Low-Cost Diagnostics

THE ARTICLE on low-cost diagnostics is interesting (C&EN, March 16, page 50). One issue that is essentially ignored in discussing diagnostics for resource-limited countries is relevance of the technology and affordability of the assays. I and others have questioned many of the efforts that have been made to deal with CD4 cells, which are diagnostic of HIV infection, for example.

The devastating impact of HIV/AIDS
in Africa has been used by several companies to promote their entry into that continent using promotions that are frequently disingenuous at best and unethical at worst. When companies promote their technologies as being focused on Africa and resource-poor settings, the implication is that they will bring these technologies to bear on these regions. However, many companies use the interest and value of Africa to promote themselves in the media. When it comes to providing something that is useful and that works, however, they fail. They give a false impression in our own society that the problems of resource-poor countries are being solved and give false hope to those most in need.

Governments and private foundations are quick to fund high-profile next-generation fixes, but when these programs are evaluated, the results are very poor indeed. It's a pity that those making grandiose claims are not called to answer for their failure to deliver. We frequently hear of scientists promoting a chip that will cost a couple of cents for a test, but in reality, it never appears, or it actually costs $10 or more. People making claims should be required to account for their actions.

It's also distressing that so many promote the concept that instruments are really not necessary—that all things can be developed using visual/color change reactions, for example, without having to design and build low-cost but still moderately clever instruments. This has been the case with CD4 for HIV/AIDS. The promotion of "technology-less" solutions has not been successful.

For example, as noted in the article, half of the projects funded by the Imperial Colleges Gates grant (and presumably a significant amount of money) have failed to produce results. Had this project been subject to careful evaluation, many of the proposed projects would not have been attempted. In the meantime, conventional and easily achievable solutions are ignored because they are not "next-gen" enough.

Clearly, next-generation solutions for many medical problems are needed, and I believe it is a laudable goal to try to bring these solutions to the table. The problem is that we start to believe the hype presented by many scientists and perhaps even more by businesses trying to raise funds.

Perhaps it is better to consider a reductionist-engineering approach through which current mature and effective technologies are reengineered to solve specific problems rather than focus so much on implausible and ineffective next-gen solutions. The problem, of course, is that such programs won't get funded. It's just not next-generation science. It's a pity that people die every day waiting for the promised next-gen solutions. Most will never come.

J. Paul Robinson
West Lafayette, Ind.

I WAS EXCITED TO READ the article on low-cost diagnostic tests for the developing world. I have volunteered in Honduran villages where people were too poor to afford the taxi ride to the local public hospital. These kinds of tests will greatly improve the quality of care available to the desperately poor, and I hope C&EN will follow up on the development.

Janice Umbaugh
Pittsburgh