As Kimberly Crisp approached middle age, bloodwork revealed that she had elevated blood sugar and cholesterol. If nothing changed, her doctor said, Ms. Crisp would need to start medication.
Despite coming from a family of medical professionals and once working as a pharmacist, Ms. Crisp, a 51-year-old in Marietta, Ga., didn’t love the idea. She had come to fear the potential side effects of medications generally and hoped to avoid a lifetime of taking them.
So when Ms. Crisp’s fitness coach told her about a company called Function, she was intrigued. For a few hundred dollars, Function would test practically any adult’s blood and urine for over a hundred biomarkers, far beyond what is typically included in an annual work-up.
Just maybe, she thought, all that data would help her figure out how to more naturally become healthier.
Amid rising interest in alternative medicine and growing skepticism of physicians, health and wellness companies have begun providing Americans a more direct route to medical testing that does not require a doctor’s visit.
In November, the telehealth giant Hims & Hers debuted extensive laboratory testing for customers, just weeks after Oura and Whoop unveiled blood-testing products of their own. The national laboratory network Quest Diagnostics now sells its own consumer-facing tests. LabCorp does, too.
But perhaps no other company has capitalized as explicitly as Function has on frustrations with the U.S. health system. “Ignored by most. Tested by us,” its website states.
For $365 a year, the company provides its hundreds of thousands of members with access to more than 160 lab tests, which it says have helped customers catch cancer early and could help identify the source of hard-to-pin-down conditions.
Already, the broader direct-to-consumer testing industry has been criticized for minimizing the role of doctors and for overtesting, which can lead to unnecessary follow-ups, treatment and anxiety.
But Jonathan Swerdlin, a founder and the chief executive of Function, said the company is simply “committed to empowering our members to own their ever-changing health.”
Research has shown that people with chronic diseases sometimes feel ignored by physicians, and several Function customers told The New York Times that they were drawn to the company after struggling with illnesses their doctors were unable to diagnose or resolve. Kelsey Cook, a 19-year-old college student in San Luis Obispo, Calif., sought answers from Function after a bout of mono years earlier left her feeling inexplicably tired and sick.
The tests, said Timothy Caulfield, a health and science policy researcher at the University of Alberta, are “intuitively appealing” because they suggest that, armed with enough data, any person can take the action necessary to live a healthier life.
But he worries that Function is “trying to generate anxiety and fear in order to sell their product,” he said. The debate is whether more data is always better.
Your Blood, Analyzed by A.I.
When Kasha Lane’s Function tests revealed more than a dozen out-of-range biomarkers, she felt relieved. Doctors had told her for over a decade that she was perfectly healthy despite unexplainable fatigue, but tests were finally suggesting something was wrong.
“I felt validated in everything that I had been trying to tell people for years,” said Ms. Lane, 39, who lives in a suburb outside Nashville.
Many of Function’s tests are conventional, like those that evaluate cholesterol levels and thyroid function. Others are more controversial. The company tests for sensitivities to foods including wheat and coffee, though medical professionals often view such tests as unreliable. It also offers early-detection cancer tests and whole body M.R.I.s — both of which have been criticized for surfacing false positives and identifying abnormal results that pose little risk of harm.
Additionally, Function sells tests that most doctors wouldn’t order unless a patient had certain symptoms. One of them is the antinuclear antibody test, or ANA test, useful for diagnosing autoimmune diseases. But as many as 15 percent of healthy people will also test positive for ANA. Ms. Lane, for example, had an elevated ANA result but no clear symptoms suggesting an autoimmune disease. She is still wondering how to interpret the meaning of her results.
Function says it is not a medical provider. The company does not accept insurance, and the blood draws themselves are performed at Quest Diagnostics locations. Customers also do not interact with a doctor. Instead, they receive a summary created by artificial intelligence and reviewed by a clinician, that includes their results, how to interpret them and what steps to take next.
Ms. Lane’s summary said that, in addition to an autoimmune disease, she could have an iron deficiency, endocrine issues and heightened cardiovascular risk. Function advised her to take a number of supplements and adopt a balanced diet, alongside other unspecified “lifestyle modifications.”
Another founder of Function is Dr. Mark Hyman, a friend of Health Secretary Robert F. Kennedy Jr.’s and a face of the functional medicine movement, which encourages preventive testing and identifying the root causes of illness, rather than treating symptoms. The approach generally prescribes diet, exercise and supplements as first-line treatment.
Mr. Swerdlin said that despite Dr. Hyman’s involvement, Function was not to be confused with functional medicine. Still, several patients interviewed for this article said a Function test was a gateway to the movement.
Ms. Lane was one of them. On the advice of a functional medicine practitioner whom she sought out, Ms. Lane followed a 90-day elimination diet and underwent more testing. Her daily routine now includes taking nine supplements, four times a day, along with a progesterone pill and topical testosterone. She also avoids gluten, dairy, sugar, corn, soy and seed oils, per Function’s recommendations.
The result, she said, is that she now sleeps better and is far less fatigued. When she retested with Function this past June, some of her markers, like those for inflammation, had improved.
Others, like her liver enzymes, were worse.
Is More Testing Always Better?
By performing tests before people develop symptoms, Mr. Swerdlin said, Function is offering an alternative to the traditional “reactive” model of American testing.
Some medical professionals, though, worry that the companies are subjecting patients to costly and unnecessary testing that could lead to false positives or detect disease that would not be harmful in a patient’s lifetime.
Standard bloodwork, performed as part of annual wellness exams, mostly screens for common conditions that have well-established treatments, such as diabetes and anemia. Outside of those tests and others personalized to a patient’s history and symptoms, tests can amount to “fishing expeditions,” said Dr. Michael Crupain, a physician and board member of the American College of Preventive Medicine.
He was also concerned that a doctor is not in the loop from the outset, deciding which tests a patient actually needs and then talking through next steps.
Without that guidance, doctors worry patients might go down a rabbit hole of trying to address mildly abnormal results that don’t necessarily require intervention.
“If you test that many markers, a few of them will be abnormal in a person who’s healthy,” said Dr. David Gorski, a professor of surgery and oncology at Wayne State University who writes about overtesting.
Dr. Hyman said that mainstream medicine was the one getting it wrong. A mildly abnormal test result, he added, may not qualify as a diagnosable disease, but it could be an early warning sign from your body that something is amiss.
“Function is not overtesting,” Mr. Swerdlin said. “Function is making sure that you’re on top of your health and looking across your whole body.”
Ms. Crisp, the former pharmacist, remains less concerned about overzealous testing than being overmedicated.
Recently, when a doctor said he wanted to update her bloodwork, she declined. But, she added, she would be happy to share her recent results from Function.
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