"I can pivot," Larkin told Business Insider. "You can dart back and completely change course in a speedboat much easier than you can when you're trying to move the Titanic. And I think that's been an advantage in this situation right now."
While the broader health care system ignored the signs that the coronavirus had begun to spread in the United States earlier this year, Larkin said she was working to provide her patients with access to tests that weren't yet being offered to Cincinnati's general population. Larkin said that while her husband, Dr. Arthur Pancioli, a physician who oversees three emergency rooms as the chair of emergency medicine at UCMC, had to wait for the local health department to develop the capacity to run tests, she was able to purchase them directly from private labs like LabCorp.
A representative for the UCMC did not respond to Business Insider's request for comment on its COVID-19 testing procedures, or on Larkin's professional history at the hospital.
At the beginning of the pandemic, Larkin could send nasal swabs off and get results within 48 hours. But as other health care providers, including urgent care centers, began to send in tests of their own, wait times for results soon stretched to 14 days. To combat this delay, Larkin and other concierge doctors began buying antibody tests that claim to be able to detect not only if a patient is infected, but if they have been infected in the past. In some cases, concierge doctors were able to get these tests weeks before labs started selling them to the public online.
Even some concierge doctors question the ethics of offering tests that aren't available to the general public
Doctors hawking high-priced extras that are, as Larkin put it, "maybe cutting edge or maybe fringe, depending on who you ask," is nothing new for the concierge medicine space.
Beverly Hills concierge Dr. David Narzarian, whose Instagram account features photos of him posing in his waiting room with stars like Dennis Quaid, Kendall Jenner, and Kelly Rowland, also performs IV vitamin therapy and anti-aging medicine in addition to primary care and COVID-19 tests. Benya's practice, CURE, also has its own salon and medical spa.
While some may say that selling coronavirus tests isn't much different from administering Botox injections, there is a key difference: The former are in short supply. Even after weeks of ramping up testing capacity, many states can only handle testing a few thousand residents a day. Every test sold to a patient who doesn't meet the CDC's criteria for testing takes one test away from another patient who does. An Insider poll conducted April 28 through April 29 found that 33% of Americans believe they may have been infected by coronavirus — but just 5% of those people have gotten tests.
"That's where the ethics of this comes into play, because I do have a lot of patients who naturally want to be tested just to be sure," Eitches said. With demand for testing exceeding capacity, Eitches said, it will be up to health care workers to decide who gets a test, which raises a question of its own: "Are we going to triage based on your access due to your socioeconomic status?"
The Medical Board of California is also considering the ethics of concierge doctors selling coronavirus tests, having confirmed to the Los Angeles Times that it is reviewing the matter, following a previous report by the newspaper's Adam Elmahrek, Amy Kaufman, and Ben Poston. A board spokesperson declined to comment further to Business Insider, saying that both investigations undertaken by the board and complaints made to it are confidential by law.
Even if average Americans could afford to buy coronavirus tests, most on the market today have not been approved by the FDA, and are notorious for giving false positives
Antibody tests can still provide a useful service for some patients who find themselves in a gray area.
New York-based ophthalmologist Dr. Yuna Rapoport continued to see patients at her practice, Manhattan Eye, even as the city's outbreak spiraled into the worst in the country. Rapoport soon developed symptoms that she described to Business Insider as mild — a low-grade fever, fatigue, and a dry cough — but said that she felt so sick in early April that she missed her appointment to get a nasal swab test. So, Rapoport decided to turn to a concierge doctor.
When a concierge doctor that Rapoport often consults with started offering antibody tests in late April, she decided to take one, even though she had already self-isolated and recovered from her symptoms. All Rapoport had to do was text the doctor the night before, answer a few questions, submit to a temperature test, and get a quick finger prick. A few hours later, she found out that she was positive for coronavirus antibodies.
What the test results actually mean for patients' daily lives is just as ambiguous as their accuracy. Even though Rapoport now knows that she has antibodies, she said she still isn't sure if that means she can't contract the virus again.
Scientists aren't sure if a person can contract the coronavirus twice, Elizabeth Halloran, a biostatistician at Fred Hutchinson Cancer Research Center and the University of Washington, previously told Business Insider. "What we hope is if you get it once, you'll be protected against it for at least a year," Halloran said. "We don't know that, but that's what we hope."
For this reason, Rapoport said that, while she has started seeing patients again in her office, she hasn't given up social distancing outside of it.
Concierge doctors have also tested many patients who have less compelling reasons to verify their immunity than Rapoport. UFC commentator and former "Fear Factor" host Joe Rogan sparked outrage among his fans when he said on his podcast that he had been tested for the virus twice, and was paying for every guest who appears on his podcasts to get tested, too. "I'm just going to test myself every three or four days," Rogan said on "The Joe Rogan Experience." "F— it."
Concierge MD LA, where the doctor who performed Rogan's test works, advertises both nasal swab and antibody tests for COVID-19 on its website for $299. A representative for Concierge MD LA did not respond to Business Insider's request for comment on its testing practices.
COVID-19 has created a surge in interest in concierge medicine
As the pandemic highlights the disparities between the health care received by the rich and poor in America, concierge doctors are both an embodiment of the problem, and, in some cases, simultaneously trying to be its solution.
Some concierge doctors, including Larkin, have not only tested their clients for free, but have opened up their testing centers to the general public. The drive-through where Gerdsen was tested was part of a two-week clinical trial in partnership with the UCMC. When it closed on May 1, it had tested over 1,200 people.
Larkin also hosts twice-weekly Facebook Lives to update both the public and her patients on the status of the outbreak in Cincinnati. Benya does the same on Instagram from Beverly Hills.
Benya said she's seen a dramatic increase in interest from potential new patients. Larkin, meanwhile, has had so many inquiries about coronavirus tests that she had to stop scheduling new appointments.
"I hope that medicine shifts this way for everyone in the future," Benya said of the benefits of concierge medicine. "It's rewarding and satisfying for both sides."
But given how rare concierge practices are, and the high upfront cost they entail, that future could be a long way off for most Americans.
(Paragraphs six and seven have been updated to correct the amount of time Oswald Mendez waited for his test results, to three business days instead of seven.)
