It is about time that more advanced diagnostics made it out of the lab and into the surgery
WE鈥橵E all been there. You get a sore throat or a hacking cough and you begin to feel bad, so you visit your doctor. The doctor says maybe it鈥檚 a bacterial infection, and gives you a course of antibiotics. Or, maybe it鈥檚 a virus, so here鈥檚 a decongestant, drink lots of fluids and have some antibiotics anyway, just to be on the safe side.
Some doctors think certain symptoms distinguish the two types of infection, but this is not a reliable method. Your symptoms reflect your immune system鈥檚 response to respiratory infection, regardless of the exact cause, so they tend to look similar. Astonishingly, in the 21st century, there is no quick way for your doctor to distinguish a bacterial from a viral infection.
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This may not matter if you get better quickly. But if you don鈥檛, you could be in serious trouble. And if you were given antibiotics, they might simply have bred antibiotic-resistant bacteria as your doctor tried different drugs until one worked 鈥� diagnosis by treatment.
We can do so much better. There are new technologies, mainly based on advances in analysing DNA, that can enable a hospital lab to diagnose what鈥檚 eating you in hours (see 鈥淕erm detector: Unmasking our microbial foes鈥�). Affordable, accurate versions could be a boon to family doctors, yet they are reaching even hospital clinics at a needlessly glacial pace, if at all.
One hurdle is a mistrust among some doctors of tests that seem to replace their judgement. But infectious diseases are caused by specific agents, so it makes sense to make testing more objective to allow treatment to be as specific as possible. Of course a doctor鈥檚 judgement will always be central, but just as standardised medicines replaced physicians鈥� 19th-century nostrums, reliable tests for pathogens can surely be worked into the financial, legal and cultural institutions of medicine.
The second block is more exasperating. . Obviously tests must be shown definitively to do what they say they do. Yet this seems to require more imagination than these agencies have been able to muster. Caution seems excessive at the US Food and Drug Administration, for example, which , when , along with .
The regulators need to be pushed into action. Doctors should be screaming for change. Besides helping patients, routine, automated diagnosis of the agent behind every infection will show us the ebb and flow of the microbial sea we inhabit; . Who knows what that could tell us about which bugs cause which unsuspected diseases, or how infections interact with each other.
鈥淩outine diagnosis will show us in real time the ebb and flow of the microbial sea we inhabit鈥�
Although germs are an ancient foe, we have yet to learn the lessons of, one of the oldest and most influential books on military strategy. To mount an effective attack, you first have to know your enemy.