July 18, 2016

Doctor calls for universal list of essential diagnostic tests

The World Health Organization has long maintained the Model List of Essential Medicines (EML), identifying those medicines required for basic healthcare delivery.

Why not a corresponding Model List of Essential Diagnostics (EDL) covering laboratory tests that should also be widely available? It's a question with major global health implications that one U-M doctor recently posed in the New England Journal of Medicine (NEJM).

Dr. Schroeder

"We believe the world can no longer wait to have laboratory testing available to all clinicians,” writes Lee Schroeder, UMHS Assistant Professor of Pathology and the first author of the recent article. “An EDL would clarify priorities for policymakers and encourage setting common goals regarding laboratory testing, paving the way toward improved health care delivery and ultimately better patient outcomes."

Schroeder’s article, Time For a Model List of Essential Diagnostics, appears in the June 30 issue of NEJM. Working with colleagues at Johns Hopkins University, Emory University, and Albert Einstein School of Medicine, he’s proposed a list of nearly 150 essential laboratory tests based largely on the World Health Organization’s EML. After all, the EML recommendations include many medications that cannot be prescribed without a test-based diagnoses.

"For each [EML] core medicine, we consulted a number of well-established sources to identify diagnostic tests considered essential for at least one of the following: diagnosing the condition for which the medicine is indicated, monitoring for medication efficacy, or monitoring for medication toxicity," Schroeder writes.

His report follows a 2015 study in which he and others looked the lab testing capabilities and capacities in the city of Kampala, Uganda.

“Many developing countries have high-quality central public health labs in large cities; the missing piece in global health is a network of smaller but still high-quality labs throughout the country,” Schroeder told the UMHS website M Health Lab for a recent article. "You can't treat what you can't test.”

Dr. Schroeder and his colleagues plan to call upon the WHO to establish a Model List of Essential Diagnostics and to encourage major stakeholders and donors to support the WHO in that process.

“Such a list should indeed lead to greatly improved access and affordability of diagnostics in resource-poor settings,” he said. “We believe it will also stimulate solutions to test supply-chain obstacles, promote country-level regulation of these laboratory tests to ensure quality, improve provider confidence in test results, and overall  encourage redesign of health care work flows to link test-positive patients to treatments.”