A Glimpse into the Future of Diagnostics

In this issue of Clinical Chemistry , a report by the teams of Sam Sia (at Columbia) and Vincent Linder (at Claros/OPKO), together with a large group of collaborators, provides a remarkable example of what happens when one rethinks, both creatively and practically, how to collect diagnostic information in the developing world (1). By combining innovative engineering, a mixture of new and familiar technologies, good design, and careful attention to limited resources (human, financial, energetic), they have produced an integrated system whose impressive capabilities suggest a new approach to the design of portable diagnostic systems: keep the quality up (in fact, provide improved performance) relative to existing diagnostic technology; decrease costs; reduce the need for trained personnel; and use the web to move, store, and apply information. These goals constitute an aspirational roadmap for diagnostic systems for the developing world; this portable diagnostic system suggests that this roadmap can be followed practically. But the significance of the work goes beyond the developing world. It represents one brick in what will surely be the foundation of a revolution that will fundamentally change the technical and business structure of diagnostics. The business model for diagnostics (as for many aspects of the medical systems of the developed world) is almost incredibly archaic in its treatment of information. It assumes that the primary value of diagnostic information is in defining the nature of disease, and the course of treatment, for individual, symptomatic patients. It also assumes that diagnostic information will usually be expensive and come from complex diagnostic technology managed and priced to maximize profitability. In this model, because information is expensive, it will be available only in cases of obvious need (i.e., for symptomatic disease). The most primitive issues of extracting value from masses of population-wide data, or even of handling the information …