PJ Online | News: Not enough funding available for diagnostic testing

The Pharmaceutical Journal Vol 267 No 7174 p701-706
17 November 2001

Not enough funding available for diagnostic testing

Diagnostic testing underpins the effective delivery of health care yet its role is under-recognised, a conference concluded this week. The conference, "Diagnostics: the best kept secret in health care", held in London on 13 November, heard that diagnostic testing offers significant benefits but that a real challenge exists in terms of its funding.

Greater use of diagnostic testing will benefit patients and health outcomes, said Professor David Taylor, professor of pharmaceutical and public health policy, School of Pharmacy, University of London. It can be used to:

identify risks to health to open the way for preventive action
diagnose disease, particularly at an early stage, facilitating early treatment and better outcomes
monitor disease progression and therapeutic interventions to improve quality of treatment

A question exists as to whether or not using expensive tests would add anything to simple measures already used to predict risks. Professor Taylor thought that modern diagnostics could provide information to help individuals understand their specific vulnerabilities to disease. It would open up new early treatment and medicines management opportunities, he said. There is also the issue of the National Health Service being able to afford the new technologies and, if it cannot, whether people should pay for them privately. "A vision for the future of community pharmacy is to provide a wider range of services, including risk identification," he added.

However, Anne Campbell, member of Parliament for Cambridge City, expressed concerns over the availability of diagnostic testing in pharmacies saying that people receiving bad news needed sympathetic and professional counselling from a general practitioner. Simon Fradd of the Doctor Patient Partnership disagreed. He said that the nearer testing could be to the patient, the better. Professor Taylor pointed out that service users wanted access to testing.

Professor Tony Moffat, the Royal Pharmaceutical Society's chief scientist, commented that pharmacists had a real role in monitoring diseases and diagnostic testing to prevent illness. In the future, this could be expanded to pharmacogenomic testing to ensure that the right drug is given to the right patient, he added.

The lack of a mechanism for funding of point-of-care testing in community pharmacy was pointed out. Andy Bufton, chairman of the public relations steering group, British In Vitro Diagnostics Association, said that there were examples of good practice in community pharmacy and that such examples should be sent to the National Institute for Clinical Excellence. Part of the institute's job was to disseminate evidence, he said.

Dr John Archer, senior research fellow, department of genetics, University of Cambridge, said that by combining genetic information and medicine in new genetic diagnostic tests, there was a potential to change the way medicine is practised. Genetic testing provided the potential to tailor treatment to individuals rather than medicines treating diseases. It also provided the opportunity to predict disease. However, "it is imperative that legislation protects people from genetic discrimination," he said.

An example of a practical application of genetic testing was in response to salbutamol therapy. Patients with asthma responded variably to medication. This could be explained by genetic differences in the beta-adrenergic receptor protein that led to small changes in the protein's ability to interact with the drug. In this way, better treatments based on genetic testing could be provided. "In the future, I believe that it will become the norm for there to be no blockbuster drugs but a series of drugs for individual genotypes," said Dr Archer.

Mr Bufton pointed out the developing link between diagnostics and drug therapy. The first medicine to be licensed on such a basis was trastuzumab (Herceptin) for breast cancer, which had been linked with a test for the HER2 receptor. "I expect we will see many more of these links," he said.

Blood pressure should be monitored every year for people with high-normal blood pressure and every two years for people with normal blood pressure, researchers suggest. They found that over a four-year period, 5 per cent of people aged below 65 years with optimum blood pressure, 18 per cent with normal pressure and 37 per cent with high-normal pressure progressed to high blood pressure. In people aged over 65 years, the figures were 16, 26 and 50 per cent, respectively. Optimum blood pressure was defined as less than 120/80mmHg, normal 120–129/80–84mmHg and high-normal 130–139/85–89mmHg (Lancet 2001; 358:1682).