Walk Right In, Sit Right Down

The U.S. is now the only industrialized nation without a universal health care program. We Americans are a footloose bunch. And most of us work all day. One place these facts converge is at Doc-in-the-Box installations, a burgeoning new medical enterprise designed to serve those who have neither a primary care physician nor the price of a visit to the ER. These stand-alone clinics, often located in supermarkets and large discount stores, are limited in the care they can offer—treating sprains and earaches, for instance. And diagnosing some illnesses. The diagnostic range they can handle could be enormously expanded by sensors in the form of lab-on-a-chip technology.

The walk-in clinic at your local MegaMart is probably staffed by RNs and physicians's assistants. They don't have a lab in the back room or access to test facilities at a local hospital. Their clients don't have time to wait around for test results (they just stopped by after work to snag some coffee or diapers), nor can they make a definite plan to come back later.

On the Spot
So this is a giant of a potential growth area for those little chip-level labs (you've already seen your veterinarian using them to detect FIV and certain other diseases). These diagnostic devices can't pick up on an infinite variety of miseries, of course, but they will be a great first filter, as will the clinics themselves.

Now, here's where it gets really interesting. When was the last time you were routinely tested for anything? Someone drew a vial or two of blood, right? A good phlebotomist can do that before you know the needle's on its way. (A bad one's another story.) But it turns out that saliva closely mirrors blood as a reporter on systemic conditions. So those little labs-on-a-chip might be capable of yielding an initial diagnosis of impending heart failure, based on a sample as simple to provide as spit. And it's easier to get a kid to go "ptui" than to hold it still for that needle poke or finger prick.

The medical community is less than enthusiastic about these upstart, maverick clinics. But they are the only source of medical care for most of those who walk in. At night. Passing through a town or neighborhood. With no insurance. And only a bit of money left over from buying the diapers and coffee. And the personnel there can and do urge those with serious medical problems to take them to more complete facilities.

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