Clinical and Diagnostic Laboratory Immunology, July 1999, p. 643-643, Vol. 6, No. 4
1071-412X/99/$04.00+0
LETTERS TO THE EDITOR
In Diagnostic Laboratory Immunology the Robot Still Needs Some
Careful Human Guidance
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LETTER |
Total laboratory automation (TLA) is coming to have a larger place
in one of the remaining bastions of manual, cerebral clinical testing
diagnostic laboratory immunology (DLI). That is the message of
R. Tomar's commentary (1). How far should the automation go, and what effect will this have on DLI, other than the obvious reduction of skilled technological personnel with the rise in computer
technicians and data managers?
There has always been a certain aesthetic beauty to DLI that is less
prominent in other diagnostic laboratory specialties. The goal of DLI
is to assess the immune system, its integrity, its qualitative and
quantitative function and dysfunction, and its state of activation
reflecting disease or immunomodulatory drug activity. DLI is the key
support of any hospital-based clinical immunology division.
We are in the infancy of knowing the best way of assessing immune
system activation and modulation. Many of our current methods of
assessing immune integrity may be improved upon. Immune evaluation often calls for tailoring the assessment tests used for individual patients: which aspects need to be examinedcellular, humoral, or
mediator-amplifier components?
There are problems of TLA in DLI, as mentioned in the commentary. The
borderline value coming from a black box automation kit can hardly
influence clinical decision making, in a field where the laboratory
assessment should be able to direct treatment decisions and directions.
The DLI specialist does better here than a technology that simply
allows one to generate a lot of values. Really satisfactory DLI
assessment of the future may be as much a reflection of learning the
correct timing and processing of clinical specimens as simply having
the technology to give a printout value. We will continue to have
mainly serum and cells from the blood for the desired assessments of
the immune system. There is still a major place for the aesthetics of
planning and executing meaningful immune assessment. The commentary
raised serious questions of whether this can be done as part of TLA or if DLI still requires more of a scientific brain and skills.
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REFERENCE |
| 1.
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Tomar, R.
1999.
Total laboratory automation and diagnostic immunology.
Clin. Diagn. Lab. Immunol.
6:293-294[Free Full Text].
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C. Kirk Osterland
Department of Medicine
Royal Victoria Hospital
Montreal, Canada
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AUTHOR'S REPLY |
Dr. Osterland has concerns that machines will produce numbers, lots of
numbers, with little or no consideration of the need for generating
those numbers. While an increase in automation could lead to an
increase in inappropriate determinations, "it ain't necessarily
so." Moreover, there are centers already performing laboratory
testing with little regard for its need. Few of these laboratories are
totally automated. Automation need not and should not replace the
selection and sequence of testing; it need not and should not replace
the interpretation of those assays. However, automation will continue
to replace manual performance of tests.
The challenge for laboratorians will be to compete for the authority to
control the "cerebral" functions associated with clinical measurements. There will be pressure from administrators, instrument and reagent sales representatives, governmental regulators, and perhaps
even our clinical colleagues to replace medical decision making with
cost controls, i.e., the machines are doing the work and we do not need
highly trained people on the dole. An uninformed public may find this a
compelling argument for reducing or even eliminating clinical judgment
from the laboratory. I am concerned that laboratorians will respond to
such pressure by hiding from or obstructing all new ventures.
The laboratorian, in addition to providing information to clinical
colleagues, will need to assume other roles such as that of ombudsman
for quality patient care and educator to the public for the public
good. While there is no substitute for astute local politicking, I
suspect that the laboratorian's agenda will be most effectively
accomplished through responsive, highly motivated, well-respected, well-funded, well-crafted national organizations.
Total laboratory automation presents another tool and another
opportunity to improve the quality of health care. It has the potential
of controlling costs. It opens up new avenues for research as well as
educational and experiential growth. However, like most tools, it is
one that must be utilized with care and concern.
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Russell Tomar
Department of Preventive Medicine
University of WisconsinMadison
610 Walnut St.
Madison, Wisconsin 53705-2397
Phone: (608) 263-7507
Fax: (608) 265-8845
E-mail: rhtomar{at}facstaff.wisc.edu
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Clinical and Diagnostic Laboratory Immunology, July 1999, p. 643-643, Vol. 6, No. 4
1071-412X/99/$04.00+0
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