Looking for trouble

BlaineVigilance is the watchword of the day. In healthcare, this suits us very well.

Techniques are emerging for pinpoint diagnostics at every stage of health and disease, from genetic susceptibility, through the development of early risk factors, and on to prognosis and effectiveness of treatment methods. With resources always limited, our best hope for the future is to identify which tests and interventions demonstrate the most improvement in clinical outcomes at each stage — and at the least trauma and cost.

Our Lab Economics feature (page 28) this month offers one real-lab example of how identifying the right test can improve both the outcome of an emergency room visit for an individual, and the financial ability of a hospital to serve its community. The article offers a model to quantify potential monetary savings, and further the patient goals of disease management, by using an appropriate cardiac marker to diagnose chest pain patients. When only half of us at cardiac risk fit the conventional profile, cardiac markers become even more important as objective measurements in clinical evaluation.

Our Hematology Industry Overview (page 22) is likewise focused on how improved instrument capability is setting the pace for earlier disease detection, more sensitive routine testing, and closer monitoring of both disease and the effectiveness of treatment. Every sample run on the latest generation of hematology analyzers has the ability to provide a wealth of information that previously could have remained hidden until the human and monetary costs would be much higher.

Look to our Disease Management feature (page 16) on testicular cancer (TC) for a discussion of how specific markers fit into the overall diagnostic work-up and monitoring of a disease that strikes apparently healthy men in their prime. As the title says, early diagnosis is key to survivability. TC is highly curable through a combination of therapies, and the great chemosensitivity of this disease begins to provide a model for cancer treatment of all types. But the real hope for triumph over this and other cancer killers may lie in discovering the process that changes TC cells from responsive to unresponsive in the most difficult of cases. Unlocking the genetic and molecular mechanisms that control TC’s chemosensitivity is an area of research with promise for the management of cancers of all types.

And, in this month’s Tech Focus section (page 34), you will find a realized promise of new molecular methods in cancer treatment: linking diagnostics with drug therapy. Tight healthcare budgets require any new product to demonstrate cost-effective improvements in clinical outcomes, but our expectations for molecular techniques pointing to the right therapies are deservedly high. This is true in cancer treatment as well as infectious disease. With amplification techniques, we can detect and identify organisms that were previously uncultivatable, and then go on to see which of the drugs in our arsenal they’ve already mutated to resist. We have the promise of improvement in both diagnosis and treatment, limiting ineffective therapies and minimizing harmful side effects. As molecular methods are adapted to kit-based techniques, with further standardization and automation, more of us will have access to this enhanced diagnostic capability.

So let’s continue our vigilance, realizing that the more we look for trouble today, the less we may see of it tomorrow.

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Ellen Blaine, Editor
[email protected]