure, nobody died, but “not being sick” is no guarantee of wellness and health, either.
If someone wants to run a marathon, they will seek out a running coach not usually a physician. If someone wants to improve their health from the perspective of effective and smart nutrition, they seek to hire a nutritionist. If that same person wanted to get stronger and lose body fat, a good personal trainer is the logical conclusion. Doctors are leaders in guiding society in restoring health when things go wrong, but when health needs to move towards higher forms of function, a performance model is needed.
One of the more common criticisms of Mr. Cuban’s position was the idea that a test wrongly interpreted can lead to unnecessary worry and overreaction.The possibility of receiving a false positive or a poor analysis is possible, but only when the experts are not involved. Blaming the test results, or its interpretation is not the real issue here. Not getting any data or establishing a realistic baseline, until it’s too late, is the real problem. When the goal of testing is overall health and wellness, monitoring and management is far more effective than screening one time.
Countless times when I see a patient with a stress fracture or similar non-traumatic bone injury, they are expecting a reactive solution to their issue, like the need to change athletic shoes, orthotic prescriptions, or running technique. While those suggestions may help to minimize the force overload of a stress fracture, they are not the only factors involved in the process of this injury. Training load, recovery, and obviously, biochemical health of the musculoskeletal system are essential to keeping athletes and weekend warriors healthy.
As a podiatrist, my limitations are only part of the equation, and deficient athletes deal sports medicine a set of cards that make it difficult to win. Being proactive is not just about education, it’s early evaluation and education about the factors that reduce or increase overall risk. Athlete profiling and questionnaires are valuable tools. However, they sometimes don't provide the answers to simple questions, like whether or not a multimillion dollar athlete has the same nutrient deficiency as a third world child.
Prostate and ovarian cancer screening are matters of disease. Knowing if an athlete is anemic or not is something that is a matter of accountability with training and nutrition. Routine blood markers show trends, annual checkups are merely a snapshot. Imagine the poor soul investing his or her entire year preparing for the Chicago marathon, only to find out after they suffer a fracture that they likely have been deficient in Vitamin D for months. The body is an incredible machine and may repair itself, unlike your car, but without having the proper resources available, simple functions like bone remodeling and repair cannot be done.
When I work with high-level athletes many of them are surprised when I ask if they brought any blood data as well as their training footwear. The relationship between biomarkers and biomechanics isn’t a clear one (yet) to most people, but only having half the information forces the process of medical decisions into guesswork as opposed to one of analysis. Athletes trying to improve performance and / or function can and do make the wrong choices when they are not guided properly. The root issue that many of the health writers and healthcare professionals had with Mark Cuban’s suggestion is the idea of more data being valuable only when it’s done right. Dr. Comite said it perfectly when she stated the following.
“The right data, at the right time, examined by medical experts who know what they are doing and what to look for, from a proactive and not just a reactive perspective, is never too much data. In fact, it is the future.”
Many medical professionals may find that the self-quantification movement is disrupting a process and profession by opening up access to medical data. Instead of feeling threatened, the medical profession should be relieved by having more information to guide patient care. The more we see individuals being part of the process during the time we are not seeing them in the office, the better. In my years working with patients, be it the elderly woman wanting to walk with her husband of 50 years or the post-surgical athlete wanting to run again, it’s a group effort that needs cooperation, not just criticism. When a patient sees my own blood data on the screen of an iPad, it opens up a discussion of accountability, of what the patient is in control of, and my own responsibility of guiding them. In the future, we can be focused on power struggles and data access, or we can focus on empowering patients with their data, and I choose the latter.
Breakthrough Sports Performance was founded on the vision of improving athletic performance by utilizing a combination of evidence based medicine with quantified clinical experience. Breakthrough Sports Performance promises an athlete-centered and transparent methodology for all patients, from world class athletes to serious non-professional competitors.
