Diagnostic Laboratory Quotes

Yet skill in the most sophisticated applications of laboratory technology and in the use of the latest therapeutic modality alone does not make a good physician. When a patient poses challenging clinical problems, an effective physician must be able to identify the crucial elements in a complex history and physical examination; order the appropriate laboratory, imaging, and diagnostic tests; and extract the key results from densely populated computer screens to determine whether to treat or to “watch.” As the number of tests increases, so does the likelihood that some incidental finding, completely unrelated to the clinical problem at hand, will be uncovered. Deciding whether a clinical clue is worth pursuing or should be dismissed as a “red herring” and weighing whether a proposed test, preventive measure, or treatment entails a greater risk than the disease itself are essential judgments that a skilled clinician must make many times each day. This combination of medical knowledge, intuition, experience, and judgment defines the art of medicine, which is as necessary to the practice of medicine as is a sound scientific base.

As many speakers noted, this tool wasn’t particularly well suited for assessing outcomes of a psychiatric drug. How could a study of a neuroleptic possibly be “double-blind”? The psychiatrist would quickly see who was on the drug and who was not, and any patient given Thorazine would know he was on a medication as well. Then there was the problem of diagnosis: How would a researcher know if the patients randomized into a trial really had “schizophrenia”? The diagnostic boundaries of mental disorders were forever changing. Equally problematic, what defined a “good outcome”? Psychiatrists and hospital staff might want to see drug-induced behavioral changes that made the patient “more socially acceptable” but weren’t to the “ultimate benefit of the patient,” said one conference speaker.11 And how could outcomes be measured? In a study of a drug for a known disease, mortality rates or laboratory results could serve as objective measures of whether a treatment worked. For instance, to test whether a drug for tuberculosis was effective, an X-ray of the lung could show whether the bacillus that caused the disease was gone. What would be the measurable endpoint in a trial of a drug for schizophrenia? The problem, said NIMH physician Edward Evarts at the conference, was that “the goals of therapy in schizophrenia, short of getting the patient ‘well,’ have not been clearly defined.

it is not uncommon for experts in DNA analysis to testify at a criminal trial that a DNA sample taken from a crime scene matches that taken from a suspect. How certain are such matches? When DNA evidence was first introduced, a number of experts testified that false positives are impossible in DNA testing. Today DNA experts regularly testify that the odds of a random person’s matching the crime sample are less than 1 in 1 million or 1 in 1 billion. With those odds one could hardly blame a juror for thinking, throw away the key. But there is another statistic that is often not presented to the jury, one having to do with the fact that labs make errors, for instance, in collecting or handling a sample, by accidentally mixing or swapping samples, or by misinterpreting or incorrectly reporting results. Each of these errors is rare but not nearly as rare as a random match. The Philadelphia City Crime Laboratory, for instance, admitted that it had swapped the reference sample of the defendant and the victim in a rape case, and a testing firm called Cellmark Diagnostics admitted a similar error.20 Unfortunately, the power of statistics relating to DNA presented in court is such that in Oklahoma a court sentenced a man named Timothy Durham to more than 3,100 years in prison even though eleven witnesses had placed him in another state at the time of the crime. It turned out that in the initial analysis the lab had failed to completely separate the DNA of the rapist and that of the victim in the fluid they tested, and the combination of the victim’s and the rapist’s DNA produced a positive result when compared with Durham’s. A later retest turned up the error, and Durham was released after spending nearly four years in prison.21 Estimates of the error rate due to human causes vary, but many experts put it at around 1 percent. However, since the error rate of many labs has never been measured, courts often do not allow testimony on this overall statistic. Even if courts did allow testimony regarding false positives, how would jurors assess it? Most jurors assume that given the two types of error—the 1 in 1 billion accidental match and the 1 in 100 lab-error match—the overall error rate must be somewhere in between, say 1 in 500 million, which is still for most jurors beyond a reasonable doubt. But employing the laws of probability, we find a much different answer. The way to think of it is this: Since both errors are very unlikely, we can ignore the possibility that there is both an accidental match and a lab error. Therefore, we seek the probability that one error or the other occurred. That is given by our sum rule: it is the probability of a lab error (1 in 100) + the probability of an accidental match (1 in 1 billion). Since the latter is 10 million times smaller than the former, to a very good approximation the chance of both errors is the same as the chance of the more probable error—that is, the chances are 1 in 100. Given both possible causes, therefore, we should ignore the fancy expert testimony about the odds of accidental matches and focus instead on the much higher laboratory error rate—the very data courts often do not allow attorneys to present! And so the oft-repeated claims of DNA infallibility are exaggerated.

An analysis of nutritional and metabolic data by Jon Pangborn, Ph.D., a well-known nutritional biochemist affiliated with the Great Smokies Diagnostic Laboratories in Asheville, North Carolina, found that the metabolism of methionine is the “most frequently impaired or disordered amino acid” among 1,500 individuals with food and chemical intolerances, degenerative diseases, neuromuscular dysfunction, and mental diseases.

Quicksilver Scientific is a CLIA-certified laboratory that specializes in superior liposomal delivery systems, mercury testing and blood metal testing for human health. Our goal is to provide top of the line products and education to practitioners so that they may better serve the health care industry.

In nature, ecosystems consist of fauna and flora, climatic characteristics, soil conditions, geologic features, and a host of other interacting influences. Similarly, the precision medicine ecosystem is made of many interacting components, including patients, clinicians, researchers, laboratory services, CDS software, genomic databases, smartphones, servers, claims data, mobile apps, biobanks to store clinical specimens, and EHRs. EHRs need to serve as gateways to this ecosystem. And for the EHR to become an effective conduit, it needs a way to organize these diverse sources in a way that lets clinicians and patients make more effective diagnostic and treatment decisions.

The Keeling Curve Courtesy the NASA Earth Observatory. NASA graph by Robert Simmon, based on data provided by the NOAA Climate Monitoring and Diagnostics Laboratory.   If the scientific story of global warming has one great hero, he is James Hansen, and not only because he is the most important climatologist of his era, whose massive computer models were demonstrating by the early 1980s that increased CO2 posed a dire threat.

three associates of the William Pepper Clinical Laboratory at the University of Pennsylvania used well over a hundred children under the age of eight at the St. Vincent’s Home for Orphans, a Catholic orphanage in Philadelphia, for a series of diagnostic tests in which a tuberculin formula was placed in the test subjects’ eyes. 23