THE IMPORTANCE OF MEDICAL LABORATORIES IN DISEASE DIAGNOSIS

Abstract

Pathologist Paul Bachner calls medical laboratories the ‘’black box’’ of healthcare. ‘’It may not be very glamorous, and it is often overlooked, but it is the engine room,’’ he writes. ‘’It is where most of the evidence comes from that drives medical decision-making’’. The reality is even starker than Bachner points out: ‘’20-70-90’’. About 20% of the nation’s medical budget is spent on pathology (70% of in-patient care and as much as 90% of health decisions made by doctors are influenced by pathology). So why then are laboratories and their staff so undervalued and sequestered away from the action? This is written with a (fortunate) degree of ignorance since I am not a pathologist, nor even a clinician. However, as a public health worker, I have been forced to face the fact that without accurate laboratory services, much of what public health aspires to may be strangled at birth (Strain & H. Ravalico, 2021). All of us who work in health aspire to help individuals, patients, improve patient outcomes, and yet we know how sparse is the knowledge base about what really works. Unless the best possible diagnosis of a disease has been made, why would we expect that a treatment discovered in a research study will work on most of the patients with the same disease in clinical practice? I find no mention of pathology in the World Bank’s vast tome on investing in health. Big mistake. Similarly, one can scour the four volumes of the 1993 World Development Report: Investing in Health and there is little mention of laboratory services. With the welcome advent and practice of providing antiretroviral treatment in countries with large numbers of HIV positive individuals, how to measure the effectiveness of that treatment without sophisticated laboratory back up? With the availability of super cheap antibiotics, how to measure increasing levels of anti-microbial resistance without investment in operational research laboratory services? So, what follows is still much ignorance, but hopefully an opening up of some of the issues faced in relation to medical laboratory services, at least in low- and middle-income countries.