HM Epstein hmepstein at GMAIL.COM
Sun Mar 11 03:26:34 UTC 2018

Dr. Bell:

Having personal experience with testing error because of how the doctor’s office mishandled the sample, I’m glad you’re raising these questions. There have been several studies I’m aware of on lab errors due to patient mixups and multiple passes at reading CTs and MRIs and X-rays that demonstrate a disturbingly high rate of second-guessing and error by the same radiologist or different radiologists in the same lab. 

I hope some of the researchers will tell us specifically what they’ve done or are currently working on. 

Of course, I’m certain you are aware that every year new Dx guidelines come out for various diseases/conditions. Many of the latest Diagnostic advancements are happening in the precision medicine field which is exploding. New more reliable diagnostic tests and retrospective studies that challenge the final Dx in each specialty may eventually impact the guidelines. 

But there are also many grassroots efforts happening at the patient-led disease specific organizations. For example, Lyme disease patients are extremely active in funding new research into the life cycle and the co-infection rates of the various tick breeds, which has a direct impact on the diagnostic guidelines. They have also raised funds to finance new methods of identifying the wide range of tick-borne diseases. The same is true for many other disease specific groups from rare genetic diseases to pediatric cancers to neurological and psychiatric conditions. 

I echo your concern though about financial influences from pharma and insurance companies who fund some of the disease specific groups. The first one that comes to mind is CHADD which as far back as 1995 was generously funded by the manufacturer of Ritalin. It’s hard to believe that the ever-broadening of the ADHD diagnostic guidelines for children and adults hasn’t been influenced by the efforts of the pharma companies. (Great book on this topic is ADHD Nation by Alan Schwarz). 

Looking forward to reading what others are working on. 

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On Mar 10, 2018, at 4:23 PM, Robert Bell <0000000296e45ec4-dmarc-request at LIST.IMPROVEDIAGNOSIS.ORG> wrote:

Dear all,

As you know I have been interested in understanding the errors of all the "tests" that we use to diagnose clinical conditions. We have little idea of many of the degrees of error in different people's hands. What is the impact of all these errors on accurate diagnoses, and do we need to know about the issue/problem? Is there even a problem?  Do we need to fix these at the same time we are refining diagnostic processes? 

Also, others (specialty societies mainly) define certain conditions for us. I have often wondered how accurate these recommendations are. The renal failure categories for example and is there ever a financial influence at play? Have we ever looked at these in some organized fashion?

Robert Bell, M.D.

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