The public health laboratory in the community control of heart disease.

Abstract

' To consider public health laboratories in terms of the control of cardiovascular diseases presupposes more than mere interest. Each laboratory has a responsibility for active attempts to utilize all its resources to help control and solve this paramount health problem. The past half-century has seen the functions of public health laboratories broaden greatly. An examination of their functions as now performed should serve a useful purpose before attempting to describe their specific utility in the control of cardiovascular diseases. We would like to make clear, frankly, that we speak only as observers, since neither of us has worked in such a laboratory for an appreciable period. As reporters, the first function we see is the provision of laboratory services to aid physicians-both in organized public health services and in private practice-in the diagnosis, prevention, and management of disease. In fact, this appears to be the main objective of all public health laboratories. All other functions, while important, seem to be part of a program leading to this objective. A corollary function we observe is the maintenance of standards. Performance of a laboratory test is not synonymous with provision of a real diagnostic tool. It is necessary to have tests which are accurate and reproducible before their true value will be realized. Public health laboratories have pioneered the way in maintenance of standards for laboratory aids. The classic example of this is, of course, the serologic test for syphilis. When mass treatment of syphilis became possible it was imperative that case-finding and diagnosis-confirming laboratory tests for syphilis be accurate and reproducible from laboratory to laboratory. The story is well known, so we will not dwell on it further. There are many other laboratory tests, including several in the cardiovascular field, which are being used extensively by physicians to aid them in diagnosis and management of their patients. There is evidence of wide variation in the results of these tests when performed in different laboratories or in the same laboratory by different technicians. Yet little effort is being made to standardize them so that physicians will have reasonable assurance of the accuracy of reported results. It is quite conceivable that maintenance of standards will become an increasingly important function of public health laboratories as they