Paper tests tear up diagnostic norms

Posted: 23 September 2011 by James Barlow

Long ago in rich countries, we began the move to cheap and easier diagnostics. Women didn’t want to wait for a doctor to say whether they were pregnant.  So, over the counter testing kits were born. Latterly, access to the Internet has also greatly extended opportunities for diagnosis. Nevertheless, expensive diagnostic equipment and expertise have remained largely the norm within the NHS and other developed world health systems.

But in developing countries, healthcare staff shortages and cost are now leading to the adoption of much cheaper and simpler care diagnostics. The changes could save millions of lives at an affordable price. If exported back to richer countries, they could lay waste to traditional diagnostic techniques and challenge the suppliers of existing equipment as well as threatening professional vested interests.

Recently, at the World Health Care Congress in Washington, I heard about Diagnosis for All, one of a number of companies that are leading the way. It recognises that paper is cheap and ubiquitous so, if you can embed a test onto a piece of it, costs could fall dramatically.

Through innovation in wax printing and micro-fluidics technology, DFA can produce postage stamp sized tests with the positive and negative controls embedded in the test. The cost is just 2.9 US cents per test. One printer – the size of a typical household computer printer – can print 200 tests in a minute. All the guidance notes are in the packaging for the test or can be sent via a mobile phone. The market is potentially huge – and not just for healthcare. Tests can be created for water, quality, food and crops.

Another company, QuickCheck Health, has produced a ‘retail clinic in a box’, an over-the-counter device for home testing. This is all about home diagnostics, supported by a virtual online visit by someone who can interpret the test for you – a ‘test at home, treat online’ approach. The company has now created 17 rapid tests. The initial market is the US and the target price for the home test is $10 with an optional $35 online clinic visit. But the potential of the device for remote areas in lower income countries is clear.

The applicability of these solutions as disruptive innovations for developed healthcare systems is considerable. Diagnosis for All is now developing its system for diabetes, putting all the functionality of a handheld glucometer onto a paper test. Meanwhile, QuickCheck Health is targeting streptococcus throat infection in the US, where 40m streptococcus tests – 80 per cent of which prove negative – are carried out annually at huge cost.

This is all about innovation driven from the ground up – widening access to healthcare through close attention to local needs.  Innovators in the field emphasise that the key is not just about developing technology but thinking about the system in which it is being deployed. It is also vital to give authority and resources to a local team to go out and develop new ideas.

Marketing and understanding how to introduce the innovation and how to shift prevailing perspectives is also critical. Throw-away diagnostic tests have vast applicability but they will also undermine existing approaches. Anyone seeking to champion these changes should be ready to face extensive vested interests that may resist such change.

Professor James Barlow is a co-director of HaCIRIC