What's Your Favorite Archaic Test?

Perthena:  Wow! I am the king of trivia and I have to admit I have never heard of that test. I Googled it and found quite a bit of info.

Cynthia: I might be dating myself, but I certainly remember all those tests you mention. I recall making up various substrates and standing before a water bath with lines of tubes doing enzyme assays. We sure have come a long way, havent we?

My all-time favorite useless test was called a photomotogram, for measuring a patient's "thyroid level".  The patient would kneel on the edge of a chair seat and we would pass a light beam through their Achilles tendon and tap it with a rubber hammer.  This was all hooked up to an EKG machine which registered the amount of reflex action.  This was 1968 in rural Alabama.  From photomograms to molecular technology, what a trip it has been!

Recently I received the following email from a reader who wants to remain anonymous. The reader makes some extremely salient points including pointing out that sometimes archaic tests are chosen because the performer (such as an independent commercial lab or  pathologist) has a vested financial interest.

I was also very impressed when the reader indicates that in his/her laboratory, they have made the clear unequvocal decision not to perform useless or clinically inappropriate tests. That is one lesson many of us could learn-we do have the right aand option not to go along with a test simply because it's been ordered. This is not without political and legal pitfalls, but it certainly can be done.

Here's the email:

> In a message dated 5/9/2008 8:31:22 P.M. Eastern Daylight Time,

> Hello-

>

> I work in cytology. How about the maturation index  in-lieu of

estrogen/progesterone levels, ( to save money). Barr body  testing instead  of a cerotype to identify Kleinfelters etc (to save money).  We get requests for these occasionally and refuse to perform them,  recommending more accurate tests, especially for such profound diagnoses as  genetic  abnormalities.

>

> Along the same vein it, is high time to boot  the conventional pap smear for ThinPrep paps and imaging. By the way  ThinPrep imaging is a much better methodology than the Surepath focal  point, which is being used by the pap mills, due to decreased cost and  personnel by archiving of 25% "low risk"  having no cytotechnologist  review at all, losing an adequacy

evaluation, a hall mark of the Bethesda  meetings to improve cervical screening.

> HPV Digiene is a loser compared to  the now available real-time PCR for HPV testing. Not all "archaic" testing  is found in the distant past. Finances ( cost reduction) and quality lab  testing are often at odds.

> The Gardasil vaccine is not a panacea for  the coming cytotechnologist shortage, due to closing schools and the baby  boomers retiring. It only is  effective against viral types that cause 70%  (at best) of the cervical squamous cancers. It is not recommended for  people already infected and we will not have 100% vaccinated due to cost  and compliance.

>If you subscribe to evolutionistic theory, survival of the  fittest would dictate the 30% of  the viral  types not protected  against, will soon dominate.

> HPV testing cannot be correlated with  cervical biopsies and gives no information concerning the pathology of the  cervix. It should never be  allowed to replace the pap smear, which can be  correlated with biopsies and is MORE sensitive to cervical pathology than  even cervical biopsy,  which often have to be repeated to confirm the SIL  detected by the  original pap smear.

>Money again is driving these  propositions, not  quality lab testing. Things will only become more dire,  if government health care is adopted and cost containment is even more a  factor. Pathologists and  corporate pap mills should look at their  conscience and motives, when  choosing lab testing. The pressure from  liability issues to relegate the  pap smear to being an archaic curiosity,  must be alleviated, before we  lose the most effective cancer screening  test.

> Name with held.

Hands down least favorite was "Red Cell Mass and Plasma Volume."

This is when Pathologist removes volume of blood, you tag with Isotope, Path reinfuses, then after a specified time, a venipuntcure to measure tagged cells.

After measuring radioactivity of pre, infused, and post samples (some needed careful dilution, too), there was a complicated

formula to arrive at the Red Cell Mass and Plasma Volume that Physician used in dx red cell proliferation disorders.

This test was nerve wracking and time consuming with much calculation.

I don't think the patient enjoyed the process, either.

Don't forget the thymol turbidity test or the cephalin flocculation test!  How about making up reagent for doing lipases with olive oil and having to wait overnight for the results?  I actually performed Folin-Wu blood sugars for real and remember boiling BUNs and hand-titrating chorides.  The flame photometer was always fun (not!) when you were under the gun to get stat electrolytes out.   And the fun we had playing with the toxic mercury from the Natelson microgasometer!  They weren't the good old days!

I have worked at three different small hospitals that all perform ESR, LDH, AST (the hospital in West Virginia at which I currently work as a traveler still refers to it as SGOT, LOL), and CK-MB (called CPK-MB at the above-mentioned facility).  I graduated from MT school at a large hospital in Winston Salem whose hematology lab has a "stat" 5-minute ESR machine that uses capillary tubes.

Our lab exercises in the didactic Clinical Chemistry course all involved the good old spectrophotometer in winter 2003/2004; the class after mine got a more modern bench-top chemistry analyzer (no fair!).

Also, most of our time in the coagulation section of our clinical training in the laboratory was spent performing PTs and PTTs on a fibrometer four short years ago. LOL