Over the past few months, fear of the potential spread of Ebola virus in the U.S. has put the country on high alert. Although experts advise that an Ebola pandemic is unlikely to be a major threat to people living in the U.S., there are still legitimate concerns about the country’s ability to diagnose and contain the virus in the event of an outbreak. Ebola is a great example of how a global-scale pandemic could disrupt our way of life, and a great example of the need for more precision diagnostics.
In the disruptive innovation theory, we classify medical care into two major categories: intuitive and precision. We define intuitive medicine as care for conditions that can be diagnosed only by their symptoms, such as allergies, Alzheimer’s disease, and mental diseases. Treating these diseases tends to focus on therapies whose clinical efficacy is uncertain. On the other hand, precision medicine is care for diseases that can be precisely diagnosed, such as type 1 diabetes and bone fractures. In precision medicine, we identify root causes of diseases with precision diagnostics and we can often use rule-based therapies for treating them, making the clinical outcome much more predictable. Over the past century, we have made significant progress in precisely identifying types and causes of many diseases, but we are still far from getting our arms around some of the toughest known disorders.
Currently, Ebola treatment is more of an intuitive medicine. While the disease is in incubation period – anywhere from 5 to 21 days – there isn’t a good way to tell whether an individual is infected or contagious. Only when the individual starts showing symptoms of the disease – flu-like symptoms including fever, fatigue, and sore throat – can the disease be properly diagnosed. Because a lot of diseases also exhibit flu-like symptoms, this symptom-based diagnosis has plenty of room for error (as seen by the Texas hospital that let an Ebola patient with high fever go home with some antibiotics). Treating a highly infectious disease via intuitive medicine can introduce mistakes and risks that we cannot afford. If we had more precise diagnostics tools for Ebola virus, much of the panic and uncertainty could be mitigated. Both the direct and indirect costs of care would also have been significantly reduced.
Today, Ebola isn’t the only deadly disease with poor diagnostic tools. Many systemic and chronic diseases such as Alzheimer’s Disease, amyotrophic lateral sclerosis (ALS or Lou Gehrig’s disease), cancer, and mental disorders are extremely difficult to diagnose due to a lack of precise diagnostics. A lack of precision diagnostics means physicians are unable to pinpoint the exact nature of these mystifying diseases, and unable to effectively treat and cure them.
In cancer, for example, most available diagnostics tools are just imaging based, providing little to no details on the molecular nature of tumors and tumor progression. Physicians are not able to make a precise evaluation based on the fundamental biology of the disease, and this results in most advanced-stage cancer treatments being ineffective and costly. If cancer diagnostics and treatment could migrate more towards the realm of precision medicine, we would potentially be able to treat more types of cancers with more effective drugs at lower costs. With the population of these deadly chronic diseases steadily growing, better diagnostics are essential to curbing the rising cost of care.
The key lesson from the “summer of Ebola” is that our lack of deeper knowledge is highly costly. Diseases that are treated via precision medicines do not require special isolation units or expensive tests to verify their nature. Our ability to precisely diagnose a disease not only lowers costs of treatment, but also alleviates our fear of the unknown. The need for new precision diagnostics has never been greater.