Milestone Laboratory Diagnostics The changing world of laboratory diagnostics: Making Best Use of the Available Options
Dr. Thomas Schinecker talks about demographic change, health policy and how increasing complexity can be managed for the benefit of patients, physicians, laboratories and the health care system. The interview was conducted by Dr. Ilka Ottleben from the LP editorial team.
LP: The world of laboratory diagnostics has continued to evolve over the past 25 years - what has changed?
Dr. Thomas Schinecker: In the past, laboratory diagnostics were extremely reliant on manual workflows, and this made them more error-prone. Not only that, the broad spectrum of diagnostic options available today would have been prohibitively expensive without parallel advances in automation. Analysis systems are so highly automated that there is very little likelihood of error, and scalability is now at a level that was simply not possible in the past. The system has succeeded in delivering more within the given cost parameters.
LP: But development continues ...
Dr. Schinecker: We will certainly see further advances in automation. Also, there are many diseases for which no diagnostics currently exist. In our overall market portfolio, we introduce many new parameters each year to broaden the spectrum. The earlier cancer is detected, the more effective is the treatment
LP: How far has automation advanced in today's clinical laboratories?
Dr. Schinecker:In many cases, things have reached the stage where a sample which is received in the laboratory is processed and analyzed virtually without human intervention, and the findings are issued on that basis. This trend will continue. Obviously, IT has a big role to play. Larger data volumes have to be managed and transferred across networks. Beyond that, automated IT-based tools help physicians make decisions. On the other hand, there are always emerging technologies where automation has not yet reached the same level of sophistication.
LP: What form do these decision aids for physicians take? Will computers soon be making the diagnosis?
Dr. Schinecker: Automation will reach a very advanced level, but it will always be the physician who makes the decision. Decision aids are similar to on-board navigation systems in cars. In this analogy, the system makes a route suggestion, but the decision whether to turn left or right is made by the physician who retains full responsibility. Some people have reservations about this, but if we do not think in these terms, the sheer magnitude of the requirements placed on us in the future will become unmanageable.
LP: What role does demographic change play in this context?
Dr. Schinecker: By the year 2020, 40% of the German population will be over the age of 60. Some of the consequences will be a further expansion of the portfolio, increased complexity and even larger data volumes. Laboratories must somehow find ways of managing this, to some extent with existing resources. Automation will be a key factor along with availability of the right parameters. The elderly often suffer from multiple afflictions. From the medical perspective, much can be done to increase our understanding of the interactions between them. The looming shortage of physicians in Germany, which to some extent is the result of demographic factors, makes it increasingly important to provide the best possible decentralized care, be it at home or by the family physician. Here again, digital solutions and data networking using equipment at the point-of-care will undoubtedly become increasingly important.
LP: New technologies will presumably also be high on the agenda.
Dr. Schinecker: Of course. Take for example microchip technology which is essential for multiplex analysis. Other technologies are also entering the mainstream such as liquid biopsy and next-generation sequencing, e.g. for personalized medicine and oncology screening and monitoring. Of course we are also working on technologies which will be introduced 10 to 15 years from now. You need a broad-based organization, which on the one hand is involved in highly innovative research. Our level of R&D investment is by far the highest in the diagnostics industry. On the other hand, you must always be open to partnerships, mergers and acquisitions. A balanced portfolio is highly important, and in my opinion we are very well positioned.
LP: Which seems to be paying dividends for you.
Dr. Schinecker: Without doubt. In the summer, we published our market figures for the first six months. It is satisfying to see that we are growing six to seven times faster than the market. This is ultimately due to the fact that we sell not just products but also solutions that reduce the overall burden on the health care system by delivering medical value-add which results in cost savings elsewhere. Our portfolio also provides the basis for process improvements which directly reduce costs in the laboratories. Unfortunately, in response to cost pressures in the German health care system, efforts are being made to reduce costs even further in laboratory diagnostics.
LP: And that creates limitations?
Dr. Schinecker: I cannot understand why in Germany we have to wait 10, 12, 13 years before new innovative technology, which generates medical and economic value-add, is accepted into the standard health care system. Attempts are being made to save money at precisely the point where opportunities exist to reduce cost at an entirely different level. Taking a long-term perspective would be the better approach. If I invest in early detection of disease, many illnesses can be prevented which otherwise would require cost-intensive treatment. Good diagnosis provides better options for targeted therapy, and that costs less than overtreatment or the wrong treatment. Preeclampsia and HPV in cervical cancer prevention are two current examples where big opportunities exist, and diagnostics naturally have a major role to play. Compared to the rest of Europe however, the remuneration level in Germany is by far the lowest. For some parameters, the laboratories do not even cover their costs. If this situation continues, the result will be lower quality and wrong treatment decisions that will generate huge costs in the system.
LP:Where do you see laboratory diagnostics 30 years from now?
Dr. Schinecker: : I think that 30 years from now, far more monitoring will take place, to some extent on healthy persons. Point-of-care equipment or other sensors may possibly keep a constant watch on patients. Data will be sent to physicians so that they can intervene before the disease progresses. If disease is detected early, it is often possible to find quick, uncomplicated and cost-effective solutions, and in my view that will be possible 30 years from now.