Access to health care varies wildly by region. In wealthy nations such as the United States, visits to the doctor’s office include more tests than ever, and sometimes more tests than necessary. Meanwhile, in third-world nations, access to a doctor, let alone the tests they provide, can be impossible.
This global dynamic is a public-health challenge as well as a business challenge. That balancing act was tackled Thursday morning by a panel of diagnostics experts at the Life Sciences Innovation Northwest conference in Seattle.
The topic of the discussion was point-of-care diagnostics, or medical tests that take place at a patient’s home rather than in a doctor’s office. In the U.S., point-of-care tests are seen as a matter of convenience and efficiency, while in the developing world, they are the most realistic means for providing basic medical attention.
“It’s about affordability and sustainability,” said Syamal Raychaudhuri, the chief scientific officer at Seattle-based diagnostics maker InBios International. “We’re talking about cheap tests — less than 10 cents a test. But you have to maintain the sustainability of the company. You have to have the compliance. You have to have oversight.”
Most entrepreneurs in the diagnostics field, Raychauduri said, started their companies to assist the developing world. But the developing world isn’t exactly a lucrative one, especially when companies have to navigate yearslong regulatory processes in multiple nations. The ironic solution might be to initially target an affluent domestic niche and allow that revenue to fund expansion into needier markets.
“I could totally see people willing to spend $20 a week on testing to prevent over-training or injury prevention for their workouts,” said Bernhard Weigl, an investigator in Intellectual Ventures’ Global Good division. “That may be a relatively low-risk way for diagnostics manufacturers in to the home care market.”
There is demand for tests administered at convenient locations. Theranos, the Silicon Valley diagnostics startup, was valued at $9 billion by venture capitalists before federal investigators found its tests didn’t meet accuracy requirements. The company, now involved in a criminal investigation, is a cautionary tale, Weigl said, but it’s also evidence of market potential. “We’ve seen the meteoric rise and, more or less, fall of Theranos,” he said. “Though their execution was quite terrible, there is a need there. There is a reason why this organization was funded so well.”
Improved hardware, cloud-data storage, and improved connectivity are fast improving decentralized diagnostics, but there’s plenty more work to be done if these tests are to meet the needs of the developing world. The most critical hurdle might be the time it takes to administer and receive test results. “Speed of the result is the primary interest for us,” said Gerrit van Roekel, who handles diagnostic-business development at the Bill and Melinda Gates Foundation. “Not so much from a clinical perspective, but simply because you probably won’t find the patient again. The patient often has to walk for hours to a clinic, and needs to receive treatment right there, so the result has to be available in 10 or 20 minutes.”
Speed and performance of the tests matter little, though, if the test itself is too expensive for a third-world population to afford. The challenge for these diagnostics entrepreneurs is to make products that enhance health not only for the wealthy who desire it, but for the poor who need it.
This story was edited to clarify the accusations against Theranos.