Mark Cuban is a renowned entrepreneur, owns the NBA Dallas Mavericks and appears on the reality TV show “Shark Tank.” He recently garnered additional attention for his medical opinions. Unfortunately, like so many “celebrities” who are loud and uniformed, his advice is terrible and only serves to undermine best care practices.
As Los Angeles Times columnist Michael Hiltzik put it, “When it comes to health-care policy, he’s brash, outspoken and very misinformed.”
Early this month, Cuban tweeted his 2.8-million followers to “have your blood tested for everything available, do it quarterly so you have a baseline of your own personal health.”
“Cuban displays an endearingly naive view of how medical data is used,” Hiltzik said, “and as a billionaire a limited sensitivity to the cost of screening.”
Cuban also tweeted, “A big failing of medicine = we wait till we are sick to have our blood tested.”
As we often note, unnecessary testing, the overuse of medical care is not just wasteful, it’s risky. As Hiltzik put it, “For the vast majority of individuals, this is terrible advice, brainless and even dangerous. As a matter of public policy, it’s egregiously misconceived.”
Other well-informed medical industry observers also weighed in on Cuban’s bone-headed social media chatter. Charles Ornstein, a highly respected health-care journalist who reports for ProPublica.org, counter-tweeted: “Please don’t listen to @mcuban advice to get quarterly bloodwork if you are healthy.”
Cuban’s unthinking but powerful actions prompted medical experts everywhere to caution against overtesting. They cited solid scientific studies that demonstrated that excessive testing and screening leads to excessive and unnecessary treatment. We’ve explained that such excess not only causes psychological stress and worry, but presents a risk of infection or other complications from diagnostic invasion.
Because the issue is so important, Ornstein offered to debate Cuban in a ProPublica podcast. Cuban declined. He believes that there more is more, that all data is good. “That may be true for investors who typically want to snarf up all the information they can gather about a company and the market it serves,” Hiltzik wrote, “but in medicine things aren’t so simple.”
Just because a screening test is a scientific exercise, that doesn’t mean it always renders a clear indication of what the tester is looking for; it isn’t always definitive that you have a certain health condition or that you don’t.
As Aaron Carroll, a health-care economist explained, “When you get a blood test, it doesn’t come back ‘sick’ or ‘well.’ It comes back with a number value.” The number must be interpreted by comparison with, for example, a population average; by putting it into context of the patient’s symptoms. A proper interpretation can take time to observe whether or not there’s a trend, which itself could be important or meaningless.
So more isn’t more; more leads to more.
As Hiltzik recounted, a just-in-case CT scan “doses the patient with radiation and a colonoscopy can leave physical damage. The risk of a false positive — an indication of a problem that isn’t there — is often greater than the risk of a false negative — not finding a marker of a condition that does exist.”
Ornstein referred to the work of Dr. H. Gilbert Welch, an expert on overdiagnosis: “Twenty years ago, a simple [PSA] blood test was introduced. And 20 years later, over 1 million Americans have been treated for a cancer that was never going to bother them. … It turned out an awful lot of men had abnormal PSAs. Most of these men were treated with either radical surgery or radiation. And roughly a third suffered side effects of treatment generally related to bowel, bladder or sexual function. Even a few have died from it.”
Public health policy should not reflect the mindless use of health resources. It should reflect a complete understanding of the state of the science and the art of medicine, it should reflect an understanding of the costs of delivering the best health care to the most people. It shouldn’t reflect the sugar daddy instincts of people too rich and entitled to use their brains instead of their bank accounts.
As Hiltzik concludes, “As a public intellectual, … Cuban isn’t especially open to professional advice or hard information. His attitude is that he didn’t get where he is today by listening to criticism. But then again, he’s a businessman and billionaire entrepreneur, not a doctor.”