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I am 55 years old and, increasingly, something of a longevity bore. I exercise vigorously, virtually every single day. I have become much more disciplined about my diet, become more attentive to sleep and developed an enthusiasm for health metrics that would have seemed faintly ridiculous to my younger self. I know how much I weigh. I know how well I slept last night. My Garmin can tell me how many steps I have taken, how far I have run and whether my body considers my latest exertions productive or merely foolhardy.
There is, however, a rather large gap in this increasingly quantified version of myself. I have almost no idea what is going on in my blood.
This is not because I avoid doctors. I dutifully attend my annual physical. My physician weighs me, checks my blood pressure and performs the various indignities appropriate to a male in his mid-50s. Then, inevitably, we arrive at blood work. He explains, quite reasonably and calmly, that it would be considerably easier to manage my health if he knew what was actually circulating through me. He can draw the blood. His nurse can do it. Or I can visit LabCorp down the street.
And then I simply don't.
I am horribly, almost preposterously squeamish about having blood drawn from a vein in my arm. I hesitate to call this a needle phobia because needles themselves don't particularly trouble me. I get vaccinated without drama. I regularly visit the dentist and have undergone dental surgery. Several years ago, after an eye injury sustained during a Tae Kwon Do match, I underwent two procedures on my right eye without much trepidation. Apparently someone operating on my eyeball is psychologically acceptable. A phlebotomist approaching the inside of my elbow is not.
My last proper blood test may have been five years ago. Possibly 10. I vaguely remember a nurse coming to my house when I was buying a life-insurance policy. More recently, I have climbed into my car with LabCorp as the intended destination, begun the journey...and then turned around.
This drives my wife and daughters crazy. Understandably. It drives me crazy, too.
There may be something more primitive at work than mere cowardice. Hematologist Chris Tiplady has written wonderfully about our peculiar relationship with blood. Blood, he observes, is something we instinctively expect to remain inside us. Even our language gives it a sinister cast: blood can curdle or boil; there is bad blood, blood money and bloodshed. Few things improve once the word “blood” is attached to them.
Medical professionals, on the other hand, understandably regard phlebotomy as routine. Not a big deal. The patient may experience something rather different: anticipation, puncture, the peculiar sensation of extraction and then the sight of one's own crimson inventory sitting in a collection tube. For some of us, rationality briefly absconds.
I am hardly alone. Harvard Health has cited estimates suggesting that fear of needles affects as many as one-quarter of adults. More interestingly for my particular neurosis, research examining people with needle fear found that 52% had avoided venous blood draws, compared with 33% who had avoided vaccinations. In other words, there appears to be a constituency of people for whom having something injected into the arm is considerably less alarming than having something extracted from it.
Avoidance, unfortunately, has consequences. Harvard notes the obvious ones: missed diagnoses, poorly monitored conditions and under-treatment. The diligence around my longevity regimen therefore contains an embarrassing contradiction. I have become fastidious about many of the things I can measure easily while assiduously avoiding some of the measurements that may matter most.
The timing is particularly daft.
Earlier this year, JACC published its 2026 snapshot of cardiovascular health in America. Its editor's foreword contains a sentence that might have been written specifically to chastise me: “We cannot improve what we do not measure.”
Quite.
Consider cholesterol. LDL particles play a causal role in atherosclerotic cardiovascular disease, and medicine's ability to lower LDL cholesterol has become increasingly sophisticated. The familiar statin has been joined by an expanding armamentarium that includes PCSK9 inhibitors, bempedoic acid and inclisiran. Yet JACC reports that most high-risk adults still do not achieve guideline-recommended LDL targets. Among the estimated 4.8m American adults with LDL cholesterol of at least 190mg/dL (a level considered severe dyslipidemia) roughly 27% were unaware of their diagnosis and untreated.
We can develop ever more ingenious medicines. But you cannot treat a number nobody has measured.
That thought has been nagging at me because modern consumer health has become exceptionally good at making previously invisible things visible. A watch measures sleep and heart rate. A continuous glucose monitor can transform blood sugar into a graph. A bathroom scale remembers your weight more faithfully than you do. Health has acquired a dashboard.
Blood biomarkers have remained conspicuously absent from mine.
Technology may finally have found a way through my impasse.
I recently ordered an at-home testing kit from Rythm Health. Instead of going to a laboratory and presenting the crook of my arm to a phlebotomist, I can attach a collection device to the outside of my upper arm, collect the required blood at home, put the sample into the supplied packaging and FedEx it away for analysis.
For most people this may sound like a marginal improvement in convenience. To me it feels mildly revolutionary.
And Rythm is part of something larger. Function Health, Superpower, SiPhox Health and others are attempting, in different ways, to make extensive biomarker testing more accessible to consumers. The broader promise is not merely more data. It is the gradual relocation of health measurement from an occasional clinical event towards something closer to an ongoing consumer behavior. Making it a habit.
There is an important behavioral lesson here. Rythm has not cured my fear. I have undergone no exposure therapy, conquered no psychological demons and acquired no sudden reserves of middle-aged valour. Technology has simply redesigned the behavior so that my particular infantile barrier matters less.
Healthcare often tries to change people. Perhaps it should spend more time designing for people as they actually are -- irrational fears, peculiar aversions and all.
Now for the "strategy consultant" part of my essay: all of this has implications for pharma, biotech and medtech.
Our industry devotes enormous attention to what happens after diagnosis. We study initiation, adherence, persistence, access, dosing inconvenience and the innumerable reasons patients fail to take medicines as intended. All are important.
But there is an earlier behavioral funnel that deserves equal scrutiny:
Measure. Know. Act. Treat. Track.
A patient who disappears at the first step never reaches the others.
That matters particularly in diseases of silent risk. Elevated LDL cholesterol does not announce itself with a flashing light. Neither do many abnormalities in blood sugar, kidney function or other biomarkers. They must be discovered. And discovery usually requires somebody to engage with a healthcare system, accept testing and return for follow-up.
We tend to describe those things collectively as “access”. But access is not always about insurance, geography or affordability. Sometimes the barrier is embarrassingly human. Fear. Hassle. Procrastination. Discomfort. An aversion to waiting rooms. Or, in my case, an apparently indomitable objection to someone approaching my antecubital fossa with a needle.
For healthcare companies, that distinction matters. The addressable population for a medicine is not simply everyone biologically eligible to receive it. It is everyone who successfully traverses the journey required to discover that eligibility.
Removing diagnostic friction may therefore be every bit as consequential as reducing therapeutic friction.
My Rythm kit is on its way, so this experiment has not yet reached its triumphant conclusion. There remains every possibility that the package will arrive and sit on my desk, silently reproaching me while I find increasingly inventive reasons not to open it.
But I am strangely excited.
Within a few weeks, I hope to be looking at a collection of biomarkers that have been absent from my personal health dashboard for far too long. Some numbers may be reassuring. Others may not be. The point, of course, is to know...and then to do something about them with my physician rather than treating a consumer-health dashboard as a substitute for medical care.
My aspiration is that a year from now blood work will have become as habitual (and boring) as looking at my sleep scores every morning over coffee. I will know my important numbers, monitor the ones that warrant monitoring and work on getting them where they ought to be, just as I currently think about exercise, weight and diet.
Which leaves me curious about everyone else.
Perhaps your Achilles heel is not blood. Perhaps it is the colonoscopy you keep postponing, the dentist you haven't visited or the blood-pressure cuff gathering dust in a cupboard. Most of us probably have some corner of our health where rational adulthood gives way to immature avoidance.
What I find intriguing, and really the occasion that drove me to write this article, is what happens when technology stops lecturing us about these imperfections and starts designing around them.
After all, the future of preventive medicine may depend not only on better drugs, diagnostics and devices.
It may depend on making it easier for imperfect humans to use them.
