Why you should care
From Pap smears and UTI tests to tracking fertility, a growing band of DIY health care startups want to save you the trouble of seeing a doctor. But is that good?
In 2009, 25-year-old industrial designer Jessica Ching received a letter from her doctor asking her to get a Pap smear. Though she was reluctant — the test is notoriously uncomfortable — the Toronto native got one. She also learned that 33 percent of Canadian women don’t, leaving many at risk for cervical cancer. That was 33 percent too many for Ching, in a country where four women are diagnosed with cervical cancer every day. Her solution was Eve Medical, launched in mid-2017, a mail-in swab kit that empowers women to take Pap smears at home. Problem solved.
Eve Medical is part of a growing number of startups developing do-it-yourself home health products and services, tapping into a fast-growing demand. Traditionally viewed as peculiar — even dangerous — DIY home health care is finding increasing traction as people recognize the benefits of being able to address their health needs on their own time, without needing a doctor at every step.
Companies cover every part of the spectrum. U.S.-based Quanovate, founded in 2015, has, since September 2018, started shipping women an Alexa-size measuring tool that tracks their fertility using artificial intelligence. It crossed 3,000 users in one month and plans to expand to China, which has a growing aging population well suited for the technology. Portugal-based Sword Health pairs a Bluetooth-connected motion tracker with a digital physical therapist for low-cost physiotherapy at home.
Scanwell Health, part of American seed accelerator Y Combinator’s 2018 batch, started shipping its FDA-cleared UTI testing tool this July. And Ching, whose kits are already available in 12 countries other than Canada — including Slovenia, Italy, Mexico and Spain — hopes to expand to the U.S.
People are more interested in taking control of their own health.
Jessica Ching, founder, Eve Medical
It’s hard to measure the exact size of this emerging market, as it touches on medical devices, biotech and more. But one pointer to the growing weariness with doctor visits is the exponential growth in direct-to-consumer lab testing, up by 1,566 percent between 2010 and 2018. It is expected to grow by a further 38 percent by 2020, topping out at $352 million, according to a 2016 report by research company Kalorama Information.
“People are more interested in taking control of their own health,” says Ching. “At-home testing is one of the ways they can do that.”
To be sure, home health kits and measuring tools aren’t new — think pregnancy tests or, more recently, devices like Fitbit. But most of these tools have traditionally limited their mandate to diagnostics, so customers and patients still needed to go to doctors as the first step toward interpreting or acting upon the test results. The new wave of DIY health care startups offers solutions that can often cut out the doctor — except in critical situations.
For Stephen Chen, the 33-year-old founder of Scanwell Health, developing home tools is about trying to “democratize diagnostics,” he says. “I always felt like the results were stuck in the system.” He’s not wrong — some people wait weeks for answers, which they’re often unable to interpret. That’s why Chen’s first product, an at-home UTI tester for $35, provides immediate answers via its app. It’s simple to use: Pee on the provided strip, scan the strip in the app and its algorithm spits out your diagnosis. It also connects you to a doctor who calls in a prescription to your local pharmacy.
Making important but hard-to-take tests accessible was Ching’s motivation too. “I’ve had friends who actively avoided their Pap tests even though they knew it was important, and had unpleasant experiences myself,” she says. For now, she focuses on HPV, chlamydia and gonorrhea, as “these are the common infections that affect women, trans and nonbinary individuals.”
But don’t assume that any speedy, easy-to-use health service is good for you. While it’s true that many telehealth companies today will write UTI prescriptions without a urinalysis, Chen cautions people that antibiotic overprescription is a real problem — take them unnecessarily and you’ll regret it when you really need them.
For the DIY health care founders too, breaking into the industry hasn’t been easy. Waiting for his kit to ship is a pain point for Chen, though he hopes to be over the counter in stores soon. Getting to market took longer than expected — as the first FDA-cleared urine-testing app, there were a number of boxes to check. But he’s proud of the certification, saying it builds credibility. “It’s about establishing trust when dealing with people’s health,” he says — no one wants the reputation of another Theranos, which was initially touted as a breakthrough health tech firm only to be revealed as having made false claims about diagnostics using tiny samples of blood.
“Blood is a firewall,” says Bruce Carlson, analyst and publisher of Kalorama Information. Some home tests utilize fingersticks for blood draws, and people dislike that. The biggest barrier, he says, is what people are willing to do — these tests are voluntary, after all. Despite this, growth is huge, which he credits to advances in technology and sample collection, making this a more attractive space for companies and consumers. “The new mobile user wants their phone to organize more of their life,” he says. “There’s a need for more health care than the system is providing.”
In March 2018, the FDA approved genomics company 23andMe to offer DIY home BRCA testing — for breast cancer risk — ostensibly green-stamping home diagnostics. But 23andMe tests only three BRCA variants (out of 500), and while the company is up front about this, Carlson says there’s a danger people will “think they are all-clear” when they’re not. “The FDA approvals [are the government] responding to pressure,” he says.
At Georgia-based nonprofit WellStart Health, chief medical officer Dr. Saray Stancic also had concerns about self-administered home tests. “[It] conjure[d] up worrisome images of misinterpreted results fueling fear,” she says.
But no longer. Stancic highlights a December 2018 report in the highly respected Obstetrics & Gynecology journal to explain her shift. Here, low-income women, a notoriously under-screened demographic, tried home HPV kits, with an in-person test, to check against success rates through lab tests. “The results were comparable,” Stancic says. “I’m happy to evolve on this one if it serves the betterment of our society.”