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Wilkinson E. The rise of direct-to-consumer testing: is the NHS paying the price?. BMJ. 2022; 379

Freeman EE, Abbott S, Kurpiel B, Okwor T. The dynamics of monkeypox transmission: Pre-exposure vaccination and vaccine equity are urgently needed worldwide. BMJ. 2022; 379

Ward T, Christie R, Paton RS, Cumming F, Overton CE. Transmission dynamics of monkeypox in the United Kingdom: contact tracing study. BMJ. 2022; 379

News Focus

02 November 2022
Volume 33 · Issue 11

High street blood tests are a worry for general practice

Companies offering private blood tests for a range of health conditions and vitamin deficiencies are piling the pressure on general practice, according to the BMA.

Misleading claims

An investigation by The BMJ (Wilkinson, 2022) has found that while the market for these private tests is booming, some companies are making ‘misleading claims’ and ‘leaving an already overworked NHS to follow up “abnormal results”.’ There are now dozens of companies offering these home testing kits for a wide variety of conditions including diabetes, cholesterol and vitamin D deficiencies. Some are even offering genetic cancer risk screening and non-invasive prenatal screening for chromosomal abnormalities.

Responding to the investigation, Dr Preeti Shukla, BMA GP committee clinical and prescribing lead, said: ‘The rise of private companies offering over-the-counter, unregulated blood tests that make dubious claims about what they can identify, is a real concern for GPs and their NHS colleagues, who are the ones who are often left to interpret results and reassure their patients.’

Tests should be safe and clinically necessary

Highlighting the role the UK National Screening Committee (UKNSC) plays in assessing whether screening is worthwhile for the NHS, Dr Shukla continued: ‘The UKNSC makes clear recommendations around screening in this country – and those tests that are safe and clinically necessary. While people are free to choose to access private healthcare and treatment, those companies offering services not approved by the UKNSC or offered by the NHS need to ensure they can provide follow-up care, rather than pushing it back to NHS general practice at a time when family doctors and their colleagues are already under unsustainable workload pressure trying to meet the needs of patients who need them most.’

There are now dozens of companies offering home testing kits

These tests come with a risk of false positive results, ‘which may lead to a catalogue of unnecessary and potentially invasive tests and anxiety for the patient’, and things may also be missed, creating false reassurance for the patient when in fact something is wrong, causing delays to care (Wilkinson, 2022).

Worry and anxiety for patients

The BMJ investigation highlighted how many of the companies send a clinician-reviewed report to the patient, but this may not be enough. Dr Shukla adds: ‘Providing people with test results with no context or explanation, nor with any follow-up arrangements, can cause unnecessary worry and anxiety, and it puts GPs in an incredibly difficult position if they are asked to interpret and explain results of tests that they have not initiated, and make decisions based on them. Of course, we would continue to encourage anyone with worrying symptoms or health concerns to approach their GP practice, as well as make use of approved and regulated testing and screening programmes available through the NHS when they are eligible and invited.’

Screening companies should not assume general practice will deal with the results

In 2019 the Royal College of General Practitioners (RCGP) published a position statement about private health screening, warning that ‘the organisation initiating the screening should not assume that GPs will deal with the results’ (RCGP, 2019). However, as the BMJ investigation points out, ‘this puts GPs in a difficult position’.

Calls for improved regulation

There are calls for better regulation of at-home tests, particularly around advertising. As a result of the investigation, The BMJ referred two companies to the UK Advertising Standards Authority for misleading claims about the accuracy or detection rates associated with at-home tests (Wilkinson, 2022).

Monkeypox can transmit before symptoms occur, with implications for infection control

A UK study has found evidence for ‘substantial’ monkeypox transmission before symptoms appear or are detected, known as pre-symptomatic transmission (Ward et al, 2022).

Understanding how the virus spreads

Transmission was detected up to 4 days before the onset of symptoms, with researchers estimating that 53% of transmission occurred in this pre-symptomatic phase. This means that nearly half of infections cannot be prevented by asking individuals to isolate after they develop symptoms. While previous research on pox viruses did not rule out transmission prior to symptoms, this work represents the first evidence to support this.

Although case numbers are declining it is key to understand how the virus spreads to help inform policy decisions.

The findings are based on routine surveillance and contact tracing data for 2746 individuals who tested positive for monkeypox virus in the UK between 6 May and 1 August 2022. Their average age was 38 years and 95% reported being gay, bisexual, or men who have sex with men.

Implications for isolation

These findings have important implications for isolation and contact tracing policies, say the researchers, adding that backward contact tracing strategies (tracing from whom disease spreads) should account for a pre-symptomatic infectious period when trying to find the contacts of confirmed cases.

Vaccine equity is urgent

In a linked editorial (Freeman et al, 2022), researchers based in the US, UK and Nigeria argue that pre-exposure vaccination and vaccine equity are urgently needed globally.

Vaccination is likely to be more cost effective than managing the consequences of preventable infections, including hospital admissions, loss of income during isolation and long term complications, they explain. They go on to highlight that many of the public health measures that have been critical during monkeypox outbreaks in high income countries remain unavailable in much of Africa. ‘As the monkeypox outbreak declines in Europe and North America, we have a responsibility to deploy effective tools for viral control on a global level - not just in wealthy nations,’ they write. ‘These tools include research into understanding transmission dynamics in African settings and the inclusion of endemic countries in vaccine trials.’