Personalized medicine. Patient-specific medicine. Genomic medicine, molecular medicine. All phrases you have likely heard to describe the new frontier of medical care. I think many of us in medicine continue to believe genomic and molecular diagnostics are still some distant, futuristic technology; that it mostly exists in research laboratories and bench top research papers and, apart from practice arenas like oncology, remains far removed from the bedside.
Polymerase chain reaction (PCR) testing falls under that umbrella of molecular medicine. While it has been studied and progressively utilized since the mid-1980s, it only recently became a household name (at least in the medical community) in the last few years when it was robustly employed to test for COVID-19. And for many, that is its continued place in therapy: a useful diagnostic to rapidly rule in or rule out specific organisms like COVID-19, influenza, or tuberculosis.
In truth, however, broader PCR testing is already being utilized to diagnose and treat thousands of patients every day across the entire spectrum of infectious diseases. This blog and other earlier blog posts expand on what PCR is, how it works, why it is a game changer, and how it is positively impacting patient outcomes, so we won’t dwell there today. Instead, let us highlight some reasons why the medical community – and the world in general – appears skeptical of new technological advances like PCR.
Dr. Calestous Juma, PhD, a professor at the Harvard Kennedy School who studies this question, observes, “Humans are instinctively designed to react to novel things in a way that aims to protect oneself.” He remarks that people often reject technology because it presents changes to their immediate world, a world to which they have worked hard to adjust. Other factors also play a role: lack of familiarity, cost concerns, generational differences, and comfort in the current standards of practice despite acknowledging the failures and pitfalls of said standards.
The classic discussion around PCR involves comparing it to culture, the current and longstanding standard for many infectious disease scenarios. In the beginning of any new diagnostic technology – when lab or in vitro data emerges, case studies and case series appear showing positive results, etc – it is easy to remain skeptical. It is easy to continue justifying the shortcomings of culture. But at what point must we accept that 80% sensitivity is not good enough? When do we decide parking patients on broad spectrum antibiotics for 3-4 days while we wait for results isn’t acceptable anymore? When do we acknowledge that modern infections are caused by more varied and drug-resistant organisms than ever before and culture simply can’t identify everything we’re looking for? When do we start to believe in data that repeatedly tells us PCR is faster, more accurate, less prone to human error, and leading to better antimicrobial stewardship in not dozens, not hundreds, but tens of thousands of patients?
And trust me, there is perhaps no greater skeptic to “the next great” anything in medicine than the person writing this article. After all, one only has to browse the Netflix documentaries section to uncover the shocking rise and fall of a lab promising to change diagnostics forever. But when data begins to support that leveraging technology and evolving our practices indeed can improve patient care, we must be willing to step – however anxiously – into the future of medicine.
Our goal at Industry Lab is to educate the medical communities around us on what PCR is, what the evidence does and does not support for its use, and how molecular medicine is a tool to be leveraged today to better care for our patients. In addition to our Town Halls, data reviews, and a 24/7 clinical consult service, we are excited to help promote a new educational tool. We actually
had nothing to do with creating this eBook, but it is too good a resource from ThermoFisher Scientific not to share! It is a compilation of experts in the field providing a PCR overview – what it is, what it can and can’t do, how it compares to current diagnostics, and how it can help impact antimicrobial stewardship. Check it out here!
As always, if you have questions about PCR testing or about how Industry Lab can partner with you to treat patients better, contact us anytime!
Dr. CJ Michaud
Director of Clinical Treatment at ILDP