Lab diagnostics remains a Cinderella sector. At approximately 2% of healthcare expenditure in most West European countries, it is too small to be of interest to the powerful sales forces and lobbyists from big pharma and big medtech.

It isn’t hard to find many examples of the poor use of lab diagnostics, particularly in the UK, where pathology has a relatively low status in the medical pantheon.

Anecdotal evidence is not hard to find. Stephen Sutton, the UK teen who recently raised £5m for cancer charities before dying of bowel cancer at 18, suffered from Lynch Syndrome, a hereditary condition. The NHS refused to test Stephen for it for six months, according to Sutton’s father. That was despite the fact that his father had been diagnosed with Lynch, treated twice for bowel cancer and had pushed hard for the tests for his son. At 15, Stephen was deemed too young to be worth testing for cancer.

Or take another much more endemic problem. Tests for hypothyroid in many countries are deemed unsatisfactory by many practitioners. Again, in the UK, patients in primary care are typically offered only the thyroid stimulating test which gives a very incomplete picture as to whether patients have enough circulating T3 and T4. As a result, many hypothyroid patients are never diagnosed. Small wonder GPs complain that their practices are blocked by hundreds of thousands of tired and depressed middle-aged women!

We could go on. Primary doctors the world over are poor at keeping up to date with new tests. And because this is a low status, low budget world, you find massive differences in testing regimes between countries. The German system, for instance, carries out nearly twice as many tests as the French. (As for the Brits, no one knows!)

The sad truth is that, because of caps on how much can be spent on tests, big pharma sees little purpose in promoting them.

Nonetheless, it strikes us as extraordinary that the large lab groups and their suppliers have done so little to push these messages to policymakers and the medical establishment.  Where are the cross-country comparisons?  Where are the studies revealing the hidden cost of failures in test regimes?  Such studies need not cost more than a few million euros to commission.

And the hidden costs are not that hidden. How much was spent over three years on a dying teen, perhaps because of a failure to administer a cancer test? How many women lead sad and unproductive lives for decades as a result of poor hypothyroid testing regimes?