Direct-to-consumer tests can cause headaches

Direct-to-consumer tests seem to be all the rage these days, but how helpful are they, really? Companies are now marketing screening tests for everything from HIV infection to Alzheimer's disease, and while they may seem to be a boon to patients, especially those with high-deductible health plans, they present some important pitfalls. A nodule detected on ultrasound at a health fair may kick off a cascade of unnecessary testing, and an elevated cholesterol level may be meaningless without a physician to put it in context. Our story examines the appeal of DTC testing, the potential problems it can create, and what physicians need to know about it.

Earlier this year, publication of ACP's guidance statements on HbA1c targets in patients with type 2 diabetes made waves in endocrinology circles as well as in the lay media. The main issue is ACP's statement that clinicians should aim for an HbA1c level between 7% and 8% in most patients with type 2 diabetes, given research on the balance of benefits and harms. Subspecialist groups, including the American Diabetes Association, the American Association of Clinical Endocrinologists, the American Association of Diabetes Educators, and the Endocrine Society, however, feel strongly that HbA1c targets of 6.5% or lower offer the best health outcomes for patients. Our story in this issue takes a closer look at where ACP and the subspecialty organizations disagree, as well as their areas of common ground.

Another feature story looks at culinary medicine programs around the country and offers tips on how you can work guidance on nutrition into your clinical practice. A Q&A discusses the advantages of talking to patients about the goals or events that might be on their “bucket lists” and using that knowledge to help guide care. Our Physician Profilefeatures a truly out-of-this-world physician, NASA astronaut Serena M. Auñón-Chancellor, MD, FACP, who will soon be spending 188 days in orbit aboard the International Space Station. Conference coverage from Hospital Medicine 2018 features the latest guidance on managing chronic obstructive pulmonary disease. And speaking of conference coverage, keep an eye out for the July/August ACP Internist, which will be devoted to Internal Medicine Meeting 2018, held April 19-21 in New Orleans.

Do your patients ask you about DTC tests before or after the fact? Do you aim for a specific HbA1c level in most of your patients with type 2 diabetes? Let us know.

Sincerely,

Jennifer Kearney-Strouse
Executive Editor, ACP Internist