WHO List Recognizes Importance of Lab in Clinical Decision Making

The following Letter to the Editor was submitted by ASCP President James L. Wisecarver, MD, PhD, FASCP, to the New York Times in response to its May 21, 2018 article, WHO Names Some Lab Tests ‘Essential,’ about the World Health Organization publishing its first-ever list of diagnostic tests that it considers essential to healthcare systems around the globe.

The New York Times article on May 21, W.H.O. Names Some Lab Tests ‘Essential,’ by Donald G. McNeil, Jr., is a great step forward in recognizing the importance of laboratory testing in clinical decision making. More than 70% of all medical decisions hinge on laboratory testing which must be rapid, accurate, and precise for every patient, every time. Too often, expense and complexity hinders the use of laboratory testing in resource-limited settings.

The achievements of the President’s Emergency Plan for AIDS Relief (PEPFAR) can serve as a model for combatting other diseases. With the support of PEPFAR, affordable, high-quality testing for HIV diagnosis and treatment is now accessible to millions of patients around the world. To achieve this, donors and governments made significant investments in laboratory strengthening and training. ASCP has supported laboratory workforce development initiatives since 2005 through PEPFAR and, more recently, our Partners for Cancer Diagnosis and Treatment in Africa initiative. In this latter initiative, the value of the laboratory diagnostics cannot be overemphasized as no patient can be treated for cancer without a confirmed pathological diagnosis.

As cancer rates in developing countries continue to rise, patients are often diagnosed too late to be treated with curative therapies. The primary reasons for this are the lack of trained pathologists and laboratory professionals along with limited access to diagnostic tests and reagents. Because of the infrastructure complexity of cancer care, fiscal models previously used for infectious diseases (which forms the bulk of the current essential diagnostics list) will not work for equitable models of cancer care. A tremendous effort is needed to push the cancer care agenda to a position of equity and excellence seen in the areas of HIV, tuberculosis, and malaria.

We welcome this development and encourage governments and donors around the world to invest more in their medical laboratory professionals. Future editions of the W.H.O. list should be expanded to include other essential tests for cancer, emerging and epidemic-prone diseases, and drug resistance.

James L. Wisecarver, MD, PhD, FASCP

President, ASCP