OP-ED

A Business Proposal for Mark Cuban

Businessman and maverick, Mark Cuban recently opined “if you can afford to have your blood tested for everything available, do it quarterly so you have a baseline of your own personal health.” I’m unsure why he said quarterly, not weekly, daily or hourly. ‘ 

He further opined that this must be done to “create your own personal health profile and history. It will help you and create a base of knowledge for your children, their children, etc.” I assume etc. refers to grandchildren’s children.

I’m unclear what my grandchildren would gain from knowing my serum free testosterone levels in 2014. That’s a lot of data to enter in ancestry.com. For that matter, the size of my grandfather’s spleen in 1956 probably doesn’t affect the way I think about my mortality. That year he had a bout of Leishmaniasis, which, thankfully, isn’t a problem in Philadelphia.

Cuban further explained “a big failing of medicine = we wait till we are sick to have our blood tested and compare the results to “comparable demographics.”

Which is to say that if your serum potassium is 7.2 mM/L (dangerously high) that could just be you; you know the unique happy-bubbly, loves chocolate cinnamon latte, likes Calvin Klein not Giorgio Armani, you. Hell with demographics. Demographics, mean and standard deviation make me less of me. I’m unique. My serum potassium is, therefore, unique.

(PS – if your serum potassium is 7.2 mM/ L please go to your nearest emergency department and don’t eat any bananas)

Cuban’s Tweets led to some disquiet in the Healthcare Twitterverse. Tweeps explained overdiagnosis and false positives, to which he asked a delightfully simple question “false positive compared to who?” Tweeps explained science and evidence. He remained resolute. He emphasized that his advice, canonical as it may seem, was only for those who “could afford it.” That’s the key point and has inspired a business idea which could reduce inequality and stimulate the economy.

Mr. Cuban should open centers for whole body testing all over the country. Let’s call it “Test All the Time for Total Information Tracking” (TAT 4 TIT). Neither the test nor downstream tests should be covered by insurance. TAT 4 TIT should be taxed differently – for every test performed, and for all businesses in the centers, such as Holistic Zen Trapezius Massage or Confucian Colonic Irrigation, 20 % of the earnings should go to public education and 20 % to the National Institutes of Health. I would very much like TAT 4 TIT to be a monopoly and to price gouge mercilessly.

This would be a fine exemplar of trickle-down economics. Let the money flow voluntarily from those in fear to those in need. If you’re 1 %, rich and have more money than common sense, have your zinc levels tested weekly. Remember to check your selenium after eating Chicken Dopiaza. Chicken Dopiaza gives the breath a garlic odor but so does a high level of selenium, and you can never know for sure that it’s not selenium toxicity without knowing your unique, personalized, baseline selenium and the annual trends.

Have your spleen measured monthly to understand its natural variation. Have your bile duct imaged bi-monthly.  Apple can create apps, such as Angry Bile Duct Tracker, which will alert at 3 am when the duct exceeds 6.12 mm.

Imagine the scintillating cocktail conversations this would inspire.

“Hi, I’m Richard Head, a contract lawyer from Boston. My spleen is 14.3 cm.”

“Pleasure to meet you. I’m Rick Mave from Atlanta. I’m a Financial Strategist. My potassium is 4.76 but I’d love to hear more about your spleen.”

Imagine the empowerment with such information.

According to Cuban’s Twitter profile he is a maverick. When I think of mavericks I think of those who haven’t confessed to being a maverick, such as George Mallory, who wanted to climb Everest “because it’s there” or Indiana Jones who would fall in to a snake pit “for fortune and glory.” It will take time to adjust to present day mavericks. Perhaps Mallory might have viewed a colonoscopy with courageous indifference.

“Why am I having a colonoscopy? Why? Because it’s there.”

When asked why testing shouldn’t be more frequent, Cuban answered “how did a quarterly blood test turn into testing all the time?” The point was comprehensively missed. Why not weekly, daily or hourly or continuous DNA error tracking? Any higher frequency is just as arbitrary as quarterly.

John Maynard Keynes warned us about the remorseless logician. Cuban’s prescription is a corollary to extreme individualism. To be fair he doesn’t wish to diffuse costs to society. It’s his personal decision and he has a right to fret and lose sleep over what he wishes to lose sleep over.

And it would be unfair to blame Cuban. He has taken the fads of modern healthcare, personalized medicine, big data and early diagnosis, and extrapolated it to nonsensical proportions. He is guilty of extrapolation, and of extrapolation only. It is the medical profession which is to blame for planting this in his mind: “a big failing of medicine = we wait till we are sick to have our blood tested.”

Failing? Isn’t the whole idea of medicine to treat the sick? How and when did that calculus change?

Conflict of Interest

I am presently wearing a Fit Bit. It has revealed to me that sitting on the couch is not exercise. This information has empowered me.

About the Author

Saurabh Jha is a radiologist and an armchair pontificator. The pontifications do not represent the views of his employer, spouse, fourth grade teacher, personal trainer or anyone remotely associated him. Follow him on Twitter @RogueRad

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TariqDrabuSaurabh JhaWilliam Palmer MDSteveOhsheaGregg Masters Recent comment authors
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TariqDrabu
Member

Wonderful Post.

Source: http://www.tariqdrabu.co.uk/

Gregg Masters
Guest

Some thoughts about Cuban: ‘Bold Vision or Big Ego’ on ACOwatch.com:
http://acowatch.me/2015/04/05/mark-im-not-a-doctor-but-so-what-cubans-bold-vision-or-big-ego/

Saurabh Jha
Guest
Saurabh Jha

You’re right Gregg: brand vs. science. Science has no chance.

There is a fallacy of golden mean with the media, that a balanced view must consider both sides, and the truth is in the middle. Media treats science as if it is foreign policy.

I saw the same thing when the anti-vaccination movement was going full steam. But the truth is not midway between Paul Offit and Jenny McCarthy. The truth is with Paul Offit.

Then, of course, there is the predictable accusation that EBM changes its mind, etc, etc, which is true, but that doesn’t mean anything goes.

Gregg Masters
Guest

Worth a listen… A roll for RCTs in economics in general and pray tell, health economics in particular.

Then again speculation by billionaires absent any tethering to a ‘fact based’ body of knowledge aka ‘brand building’ seems to be persuasive in a somewhat inexplicable fashio:

http://freakonomics.com/2015/04/02/how-do-we-know-what-really-works-in-healthcare-a-new-freakonomics-radio-podcast/

Courtesy of Freakomocs radio.

William Palmer MD
Guest
William Palmer MD

Some of us love testing. We think that all medicine boils down to chemistry. We think there are over 4000 metabolic inherited diseases (so far) and we believe in
Francis Collins’ statement “everyone has some genetic abnormality.” We think that testing gives another side to the patient’s history, the chemical history. Just as you cannot extract too much history from a patient, so too can’t you ever get enough chemical data.

SteveOhshea
Guest
SteveOhshea

We may discover, or rediscover, our American interest in race genetics and the clustering of metabolic inherited diseases, most of which are recessive. In the book, “A Troublesome Inheritance: Genes, Race and Human History,” Nicholas Wade asserts that “fourteen percent of the human genome has been subject to evolution that has been recent, copious, and regional.” American science drifted away from its interest in genetic refinement, an active topic of a century ago or so – largely because we could not assemble direct genetic data as is now possible. We can now determine the genetic composition of a population and… Read more »

SteveOhshea
Guest
SteveOhshea

Jolly. Let’s have Mr. Cuban’s business monitored real time by Federal Department of Commerce auditors, just to make sure there’s no deliberate or accidental fraud. [That’s Newspeak fer ya!]
That way, the IRS can jump in with a strategic intervention if there’s abnormal accounting practices. Sound insane? ‘Coz it is.

Gregg Masters
Guest

More than anyone else, at the end of the day Sherry Reynolds aka @cascadia nailed it in this tweet:

Sherry Reynolds @Cascadia · 2h 2 hours ago
Disconnect in medical testing thread @charlesornstein + et al are giving facts @mcuban is building a brand – guess who will win?

Oh the tender underbelly of American Medicine….
Gregg
@2healthguru

Whatsen Williams
Guest
Whatsen Williams

Mr. Cuban is a charter member of the worried well.

bird
Guest
bird

my brother in law just got a promotion and was told he has to get some corporate screening test done. he is about 5-8 150 pound no cardiac risk factors, no family history and very active, can run for hours without pain or sob and is only 46 years old. He followed thru with mandated stress test, had a borderline stress test, he has a high deductible plan so then had to pay another 3-4k for numerous other cardiac test out of his own pocket only to find out that he was healthy in first place. So i guess at… Read more »

Terry Nichols
Guest
Terry Nichols

A truly wonderful post. And Dr. Jha did not even get into the amazing statistical analysis that can be done with this rich data set: confidence intervals about when variations are probably random; coefficients of correlation for different test results. Not to mention push ads for drugs for diseases that you might have, even before they are recognized as diseases. O brave new world that has such data in it!