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One of the things that has surprised me as I learn more about longevity medicine is how easily more testing has become synonymous with better medicine.
We now see health packages offering enormous panels of blood tests.
Hormones. Vitamins. Minerals. Inflammatory markers. Tumour markers. Metabolic markers. “Longevity biomarkers.”
Sometimes dozens—or even hundreds—of measurements at once.
It certainly feels thorough.
But I don’t believe good medicine means testing everything we possibly can.
Good medicine means knowing what we are looking for, why we are looking for it, and what we will do differently depending on the answer.
That distinction matters.
Every medical test has limitations.
One of the simplest examples is the laboratory reference range.
For many blood tests, the reference interval represents the range within which approximately 95% of a healthy reference population falls.
That means, by definition, around 5% of healthy people may have a result outside that reference interval even though nothing is necessarily wrong with them.
Now imagine testing one marker.
There is some possibility of an unexpected abnormal result.
Test 10 independent markers and that possibility increases.
Test 50 or 100, and it becomes increasingly unsurprising that something will be flagged high or low.
Suddenly, a perfectly well person has an “abnormality”.
And now we need to decide what to do with it.
Repeat the blood test?
Order another test?
Do a scan?
Refer to a specialist?
Start a supplement?
Start treatment?
Or worry about it for the next six months?
This is one reason more testing is not automatically more reassuring.
Sometimes it creates uncertainty rather than reducing it.
This is another concept that deserves much more attention.
Outside the reference range does not automatically mean unhealthy.
Laboratory reference ranges are statistical tools. They are not always hard biological boundaries separating health from disease.
A result also needs to be interpreted in context.
How abnormal is it?
Is it persistent?
Does the patient have symptoms?
What medications are they taking?
What is their age and sex?
Were they fasting?
Had they just exercised?
Is pregnancy relevant?
What is their medical and family history?
Does this particular result actually predict an important health outcome?
The number matters.
But the person around the number matters more.
This is one of the most useful concepts in medicine.
Before ordering a test, we should already have some idea of how likely the disease is in this particular patient.
That is the pre-test probability.
Imagine testing for a relatively uncommon disease in 10,000 completely healthy people with no symptoms or risk factors.
Even if the test is quite accurate, some healthy people will test positive simply because no test is perfect.
When the underlying likelihood of disease is very low, a positive result is more likely to be a false positive than when the same test is used in someone with symptoms or significant risk factors.
This is why the question shouldn’t simply be:
“Can we test for it?”
It should be:
“Is there a good reason to test this person for it?”
Preventive screening bodies explicitly take this into account: when disease prevalence is low, and test specificity is less than perfect, false positives are expected and may lead to unnecessary diagnostic procedures.
Sometimes, absolutely.
This is why evidence-based screening saves lives.
We screen appropriate people for conditions such as hypertension, diabetes and certain cancers because there is evidence that identifying disease or risk at the appropriate stage can lead to meaningful intervention.
Singapore’s Ministry of Health recommends screening according to factors such as age, sex, medical history and individual risk, with appropriate follow-up after results.
But there is an important distinction between:
screening for something because evidence shows that doing so improves outcomes
and
testing for everything because we are afraid of missing something.
Screening itself can cause harm.
False positives can lead to further investigations.
Incidental findings can lead to more scans.
Some people may be diagnosed with conditions that would never have caused them harm—what we call overdiagnosis.
And treatment of those findings can sometimes create harm of its own.
So “finding more” is not always the same as “helping more”.
Longevity medicine has created an extraordinary appetite for measurement.
Biological age.
Cortisol.
Sex hormones.
Insulin.
Inflammatory markers.
Micronutrients.
Heavy metals.
NAD metabolites.
Genetic profiles.
Metabolomics.
Proteomics.
Some of these areas are scientifically fascinating.
But I think we need to separate three questions:
Can we measure it?
Do we understand what the measurement means?
Does changing it improve someone’s health?
Those are not the same question.
A biomarker can be associated with ageing without being a useful clinical test.
A result can correlate with disease without proving that treating the number changes the outcome.
And a “biological age” changing after an intervention does not necessarily mean that person will develop less disease, remain functional longer or live longer.
A measurable number is not automatically an actionable number.
This is another area where I prefer targeted investigation.
If someone presents with hair loss, for example, there may be very good reasons to investigate iron status or thyroid function depending on the clinical picture.
If a woman has symptoms suggestive of a hormonal or endocrine disorder, appropriate hormonal investigations may be useful.
If someone has a dietary restriction, gastrointestinal disease or another reason to suspect nutritional deficiency, targeted testing may make sense.
But that is different from checking every vitamin and hormone in every healthy person because:
“Why not?”
For me, the question before ordering a test is:
What clinical question am I trying to answer?
And ideally, I should already know:
What will I do if the result is normal—and what will I do if it is abnormal?
If neither answer changes anything meaningful, I need a very good reason for ordering the test.
This is the part we sometimes forget.
Tests don’t exist in isolation.
An abnormal result creates pressure to do something.
A borderline hormone becomes a supplement.
A mildly abnormal biomarker becomes another medication.
A “low” vitamin becomes a high-dose replacement.
Another blood test gets ordered to monitor the first blood test.
Before long, a healthy person can accumulate diagnoses and interventions without us ever demonstrating that we have improved their health.
Preventive medicine has a term for part of this problem: overdiagnosis and overtreatment.
And this is precisely why screening recommendations consider harms as well as benefits.
Absolutely not.
I am strongly in favour of appropriate health screening.
There are things I very much want to know as someone ages.
Blood pressure.
Cardiovascular risk.
Glucose metabolism.
Lipids.
Bone health where appropriate.
Cancer screening according to age, sex and individual risk.
And additional investigations when symptoms, examination findings, family history or medical history give us a reason to look further.
The Singapore Ministry of Health’s current approach similarly emphasises evidence-based screening personalised to an individual’s risk profile rather than indiscriminate mass testing.
That is not doing less medicine.
That is practising more thoughtful medicine.
As we develop our approach to healthy longevity at VIDASKIN, I don’t want the size of our blood panel to become a measure of how sophisticated we are.
I would rather begin with the patient.
What are you concerned about?
How are you functioning?
What has changed?
What is your family history?
What stage of life are you in?
How are you sleeping?
How is your body composition?
Are you losing muscle?
Are you going through perimenopause?
What are your cardiovascular and metabolic risk factors?
What are we actually trying to prevent or improve?
Then we investigate appropriately.
Sometimes that may mean a fairly comprehensive assessment.
Sometimes it may mean only a handful of tests.
And sometimes the most appropriate investigation may not be a blood test at all.
Personalised medicine should not mean testing everything.
It should mean testing what matters to the person in front of us.
I understand why enormous testing panels are appealing.
They make us feel proactive.
They give us numbers to optimise.
They make healthcare feel sophisticated.
But medicine isn’t a treasure hunt where the objective is to find as many abnormalities as possible.
The objective is to help someone remain healthy.
So before ordering another biomarker, I think we should ask:
Why am I measuring this?
What does an abnormal result actually mean?
Will knowing it change what I do?
And most importantly, is there evidence that acting on it improves an outcome that matters?
Sometimes the answer will be yes.
Then we should absolutely test.
Sometimes the answer is:
We don’t know.
And being comfortable with that uncertainty is also part of good medicine.
Because in longevity medicine, as everywhere else:
More medicine is not necessarily better medicine.
Better medicine is better medicine.
Founded in 2015, Dr Vicki has grown with the clinic, to become one of the leading aesthetic clinicians in Singapore. She is an appointed key opinion leader and trains other aesthetic doctors on how to best use prestigious brands and treatments.
