Molecular Diagnostics in the Third World

 As we once again welcome another Acta Medica Philippina issue on the prolific Human Genetics Unit of the National Institutes of Health, perhaps one of the top biomedical research groups that is actively publishing papers in the Philippines today, the issue of molecular and genetic testing in a developing country like ours comes into focus. The National Government, through legislation, seeing the importance of genetic testing of all newborns in the Philippines, has brought down the cost of this expensive procedure to the reach of almost every Filipino, allowing unprecedented numbers of babies to be tested; if not for the efforts of Dr. Carmencita David-Padilla and her group, genetic testing shall only be a procedure for the rich. In this current issue (and three previous) devoted to genetics, articles have described the hundreds of lives that have been changed for the better due to illnesses and conditions that would otherwise not have been detected. We are now following the footsteps of developed countries that do routine genetic testing on their newborns.

And this is just the beginning.

Advances in molecular biology and the unraveling of the human genome has brought about a new generation of diagnostic tests that uses molecular probes and similar devices to detect diseases that usually take dozens of laboratory procedures and work-ups. Nothing can really stop technological advancement. It is only the ability to buy the equipment and the high costs of training of personnel to do these tests that can stop us from having this sophisticated technology. Not surprisingly, some groups in the private sector apparently have the resources to do it. These “machines” come with a heavy price tag, which should translate to “expensive” tests. In a country like the Philippines, where third world concerns like tuberculosis have yet to be eradicated (in fact, some of these diseases are making a comeback, with a vengeance), do we really have a place for these more sophisticated tests where a significant portion of the population cannot even afford to pay for the diagnostics and medication for basic diseases?

It does seem we live in a paradoxial world - the advancement of science and technology in a society is the key to eradicating more basic problems like hunger and poverty. I think nobody will disagree with such a basic premise and it has already been proven. Perhaps, if more and more tests are made available, then costs would eventually drop and everyone would benefit. HIV testing and medication seemed to cost way too much just a decade ago but now nobody seems to mind this. So I guess we have to embrace new technology and educate ourselves on its cost-effectiveness, compared to some of the “older,” less sophisticated tests of the past and make intelligent judgments, as we wait for costs to go down. Or we can follow the lead of the NIH, and legislate for lower costs of these important technologies make them available for more and more Filipinos.

Jose Ma. C. Avila, MD
Editor-in-Chief