Newsletter Monday
Hello Reader,
How often are you tempted by testing to see how healthy you are? Just this weekend I noticed 2 quite different options on the testing spectrum online.
On one hand, NHS England has been publicising an expansion in genetic screening for inherited cancer risk.
On the other, the private “health optimisation” market continues to grow - including Dr Rangan Chatterjee’s new Do Health app, offering blood tests alongside personalised lifestyle plans.
These aren’t the same thing.
But they sit under the same umbrella question:
When does testing genuinely help… and when does it simply create noise?
The NHS side: this may have value, if it’s done properly
Targeted genetic testing can be genuinely useful when it identifies people at clearly higher risk and there’s a plan attached such as increased surveillance, preventative options, and proper follow-up - with a real person ideally.
NHS England’s new programme is essentially designed to do that more consistently.
Using a central register, eligible patients will be invited for regular checks rather than falling through the cracks.
And this part matters: the value isn’t the test alone.
The value is the context and pathway that comes with it.
Lynch syndrome is an example of screening done well: targeted testing, clear follow-up, and real prevention.
NHS England even referenced their Lynch syndrome register as proof that this model can work - when results are paired with counselling and a clear surveillance plan.
Hooray for progress.
The private market: convenience… with a predictable downside
Private tests and screening can feel empowering.
Sometimes they are.
But there’s a known downside to un-targeted testing, and of testing well people.
The more you test, the more you find borderline results, incidental findings and false positives - things that create worry without improving outcomes.
A real example: Davina McCall accepted a free MRI brain scan expecting to “ace it”… and it found a colloid cyst.
It suddenly it became something she knew about, permanently.
So even if something may never cause harm.
You can’t un-know it.
And this is why I feel uneasy about the direction of the market with regard to private testing.
I hope that Dr Chatterjee sincerely wants to help people with his new subscription health app with lots of biomarkers and results to look over.
But I’m cautious about any model that sells reassurance while the difficult part - interpreting uncertainty - is left to the individual to manage alone.
A test result needs an interaction to follow it, unless it's completely normal.
Otherwise how the hell do you know what to make of it?
I've had many patients bring in private test results marked as borderline and had no one to ask.
The question most people don’t ask before they test
Before any test - genetic, blood, scan, “health screen” - it’s worth asking:
- What are we looking for?
- How likely is it in someone like me?
- If we find it, what changes - and does that change actually improve outcomes?
Because if there isn’t a clear next step, what you may have bought is not peace of mind… but a new worry.
And that brings me to a more personal question:
How much do you actually want to know about your risk?
Risk information isn’t neutral.
If you find out you’re at increased risk of something serious and there isn’t a clear plan attached, it’s like buying a house next to a volcano.
It might never erupt… but good luck forgetting it's there.
Your risk also impacts those who care about you too.
Some people can hold uncertainty lightly.
They absorb the information, make sensible choices, and carry on.
Others can’t.
The information loops. It grows.
A mildly abnormal number becomes a daily mental itch.
They don’t sleep. They retest. They spiral.
Neither response is a moral failing - it’s just how different brains handle uncertainty.
My bottom line
This isn’t an argument against testing.
It’s an argument for testing with a plan.
For proper counselling. For realistic risk framing.
For knowing what “next” looks like before you open the envelope.
And if you’re generally well, the biggest health returns are still painfully unglamorous: build strength, move often, eat enough protein and fibre, sleep properly, and try not to outsource your peace of mind to apps and numbers.
Because more information isn’t always better health.
Sometimes it’s just… more information.
With best wishes,
Lynette
