By Dr. Patrick Luedtke, M.D., President, APHL, Director, Unified State Laboratories, Utah Department of Health
Notes from the President will be a regular series.
Currently public health laboratories focus on infectious disease. Recently an APHL member and fellow lab director asked me for my thoughts on branching out to testing related to chronic disease prevention. I have given a good deal of thought to how public health labs will or could fit into a new prevention-based health system, which seems to be bounding down the healthcare highway toward us at a high rate of speed. While I certainly have no solutions, I have no shortage of ideas and concerns.
It seems to me the roles of public health laboratories in a prevention-based health system could be made to fit into four broad categories:
1. Provision of test results
Public health laboratories could begin or continue providing a panel of prevention-based testing that perhaps focuses on CDC director Dr. Thomas Frieden’s “winnable battles.” Testing could include fasting blood sugars, lipid panels, and others. Some of APHL’s local laboratory members already perform this testing on a regular basis. For others, it seems to me adoption of this type of testing would be quite dependent on local/state politics.
2. Prevention-focused research
I envision public health laboratories could play a meaningful role in prevention-focused research. For example, we are approaching 80 million American adults with hypertension, 95% of whom have no known cause for their high blood pressure. Additionally, it is well known that high blood levels of calcium and potassium as well as low levels of sodium produce significant decreases in many with high blood pressure. That being said, very little is known about body-burden of select metals/chemicals at birth and the resulting development of hypertension. The same could be said of other common diseases of public health import. Therefore, given the public health laboratory’s role in newborn screening (NBS), it is not a stretch to imagine an expansion of the NBS panel to include heavy metals, other select chemicals, etc. with the aim of identifying “at-birth risks” for chronic disease development.
3. Regulatory systems
It seems to me that traditional public health laboratory roles of oversight in the clinical lab arena will likely not change substantially in the future. In fact, they may expand as point-of-care testing increases and direct access testing labs proliferate.
4. Health outcomes partnering
I believe public health laboratories have an opportunity to move from the old “program evaluation” and internal “quality improvement initiative” paradigms to become active members in systems that focus predominantly on the final impact an intervention has on patient outcome. This is an area that clinical medicine is rapidly moving into, and an area I feel that public health laboratories need to seriously study.
— The opinions expressed here represent those of the author and not APHL.
Public Health Labs and Epidemiology departments have been instrumental in monitoring and understanding infectious diseases, which has led to great strides in prevention programs. So, why should the public health community, and labs in particular, not take up the challenge of trying to better diagnose, understand, and prevent chronic diseases as well?
Take one example: Prostate Cancer. Current diagnostic tests (i.e. PSA) fall short of what is needed by the medical community for confident patient diagnosis. Could Public Health Labs serve as reference laboratories for further types of confirmatory testing? This would allow the public health community as a whole to gather more information on this disease, and diagnostic tests for it, that will help out the medical community as a whole at a population-based level. It is these types of monitoring and research efforts that can only be done at the government public health level, not at individual hospitals or clinics.
Also, what about genetic testing. As more and more of these tests begin being used for preventative medicine – what role should Public Health Labs have in monitoring their use? Will confirmatory testing be needed for genetic tests?