When Will the Future Arrive?
Medical Establishment Sabotages Cure for Chronic Infections (Part 5)
“How do you get rid of a dogma?” leading microbiologist Dr. Alan Wolfe asks.
The answer? “Death and retirement.”
Dr. Wolfe uses that cheeky Q&A with all his students. The severe opposition brought to bear against MicroGenDX’s Next Generation Sequencing for bacterial and fungal infections has so far caused many to accept such grim humor for reality.
Or envision, as Dr. Wolfe does, a utopian future in which we have an ideal point-of-care instrument, one that reports on the entire urinary microbiome. He sees this as reporting on “good [bacterial] guys, bad guys, and immune system markers. It would spit out a care recommendation based on an algorithm educated by tens of thousands of individual cases.”
No doubt what Dr. Wolfe foresees is highly desirable, but delaying the use of the molecular diagnostic testing tools we already have in hand until then would be tragic, because millions are suffering needlessly now, for the sake of what is an antiquated, if comfortable, status quo.
Happily, the physicians we have met who have done research into MicroGenDX or have clinical experience with its use do not expect patients will have to wait too much longer for molecular testing to replace traditional culture as the new standard of care. In fact, they see this as almost inevitable.
Dr. Parvizi of the Rothman Institute at Jefferson University says, “I don't know whether it's five years, 10 years, or exactly when, but culture will become a secondary thing, perhaps even disappear from the scene. And we will be relying on molecular techniques just as in the oncology field. People are doing genotyping of cancers. The use of molecular technology to genotype cancer has resulted in an immense improvement in survivorship from cancers. We need to do the same with infections, because telling a patient that they have an infection of their hip or knee prosthesis is equivalent, in terms of five-year survival rates, to handing them a diagnosis of cancer.”
The Infectious Disease specialist, Dr. Cliff Martin, says, “There’s no doubt that molecular testing is the way of the future for infectious disease diagnosis—no doubt at all. With very few tweaks we are using the same methods we used 100 years ago, and every other area of medicine has advanced well beyond.”
Dr. J. Curtis Nickel agrees: “I have no doubt at all that PCR NGS will supplant the inaccurate culture approach, which, you know, should have been relegated to the wastebasket of medical history years ago. But boy, do these things ever go slow.”
I asked Dr. Nickel how this sea change in medical practice might come about. He said that there could be a definitive study that catches everyone’s attention that absolutely shows molecular technology’s superiority to culture. Or a prominent urologist, likely someone who had previously voiced reservations, could change his or her mind and pave the way for others to do the same. Or finally, the evidence will accumulate to the point that a guideline committee like that of the American Urological Association is simply compelled to re-write its standards of care. He points out that it should already be used as the standard of care in patients whose cultures are negative or provide only equivocal results, which is the way he currently uses it in his practice. He believes more and more physicians will follow his lead in this, which, by itself, would be a first practical means of adoption. That’s the very thing activists like Carrie Anne are calling for through her Change.org petition.
Dr. Nickel notes that the profession is used to acting on simplistic data. When traditional cultures come back positive for E. Coli, for example, the results are unequivocal. “We’ve grown so comfortable using that for 120 years. So, it’s tradition, it’s status quo, it’s proven, it’s very difficult to break that inertia.”
Dr. Timothy Hlavinka points out that using MicroGenDX NGS has enabled his small office, consisting of two urologists and two mid-level providers, to treat thousands of difficult urological cases successfully and gain an international reputation in the process. “It is so emblematic of our healthcare crisis,” Dr. Hlavinka says, “a technology that needs to be out there at the forefront, where people are making decisions based on it. It's 110% going to be the standard of care, where people are pretty much obligated to use it and get familiar with it.”
In Dr. Hlavinka’s experience physicians who use the technology for any length of time rapidly become adept at its uses and soon would not do without it.
Besides the formal objections of diagnostic confusion leading to poor antibiotic stewardship, there may be a darker aspect to the resistance this advanced diagnostic tool has encountered. There seems to be jockeying for position as to whom will reap its spoils. Who gets the credit and who makes a fortune?
Dr. Nickel commented that in his 35 years of being a practicing urologist and urological researcher he’s never before seen the type of politics that is known to plague research into new drugs or medical devices. Research in these areas was like “a space race,” where fortunes and reputation hung in the balance. Now the same “space race” mentality has come to the fields of infectious disease and microbiology. “Next generation sequencing is going to be the new technology that will drive the field—not only discoveries in the field but day-to-day diagnoses. For both these reasons, academic careers will be made, and fortunes will be made as well. That’s what’s made the field so difficult for early investigators who want to be involved.”
While the medical establishment sorts its winner and losers, millions of patients suffer and see their lives fall apart. In the end one has to ask, for what?
Kerstin Martin works beside her husband at MicroGenDX as Director of Customer Service and Care. She talks about fielding calls day after day from patients and their families. Patients often break down in tears because they are in pain and the system has failed them. They are exhausted from trying to battle their infections, but no one listens.
Then there are the calls from families and close friends. Cases where open foot wounds lead to amputations followed by osteomyelitis and death. Others where women with chronic infections commit suicide after being put on antidepressants and painkillers and told their symptoms are not all that bad.
She wonders why a physician whose methods keep failing him would not ask himself how that might be changed. Too many simply accept that some people do not get better, she says, and move them out of their practice and close the book.
“Are we really such awful creatures of habit?” she wonders. “What you can't do in my eyes,” Kerstin says, “is see that molecular testing works, then out of laziness, continue to use the old method, because you don't care. That to me is unacceptable.”
She admits that it might take the physician longer to study the report, think through the case, and come up with a targeted treatment plan.
“Physicians need to go back to being that bright-eyed and bushy-tailed medical student who took the Hippocratic oath,” Kerstin insists. “The one who wanted to be a doctor in order to help people.”
This concludes our 5 part series, supported by MicroGenDX. The author gratefully acknowledges the physicians, medical researchers, technical support staff and others who gave generously of their expertise and time in support of this project.