Table Of ContentCLINICAL LABORATORY
SCIENCE IN THE
CHANGING SCENE OF
HEALTH CARE
CLINICAL LABORATORY
SCIENCE IN THE
CHANGING SCENE OF
HEALTH CARE
Edited by JP Ashby
Department of Clinical Chemistry
Northwick Park Hospital and Clinical Research Centre
Harrow, Middlesex, UK
Proceedings of the sixth ECCLS Seminar held at Cologne, West Germany, 8th-10th May, 1985
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British Library cataloguing in Publication Data
ECCLS Seminar (6th: Cologne)
Clinical laboratory science in the ·changing
scene of health care : proceedings of the
sixth ECCLS Seminar held at Cologne, West
Germany, 1985.
1. Diagnosis, Laboratory
I. Title II. Ashby, J.P.
616.07'5 RB37
ISBN-13: 978-94-010-7934-1 e-ISBN-13: 978-94-009-3197-8
001:10.1007/978-94-009-3197-8
Published in the USA by
MTP Press
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Library of Congress cataloging-in-Publication Data
ECCLS Seminar (6th: 1985 : Cologne, Germany)
Clinical laboratory science in the changing scene
of health care.
Includes bibliographies.
1. Diagnosis, Laboratory--Philosphophy--Congresses.
2. Medical care--Congresses. I. Ashby, J.P.
II. European Committee for Clinical Laboratory Standards.
III. Title. [DNLM: 1. Delivery of Health Care-
trends--congresses. 2. Technology, Medical--trends-
congresses. W3 EC9 6th 1985c / QY 21 E17 1985c]
RB37.A2E29 1985 616.07'5 86-21150
Copyright 1987 MTP Press Limited
Softcover reprint of the hardcover 1st edition 1987
All rights reserved. No part of this pUblication
may be reproduced, stored in a retrieval
system, or transmitted in any form or by any
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recording or otherwise, without prior permlssion
from the publishers.
ts
c::<>~ te~
Preface vii
List of Contributors ix
PART 1 CURRENT CONCEPTS OF HEALTH AND HEALTH CARE
1 A European overview of the health care scene
KS Johansen 3
2 Is there a European concept of health and health care?
JGW Wittkiimper 7
3 The effects of health and safety legislation on the
practice of clinical laboratory science
A Berlin, AE Bennett and WJ Hunter 19
4 Current economic, technical and political pressures at
the laboratory level: some benefits towards health
care delivery
JG Lines and N Sanders 33
PART 2 THE CLINICAL LABORATORY IN THE
CHANGING SCENE OF HEALTH CARE
5 The clinical laboratory in the changing scene of health
care as seen by a professional society member
M Roth 41
6 The clinical laboratory in the changing scene of health
care as seen by an industry member
JE Barclay 45
7 The clinical laboratory in the changing scene of health
care as seen by a health agency member
R Netter 55
8 The clinical laboratory in the changing scene of health
care as seen in the USA
R Nadeau 59
v
CONTENTS
PART 3 WOULD THE VALUE OF CLINICAL
LABORATORY SCIENCE BE INCREASED BY
FURTHER WRITTEN AND MATERIAL STANDARDS?
9 Would the value of clinical laboratory science be
increased by further written and material standards
in histology?
J Rygaard 67
10 Would the value of clinical laboratory science be
increased by further written and material standards
in cytopathology?
OAN Husain 73
11 Would the value of clinical laboratory science be
increased by further written and material standards
in microbiology?
AHW Wahba 81
12 Would the value of clinical laboratory science be
increased by further written and material standards
in immunology?
I Batty 87
13 Would the value of clinical laboratory science be
increased by further written and material standards
in haematology?
SM Lewis 99
14 Would the value of clinical laboratory science be
increased by further written and material standards
in clinical chemistry?
B Leijnse 103
15 Would the value of clinical laboratory science be
increased by further written and material standards
in toxicology?
SS Brown 107
PART 4 FUTURE ECCLS INVOLVEMENT
16 Future ECCLS involvement as seen by industry
G Kokholm 119
17 Future ECCLS involvement as seen by health agencies
DH Calam 123
18 Future ECCLS involvement as seen by professional
societies
M Hjelm 127
vi
Prefa.ce
The sixth ECCLS seminar was held in May 1985 at Walberberg near
Cologne. It was perhaps appropriate that almost six years after
its inauguration, ECCLS should stand back and look at the chang
ing scene in health care, examine its impact on clinical laboratory
science and assess the requirements for further written and
material standards in laboratory practice.
The seminar highlighted the increasing economic pressures
which many laboratory directors now face, emphasizing the need
for accurate and reliable management information. It became ap
parent that the extent to which standardization has been intro
duced into the different laboratory disciplines is variable and al
though a considerable amount has already been achieved, it is
clear that much yet remains to be done: it is the definition of fu
ture requirements which constitutes the principal message of this
book.
As with previous ECCLS seminars the speakers were chosen
for their acknowledged expertise in their own fields. Editorial
changes to the papers presented in this volume have been made
only to ensure consistency in the style of presentation.
JP Ashby
vii
Li.st <>f C<>Y1tri.o-u.t<>rs
JE BARCLAY DH CALAM
Technicon International Div. National Institute for Biological
6-10 Quai de Seine Standards and Control
93200 st. Denis Holly Hill
France London
UK
I BATTY
Wellcome Research Laboratories M HJELM
Langley Court Department of Clinical
Beckenham Biochemistry
Kent Institute of Child Health
UK Guildford Street
London
AE BENNETT UK
Health and Safety Directorate
Commission of European WJ HUNTER
Communities Health and Safety Directorate
Batiment Jean Monnet Commission of European
Plateque du Kirchberg Communities
BP 1907 Batiment Jean Monnet
Luxembourg Plateq ue du Kirchberg
BP 1907
A BERLIN Luxembourg
Health and Safety Directorate
Commission of European OAN HUSAIN
Communities Regional Cytology Centre
Batiment Jean Monnet st. Stephen's Hospital
Plateque du Kirchberg Chelsea
BP 1907 London
Luxembourg UK
SS BROWN KS JOHANSEN
West Midlands Regional World Health Organization
Laboratory for Toxicology Regional Office for Europe
Dudley Road Hospital 8 Scherfigsvej
Birmingham DK-2100 Copenhagen
UK Denmark
ix
LIST OF CONTRIBUTORS
G KOKHOLM M ROTH
Radiometer AI S Central Laboratory of Clinical
Copenhagen Chemistry
Denmark Hopital Cantonal Universitaire
CH -l211 Geneve 4
B LEIJNSE Switzerland
Department of Chemical
Pathology J RYGAARD
Erasmus University Patologisk-Anatomisk Institut
Rotterdam Kommunehospitalet
The Netherlands DK-1399 Copenhagen K
Denmark
SM LEWIS
Department of Haematology
Royal Postgraduate Medical N SANDERS
School William Harvey Hospital
Du Cane Road Ashford
London Kent
UK UK
JG LINES AHW WAHBA
William Harvey Hospital World Health Organization
Ashford Regional Office for Europe
Kent 8 Scherfigsvej
UK DK-2100 Copenhagen
Denmark
RG NADEAU
EM Diagnostics Systems Inc JGW WITTKAMPER
480 Democrat Road Institut fUr
Gibbstown, NJ 08027 Politikwissenschaft
USA der Westfalischen Wilhelms
Universitiit
RNETTER D-4400 MUnster
Laboratoire National de la FRG
Sante
25, boulevard Saint-Jacques
75680 Paris Cedex 14
France
x
Pa.:rt 1
c:aJRRENT CONCEPTS OF
HEALTH ANI> HEALTH CARE
1
.A. E"u.ropeaY1 Ov-erv-i.evq- of the
Hea1th Care SceY1e
KS Johansen
THE PRESENT SITUATION
General socioeconomic developments and - perhaps to a somewhat
lesser degree - improved health care, have led to an improvement
in key health issues. Life expectancy at birth is between 65 and
73 years for men and 72 and 80 years for women. However, in the
less developed, southern areas of Europe, the life expectancy is
lower - around 52 years for men and 55 years for women.
Although differences exist between the countries and areas
of Europe, it is becoming more and more apparent that a rapid
social change, coupled with a high standard of living and accelerat
ing technological developments, leads to fundamental lifestyle and
environmental changes, with resulting serious health implications.
The rapidly expanding car industry affects urban design, in
creases noise and chemical pollution of the environment, produces
accidents characterized by a high death rate and severe dis
abilities, and reduces drastically the physical activities of daily
life. Of major importance in Europe, also, is the high prevalence
of cigarette smoking, which is clearly associated with several types
of cancer and with cardiovascular diseases. Another matter of
great concern is the abuse of alcohol, which is an important cause
of road and work accidents; it is also associated with mental illness
and suicide and plays an aggravating role in several major dis
eases. The abuse of other drugs constitutes a serious and grow
ing problem in most countries. Obesity and unbalanced nutrition
are major problems in the more affluent countries of Europe, while
the lack of nutrients leads to stunted growth in the poorer
countries. A high incidence of sexually transmitted diseases has
accompanied changing lifestyles and sexual attitudes. Lack of
physical exercise, a frequent result of more affluent lifestyles, may
well prove to be an important factor in ill-health. The rapid in
troduction of new chemicals in increasing quantities, which affect
air, water, food and the working environment, has posed new
problems of risk identification, surveillance and control. The
wider use of nuclear energy involves potential risks from radiation
3
