An email from Dr Colin Fink, University of Warwick Science Park, Micropathology.Ltd in response to the letter written to warmwell.com by Dr Roger Breeze Ph.D., MRCVS
The attitudes of the UK Public SectorDear Mary,
I have read your letter from Dr Breeze at Plum Island concerning the resistance to the use of the rapid thermocycler for diagnosis in the field, with a mixture of sadness and amusement.
As you may well remember we had facilities and the primers for rapid diagnosis of FMD in 2001 but DEFRA and the Vet agency refused to supply us with non-infectious material to calibrate our assay.
The excuse was that FMD (although in cases of assumed infection, acceptable to be carted about the country in carcases on leaking lorries) was a Category 4 organism and therefore only to handled in facilities in which one would also handle Ebola and Lassa viruses.
Of course this was nonsense. Once the RNA is extracted the organism has no infectious risk.
The confusion was because of out-moded thinking aligning a risk in growing up organisms within the laboratory with that wrongly perceived to be similar in molecular diagnostics.
Rapid diagnostics using RNA/DNA amplification has no infection risk as the organism is destroyed to extract the RNA/DNA. Along with Fred Brown and Ruth Watkins and others I made as many representations as I could about this one aspect of lack of public sector understanding and co-operation (including having questions asked of the then minister Lord Whitty in the House of Lords,) as there were many people representing different organisations who wished to have an independent testing facility to challenge the 3 kilometre rule on culling.
The unwillingness for MAFF/DEFRA and the Vet Agency to co-operate resulted in another important lost opportunity: Although the culling policy had no sound science behind it, the possibility existed for a monitoring of the carcases using the very sensitive molecular diagnostic systems and a chance for gaining such unique information of the true level and spread of infection.
I have often wondered whether this opportunity was thrown away because of continuing incompetence or that the true level of infection in the culled animals would have been an embarrassment to know?
Madness followed by mindlessness??
We see some of the same difficulty in our human rapid diagnostic work and locally in the NHS we have our samples withheld by Consultant Microbiologists and our service denied to clinicians in specialist hospital settings.
As a result some of our samples from the NHS (we undertake about 2/3rds of the transplant screening for the NHS and about 1/3rd of the acute disease screening) come from Medical Directorates who choose to by-pass the NHS Microbiologists.
The present UK government has a Review Panel convened to help direct 'modernisation' of pathology services. As individuals we opted out of the NHS eleven years ago due to frustration with process and a lack of progress in implementing new technology. In those eleven years we have established that efficiency in providing a rapid diagnostic service coupled with economy and good administration is possible to provide diagnoses early in a disease cycle.
No one could doubt that proper us of this information may improve the delivery of health care. We still await any useful change in the Public Sector mentality.
This week I have discovered that I have been refused information on the UK Health Protection Agency new price list for the NHS diagnostic services in the financial April 2006 . The reason given by the senior infectious disease physician who made the decision was 'he is not a doctor working in the NHS' . The real reason is more prosaic and once again illustrates the Victorian attitude to 'trade' and an underlying fear of the 'commercial' sector.
I am beginning to believe that many of my colleagues in the public service have no incentive nor any stomach for improvement or change and their fear real or imagined, allows them to use any method to resist outside influence for improvement. No one doubts that things could be so much better. In that and more Dr Breeze and I may be sharing a view.
Colin Fink .
-- Dr Colin Fink MICROPATHOLOGY LTD University of Warwick Science Park, Micropathology.Ltd http://www.micropathology.com
(Some background information on warmwell)