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Transcript: Can You Trust Your Gut When It Comes To D.I.Y. Health? - Consume This podcast

The ability to access healthcare services is vital for the overall well-being of individuals. In this episode we examine how rapid technological developments are changing the way we engage with the health system. Dr Ruth Large talks us through the NZ Telehealth Forums ‘Patient Anywhere, Clinician Elsewhere’ model. We’re then joined by Dr Richard Gearry who helps us understand the risks and benefits associated with D.I.Y. home health testing kits.

Jon Duffy: Alright. Testing 1, 2, 3 for volume. Testing 1, 2, 3. Lucy can you say testing 1, 2, 3.

Lucy: Testing, 1, 2, 3.

Jon Duffy: Okay, that's good. Okay Lucy, so I have to open this thing that I've got from work, which is, uh,

Lucy: A box.

(Sounds of box being opened)

Jon Duffy: It's got, um, critical products written on it. So let's open it up and see what's inside. What can you see?

Lucy: Paper.

Jon Duffy: Paper. Yep.

Lucy: In a bag

Jon Duffy: and a big sign that says, stop! Before you begin your stool collection more is not better!! Two exclamation marks.

Lucy: Ew.

Jon Duffy: Do you know what a stool sample is?

Lucy: A poo sample.

Jon Duffy: It's a poo sample. Collection requirements.

Lucy: The different types of poo.

Jon Duffy: There are different types of poo pictured on this gut health questionnaire form, which I'm gonna have to fill out.

Lucy: It looks like a urine test.

Jon Duffy: It does look like a urine test, except it's not for urine. What's it for?

Lucy: Poo

Jon Duffy: yeah, there's some liquid inside the bottle. Do not overfill your collection tubes. Note that there is a line, a fill line in the tube.

(Laughter)

Add small amounts of specimen at a time to be sure that the total contents do not go above that line.

Lucy: I think that's the line.

Jon Duffy: Oh, that's a lot of poo now I think. Um, You're right. All right. Yeah. So are you able to hold that while I do the poo?

Lucy: No.

(Laughter)

Jon Duffy: All right well, I'll get off and do the business.

Lucy: What do you want me to do?

Jon Duffy: Just wait there.

(Laughter, scene change)

Sophie Richardson: What an earth is going on there. Poor child is wrangled into these poo samples.

Jon Duffy: Well, yes, I had to do a poo for work. It's not in my job description.

Sophie Richardson: Mm-hmm.

Jon Duffy: But, um, I did

Sophie Richardson: paid to poo

Jon Duffy: I do it anyway for the love of it. No.

So this week on Consume This, we're looking at kind of the changing nature of our interactions with the medical industry, healthcare, and in particular the rise of do it yourself medical stuff.

Sophie Richardson: Mm-hmm.

Jon Duffy: So things like home health tests from companies like i-Screen, there's a company called Lifery and uh, Prima Home is another one. These companies all produce tests that you can do at home, and they're increasingly available in chemists and wellness stores across the country. And it's not just for the microbiome which is the test that I did.

Sophie Richardson: Mm-hmm.

Jon Duffy: But it's for all kinds of things. As part of this episode, we conducted a nationally representative survey to discover how many of you out there in New Zealand are using these types of tests.

So Sophie, what do you think? What's the number? How many people out of, let's say 10, are using these tests?

Sophie Richardson: Oh, well, oh, that's interesting that you said it was out of 10. Because my initial feeling was not that many because they're quite expensive.

Jon Duffy: What, like just 10 people?

Sophie Richardson: No, like one in a hundred is what I was like imagining.

Jon Duffy: Well, just in terms of maths, you're right. Oh oh one in a hundred.

Sophie Richardson: Yeah.

Jon Duffy: No, in terms of math, you're wrong. It's one in 10.

(Laughter)

Sophie Richardson: Oh, okay.

Jon Duffy: One in 10. So 10% of us are using these tests on a regular basis.

Sophie Richardson: Great. I mean, that is actually much more than I thought. Yeah. Cuz your test alone costs like $300, which is quite expensive.

Jon Duffy: Yeah, it's not cheap. And I spent that money as a healthy person.

(🎶🎶🎶 Music in 🎶🎶🎶)

Jon Duffy: You are listening to consume this with me, Jon Duffy and my co-host Sophie.

Sophie Richardson: Hello

Jon Duffy: This is the fourth and final installment of our health mini-series. We've covered drug testing, vaping, and natural health products. And in this episode, well, you might have guessed it from the intro, maybe, we are looking to the future and investigating how access to healthcare is evolving. We'll get into the DIY like our poosperiment. And by the way, I haven't seen the test results yet, but I'm informed we have them. So fingers crossed I am all good and healthy.

But first, Soph

Sophie Richardson: Yes

Jon Duffy: This may seem like a bit of a tangent, so just bear with me.

Sophie Richardson: Okay.

Jon Duffy: I want to talk about geography.

Sophie Richardson: Yes, it does seem like a tangent from poo. Yeah.

Jon Duffy: You know this. I know this. We hear about it all the time in the media, but I'm gonna reiterate it. We're a large country with a small distributed population. There's about 19 of you out there per square kilometer. Now that doesn't actually mean terribly much to me. So to give you a bit of context, the global average is about 60 people per square kilometer.

Sophie Richardson: Wow.

Jon Duffy: And there are tons of upsides to this. You know, our sparse population. Beautiful native bush, amazing empty beaches, great air quality. Sophie Richardson: Clean green, New Zealand.

Jon Duffy: Yep. So on and so forth. Uh, whether you buy into that image or not. But there are also some drawbacks, and one of the big ones, as we've seen recently, is our infrastructure.

Sophie Richardson: Mm.

Jon Duffy: And there are times when we, as a country, well, we struggle to provide our communities with the resources that they deserve. It's difficult and expensive to provide necessary, but niche services to small dispersed populations, and that also applies to healthcare.

Sophie Richardson: Mm-hmm.

Jon Duffy: And there has been a massive debate about this particularly with the health reforms that have taken place over the last few years.

Sophie Richardson: Mm-hmm.

Jon Duffy: Which is why I want to introduce you to someone who's helping us rethink some of these physical barriers. Dr. Ruth Large.

(🎶 Short music sting 🎶)

Dr Ruth Large: So my main areas of interest is in access to healthcare, particularly rural and remote access to healthcare. That's kind of where my initial interest lay. I think we've had this tendency, particularly within a paternalistic medical system, to think of the medical professional's time as being far more valuable than the person who's actually at the other end.

So we've sort of accepted that people will travel long distances or take a whole day off work in order to do that. Rearrange their family circumstances, whatever that may mean. That's swung now to certainly being a lot more considerate.

Jon Duffy: And what Dr. Large means here is the system is slowly becoming more considerate of your time as a patient, not just your doctors. Amongst her, many, many other roles Dr. Large is the Chief Clinical Officer of Whakarongorau Aotearoa. That's the organization that runs Healthline. She also chairs the NZ Telehealth Forum.

Dr Ruth Large: So telehealth is the use of digital technology to assist a patient when the provider and the recipient are separated by time and or distance.

Jon Duffy: Even before becoming the chair she's been a key part of the forum for over a decade.

Dr Ruth Large: As time's gone on, I've recognized that actually access to healthcare can be just as difficult if you're in the city. Whether that's because of your work circumstances, or whether that's because you've got a disability that makes it difficult to get around, or because you have difficulty getting access to transport or it's too expensive.

Sophie Richardson: Yeah, I think that's quite true. I mean, I live in a major city, I have access to public transport, and I don't have a disability, and I still find it difficult sometimes to get the to the doctor in the hours that they provide. So I can only imagine it must be even more difficult for people who have those barriers. And sometimes there are several of them.

Jon Duffy: Absolutely.

Dr Ruth Large: If you think of the oncology patient or somebody with a chronic terminal illness, every day is valuable. And if you're gonna spend a full day trying to get to a healthcare access appointment, that can make you incredibly tired and it can take a day out of your life that you would much rather be doing something else.

So I think just thinking in those terms makes a difference.

Jon Duffy: And the NZ Telehealth forum have essentially spent those last 10 years thinking in exactly those terms. They've been busily coming up with strategies to make access to healthcare easier for us. And of course, this is also being facilitated by significant advances in medical technology.

Dr Ruth Large: Yeah, that's right. Over that time you know I carry an ultrasound in my pocket now. I've got a digital stethoscope. You know, all of these things that just weren't even in our vision 10 years ago.

Jon Duffy: So in response to the possibilities opened up by these technological developments the telehealth forum has created the PACE model. And that's an acronym for Sophie... any ideas?

Sophie Richardson: I don't know, but I thought it was to do with children, cuz I'd heard of the one where it's like playfulness, acceptance, curiosity, and empathy, which I don't think is applying here.

(Laughter)

Jon Duffy: It seems slightly out of context.

Sophie Richardson: Yeah.

Jon Duffy: Yeah. Actually it's patient anywhere, clinician elsewhere.

Sophie Richardson: Well, that sounds good.

Jon Duffy: Yeah. Um, the basic premise of pace is that you should be able to easily and remotely access high quality care wherever you are in the country.

The concept in its entirety, I guess is, is almost completely brand new. It stems from a white paper, the telehealth forum, published around 12 months ago, and we'll put a link to that in the show notes for you as well.

Sophie Richardson: Okay, great. I'll read that later.

Jon Duffy: So, yeah, it could be as simple as having a video call with your doctor rather than driving into town. Or it could also be as complicated as being hooked up to medical instruments by a nurse in a small, regional primary care facility with all your results being transmitted in real time and assessed by a specialist in a totally different part of the country.

Sophie Richardson: Wow. And I presume also internationally.

Jon Duffy: Yeah, well, why not?

Sophie Richardson: Mm-hmm.

Dr Ruth Large: Theoretically... And that's where the technology comes in. So the technology is the enabler. It's not the be all and end all. Some conversations are actually fine by the phone, others, you really need video. Others you might need extra pieces. So, you know, a digital stethoscope, the ultrasound that we've talked about. What we call remote patient monitoring. So devices that might look at the rhythm of the heart or give how much oxygen's in the lungs. All of those sort of things, which we can now sort of plug in. And some of this happens already, so, you know, it's not like we're reinventing the wheel.

There's lots of really great examples in New Zealand and overseas of us doing this. It's just that it's been in relative silos and isolated to particular specialties in particular areas.

Jon Duffy: Another great example of this is the National Poison Center. So if you think you've been poisoned, you can call 0800 POISON for help. It's simple, quick. And easy to access.

Sophie Richardson: Good to know.

Dr Ruth Large: Now, those amazing doctors, nurses and pharmacists are in Dunedin, but anybody in the country can get access to those people. So we're already doing that by phone, which is absolutely fine generally speaking for poisons. But then we've also got things like, you know, renal dialysis units in in Northland, who are supported by Whangarei.

We've got areas in the Waikato which are also supported by telehealth services.

Jon Duffy: And that's really what the PACE model comes down to. It's not about reinventing healthcare or replacing in-person access. It's about providing us with alternative options. Options that better suit our needs and improve the availability and quality of care. And crucially, joining all those services up so you can be referred between them.

Because if you think you've been poisoned, your best option probably isn't to wait a few weeks for an appointment at your GP.

Sophie Richardson: Yeah, no. You go straight to the emergency room or call the 0800 number. One or the other.

Jon Duffy: Yeah.

So technology has rapidly improved over the past decade, and that's been a big enabler of the PACE model. But our push into telehealth has also been enabled by something a bit less obvious... A big structural change in the health system. The scrapping of district health boards.

Dr Ruth Large: Previously we have operated in silos.

So every district health board has had their own group of people they've looked after, for example. So we know that the postcode lottery is real. If you live in Auckland, your care is very different from if you live on the top of the Coromandel. Some of that's got to do with distance. Some of that's actually just got to do with the fact that your district health board is different and you have different things in place. But, what that also means is that you couldn't necessarily access those people with that particular special interest because you're in a different health board area.

So with Te Whatu Ora now dissolving those district health boards, that then means that every patient theoretically should be able to access any specialty service no matter where they are. And even more to the point, every clinical person employed by Te Whatu Ora theoretically has a responsibility to every New Zealander, and that's quite different from what we've had before because before it's just been a responsibility to the people in your boundary.

Jon Duffy: Yeah, so previously individual health boards had their own pots of money and no real incentive to make their facilities and staff available outside of their own region. This is no longer the case due to the new national approach. If the best doctor for your medical issue is in say, I dunno, Dunedin, you should be able to speak to them even if you live in Matapouri. And under a PACE telehealth concept that could be remotely, at a time that's convenient with no need to take time off work or spend money on travel.

And as well as the potential benefits the concept could realise for patients, they also see PACE as making life easier for primary healthcare workers by providing them with better access to support.

Dr Ruth Large: I mean I can't imagine how difficult it must be for many of our rural GPs at the moment, sitting in a rural general practice thinking, gosh who am I gonna hand my patients over to?

Jon Duffy: But whilst Ruth and the telehealth forum are confident about the benefits of PACE there are still a lot of things that need to happen to make it a reality.

Sophie Richardson: Hmm. In theory, this all sounds great and I'm on board. I guess we're experiencing this all for the first time, so the proof will be in the pudding.

Jon Duffy: Certainly will be.

Dr Ruth Large: Oh look, we're in election year, right? Anything could happen. It needs some decision making. A definitive, yes, this is a pathway we're going to go. And I think we can see that within Te Whatu Ora's general principles, but it's the how to. The enablement part starts with the data and digital team. Um, and a plan, particularly within booking appointments, uh, it sounds simple, right?

But actually it isn't. Booking is quite complex. So booking tools are probably one of the first things. Being able to access a medical record wherever you are is the next key thing.

So those are enablers, and whilst those pathways are being pulled together, then we need to be looking at what does this mean for all of our clinicians up and down the country? How do we start making sure they're trained in delivering telehealth?

It kind of sounds simple, but there's a lot of complexity behind it. You know, something like this, you're probably looking at at about a five year horizon. That doesn't mean that you can't start delivering stuff already, because like I say, we already are. It's stitching it all together and the majority of that, like I say, actually really just needs that key decision to go this is where we're going.

(🎶 Short music sting 🎶)

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Jon Duffy: So really interesting. What do you think Sophie?

Sophie Richardson: Yeah, I can see the benefits. I think for rural communities and those who are less mobile, being able to access medical help when it's convenient to them is just super beneficial. Cause we know that lots of people put off going to the GP or going to the doctor about things that are treatable, but they put it off for too long and then things become a big problem.

But then also I think personally, while I can see the benefits, I do like the relationship I have with my GP and I feel a connection with them and I feel like because they see me more regularly, they sort of get to know you as a person and know what you are like, and so what's normal for you. I personally would prefer to keep doing that which is what I've done rather than access free GP services, but they're tele ones through my health insurance.

I'd rather pay to go and see the same person that I see all the time.

Jon Duffy: Mm-hmm. Yes. My takeaway was that, you know, if there are ways of making primary health more efficient

Sophie Richardson: mm-hmm

Jon Duffy: I'm particularly thinking of the GP model here, particularly if GPs have more time to spend with each patient because many of the models that we have in primary healthcare are just based on funding as many people through that, GP clinic as possible. And you know, I have to feel for the GPs because,

Sophie Richardson: oh yeah

Jon Duffy: you know, 15 minutes, it's not a lot of time, it's not a lot of time to diagnose what could be a quite a complex series of issues that a particular patient might have.

Sophie Richardson: Yeah.

Jon Duffy: Yeah. It's, it's a tough gig. Anyway, we digress.

Sophie Richardson: Mm-hmm.

(🎶🎶 Music 🎶🎶)

Jon Duffy: So to get our digression under control on this episode of Consume This we are looking at how the way we access healthcare is evolving. As we've heard the medical system is slowly adapting to take advantage of new technologies, and so are businesses.

Sophie Richardson: Which is why at the start of this episode you heard Jon preparing to poo in a pot. DIY home health test kits, which you can buy online and in wellness stores are becoming increasingly popular.

Jon Duffy: A quick scroll through, just one website has tests for things like hormone imbalance, heart health and diabetes. And with prices ranging from $50 to $700, they come at significant cost, but that doesn't seem to have stopped us from using them. As we mentioned at the start of the episode, one in ten of you reported buying one. The most common were cholesterol, allergy and microbiome tests.

Sophie Richardson: So, Jon you've been testing this out for us. What on earth is a microbiome test? Why were you pooing in jars?

Jon Duffy: Well, those are really good and relevant questions, Sophie.

(Laughter)

Jon Duffy: So the microbiome test involves pooing in a jar because that's how they test what the contents of your microbiome is. What is your microbiome? Is probably a natural question to flow from that.

Sophie Richardson: Mm-hmm.

Jon Duffy: And I have to admit, I'm not a hundred percent sure. There was a lot of detail in the test and in the questionnaire that I had to fill in prior to the test. But basically it's all the kind of bacteria and things in your gut that helped you digest your food and, and process stuff and

Sophie Richardson: Right.

Jon Duffy: Yeah. Break stuff down and all that kind of stuff. That's my understanding of it.

Sophie Richardson: Okay. So we left you where you were heading off to the loo. Do you just have to poo in the pot? I mean, it sounded like there were fill lines, which is quite difficult with a poo. It's not like a, a pee, you just cut it like shut it off.

Jon Duffy: Yeah. It's not like you tell your body, right. I need exactly 600 milliliters of poo.

Sophie Richardson: Yeah.

Jon Duffy: To fill this appropriate vessel. No. Uh, so you want the nitty gritty? You want the actual detail of

Sophie Richardson: Yeah, yeah, yeah

Jon Duffy: how it, how it happened.

Sophie Richardson: Yeah. Uh, skip forward to, you know, 30 seconds in the episode if you don't wanna listen to this.

Jon Duffy: The interesting thing was that particular morning I got up and I was like... Don't need to go.

(Laughter)

Jon Duffy: So I had to have quite a large breakfast because it was very specific about what days of the week. I had to do it on a Sunday or a Monday morning. It was frustrating because Tom, our producer, had been on me about getting this podcast done and you know, me getting the test done and getting it off to the lab so I can get the results back and take it all from there. I was like, I'll do it, I'll do it, I'll do it, do it.

And then, then I reread the instructions like, oh bro. I've gotta wait a whole nother five days.

(Laughter)

Jon Duffy: Which just poor Tom. Long suffering Tom.

Anyway, I actually chatted to my wife, who's in the medical profession. I was like, how do you advise people when you need a poo sample from them? And she's like, make a nest.

Sophie Richardson: Oh, like what does that mean?

Jon Duffy: Basically you block the toilet up with toilet paper.

Sophie Richardson: Right?

Jon Duffy: Poo on said toilet paper, scoop poo into specimen jar.

Sophie Richardson: And what, did it come with a scooper or did you have to use a...

Jon Duffy: it did.

Sophie Richardson: Oh, okay. Thank God.

Jon Duffy: The top of one of the jars has a scoop.

Sophie Richardson: I've been to your place for dinner. I was worried I was gonna have to like, you know, bring my own cutlery.

(Laughter)

Jon Duffy: Yep.

And so, uh, yeah, made the nest, did the poo, scooped the poo, put it in the jar, sent the jar to Hawkes Bay.

Sophie Richardson: Oh

Jon Duffy: got uh, an email back from the lab saying, um, we are missing a sample. re-read the instructions.

Sophie Richardson: You didn't do enough poo?!

Jon Duffy: Yeah. Re-read the instructions. And that other specimen jar, they wanted me to fill that too, and I didn't do it.

Sophie Richardson: Oh.

Jon Duffy: So, they sent me a new kit. Did it properly and, um, yeah, off they went. And I think we've got the results back.

Sophie Richardson: Yeah.

Jon Duffy: You've, you've seen the results, I have not seen the results.

Sophie Richardson: Yeah.

Jon Duffy: So I'm really, really interested to find out whether there's something lurking in my microbiome that shouldn't be.

Sophie Richardson: Mm-hmm.

Well, we will find out, although I will just say,

Jon Duffy: Or...how excellent my microbiome is. I'm quietly confident that it's gonna be excellent.

Sophie Richardson: Okay.

Jon Duffy: And I'd have no basis for that confidence whatsoever.

Sophie Richardson: It's just classic white man confidence really.

Jon Duffy: Exactly. Everything else has worked out, so why shouldn't this.

(Laughter)

Sophie Richardson: Exactly.

Um, let's look at these results Jon uh, we've got the homepage here and it says "Hi healthy". I presume that's not a comment on whether you are healthy or not.

Jon Duffy: We, we used an alias. My, my alias for this particular test was healthy gutman.

Sophie Richardson: Oh, well there you go. You were also presuming that you were healthy.

It says initially that there are 34 desirable things in your poop, and by the looks of things three abnormal things, so.

Jon Duffy: And that's in red too?

Sophie Richardson: It's in red yeah.

Jon Duffy: It could mean abnormal as in like, abnormally excellent.

Sophie Richardson: Sure. Let's find out. It gives you an overview sort of page at the start there.

Jon Duffy: Stool color - brown. I love that. That's good.

Sophie Richardson: There was no mucus and no blood, which is also good, I think.

Jon Duffy: Yeah, yeah, yeah. That would be alarming.

Sophie Richardson: So the overview, looking good so far.

Jon Duffy: Cool.

Sophie Richardson: And then we get into beneficial bacteria.

Jon Duffy: Mm-hmm.

Sophie Richardson: Which it does say here that you are inadequate which...

Jon Duffy: yeah, I think that's an unfortunate use of words.

(Laughter)

Sophie Richardson: It says your Bifidobacteria is, I'm not sure what this rating scale exactly means, cause it's not particularly clear. It's like green, good, red, bad.

Jon Duffy: So it's inadequate. Uh, Bifidobacteria are considered friendly bacteria that are found in fermented foods like yogurt and cheese.

Sophie Richardson: Also inadequate, uh, lactobacillus. The other bacteria they look normal for you.

Jon Duffy: Good.

Sophie Richardson: That's good.

Jon Duffy: I actually got a two on e Coli, didn't I? That's good.

Sophie Richardson: Yeah. Which, I mean, poo does generally contain e coli, so that's...

Jon Duffy: So this looks interesting. So no campylobacter. No salmonella. I recognise some of these names.

Sophie Richardson: Mm-hmm.

Jon Duffy: Parasites.

Sophie Richardson: Um, oh dear. You've got one parasite.

Jon Duffy: Mm-hmm.

Sophie Richardson: It's a dientamoeba fragilis.

Jon Duffy: Ooh.

Sophie Richardson: Which is a bacteria that can be present in the gut for months or years and can be misdiagnosed as IBS. That doesn't sound good.

Jon Duffy: Guess that's irritable bowel syndrome, isn't it?

Sophie Richardson: Yeah.

Jon Duffy: Oh, infection.

Sophie Richardson: Have you been having?

Jon Duffy: No, I Infection can cause diarrhea, abdominal pain, cramping. I've had none of those.

Sophie Richardson: Oh, they've got some recommendations down the bottom here for you, Jon. it says you should consider clinical nutrition. I'm not really sure what that means. You should optimize your beneficial bacteria, so maybe eat some more yogurt and then you should manage potential pathogens.

Jon Duffy: You could say that about anything. Manage potential. I don't know. Electrocutions. Sophie Richardson: Don't put your finger in the socket.

Jon Duffy: That's random statement.

Manage potential things falling on your head randomly from buildings. I dunno.

Sophie Richardson: Yeah. I don't know, to be honest. It's vaguely interesting, I guess, but I'm not really sure if it tells us anything.

How do you feel?

Jon Duffy: It's really nicely presented.

Sophie Richardson: Sure.

Jon Duffy: Yeah. Soft really kind of soothing colors.

Sophie Richardson: Yes

Jon Duffy: but I come away with questions like... there's a parasite in me. Am I gonna die? And it's not telling me whether I am yeah or not. So that's about the best that we can do as laypeople to try and understand these results. It's probably a good idea for us to get in touch with someone with a bit more expertise than me and Soph...

He's a trustee of the Gut Foundation, academic head at Otago University School of Medicine, medical director of the New Zealand Nutrition Foundation., And some other stuff. This, this dude is imminently qualified to diagnose, uh, my microbiome. And just an apology about the quality of the phone connection on this call to Dr. Richard Gearry in Dunedin. It's not the best, but bear with us.

(Phone ringing)

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Jon Duffy: Hi, Richard. Well, thank you very much for joining us. Sophie and I have just been going through my microbiome results and I understand that you've had a bit of a chance to have a look at them offline. And we are really keen just to get your first impressions of the results. We know nothing and have just been trying to figure them all out, but it'd be great to get your kind of professional insight on them.

Dr Richard Gearry: Yeah. So I mean, the first thing is that we've produced predominantly a healthy poo. So congratulations.

Jon Duffy: I hope you're listening, mom. I hope you're listening. I told you I'd amount to something.

Dr Richard Gearry: So that's, that's the first thing. The second thing is that, you know, there's no blood there and, you know, blood in your bowel motion, that's a big deal. So that's reassuring. Doesn't mean there's zero chance of a problem, but you otherwise well so there's no reason to think that. So that's a good thing to know.

Of course that you might have seen yourself without needing to send it to the lab. But nonetheless, it's good that they can make that sort of description. But when we drill down to the microbiome, so these are the trillions of bacteria, viruses and pathogens and, and, and parasites and live inside us. That's really where the interest is, certainly from a, from a research point of view, from my perspective, but also increasingly from a general population point of view.

So one of the things we saw for you was that some of your concentrations of lactobacilli and bifidobacteria were slightly low.

Jon Duffy: Mm-hmm.

Dr Richard Gearry: These are probiotics. And probiotics by definition are bacteria that do something beneficial for us. So they might improve our immune system or help us to digest food or do things like that. And certainly bifidobacterial, lety are known to be beneficial like that and, and that that's of interest.

But the problem that we have with this sort of result is that it's really just a snapshot in time. And we know that what you eat on a certain day may change the concentrations of these bacteria. And we also know that just because it says that your bacteria are low doesn't mean that necessarily increases your risk of something bad happening.

You know, it's just one point in time. And we know that some of the changes that we see occurring with bacteria in people who've got diseases aren't necessarily a causation. They're just an association and we all know if two things happen at the same time, they may be linked, but they may not be as well.

That's really, I think, one of the issues we have with this sort of information.

Sophie Richardson: Are they actually useful? Like is it useful paying $300 for this sort of test?

Dr Richard Gearry: I personally believe that it's not useful. Uh, and the reason I I say that is that at the moment we are doing research using similar sorts of panels, but with much more complicated information.

And I believe that science has overtaken our ability to understand what's going on. We don't really know what it means. We know that for some diseases there may be increases or decreases in certain types of bacteria, but we don't believe that having those increases or decreases actually causes the disease. It may be a result of the disease.

Sophie Richardson: Mm-hmm.

Dr Richard Gearry: So therefore, when we try and interpret it in this way where someone says, here is your microbiome, this is high, this is low. I don't believe we have any evidence to say that there is an intervention that someone should undertake to change their microbiome in a certain way. I believe what we're better to do is to live a healthy lifestyle and then that should lead to a healthy microbiome as a byproduct of that.

Now I do believe in the future that we will have the ability to modulate our microbiome. And potentially increase or decrease our risk of various diseases. But right now we've got the ability to measure our microbiome. We've got the ability to know what's there, what's high, what's low, but we don't have the ability to understand whether there's a causative effect between what we see in that vast array of bacteria and a potential disease that may or may not occur.

Um, so I have patients who bring me these, and they say to me what do you think? And I think, well, this is very interesting, but I'm not sure that I can necessarily make a health recommendation on the basis of it because I don't know that there's a cause and effect here. All I can say is that you're best to have a healthy diet, which is full of fruit and vegetables and everything else that you know is healthy for you. And through doing that, that should lead to a beneficial microbiome. The labs are ahead of the game here. They're in a position where they can provide this information. But it does worry me that it does prey slightly on people's vulnerabilities. And whenever you see something written down that you think you feel deficient in, I hope Jon that you, you're okay here, that you know you're feeling okay about yourself. Just cuz you're a little bit bifidobacteria deficient that doesn't mean that you're a bad person or anything else is going on.

Sophie Richardson: No, he's a bad person for other reasons. Richard.

(Laughter)

Jon Duffy: I'm still, I'm still processing it actually. It's kinda quite a shock....

Dr Richard Gearry: But you could see how in the wrong hands people could go down mammoth rabbit holes, which they'll never get out of. And it takes a lot of time and effort to pull that back. So I am worried about this. But equally, you know, companies are perfectly able to offer what they offer. But if we go down further, uh, low down, there's information about parasites. For example, Giardia, dientamoeba, et cetera.

Here's some here. Here. Here's some pathogens. We can stop. Stop here. But yeah, campylobacter , salmonella. If you had those, it's important to know about it. However, I'd also say that if you've got one of those, you are having profused, watery diarrhea with gastroenteritis.

Sophie Richardson: I think you'd know about it anyway.

(Laughter)

Dr Richard Gearry: It's still interesting but the relevance in this situation is a little bit difficult to know about.

Sophie Richardson: Mm-hmm.

Dr Richard Gearry: If you go down a little bit further here, um, uh, the parasites. Okay. So just there. So, um, blastocystis hominis and Dientamoeba fragilis are both parasites and you're lucky enough to have a, we friend there Dientamoeba fragilis. And these are parasites which can live with us and cause no problems, but they can also cause problems. So the information on whether you should treat someone blastocystis or dientamoeba is quite varied.

Do you worry that I've now got a parasite and I need to have eradication therapy when in fact that's quite complicated antibiotic therapy, which in its own right, could cause side effects and problems. And if you never knew about this, you'd never worry about it, and therefore it wouldn't become a problem. So there are issues reporting these things, but we don't completely understand what the relevance is in an individual, whether it needs to be treated or not.

Sophie Richardson: Mm-hmm. I just wanted to know, Richard, how you feel about the whole industry, not just necessarily with this test that Jon's ordered, but the sort of DIY test industry generally. Like should we just go to our GP cuz it'll surely be cheaper than the $300 that Jon's forked out.

Dr Richard Gearry: Yeah, I mean I suppose we're at the edge of knowledge and I think that there are always people who are early adopters who want to push the boundaries and see what's going on. It comes down a little bit to what you do with that information and

Sophie Richardson: mm-hmm.

Dr Richard Gearry: Uh, and it worries me a little bit that the providers of these services probably don't really have to deal with that. They can provide the information, but then thereafter their default will always be "well you need to go to your doctor or you can pay for us to see a dietician through our service" . So that's what really worries me is that they then load a lot of information.

So if I was a general practitioner and I saw this I'd be...

This is what I do as a researcher as well as a clinician. So I feel as though I'm able to manage this quite well. But it'd be like me trying to look at a EEG of a brain as a gastroenterologist. I wouldn't know where to start. And it's that relevance and that background and perspective that I think is more worrying, and this is where we're sort of in this gray zone where we have the ability to generate data, but we don't have the ability to understand the data.

Sophie Richardson: Mm-hmm.

Dr Richard Gearry: Uh, and that's where patients can be left I believe in a bit of a gray zone. And in fact these aren't often patients, they're the worried well.

Sophie Richardson: Yeah.

Dr Richard Gearry: So that people who otherwise want to optimize their health and do the best that they possibly can. But I don't think there's a lot there that I would action or do myself.

I think it's really interesting. Would I like to know what my microbiome is like? Sure I would, but I wouldn't do anything about it probably because I know that what I need to do is have a healthy diet and lead a healthy lifestyle and do those things, and I'll choose to do that or not.

But I don't think this would drive me to do that one way or another because I don't think that the information there is strong enough to say that that's what I need to do. So really interesting. Fascinating. There will be a time where this information will take us a lot further and give us a much deeper insight into our health, but I personally believe that that time is not yet arrived. As they were saying the states, it's not ready for prime time.

(Laughter)

Jon Duffy: Excellent. Fascinating.

Sophie Richardson: Yeah. Who knew there was so much to learn from poo?

(🎶 Music 🎶)

Jon Duffy: Yeah. Well, Richard, look, thank you so much for generously offering up your time this evening.

Dr Richard Gearry: It's been a pleasure to come along and as I say people just need to think about not just the benefit of the test, but the cost and what they might do with the results. So thanks once again.

Sophie Richardson: Great. Well Jon I think that leads us straight into - what earth are you gonna do about your test results?

Jon Duffy: This has been a fascinating journey and I have to say, If I wasn't in the privileged position of having gone through this experiment and just had my results assessed by what appears to be the most qualified person in New Zealand to assess those results, I think I might be a little bit worried about the fact that there's a parasite in me.

Maybe I would've bought further tests or gone to the GP and the GP might've gone "well, oh, I dunno, cuz this is outside my area of expertise, so you need to go to a specialist" and cha-ching, cha-ching, ch ching. You know, the dollars are racking up. So I could see how someone would get into a spiral.

Sophie Richardson: Mm-hmm.

Jon Duffy: With these home tests, because you know, only medical professionals really have the expertise to interpret these results. The businesses themselves can only really give you high level general advice. Which can obviously lead to more questions, than it answers. So I guess that's problematic. However, had this turned out something that was really alarming, there could have been real cause for me to go and get checked out by my GP. So there's good and bad in this I think.

Sophie Richardson: Mm-hmm. I mean, your test was paid for by consumer, so would you pay the $300 yourself?

Jon Duffy: It is unlikely.

Sophie Richardson: Yeah.

Jon Duffy: So I think what occurs to me as we kind of tie all this together is that there's heaps going on in our health sector.

Sophie Richardson: Mm-hmm.

Jon Duffy: And technology's enabling some really cool things, although boy oh boy is, there are a huge amount of work still to do to actually realise the benefits from the PACE model and the interventions that are being made to make it easier for us to access healthcare. But that's not to say that this thing might not evolve into you know, our new way of interfacing with the health system, we just dunno yet. It's too early.

Sophie Richardson: Great.

(🎶 Credits music plays 🎶 )

Jon Duffy: Consume this is brought to you by Consumer NZ. It was hosted by me, Jon Duffy and Sophie Richardson. It also featured a cameo from Lucy at the start. Hey, Lucy.

The survey we referenced in this episode was conducted and analysed by our colleague and data legend Scott Moore. If you wanna know more about the Gut Foundation or the NZ Telehealth forum, check out the links in the show notes.

This episode is the final installment of our health mini-series. Our thanks go out to everyone who's taken the time to speak with us throughout the series.

This episode and indeed the entire series was produced by Tom Riste-Smith and made possible with generous support from the Ministry of Health. We'll be back very, very soon with some more non-health related stories for you. .

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