DACNSTCS,

DSEASE
DEvELFMENT
!
WRKSHF REFRT
Alic Srrr
Michll Toylor
Joms Smirh
on Horpr
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dagnostc process. What, we ask, nght a soco-technca product pro|e that ncorporated such nsghts
ook ke? |n ths connentary on the workshop we suggest that such a pro|e woud trace dagnostc needs,
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Hoving Ln llr in rh long gross lor
svrol yors whil donors, ocrivisrs,
govrnmnrs ond puLlic holrh xprrs
locusd on rh qusrion ol occss ro
virol mdicins, rh issu ol diognosis is
rodoy or rh vry rop ol rh gloLol holrh
ogndo. Th ris ol diognosis os o gloLol
holrh issu hos rroc|d irs rlormulorion
inro o qusrion ol occss ro diognosric
dvics. A nw wov ol poinr ol cor,
ropid drcrion, low-cosr diognosric
dvics hos mrgd os o mulri-locrd
solurion ro rh povrry ol loLororory
inlrosrrucrurs in rsourc poor srrings,
rh high cosrs ol rrormnr rhor lollow
lrom ovr-diognosis, rh Lurdn ol
morLidiry gnrord Ly diognosric rror
ond, incrosingly, rh improriv ro
moniror ond voluor rh "impocr" ol
gloLolly lundd puLlic holrh progroms.
Tiny, modsr-loo|ing rchnologis, such
os rh nw immunochromorogrophic
ropid rsr lor slping sic|nss rhor
drcrs onriLodis ogoinsr Tryponosomo
Lruci gomLins in 1S minurs, or
imLud wirh rh promis ol holrhir,
mor conomicol ond mor quiroLl
lururs. Bilorrol donors, philonrhropic
orgonisorions, minisrris ol holrh,
univrsiry rsorchrs, ond lronrlin
holrh wor|rs or oll wor|ing hord ro
rurn rhos promiss inro o roliry.
Bur how much wor| con rh diognosric
dvic irsll do? This qusrion wos or
rh horr ol o wor|shop on 'Diognosrics,
Disos & Dvlopmnr' rhor wos hosrd
or rh Univrsiry ol EdinLurgh on 30rh
Jonuory 2014. Th wor|shop Lroughr
rogrhr sro|holdrs lrom ocodmio,
civil sociry ocrivism, privor indusrry
ond non-prolr producr dvlopmnr
porrnrships ro oddrss rh opporruniris
ond chollngs ollordd Ly rh ropid
dvlopmnr, prolilrorion ond roll-our
ol nw diognosrics lor dvlopmnr.
Th rorionol Lhind rh xprimnrol
lormor wos simpl. Whil rh sociol
scinrisrs ond civil sociry ocrivisrs
who porricipord in rh vnr wonrd
ro lorn mor oLour rh spcilciris
ol rh "porrnrship" Losd producr
dvlopmnr opprooch rhor incrosingly
dominors rhis scror ond rh consrroinrs
imposd Ly rh insrirurionol conrxrs,
lunding srrucrurs ond rgulorory
nvironmnrs in which rhos dsigning,
dvloping ond implmnring nw
dvics musr opror, rprsnrorivs
lrom indusrry wr |n ro lnd our
mor oLour rh holrh sysrms ond cor
nvironmnrs in which rhir dvics will
ulrimorly nd ro wor|. Th locus on nw
diognosrics os rh solurion ro proLlms
ol diognosis hos sn xrroordinory
progrss in rh dvlopmnr ol
ollordoLl rchnologis. Bur rhs
rchnologis hov Ln occomponid Ly
unonricipord chollngs, oLsrocls ond
complicorions: in rh gloLol rgulorion
ol ropidly xponding mor|rs, rh
inrgrorion ol nw diognosrics wirh
xisring holrh sysrm inlrosrrucrurs, ond
rh unlorsn rchnologicol glirchs
rhor occur in dillculr nvironmnrs. Ths
mrging chollngs highlighr rh urgnr
nd lor cross-scror diologu oLour rh
widr implicorions ol ond opporruniris lor
nw diognosrics in lrogil holrh sysrms.

0#,(%-,'2"0

Th opning ponl on "innovorion
nrwor|s ond insrirurionol conlgurorions"
highlighrd rh signilconc ol
porrnrship os Lorh o Luzzword ond
on ocruol consrllorion ol rlorionships.
Morcus Lovll Smirh lrom Diognosrics lor
All highlighrd som ol rh chollngs
occomponying rh 'non-prolr' porrnrship
modl lor rchnology dvlopmnr.
Non-prolrs ovoid rh mo|or Lios ollcring
Big Fhormo, os rhy or nor rquird ro
mo| producr choics Losd on prolr
morgins. Bur h poinrd ro rh consronr
prssur on non-prolr orgonisorions ro
rois copirol. All Lur 1 ol rh S spo|rs
dpndd on "solr lunding" lor rhir
producr dvlopmnr wor|. As Rogr
Fc| poinrd our in rh cos ol FATH
rhis mons rhy hov ro lnd $300 million
dollors in "porrnrship" lunding vry
yor ro nsur rh sroLl mploymnr ol
3
1200 popl mployd ocross pro|crs
in 70 counrris. Monwhil Chris Low,
whos hi-rch prsonolisd diognosrics,
such os smorrphon Liomdicol snsors
lor Llood glucos, hov rsulrd in
svrol spin-oll componis, poinrd ro
rh currnr dorrh ol olrrnorivs ro solr
lunding whn h suggsrd rhor his
dvics wr unli|ly ro L xrndd
ro low-incom counrris Lcous rh
rrurns lor invsrors in such conrxrs wr
roo low. Monwhil, rh prsnrorion
Ly Frr Jllris lrom CALvmd, on
orgonisorion rhor locuss on improving
poor livlihoods rhrough prorcring
livsroc| holrh, highlighrd rh vry
dillrnr opporruniris lor mor|r-drivn
dvlopmnr ollordd Ly rh humon-
onimol inrrloc. Livlihood dpndnc
on livsroc| prsnrs o clor lin|, lor Lorh
locol lormrs ond inrrnorionol invsrors,
Lrwn diognosrics ond conomic
dvlopmnr rhor is olrn missing in rh
humon holrh dimnsion ond rhor noLls
CALvmd ro opror occording ro whor
Jllris colls o 'susroinoLl conomic
lromwor|'.
Mony ol rh FDFs shor lunding
srroms, wirh rh |y lundrs - Cors
Foundorion, DFD ond NH mphosising
rh dvlopmnr ol 'novl' producrs
rhor rduc complxiry ond noLl
implmnrorion in low rsourc srrings.
A common longuog ol 'rronslormoriv
innovorions' (Rogr Fc|) ond
'rronslormorionol improvmnr' (Frr
Jllris) ocross rh FDF prsnrorions
poinrd ro rh wighr ol xpcrorion
currnrly Ling plocd on nw diognosric
dvics, ond olso prhops ro crroin
Lioss wirhin rhor lunding nvironmnr.
Nonrhlss prsnrorions on rh
vrydoy ocriviris ol producr dvlopmnr
rvold o mulripliciry ol rlorionships
ond insrirurionol orrongmnrs, ond
chollngd rh sociol scinrisrs prsnr
ro produc mor ln-groind onolyss
ol whor porrnrship mons in procric.
Josph Ndung'u ol FND dscriLd
how ir rndd ro concnrror irs llorrs
rowords rh srorr ol rh piplin, on rh
crorion ond voluorion ol nw diognosric
prororyps, wirh dcrosing ngogmnr
os rh piplin progrssd, whil Rogr
Fc| suggsrd rhor FATH's grorsr
conrriLurion wos ro rh middl ol rh
piplin - dvlopmnr, opprovol ond
implmnrorion which rquird rhm
ro moinroin o much grorr inlrosrrucrur
ond loLororory loorprinr. Thy hov rhir
own Sorrl Losd R&D inlrosrrucrur,
wirh o Liosolry lvl 2 isolorion lociliry
ond nvironmnrol rsring loL.
s producr dvlopmnr drivn Ly
"rchnology" or "nds"? Who dlns
such nds mrgd os o |y qusrion lor
rh doy. This wos highlighrd whn Rogr
Fc| poinrd our rhor FDFs olrn srruggl
ro rror rhir nd usrs os clinrs whil
rhir lunding coms lrom lswhr,
whn Chris Low orgud rhor nds
or osy ro idnrily Lur privor-scror
lunding lss so, ond whn Frr Jllris
suggsrd rhor rh rlorionship Lrwn
nds ond rchnology is Lsr concivd
os on on-going procss ol ngoriorion
ond odoprorion whr o 'Lsr lr' mighr
ulrimorly mrg.
Whor ond who, Corolin Jons os|d,
or diognosric dvics ocruolly lor?
Sh nord rh shilring gools lor molorio
diognosis, whrLy on orlir clinicol
gool ro idnrily inlcrd prsons lor
rrormnr hos Lcom o mr odd-on
ro o lorgr puLlic holrh gool - voluoring
rh implmnrorion ond impocr ol molorio
conrrol progromms, in lin wirh gloLol
conrrol ond liminorion rorgrs. This
prscinr qusrion grw in signilconc
os rh doy wnr on. Josph Ndung'u
dscriLd rh prcivd nd ro moniror
impocr ol puLlic holrh progroms ro L o
driving lorc Lhind rh dvlopmnr ol
nw diognosrics lor Nglcrd Tropicol
Disoss. A prsnrorion lrom Anni
Wil|inson dscriLd rh Lioscuriry
concrns rhor hov lromd diognosis
inrrvnrions lor losso lvr in Sirro
Lon. Chris Low xploind rhor rh
mHolrhcor phon opplicorions his rom
wr dsigning rorgr rh 'worrid wll'
in o Lid ro idnrily illnsss soonr ond
Lring down mounring holrh cosrs, roising
qusrions oLour rh woys in which nw
diognosric dvics mighr Lorh cror
os wll os rspond ro prcivd nds.
Th xponding rmir lor diognosric
rchnologis is li|ly ro hov imporronr
consquncs lor norionol holrh sysrms
os rhy orrmpr ro inrgror nw rsring
rgims ond doro srroms wirhour
complmnrory incross in Ludgrory
supporr.
Jnnilr Cohn lrom Mdcins Sons
Fronrirs orgud rhor rh signilconr
vorioLiliry in rh pric rhor minisrris ol
holrh poy lor diognosric dvics indicors
considroLl lwoy in dvic pricing. For
xompl rh cosr ol on Hv virol lood rsr in
Knyo is 11.S0, in Thoilond rh som rsr
cosrs $44.07. Diognosrics, Cohn orgud,
hov o long woy ro go in rrms ol occss
Ly comporison wirh phormocuricols.
Rorhr rhon dmonding mor rgulorion
MSF's ogndo is ro provid grorr
rronsporncy, wirh rh gool ol ossisring
govrnmnrs in ngorioring down pricing.
This provo|d srrong disogrmnr lrom
Chris Low, who llr rhor rh suLsronriol
R&D cosrs involvd in diognosrics wr
Ling ployd down. Cohn's |y poinr wos
rhor occss ro inlormorion could prvnr
mor|r loilur in conrxrs ol grorsr
nd. Whr rh dvics supporrd Ly
FDFs loll on MSF's pricing spcrrum wos
unclor, ond ir is signilconr rhor rhis morol
dLor oLour rh rol ol Lusinss in
puLlic holrh involvd rh rprsnrorivs
lrom civil sociry ond commrciol indusrry
rorhr rhon puLlic-privor porrnrships.
ndd rh rnsion Lrwn colloLororion
ond compririon mrgd os o mo|or
rhm rhor wos crysrollisd in o discussion
oLour whrhr w should dsign singl
or mulriplx dvics. n rh on hond
mulriplx dvics ollord opporruniris
lor cross-suLsidy. Josph Ndung'u
undrscord FND's opprooch ro
diognosric dvlopmnr which s|s our
'rchnology plorlorms' opplicoLl ro mor
rhon on disos. n rhis woy producrs
dvlopd lor prolroLl disoss li|
molorio or TB hov rhir opplicorions
xplord lor non-commrciol disoss.
Hr h cird rwo xompls ol cross ovr
producrs rh iLED microscop ond rh
LAMF rsr which, whil iniriolly dvisd
lor TB - or now Ling usd ro diognos
rh nglcrd rropicol disos Humon
Alricon Tryponosomiosis. EsroLlishing o
good rlorionship wirh rh monulocrurr
is o |y componnr ol rhis FND srrorgy.
n rh orhr hond ir wos nord rhor whil
rh Bill ond Mlindo Cors Foundorion
would idolly li| ro s rh dvlopmnr
ol univrsol do-ir-oll diognosric dvic
rhr is in locr no opprir lor rhis |ind
ol dvic lrom indusrry quorrrs os ir
would |ill oll compririon in rh mor|r.

(2- 0&"%( &+ )#,-

Th qusrion ol singl vrsus mulriplx
surlocd ogoin in rh sssion on "poinr
ol cor chollngs". Clor Chondlr's
xrnsiv lld rsorch on ropid
diognosric rsrs lor molorio in Tonzonio
suggsrs rhor rhy hov hod vry lirrl
4
impocr on rrormnr procrics, porrly
Lcous o ngoriv rsulr lor molorio
srill llcrivly lovs rh porinr
undiognosd. For mony ol rh porriciponrs
lrom indusrry rhis xompl poinrd ro
rh imporronc ol rh mulriplx rsr rhor
would noLl holrh wor|rs ro diognos
lor mulripl common disoss or rh
som rim. r olso poinrs ro rh pornriol
prolilrorion ol inlrosrrucrur oround
supposdly sll-conroind diognosric
dvics, os rh oLiliry ro diognos lor
on disos ncssirors rh diognosis ol
lurrhr disoss.
Corolin Jons suggsrd rhor prsuming
rh nd ro diognos or oll cosrs wos
proLlmoric ond would ro| us ro o ploc
whr 'il w con'r diognos ir, ir dosn'r
xisr'. n hr opinion rhis sronc would
ris| pirring rchnology ogoinsr o clinicion's
s|ill, ond o holisric opprooch ro holrhcor
ogoinsr rh simplisric improriv ro
odminisrr drugs. Corolin Jons olso
rmindd us rhor ir wos only in 13 rhor
rh WH roo| rh dcision ro rror oll
lvrs os 'molorio' ond rhor rhis rgimn
ol prsumpriv rrormnr olrn rplocd
nuoncd locol disrincrions Lrwn
ryps ol lvrs. Bhoviour chong con
L succsslul, sh suggsrd, Lur Ly rh
rim ir hos Ln ochivd ir mighr no
longr L dsiroLl.
Whr rh clLrorion ol nw diognosric
dvics hos locusd on rhir oLiliry
ro oLvior rh nd lor diognosric
inlrosrrucrur ond rchnicol xprris
in rmor srrings, rh prsnrorions
Ly Clor Chondlr ond Chrisrino Acup
highlighrd rh conrinuing imporronc
ol rh holrh wor|r in rh diognosric
procss. Clor Chondlr orgud rhor
rroining rhor rducs rh holrhwor|r's
rol ro rh Llon|r lollowing ol rsr rsulrs
rorhr rhon using clinicol |udgmnr
con lod ro ds|illing. Monwhil Alic
Srrr poinrd our rhor xrnsiv rroining
progroms wr rquird ro occompony
rh roll our ol molorio RDTs in Fopuo Nw
Cuino. Th poinr ol cor oprorionol
proLlms rhor lollowd o sysrm-wid
chong in rh dvic supplir suggsr
rhor signilconrly mor "s|ill" is involvd
in rh odminisrring ol such rsrs rhon
commonly rcognisd. Chrisrino Acup
lrom EdinLurgh Univrsiry highlighrd rh
conrinud imporronc ol microscopy ro
diognos Humon Alricon Tryponosomiosis
in highly-ndmic oros ol Ugondo, ond
suggsrd rhor invsrmnr in sroll rroining
wos prhops rh Lsr woy ro nsur coss
would L pic|d up or poinr ol cor in
rhor srring.
Cruciol hr or issus ol rrusr, Lorh
in rlorionships Lrwn porinr ond
clinicion ond clinicion ond rsr. Diognosric
rsrs or only uslul in cos monogmnr
il rhy or ocrd on ond rhis dpnds
on rh holrh wor|r rrusring rh rsulr.
Josph Ndung'u ond Lors Crdsrd ol rh
Wllcom Trusr Lorh suggsrd rhor rh
rlioLiliry ol holrh dvics (in rhis insronc
HAT RDTs ond DDT Ld nrs) could L
douLl-chc|d wirh supplmnrory
rsrs. ndd FND or currnrly involvd
in rh dvlopmnr ol posiriv conrrol
wlls rhor will noLl holrh wor|rs
ro rsr rh occurocy ol dvics on sir.
Bur mighr rhis solguord pornriolly
undrmin rorhr rhon srrngrhn usr
rrusr in rh originol dvic?
Monwhil ir is olrn ossumd rhor
rh popl odminisrring poinr ol cor
diognosrics or rroind holrh wor|rs.
Bur Dovid MoLy's, Noro Engl's ond
Anni Wil|inson's prsnrorions oll
drw orrnrion ro rh incrosing rol ol
inlormol providrs os o poinr ol occss
ro diognosrics. Hr rh issu is olrn
rh loc| ol rrusr rhor policy mo|rs hov
in rh inlormol scror. Anni Wil|inson
poinrd our rhor inlormol providrs
nd ro L rcognisd os on incrosingly
imporronr porr ol lurur holrh sysrms
rorhr rhon simply os on oLsrocl ro
quoliry cor. Monwhil Noro Engl
xrndd rh diognosric ncounrr
ro includ rh porinr os wll os rh
corgivr. n ndio's highly privorisd ond
dcnrrolisd holrh sysrm rh onus
is on rh individuol porinr ro novigor
rh sysrm. By lollowing rh porinr in
such srrings ir Lcoms oppornr rhor
diognosis is Lrrr concpruolisd os o
procss or cycl rorhr rhon o producr.

,-$5/#(&,6
-%.",&%1-%('

Th issu ol rrusr mrgd ogoin in
rlorion ro gloLol rgulorory lromwor|s.
Dovid MoLy poinrd our rhor rh WH
simply connor |p up wirh rh currnr
poc ol diognosric dvlopmnr. Whr
in rh phormocuricol indusrry only lour or
lv nw drugs rquir pr-quolilcorion in
o givn yor hundrds ol nw diognosric
dvics or coming onro rh mor|r
onnuolly. This hos rh pornriol ro Lorh
rduc rh quoliry ol dvics ond rrusr in
rhos dvics Ly holrh wor|rs. Dovid
MoLy discussd o nw nrrnorionol
Cnrr lor Diognosrics sr up or LSHTM
Ly Frolssor Rosonno Fling wirh mission
7
ro lociliror rh dvlopmnr, voluorion
ond implmnrorion ol occssiLl, quoliry
ossurd in-virro diognosrics lor gloLol
holrh rhrough inlormorion shoring ond
odvococy. Th Cnrr is wor|ing wirh o
voriry ol orhr orgonisorions, such os
rh CloLol Hormonisorion Tos| Forc,
rh Asion Hormonisorion Wor|ing Forry
ond rh Alricon Sociry lor LoLororory
Mdicin ro rry ro hormonis rh
rgulorion ol diognosric rsrs gloLolly.
This roiss imporronr qusrions oLour rh
lurur rol ol rh WH in rh diognosrics
lld, ond whor |inds ol insrirurionol
nrwor|s ond porrnrships will noLl
llcriv rgulorion in o ropidly growing
mor|r.
Equolly imporronr is rh locr rhor mdicol
quipmnr dos nor usuolly nd ro
undrgo rh som lvls ol rsring
ond quolilcorion ro mr counrry lvl
rquirmnrs os phormocuricols.
This mons rhor irhr counrry lvl
guidlins/lows nd ro chong or
govrnmnrs or vn mor dpndnr
on gloLol rgulorion ond pr-quolilcorion
sysrms. Josph Ndung'u poinrd
our rhor FND's opprooch ro pro|cr
monogmnr is S crrild. Dos rhis
rprsnr on llorr ro Lgin ro inrroduc
srondords inro o lorgly unrgulord lld?
Drrmining rh corrcr rol lor WH
ond orhr Lodis in providing rgulorory
ovrsighr ovr mrging diognosrics
is poromounr givn rh poc or which
nw diognosric dvics or coming
onro mor|r. Bur orming Lodis wirh
rh copociry ro nlorc rhir ourhoriry
will L chollnging. Ar o rgulorory lvl
rh vorying copociry ol norionol ond
rgionol ourhoriris ro oprorionolis
llcriv solguords rminds us ol rh
Lroodr sysrm rquirmnrs ndd ro
supporr nw poinr ol cor diognosrics.

2"!!-% "%+,#'(,5)(5,-'

'Holrh sysrms inrgrorion' wos rh rhm
ol rh rhird ond losr ponl. on Horpr
dscriLd rh roll our ol corrridg-Losd
Cn Xprr mochins lor rh diognosis ol
mulri-drug rsisronr ruLrculosis in Npol.
nrndd ro improv rh occurocy ond
spd ol diognosis, rh $2S,000 mochins
ncounrrd numrous oprorionol
chollngs in rh lld. Bro|downs wr
common ond lrqunr powr ourogs
oddd ro diognosis rims. Th mochins
gnrord on incros in posirivly
diognosd TB coss - coss which hod
nor Ln Ludgrd lor in rh norionol
rrormnr Ludgr, ond rhr wos no room
in rh norionol doroLos lor corgorising
rh oddirionol coss pic|d up Ly rh
mochins.
nrrsringly, whil CnXprr is lrd
os o poinr ol cor TB diognosric, rh
prsnrorions Ly on Horpr ond Jnnilr
Cohn drw orrnrion ro rh suLsronriol
inlrosrrucrur dmonds rh mochins ploc
on xisring loLorororis rh mochins
rquir o dpndoLl lcrriciry supply,
o wor|ing compurr, corlul inlcrion
conrrol ond o s|illd oproror. ndd
rh discrponcy Lrwn rh s|illsrs
ol xisring loL rchs ond rh loL rchs
ndd ro opror rh mochins hos sn
rh inrroducrion ol lnonciol incnrivs lor
rchnicions ro conducr rh rsrs in Npol,
roising lurrhr qusrions oLour rh ovroll
cosr-Lurdn ol such dvics ond rhir
posr-donor susroinoLiliry.
Th limirorions ol CnXprr Lroughr rh
discussion lull circl ro rh implicorions
ol pornriol mulri-plorlorm monopolis
lor holrh sysrm copociry. Cphid, rh
compony rhor monulocrurs CnXprr
is currnrly plonning rh dvlopmnr ol
corrridgs ro rsr lor mulripl disoss. Th
nd ro inrgror nw rsrs inro xisring
inlrosrrucrur or ro cror nw supporriv
inlrosrrucrur lor nw diognosric rsrs
mor|s rhm our os uniquly dillrnr ro
phormocuricols, which con L swirchd
in ond our ol holrh sysrms. nsrod,
hoving Luilr rh rquird inlrosrrucrur
lor diognosrics, ir is much lss li|ly
rhor o diognosric dvic will L osily
suprsdd Ly on improvd or chopr
dvic. Th inlrosrrucrur loundorions
giv rh rsr o smi-prmonnc, which
moy hov cosr ond llcocy rprcussions
lor rh norionol holrh sysrm lorr down
rh lin.
n Horpr's srudy CnXprr wor|d os on
rhnogrophic proL, Lringing inro locus
inlrosrrucrurol copociris ond consrroinrs
rhor or orhrwis dillculr ro discrn. This
roiss mor gnrol qusrions oLour rh
rlorionship Lrwn diognosric dvics
ond holrh sysrm inlrosrrucrurs. Svrol
ol rh poprs discussd rh proLlms ol
rmprorur sroLiliry, Lorh in rrms ol rh
dvlopmnr ol dvics which rmoin
sroLl or high rmprorurs ond in rrms
ol |ping rhos dvics or rh corrcr
rmprorur whn in rronsir or in srorog.
n orhr words, whor hoppns ro rhs
dvics Lrwn rh poinr ol monulocrur
ond poinr ol cor is |usr os imporronr os
whor hoppns ro rhm in rhir momnr
ol us. Tmprorur conrrol is on ol
rh clorsr indicorions ol rh ncssiry
ol holrh sysrm inrgrorion. Do 'cool
choins' nd ro L crord olongsid rh
roll-our ol poinr ol cor dvics?
Th cos srudis ol nw diognosric
dvics discussd or rh wor|shop
suggsr rhor poinr ol cor dvics do nor
suLsrirur lor loLororory inlrosrrucrur
or ngor rh nd lor ir. nsrod rhy
mighr ocruolly rquir nrirly nw ryps
ol inlrosrrucrur Ling Luilr up oround
nw, pornriolly 'inlrosrrucrur-lir' rsrs:
solor, cool choin, moLil rchnologis ro
gosporiolly coprur diognoss. n rhis
scnorio nw rsrs or nor rmoving rh
nd lor inlrosrrucrur Lur moy in locr
L rplocing ir wirh mor plorlorm-lss
physicol inlrosrrucrurs rhor rquir mor
sophisricord rchnologicol plorlorms

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Con diognosis L conroind in o singl
dvic? Whr o policy ond invsrmnr
locus hos incrosingly norrowd diognosis
down ro diognosrics, rhis wor|shop
drw orrnrion ro rh inlrosrrucrurs,
insrirurions, ond procrics rhor mo| up
rh diognosric procss.
To|ing Noro Engl's concpr ol rh
diognosric procss os o srorring poinr
w suggsr rhor rhis procss mighr L
xpondd Loc|words lrom rh poinr ol
cor ro includ o locus on rh lunding
srrucrurs, rgulorory nvironmnrs,
porrnrship ogrmnrs ond loL Lnch
colloLororions rhor noLl ond dircr
rh low ol producr dvlopmnr,
ond ourwords ro rh holrh sysrm
inlrosrrucrurs, logisrics ond complxiry ol
poinr ol cor inrrocrions rhor nw dvics
musr ncssorily nrongl wirh.
n vry procricol woy ro rhin| rhrough rh
implicorions ol xponding rh poromrrs
ol diognosis in such o woy is ro locus on
rh rol ol Torgr Froducr Frolls. Torgr
producr prolls or o cnrrol porr ol rh
orly producr dvlopmnr cycl ocross
rh mdicol dvic indusrry. Ar prsnr
TFFs locus on rchnicol spcilcorions ond
or usuolly wrirrn wirh ossisronc lrom o
voriry ol rchnicol ond scinrilc xprrs,
which rorly rsonor dircrly wirh 'nd
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ol divorcing rchnology lrom conrxr:
prlcrly luncrionol rchnologis or
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rsr rsulrs or rngoriord, nw
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il rhs insighrs, olrn gornrd lrom
sociol scinc rsorch, wr usd ro
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proll in woys rhor ollordd improvd
holrh sysrm inrgrorion? Whor mighr o
socio-rchnicol producr proll rhor rroc|s
nds, limirorions ond opporruniris
rhrough insrirurionol orrongmnrs, poinr
ol cor procsss ond holrh sysrm
inlrosrrucrurs loo| li|?
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