23/09/2021
WHICH LAB IS THE BEST FOR TESTING FOR CHRONIC ILLNESSES AND WHY?
While some 20 years ago there was not a great selection of labs for detecting chronic infections, this has now almost become the opposite. It is, however, more important than ever to learn how to choose the right labs and understand what cost factors are incorporated into their retail prices – what makes one lab less and another one more expensive.
One important aspect to consider is that mainstream medical science is only aware of a few chronic infection induced illnesses (ie: HIV or TBC) and most infections, especially the bacterial ones are understood to be acute in nature. As a result of that, most tests accepted by insurance are the ones that have been calibrated to detect acute infections. The calibration of tests for acute case is rather straightforward since the symptoms are fairly pronounced and the number and proliferation of pathogens are also high, therefore the immune system is trying to match those with a higher level of antibodies that ultimately get captured and reported. The calibration basically consists of setting the thresholds (ie: what’s the cutoff for being negative/positive) in a way that will the most accurate results most of the time. If the bar is set too low and the test is too sensitive then it is possible to get false positives (due to residual antibodies to prior infections or cross-reactivity), but if it’s set too high then false negativity may occur. However, since most acute infections are known to medical science for many decades there were ample time to set these thresholds and cut-offs appropriately and the commercial test kits laboratories use come with calibration values, so no need to calibrate for each application.
In a chronic illness setting this is far more complicated, because research must precede the calibration and there are no commercially available kits to save this work yet. If we consider antibody testing it is problematic that IgM is often not detectable and high level of IgG may mean two completely different things: active infection, or immunity. Having said that, some pathogens have the capability to manipulate the immune system and lower the amount of circulating antibodies in the blood making it impossible to just create a single formula for all microbes to define positive/negative results. So all these tests must be individually calibrated by the actual laboratory that whishes to render this as a service and these tend to be American labs with a lot of capital to use for this purpose. For the calibration they have to collect samples from known positive candidates (people who have symptoms) and also from negatives (healthy individuals). The task at hand is to set the thresholds in a way that most known sick people will get a positive, while the healthy ones a negative result. It is understood that the cost of doing such a research, ie to recruit a statistically significant cohort of sick and healthy individuals that is representative of multiple age groups and s*x could be really high and prohibitive for the average commercial labs. Once the research that is going to be the basis for the calibration is done, then it must be published and accepted in respectable medical journals to earn credibility. As one can imagine these specialty labs will incorporate all these development costs into their final product, hence the price tags for these tests can be significant.
So all in all, the important aspects to consider when selecting a specialty lab for your test are their ability to invest into a calibration study and whether or not they published those as well. Also, labs usually employ a particular technology for all their tests, therefore a certain type of test for a specific pathogen may be best using one laboratory while for another type of test or pathogen, another laboratory may be more suitable. It is always advisable to seek input from a medical professional when selecting the right tests factoring in individual circumstances to support getting the right differential diagnosis at the lowest costs possible.
