The human condition: Patient, test thyself

Home testing is one more step towards DIY health care. Look after yourself, is the message - no-one else will. Eleanor Bailey reports

Here's a modern poser. Which of these major life issues is the odd one out: your health, your pension, your marriage or your funeral? Answer: your funeral - it's the only one which you can still expect someone to organise for you. Like everything else these days, you must roll up your sleeves and get stuck in.

We are expected to know about our bodies. No longer can we merely mosey along to the doctor, mumble a few symptoms and collect a prescription. The NHS is under pressure, the Government wants us to take care of our own health and the market dictates it must be so: look after yourselves because no one else will, is the message. And the boom in self-diagnostic kits available from the chemist for cholesterol, blood pressure, fertility and any number of other conditions shows that increasing numbers of us are taking our health into our own hands.

The growing interest in health - witness the health news explosion in the media in recent years - is clearly a positive thing. However, the fear among health professionals is that the trend is already going too far, and that people will rely on the chemist, self-diagnosis and self- help rather than going to the doctor. "I'm a great believer in people giving up smoking, women examining their breasts, people being encouraged to take up exercise and so on," says Dr Danielle Freedman, Clinical Director of Pathology and Pharmacy at Luton and Dunstable Hospital, who has extensively researched testing kits. "But when it comes to people self-diagnosing," she says, "it does concern me. In many cases it seems to be taking control too far. There is a danger firstly of misinterpreting the results - some of the results of, for example, cholesterol kits are extremely variable. Secondly, people will either panic unduly or be lulled into a false sense of security - just because they have been cleared of one illness doesn't mean the symptoms are not something else."

More than 30 former prescription drugs have been reclassified for over- the-counter sale since 1992, compared to only 10 in the previous decade. This has contributed to a kind of drugs inflation where we are able to buy and recommend ever more potent remedies without recourse to a GP. Money is, of course, a motivator. Self-diagnosis (or more crucially, self- going-to-chemist-and-paying-for-self's-treatment) means a cut in the pounds 3.6bn NHS drugs bill and increases spending on other drugs (good for both government and pharmaceutical companies). Pharmacists, too, are delighted to be treated as one-stop high street health advisors.

The self-help culture is being cultivated with campaigns to encourage us to protect ourselves from the dangers of tobacco, alcohol, sun, drink and everything else that could make us succumb to something nasty (and expensive) in years to come. Careful efforts are made to make sure that we take it in good spirit. "Research shows," said a Health Education Authority spokes-man, "that 80 per cent of people endorsed humour in an anti-smoking campaign. If we try and drum it home people think it is too nannying. We try and show people that the onus is on them to make the behavioural change'

And ignore it at your peril. For while it is hotly denied by most health professionals that, for example, smokers with lung cancer would ever be denied treatment, rationing is creeping in via the back door. Karen Williams, spokesperson for Action on Smoking and Health (ASH), thinks that the current climate of self-help makes this all the more dangerous. "It is grossly unfair to put all the responsibility into the individual's hands. The Government has a responsibility to protect young people."

But today's health consumer is not willing to wait four months for a test, then a further two months for the results. Years ago, if somebody didn't know what was wrong with you, or what to do about it if they did, that was the end of it. Now there is an assumption that whatever the trouble may be, something can be done. There will be a specialist somewhere.

"The ordinary GP cannot keep up with information on everything," says Guy Howland, Chief Executive of the Patients Association. "Most doctors may never come across a patient with meningitis, yet must be able to spot the one case out of thousands of children with fever and earache. It's in our interest to know more ourselves."

In 1993, when Sandra Singer's mother was dying of Pseudomyxoma Peritonei, it was not diagnosed until too late. An extremely rare growth in the peritoneum, it was hardly surprising her doctor had not come across it before. But rather than accept fate stoically, Sandra Singer took action so that other people need not be so short of information. She set up Medisearch, a research company which the public can ring for information on any medical topic. For pounds 29.99 the company supplies the latest articles, papers and on-line information around the world. Medisearch is strictly an information service, although experts were initially concerned that they would be working in competition with the NHS. "We help people discuss the problem with their doctor in an informed way," says Singer. "Many people are still afraid to ask doctors and consultants questions - and in any case, every doctor cannot know everything. We have dealt with 3,000 different problems since we started."

Singer believes visiting the GP is akin to buying a jumper from a chain store: you know you get a quality product, but it's one look for everyone. We would look better in something tailor-made, but that isn't possible for the price we are prepared to pay.

Up till now, the philosophy that "no one knows your body better than you" has been cynically viewed as the remit of cosy complementary medicine. But increasingly the patient having an educated opinion is not just a nuisance but a necessity. "In so many areas," says Guy Howland, "there is not just one right way. If people feel more in control of their illness, they are more likely to get over it."

We cannot simply unlearn our new knowledge, and the growing personal interest in health is an inexorable progression. "Ultimately," says Professor Karol Sikora, Deputy Director of Clinical Research for the Imperial Cancer Research Fund, "a computer will take your DNA sequence and be able to print out the risks you face of contracting any one of a huge number of diseases.

"In some cases these risks will be rather staggeringly high. But the question will always remain, once you have this information, what do you do then apart from worry?"

OVER-THE-COUNTER CULTURE: WHAT'S AVAILABLE

Home Pregnancy Kits

Status: Now so commonplace that a GP would be surprised if a woman who thought she might be pregnant hadn't used one.

Efficacy: Generally now very reliable, have become much more sensitive.

Cholesterol Kits

Status: Available from chemists for the past two years. Takes less than 20 minutes, using a drop of blood from the finger to measure fat concentration.

Efficacy: Cholesterol levels can fluctuate wildly from day to day. May give false security or needless anxiety. Less accurate than testing with a full blood sample.

Diabetes/Blood Sugar Reading

Status: Accurate and easy to administer. Seen as a positive step for people taking control of their health.

Efficacy: Good. One study showed that insulin- dependent diabetics who test their own glucose levels control their condition significantly better than those who do not.

Fertility/Ovulation Tests

Status: Available in chemists. Considerable choice now available covering urine testing, temperature taking and discharge monitoring. Now available is the Unipath Personal System of contraception, featuring a microchip which "learns" a woman's cycle and gives a personal reading without repeated testing.

Efficacy: A helpful indicator for couples who have difficulties conceiving and, for the regular or brave, can work as a natural contraception. Hands control of fertility back to women.

HIV Testing Kits

Status: Available in the USA. Illegal over here.

Efficacy: May be reliable, but raises questions over the wisdom of obtaining results over the phone, since free, confidential person-to-person tests are widely available anyway.

Prostate Cancer Tests

Status: Available soon.

Efficacy: Controversial. May work, but to what end? Because the technology is coming, self- administered tests for cancer will inevitably become more prevalent, but many professionals are worried about the effects of people finding out they have a potentially fatal disease, alone, in their bathroom.

Genetic Tests

Status: The future of self-diagnosis kits. London-based University Diagnostics pioneered genetic testing by post, with a mouthwash kit to identify cystic fibrosis carriers. Biochemical screening for Down's syndrome and spina bifida in foetuses are available by post, and sickle cell anaemia tests are in research.

Efficacy: Again, controversial. Finding out alone or late in pregnancy could be traumatic. Is there always a benefit in finding out?

Blood Pressure Monitoring Kit

Status: Available from chemists. A cuff that works in a similar way to hospital system.

Efficacy: Not as accurate as a manual hospital test. Needs to be done regularly.

Tests in the pipeline

Colonic Cancer, Gastric Ulcer, Cervical Cancer, Chlamydia, Allergies, Asthma.