Should you let people check on the internet whether they’ve got an increased risk of contracting a serious disease? Yes, because GPs don’t have time for such time-consuming screening, say the brains behind a new online health test. Yes, says the ethicist, but only if there’s something you can do to reduce the risk once you know about it. An English version of the test is will also be online soon.

Do you belong to a high-risk group for a common condition like cardiovascular disease, diabetes or cancer? From today Dutch people can find out for themselves. An online test has been developed by the Bronovo Hospital in The Hague in collaboration with GPs.

The test comes in two parts, basic and advanced. The free basic version lets you check your risk of developing diabetes and cardiovascular disease, and sustaining kidney damage. The advanced version comes with a 20-euro price tag, and focuses on six different types of cancer, a number of common preventable diseases, and the risks posed by an unhealthy lifestyle.

Impossible
The test is based on official guidelines used by all Dutch GPs. So what’s the point of an online test? Why not just let doctors do it? It’s a question of time, says surgeon Arthur Niggebrugge, one of the project’s initiators.

"The 28 guidelines – if you go through all the questions in detail, which is very important – make for around 150 questions. The average Dutch GP has 2500 patients. So work it out – it means you’ve got to ask 2500 times 150 equals 375,000 questions to screen all your patients for these conditions." In other words, it’s impossible.

Prevention
But don’t you simply scare people unnecessarily if you tell them they’re at risk of contracting a disease? Ethics professor Heleen Dupuis adds a key proviso. "The golden rule with screening and offering this kind of health check is that you only do it with diseases where you can really expect a major benefit from a change of behaviour or early diagnosis," she says.

And that’s just the point of this test, says Arthur Niggebrugge – it’s intended to be preventative. All too often he sees people turn up at the hospital with conditions that were either preventable or that could have been treated more effectively had they been caught at an early stage. This is particularly true of cancer.

Charge
But if prevention is the main aim, isn’t it a shame you have to pay for the advanced test? After all, in theory it could save the medical insurance companies from having to foot the bill for much more expensive treatment. Arthur Niggebrugge agrees in principle:

"It’s taken a lot of work and investment. We’ve paid for it out of our own pockets and we have to cover the costs first. We would actually like to bring down the financial barrier too. As soon as we’ve recouped the costs we want the government and the medical insurance companies to offer the test free of charge."

Damages
The initiators want to make the test available around the world – an English version will also be online in two months. Of course, this increases the risk of claims for damages. Imagine the consequences if a test told someone they had nothing to worry about, and they went on to get seriously ill.

The initiators have been careful to cover themselves. The test will never tell you definitely whether or not you’ve got a particular condition. It’s not a diagnosis. It only provides an average risk factor as a percentage. If there’s cause for concern, it gives you advice on how to make your lifestyle healthier, or recommends that you see a doctor.

All in all, it’s hard to think of objections to the new self-test. Ethicist Heleen Dupuis agrees: "It’s about prevention. That’s fundamental. From a medical perspective, it’s the best thing there is."