Copyright 2001 The New York Times Company 

February 1, 2001 
The Medicine Chest Pumps Up
By TRACIE ROZHON

JEFFREY SEWARD started checking his blood pressure at home about a year and a half ago, when he turned 50, with a monitor he bought in a drugstore for $80. "I've got a history of high blood pressure in my family," he said.    "And when I hit middle age, I started seeing the signs."

At first, he got carried away: he took his blood pressure every hour and a half. He is now down to two or three times a day.

Fred Hovasapian and his wife, Rona, also have started checking their blood pressure at home, and Mr. Hovasapianmeasures his blood sugar twice a month with a home kit. "We're not neurotic about it," he said, with a laugh. "We'veseen people taking their blood pressure in the supermarket."

As the baby boomers and their younger cousins mature, they are becoming more involved in assessing their own health— often without the direct supervision of a doctor. To them, this no longer means simply working out in a gym, butwatching for the onset of the illnesses that shortened their parents' lives. Younger consumers, too, are interested in theirown health and that of their children — born and unborn.

The home medicine chest used to contain tweezers, aspirin and Vicks VapoRub. As medical technology expands, so,too, does the medicine cabinet. Americans are embracing self-testing and self- treating devices that were not eveninvented a decade ago — or that were not nearly so reliable.

Increasingly, Americans of all ages are measuring their own blood sugar, monitoring their blood pressure,eavesdropping on their heartbeat and worrying over their body fat. They are even checking for urinary tract infectionsand colorectal cancer — in the comfort of their own split-level. The sales of one home EKG machine, imported fromGermany, has doubled in the last year. And lots more are in the development stage: a Japanese toilet will test a user'sblood sugar and look for signs of cancer — automatically. 

Doctors, insurers and pharmacists confirm the boom in at-home monitoring and treatment. "There's a great increase inthe demand for home care devices," said Alice P. Pentland, the medical director of the new Center for Future Health atthe University of Rochester.

 To Dr. Bob Buxbaum, an assistant professor at Harvard Medical School, the rush to self-diagnosis is indicative of "the medicalization of everyday life." The downside, he added, "is that people begin to obsess about every detail" and that they may not properly use the information they gather.

The Media Lab at the Massachusetts Institute of Technology is working on making at-home devices easier to use.  Already developed are shoes embedded with computer chips, which detect tell tale changes in gait, and a training machine equipped with tiny cameras that appraise a stroke victim's exercise technique.  In the works at Rochester are a mirror that checks for signs of skin cancer and "pillowcases" with sensors that read nocturnal breathing rhythms. 

"We're on the cusp of a revolution in the types and numbers of home devices, of drugs that allow outpatient care," saidStephen J. Ubl, an executive vice president of the Advanced Medical Technology Association, a trade group based in Washington. "As the tests got more sensitive, people were able to carry them out in their own homes — the wholeparadigm has shifted.

"Where people once relied on the privacy of a doctor's office for the answers to sensitive questions, they now unwrap home pregnancy tests ($22)—or ovulation monitors ($270) for fertility treatments. And there are kits that screen forH.I.V.: when customers buy the kit ($90), they receive a confidential number. Although they still need a lab to interpret the test, they can phone for results 24 hours a day using only the code. Similarly, people can do their own drug tests at home, eliminating the chance of unexpected results on a mandatory test for a job.

At Zitomer, a pharmacy on Manhattan's Upper East Side, Phil Zam, a pharmacist, piles up glucometers, pregnancytesters and blood pressure aids — all for sale and most of them for under $100. A glucometer goes for $59.95; a bodyfat monitor for $176; colon cancer test strips (throw them in the toilet, and if they turn blue, there may be a problem) cost $7.59 for five tests.

Demand for such devices has mushroomed in the last five years. Mr. Zam estimated that sales have doubled from 1999to 2000, but would not give specific numbers. Most of the devices are not covered by insurance, but consumers say theydo not care: the important thing for now, they say, is to safeguard their longevity.

Last week, the Center for Future Health opened a "smart home." With Naugahyde easy chairs and almond- colorFormica kitchen cupboards, it could be any Sheetrocked suburban one-bedroom apartment — with one substantialdifference. The pseudo- apartment, designed to test daily health care routines, will be used to observe volunteers behindtwo-way mirrors.

 Here is the way it will work: first, a high-tech device will be developed, either at Rochester or at M.I.T., which iscollaborating with the center. Students and professors will watch volunteer families use the invention. "A 22-year-old graduate student can develop something and think it's great, but if it's too complex, the patient willthrow up his hands," Dr. Pentland said. By observing the behavior of the families, the researchers will be able to make products easier to use.

"We're a research lab charged with developing more home health care use," Dr. Pentland continued. "We're developingone version that puts the doctor in the loop. But with sensors, we're developing a level of home supervision that takesthe doctor out of the loop, for prevention." For the geriatric population, "it means being able to regulate their medicines as easily as putting on a pair of eyeglasses,"she added. "For younger parents, it may mean making it easier to treat a hyperactive child in the home. A device may signal when they need a trip to the doctor — or that it's time to sit down and read them a story."

The experiments, which will start within the next two months, she said, are merely a continuation of the trend that started when drugstores marketed the first home blood pressure meter a decade ago. M.I.T. is developing a game fordiabetic children to play over the Internet with other children, a game that teaches them to control their blood sugar through diet. 

But while some doctors welcome home technology, others question the consumer's competence. At Empire HealthChoice, the new name for Empire Blue Cross and Blue Shield, Alan E. Sokolow, the chief medical officer, said hiscompany rarely paid for devices not specifically prescribed by a doctor."If the doctor merely recommends or suggests, we don't cover it," he said. "If it's dialysis at home, or certain treatmentsfor asthma, then we may."One of the main problems with home monitoring and testing, Dr. Sokolow continued, is the consumer's "jumping toconclusions, and taking too much responsibility" for medical decisions made without consulting doctors. "There is a potential for error," he said. (The American Medical Association, a spokeswoman said, has no policy on the subject ofhome health care devices — and therefore would not comment on them.)

One doctor grumbled that the machines do not cut down on the number of office visits. On the contrary, he said, they may actually increase them because some patients rush to the phone with every innocuous rise or dip in blood pressure.The objections of doctors notwithstanding, home testing and treatment is here to stay.

Take the Japanese Smart Toilet, being developed by Matsushita and planned for release in the United States in 2003.The toilet provides a morning checkup, reads body weight, fat content and urine sugar levels and, if you want, notifiesyour doctor if results are amiss. The toilets are to retail for at least $1,500.But for some people, there is a limit to the technology they want to invite into the home.Along with borderline high blood pressure, Mrs. Hovasapian has high cholesterol. But she said she was not rushing outto buy a home cholesterol monitor. "I'm trying to keep my weight down," she said. "I don't want to drive myself crazy. I don't want to get paranoid."                         

Copyright 2001 The New York Times Company