Daybreak - At-home blood tests are soaring, and throwing up wrong results

Episode Date: June 26, 2024

The pandemic, as brutal as it was, forced a lot of businesses to double down on convenience and accessibility. Whether it was your online education or quick deliveries or at home blood tests. Just to be able to skip that dreaded visit to a hospital or a diagnostic centre meant so much to most people.Accredited labs popped up all over promising to come right to your doorstep and collect your samples from the comfort of your home and that too for super affordable prices. Healthians, a testing lab startup has seen bookings triple since the pre-pandemic era. Now, the company handles 12,500–13,000 bookings daily, with nearly 75% of its business coming from home collections.But while home tests are gaining popularity, whether you can trust them 100% is still under question. Phlebotomists and runners hold the keys to a sample’s fate and accuracy. Tune in.Daybreak is produced from the newsroom of The Ken, India’s first subscriber-only business news platform. Subscribe for more exclusive, deeply-reported, and analytical business stories.

Hi, this is Rohan Dharma Kumar. If you've heard any of the Ken's podcasts, you've probably heard me, my interruptions, my analogies, and my contrarian takes on most topics. And you might rightly be wondering why am I interrupting this episode too. It's for a special announcement. For the last few months, I and Sita Raman Ganeshan, my colleague and the Ken's deputy editor, have been working on an ambitious new podcast. It's called Intermission.

We want to tell the secret sauce stories of India's greatest companies. Stories of how they were born, how they fought to survive, how they build their organizations and culture, how they manage to innovate and thrive over decades, and most importantly, how they're poised today. To do that, Sita and I have been reading books, poring over reports, going through financial statements, digging up archives, and talking to dozens of people. And if that wasn't enough, we also decided to throw in video into the mix. Yes, you heard that right. Intermission has also had to find its footing in the world of multi-camera shoots in professional studios, laborious editing, and extensive post-production.

Sita and I are still reeling from the intensity of our first studio recording. Intermission launches on March 23rd. To get alert, as soon as we release our first video. episode, please follow intermission on Spotify and Apple Podcast or subscribe to the Ken's YouTube channel. You can find all of the links at the ken.com slash I am. With that, back to your episode. On a scale of 1 to 5, how much do you trust an at-home blood test? You can tell me a answer in the comment section. The point of me asking this question is this. The pandemic, as brutal as it was forced a lot of businesses to double down on convenience and accessibility, whether it was

your online education or quick commerce or at-home blood tests. Just to be able to skip that dreaded visit to a hospital or a diagnostic center meant so much to most people. Accredited labs popped all over the country promising to come right to your doorstep and collect your samples from the comfort of your home. And that too for super affordable prices. What more could you ask for, right? Take Healthians, a testing lab startup based out of Bangalore, for example. It has seen its bookings triple since the pre-pandemic era. Now, the company handles 12,500 to 13,000 bookings daily with nearly 75% of its business coming from home collections. But while home tests are gaining popularity, whether you can trust them 100% or not is still under question.

Let's take the case of Anuch. Both his parents who are in their 60s got a home test done through Pharmacy's thyroid care and they found out that they were suffering from diabetes. You can imagine the level of stress that they went through only to realize two days later that it was a false report. So when Anuch spoke to the Kenz Shivani Varma, he, was fuming. He said they're treating home collection like food delivery. And that is not far from the truth, considering the number of similar cases that have come to light lately. What could be the

reason for these inaccurate results? Here's a hint. In India, anybody with a license can operate a diagnostics lab. An accredition from the National Accredition Board for Testing and Calibration laboratory's or NABL is not mandatory. Welcome to Daybreak, a business podcast from the Ken. I'm your host, Nickda Sharma, and I don't chase the new cycle. Instead, every day of the week, my colleague Rahe Philopos and I will come to you with one business story that is worth understanding and worth your time. Today is Thursday, the 27th of June.

To a point where even doctors do not entirely trust reports from e-dial. diagnostic platforms. To understand why the ken spoke to Vishabhasein, the director of Dr. P. Bhaasin Pat Labs, a Delhi-based diagnostics lab. And here's what he told us. Just as you'd think twice before ordering a panir sizzler for home delivery due to quality concerns, but you might go for a pizza, certain lab tests fit the home collection bill while others do not. Since some samples can be collected at home without getting affected, they are widely accepted. but there are some that will get affected. The thing is, there are a whole bunch of conditions that need to come together for a home

collected sample to work. At least 10 former and current executives, phlebotomists, lab technicians and pathologists told again that test results are only accurate if the sample is collected properly, transported under specific conditions and deposited at the lab as soon as possible. But many of them also admitted that these ideal conditions are often not met. Basin, who has over a decade of experience in the diagnostics industry, noted that the travel time from sample collection to a testing lab for many companies, including startups like Healthians, can be up to six hours. So the Ken reviewed 17 reports from home collection service users.

The time from sample collection to lab receipt, changed from three and a half hours to nine hours. Only Orange Health Labs managed to receive a sample within 20 minutes. Max Labs and even listed companies like Dr. Lal Path Labs and Metropolis did not specify the time the samples reached their labs. So you see how the pandemic created the perfect pathway for the transformation of this unregulated and unorganized diagnostics industry. But in the race to offer convenience to customers, the business,

is becoming a victim of intermediation. And accuracy, which is of utmost importance in this case, has gone for a toss. Stay tuned to find out how exactly. Viniath call a New Delhi-based fintech professional usually books Max Lab services a few times a year for all kinds of tests, from complete health checkups to specific assessments like thyroid, CBC and lipid profiles. Now, one fine day, Vinet noticed a good. concerning pattern. On three occasions, the potassium levels in his Max Lab report had spiked indicating hypercalaemia, which essentially means a big risk of heart attack. He wasn't so sure of it, so he sought a repeat test for potassium alone from Dr. Lal Pathlabs and the results were normal.

Call shared these reports with an independent doctor to confirm. But until he was sure, him and his entire family went through hell. talked about it with us. He said that everyone was worried that something was wrong with him. And you cannot put a cause to something like that and you cannot let go of a wrong test. Now, let us try to understand what could have happened in this specific case. Bacin explained it to us. He said that with general health checkups, potassium is the test that gets the most impacted due to transport conditions. Hemolysis, the destruction of red blood cells can increase potassium levels.

If the values are off the charts or missing from the report, it is a clear sign that the sample was compromised. Even Dr. Shantakumar Murida, who works with NABL, told us that potassium test is indeed time sensitive. The Ken found that Max Lab reports omitted crucial information about sample arrival times. It only gave details about when it was collected and when the report was released. Same with Dr. Lalpath Labs. Even with a comprehensive package like the well-wise essential body checkup from Max Labs, reports only displayed collection dates and times. Now, here is what is the most concerning thing. Potashim is not just a footnote in blood work. Murudah told us that it plays a super important role in kidney function tests. Even in diabetes, kidneys are often the first organs

that get affected. So checking potassium is standard in blood work for patients with the most common issues like kidney disease, hypertension and heart issues. There are basically three variables that play a huge role in the accuracy of these tests. Number one is pre-analytic or before the sample reaches the lab. Number two, is analytic? or during the lab processing. And number three is post-analytic or after the test is conducted. With home collection, the spotlight is on the pre-analytic stage. And that is where phlebotomists and runners play a crucial role.

They are the ones who hold the keys to a sample's fate and accuracy. Stay tuned for more on this. Every day early in the morning, phlebotomists across India don't their uniforms and masks and hit the ground with their square bags slung over their shoulders. Each one is given a specific area and they have to travel 15 kilometers or more to collect samples. Tata 1MG employees over 800 phlebotomists and Helthians has a fleet of around 1800. Deepak Sani, the CEO and founder of Helthians, claimed that phlebotomists from his company collect 8 to 9 samples daily.

Ken has learned that the figure can go up to 22 for some of these platforms, which basically means around 15 minutes or less per patient. To go deeper into the process, we at the Ken booked serum electrolytes tests from six labs across three metro cities. We saw how some phlebotomists were ill-prepared, they did not have enough ice packs, or were opting for ice boxes instead. But multiple lab technicians that we spoke to said that the sample should be nestled between many ice packs.

We also learned how these labs transport the samples. Dr. Lal Path Labs and Metropolis phlebotomists take the sample to their nearest centers, which then send them to a regional or a central hub. Those who work for Tata 1MG, Healthians, Farm Easy and Red Cliff meet the runners periodically in designated areas to hand over these samples. These runners then transport the samples in chiller boxes to, labs which may be situated far away. Take Healthians for instance. Most of the tests collected in Delhi and CR are processed at its Gurgao lab and this is based on information that we receive

from six people including three former phlebotomists and lab technicians at the company. The distance between New Delhi and the lab is around 33 kilometres while places like Ghaziaabad and Greater Noida are even further away. All are typically congested with traffic. So what happens if blood samples do not survive the journey? Well, it is a nightmare situation for phlebotomists who have to bear the financial burden of that. A farm easy phlebotomist who earns 160 rupees per collection receives no extra pay to collect samples for the second time. Some of the platforms also offer fixed salaries of 18 to 20,000 rupees per month. Some labs like Dr. Lalpat Labs give ice pack replacements.

to the phlebotomists, but others like Redcliffe, 1MG, Farm Easy and Healthians do not provide such facilities. Here's what one phlebotomist told us, and I'm quoting, let us say I collected your sample at 6am. I will keep collecting till 7.30am. I'll meet the runner at around 8 who will spend another hour or so collecting the samples from other phlebotomists. Your sample will keep travelling for at least 3 hours.

End quote. samples, except one that the Ken gave for the serum electrolytes test, took more than three hours to reach the labs. The tests were done from 1MG, Farm Easy, Orange Health, Lalpath Labs and Metropolis. Only Orange Health sample reached in two hours. So, all of this for the sake of convenience, right? Anuj, from earlier in the story whose parents were given a false diabetes report, believes that discounts play a big role. Of course, people will feel great when they get a test that is worth $3,000 for $1,500. And then comes the most important factor, which is how easy it is for someone to run a

diagnostic lab in India. Anybody with a license can operate a diagnostics lab, NABL accredition is not mandatory. And while both Tata 1MG and Healthians cited annual audits, doctors' authentic, of reports, repeat collection of compromise samples, and the NABL accredition, the truth is that the autonomous body, which is under the Ministry of Commerce and Industry, is not a regulator. Like Dr. Murada said, and I'm quoting him, it, that is, NABL, does not have the authority to penalize a lab or initiate any action.

Unfortunately, it is also not mandatory for a lab to have qualified doctors such as a pathology, or a microbiologist. Anybody can run it, end quote. Isn't that absolutely insane? Daybreak is produced from the newsroom of the Ken, India's first subscriber-focused business news platform. What you're listening to is just a small sample of our subscriber-only offerings.

A full subscription unlocks daily long-form feature stories, newsletters and podcast extras. To subscribe, head to the Ken.com and click on the red subscribe button on top of the Ken website. Today's episode was hosted by Snickda Sharma and edited by Rajiv See.