Rapa Newsy’s - If you had $500 to invest in checking baseline labs and then later surveillance labs / testing, what would you put on your list? Here is a short list. Make arguments for what to add or what should not be on this list.
Advanced lipid testing - Lpa / LpPla2/ ApoE/ ApoB
Cardiac Calcium Score / CIMT
Hormone testing - testosterone/ estradiol/ progesterone (women)/ TSH, free T3
Mammogram (age specific women)
Biologic Age testing ?
It depends on what your goals are.
If one is looking to save money and consistent serial labs - just focus on routine labs:
- CBC with diff
- Lipid panel
- CGM Freestyle Libre 3 or Dexcom (ie via Costco if out of pocket). DTC is cheaper but not FDA-approved.
- DTC Smartwatch and/or Actigraphy, 2nd hand (device must have some validation on accuracy with the “gold standard”. In several years - a full set of vitals with decent accuracy should be possible though)
- DEXA w/ visceral fat estimation (if you have some budget left) or fat calipers + physician’s scale + tape measure.
If you’re really looking to save money, go a few weeks after donating blood to an urgent care clinic with a blood draw and in-house labs that are in-network, preferably run by a private equity firm and all NPs. Then, tell them some real symptoms you’re having that may be related to inflammatory processes (ie joint pain), recently donated blood (CBC), on niacin for “high cholesterol” and dad had HTN/silent MI/stroke/TIA/whatever CVD risk in the family (lipid panel), and take a lot of supplements (gets LFT for sure).
Should be enough to trigger all of them for a $5-10 copay without actually lying. Personally I just get them frequently with my concierge PCP anyways, so it’s about the same.
You can probably get DEXA for free in an exercise physiology lab or pay $40 or so at an academic center as well. Or if that’s too much - second-hand professional fat calipers, tape measure, and a physician’s scale at a liquidation auction.
For CGM, you could go with $150 per month/$75 per refill or you could just get refills fewer times to keep within $500. Could go cheaper with non-FDA approved, but I would be wary.
For WGS, preferably CLIA-certified which is about $1000 or you can probably get it via a clinical trial for free. If that’s too much…there are certain concierge clinic startups funded by VC firms that run a “free trial” promo where you can get DTC WGS from 23andMe for free. For DTC, you should definitely use certain maneuvers to preserve privacy. If I had to do DTC, the strategy is to use my second legal name on my other passport (well, I did that with CLIA cert lab anyways along with other things just to be extra sure in case of a security breach). Don’t let insurance companies get access to your WGS data. Companies can go bankrupt and all the policies they have are thrown out of the window as they sell your data to the highest bidder.
Definitely can make it within $500, not including upfront equipment costs - which isn’t really all that much.
@tongMD Thank you! These are all great points. Lets assume that you have a primary care provider that would get yearly heath maintenance labs - cbc, cmp, lipid panel and yearly preventive testing - mammogram and pap. What would you want to pay for above and beyond to monitor you health span / longevity? I am trying to see where true value comes into play vs. a shot gun approach that is not efficient and may not be based in much data support. I do like the Oura Ring / Whoop / personal data devices that assist on your decision making. Continuous glucose monitoring would be an interest since many disease processes branch off of an imbalance of sugar / insulin.
Well… you already know the answer - USPSTF guidelines
Haha! I hate to say this as a physician and I totally respect people that come up with guidelines, but not a fan of many guidelines that come out.
Yeah economically efficient on a population level when having a high bar for strong evidence.
I mean what you’re asking is highly individual-based with “precision medicine”, so there’s no real single answer - kind of the opposite of what they’re practicing. I’m just trying to offer information as to what is reasonably available to almost everyone, rather than unavailable to almost everyone.
But in case one wants the full answer:
The other problem is you need labs to run validated “multi-omics” if you really want to get to “high value” - which isn’t cheap unless you go with clinical trials.
Then - you need computational biology/biochemistry experience, and TensorFlow/Python-PyTorch/ML experience - probably at least MS/PhD level to really make any decent interpretations.
That’s why I just end up doing it myself - instead of hiring someone as it’s way too pricey these days for my tastes to get anyone decent - which will easily go out of a $500/year budget very quickly.
I will also note one could get pretty much any gene therapy reliably done in Colombia, if you know the right people and exactly what you’re looking for, assuming you have something pretty serious that is worth the risk of failure. You could get most APIs made with a trusted vendor in China to get personalized meds.
It’s actually not that expensive and one with the right knowledge could do almost anything, except the expensive validated “multiomics” tests and certain cell-based therapies ie CAR-T that run to $1,000,000 easily.
Great points of discussion.
Individual approaches based on many variables - age, sex, genetic make up, medical history, short term goals and long term goals.
The topic of what labs to get and follow can be as confusing as what modalities to use to maximize your Health Span / Longevity goals.
We have many people spending their money on testing to compare their chronologic age vs. their biologic age - yet no one seems to agree that any of these tests are accurate. If you are 60 y/o and your testing says that you are 25 y/o then what? You are on pace to live 50 - 60 years more ( 110 - 120 y/o)? I like the testing, especially when I get results that make me feel good, but not sure its worth the portion of my $500 or even $1,000 if there are better and more efficient testing.
How do we measure and weigh subjective results? Some would say no value and others think it is only true value of importance.
When do you stop taking a supplement, Rx and or modality that you started because of belief in it affecting your longevity and or Health Span? @Maveric78 had some great points about NMN. Experts are shifting away from it, but many are continuing it because they still see a value in it.
When do you drop a lab or test that you believed in for a “better” test? I am hoping we all see some kind of consensus on some tests vs. a decent discussion on pros and cons of other tests.
@tongMD - As always, I appreciate your detailed thought process