The development of newer and better biosensing technologies will have almost no impact on health care.
Why? Because detection of biomolecules is rarely the limiting factor in making a diagnosis or prognosis. What’s missing is not the ability to generate information, but the ability to interpret it.
Most single biomarkers fall in the range of being somewhat helpful to mostly worthless. There are exceptions, like high-sensitivity troponin assays for assessment of myocardial infarction or cardiac death risk[1] [2] , which have very high likelihood ratios [3] . But assays like PSA for prostate cancer are far more typical – the overlap in values between patients with and without disease is large.
From Urology information – Prostate Specific Antigen – John Donohue.
Better/faster/cheaper detection of PSA, and most other biomarkers, will do exactly nothing to improve patient care.
Academics – physicists and engineers especially – get all excited when they develop a new sensor technology, and rush to found a startup. They expect that the world will love their genuinely cool technology just as much as they do. This almost never happens.
The only real opportunity for biosensor technology is in enabling panels of biomarkers, and even then only for indications where rapid, near-patient testing is of high clinical value. This includes conditions like myocardial infarction, stroke, acute infection/sepsis and possibly traumatic brain injury. These are “Golden Hour” indications where rapid diagnosis and intervention are crucial. There is not much value in rapidly diagnosing chronic conditions like cancer or diabetes, because treatment plans are developed over days or weeks.
Engineering bugs to tweak our metabolisms or dispense therapeutics or tame autoimmune diseases has a much higher potential impact. I’ve written about this here and here. We’ve not had much success in finding drugs that control obesity; insulin therapy leaves much to be desired; autoimmune disease therapies are ineffective or dangerous. There’s no guarantee that microbial medicines will improve our treatment of any of these conditions, but they have a decent shot and I’d be surprised if all attempts fail. These are big health problems and even modestly effective treatments would be a major step forward.
Bet on the bugs.
Disclosure – I consult for MBio Diagnostics , which develops multi-analyte near-patient rapid diagnostic tests using a really cool technology (planar wave-guide illumination)
Footnotes
[1] Association of High-Sensitivity Cardiac Troponin I Concentration With Cardiac Outcomes in Patients With Suspected Acute Coronary Syndrome.
[2] Novel Risk Stratification Assays for Acute Coronary Syndrome.
[3] Diagnostic accuracy of a point-of-care troponin I assay for acute myocardial infarction within 3 hours after presentation in early presenters to th… – PubMed – NCBI