For First Time, WHO Names Some Lab Tests ‘Essential’

For the first time, the World Health Organization has published a list of diagnostic tests that it considers essential to every health care system in the world.

The list, published last Wednesday, is similar to the agency’s essential medicines list, which the WHO introduced in 1977.

In its day, the medicines list was revolutionary because it was both a global guide to rational treatment regimens and because it fostered the idea that certain medicines were so important that they should be available to the whole world, regardless of price.

The WHO expert panel that created the diagnostics list hopes it will eventually be just as revolutionary.

“I’m thrilled about it,” said Dr. Madhukar Pai, director of global health for McGill University’s medical school and a member of the panel that spent two years creating the list.

“But I’m very aware that publishing a list in Geneva will not magically make malaria test kits available in Vietnam. Each country has to make its own list to give the idea teeth.”

The WHO lists 113 diagnostics. Fifty-eight are the routine blood and urine tests that are run in most American medical offices: measurements of red and white blood cells, blood sugar, liver enzymes and so on, along with tests for one-time events like pregnancy or transfusion blood-typing.

The remaining 55 are tests for diseases the WHO considers of highest priority: HIV, tuberculosis, malaria, hepatitis B, hepatitis C, HPV and syphilis.

Without diagnosis, care is crippled, Pai said.

“I grew up in India and often worked without diagnostics, managing with whatever I could get,” he said. “If you don’t know someone has hep C or drug-resistant TB, how are you going to cure them?”

Panel members hope to soon expand the list by adding tests for viruses like flu, antibiotic resistance in bacteria, cancer, heart disease and other ills.

They also hope to add an essential “devices” category to include diagnostic equipment like X-ray and CT scanners, ultrasounds, fiber-optic scopes, automated blood analyzers, PCR machines and so on.

Although many of these tests and devices have been around for decades, there is great variance in the ways diseases are diagnosed in different countries.

Worse, doctors often prescribe antibiotics or other drugs without diagnoses, which can hurt patients and speed drug resistance.

Besides setting universal standards, the list is meant to encourage countries to build the laboratories needed to do the tests. It is also meant to give the diagnostics industry — which is far more fragmented than the pharma industry — targets to aim at, which should lower prices.