Ears Wide Open

Have you ever wondered how you can use what you know as an analytical scientist to make an impact on people's lives? I have and, fortunately, I found that the first step is easy: listen to people in need. Better yet, befriend a professional who speaks with many such people regularly. In my case, this was a clinician who told me stories of trial and error for analyses and therapeutic decisions that made my head spin. Clinicians have batteries of tests at their disposal to guide decisions and to monitor patients, it’s true, but conversations invariably raise complaints about test inadequacies, poor ergonomics, and high lab fees.

Have you ever wondered how you can use what you know as an analytical scientist to make an impact on people's lives? I have and, fortunately, I found that the first step is easy: listen to people in need. Better yet, befriend a professional who speaks with many such people regularly. In my case, this was a clinician who told me stories of trial and error for analyses and therapeutic decisions that made my head spin. Clinicians have batteries of tests at their disposal to guide decisions and to monitor patients, it’s true, but conversations invariably raise complaints about test inadequacies, poor ergonomics, and high lab fees.

A typical scientist’s reaction to hearing this is to claim, “I can do the same thing more accurately” or “I can do the same thing cheaper.” But before you rush to develop new analytical technology that improves things on one axis, delve more deeply into the real world; listen to your clinician friend a little more intently.

Many of today's practices are products of circumstance. A diagnostic technology that once offered a big leap in accuracy can become a gold standard for treatment decisions, but as new risk factors are uncovered by research and the at-risk population balloons, the same technology may well be too expensive and unwieldy to use as a screening method.

A great example of this is colon cancer, where colonoscopy is the gold standard for detecting both cancer and pre-cancerous lesions. Colonoscopies are expensive (and only a fraction of those at risk comply). Home screening tests do exist – the fecal occult blood test (FOBT) and fecal immunochemical test (FIT) – but they detect late-stage cancers, not pre-cancers. The correct diagnostic – the real gold standard – is a cheap, easy and accurate test for precancers. It would help to significantly reduce mortality and the cost of treatment.

A different problem is exemplified by prostate and breast cancers. For these disease, cheap and easy-to-use biomarker-based screening tests are widely-available. Unfortunately, in too many cases they are unlikely to result in care that changes outcomes. More accurate tests are costlier and more difficult to perform as they require tissue samples.

There are tests in development for these cancers that will provide a better balance between accuracy, usability, and cost. Throughout medicine, the same needs apply: to catch signs of disease or acute injury earlier, when progression may still be arrested, and to do so without burdening the healthcare system's already stretched resources.

An approach that has not yet been well explored is putting screening and monitoring tests in the hands of the people. Until the recent advent of portable separation and analytical technologies, testing products for consumers were seen simply as sample acquisition (at best, sample preparation) devices ahead of the lab. Additionally, clinicians hold a legitimate fear that personal testing would lead to people making their own treatment decisions, misinterpreting results and stampeding into the healthcare system, or, worse still, misinterpreting results and gaining a false sense of security.

By fully exploring the world of clinicians, we are able to learn more than just the need for better testing; we can discover the fears and anxieties that come with the territory of medical practice. Learning as much as we can about the clinical world is the key to a truly successful contribution.