Estimating the environmental impact of inappropriate laboratory testing

In a recent letter commenting a previous article published in the Journal of Laboratory and Precision Medicine (1), Joseph Watine has outlined an intriguing and almost overlooked consequence of inappropriate laboratory testing, i.e., the potential impact of redundant or unnecessary tests on environmental protection (2). Notwithstanding this concept is theoretically straightforward, Watine failed to provide significant data in support of this statement, which hence remains hypothetical in essence.

To obtain a more reliable and touchable picture, we have made some speculative calculations for estimating the potential economic and environmental impact of wastage attributable to laboratory inappropriateness. According to the local facility (i.e., the laboratory of Clinical Chemistry and Hematology of the University Hospital of Verona, Italy), the global consumption of and cost per test of water, energy and personnel resources for clinical chemistry and immunochemistry testing performed on the analyzer Roche Cobas 6000 testing (two c501 modules and one e601 module; Roche Diagnostics GmbH, Mannheim, Germany) (Figure 1) are shown in Table 1, as estimated by the current tender and manufacturer’s declaration (3). Overall, each inappropriate test may hence impact by approximately 0.286€ on the hospital budget, 0.2% of which attributable to wastage of water, 3.2% to wastage of energy and 2.2% due to unnecessary personnel cost.

Figure 1 Manufacturer’s specifications for the clinical chemistry and immunochemistry analyzer Roche Cobas 6000 (i.e., configuration c501-c501-e601).

According to recent statistics, the current consumption of water, electric energy and the overall number of laboratory tests performed per year in Italy are approximately 5,348,272 million liters, 342,379 GWh and 668.8 million tests, respectively. Even assuming the worst scenario in clinical chemistry and immunochemistry (i.e., 30% of unnecessary/redundant tests) (4), the overall impact of laboratory inappropriateness in clinical chemistry and immunochemistry (i.e., the largest diagnostic area) would hence expectedly account for less than 0.0002% of total water consumption and less than 0.0001% of total electric consumption in Italy.

Can these figures be considered really meaningful in terms of environmental protection? Although we do not have a definitive answer to this question, and with the awareness that water and energy consumption for inappropriate laboratory tests is a very tiny drop in the immense ocean of human wastage of resources (as for our speculative calculations), the comment of Joseph Watine should be cherished since it adds more, though substantially weak, evidence that additional efforts should be made to reduce the burden of laboratory inappropriateness. Yet, environmental protection inside and outside the laboratory probably would much more benefit from other types of interventions, such as repairing water leaks and leaky toilets, installing water aerators and systematically shutting-off ancillary services to reduce energy use and maintenance requirement, unplugging equipment and turning off lights when not in use, using available sunlight to illuminate work spaces or switching to compact fluorescent bulbs.

Acknowledgments

Funding: None.

Footnote

Provenance and Peer Review: This article was commissioned by the editorial office, Journal of Laboratory and Precision Medicine. The article did not undergo external peer review.

Conflicts of Interest: Both authors have completed the ICMJE uniform disclosure form (available at http://dx.doi.org/10.21037/jlpm.2017.07.10). Giuseppe Lippi serves as the unpaid Editor-in-Chief of Journal of Laboratory and Precision Medicine from November 2016 to October 2021. The authors have no other conflicts of interest to declare.

Ethical Statement: The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.

References

1. Montagnana M, Lippi G. Overusing laboratory tests: more advantages or drawbacks? J Lab Precis Med 2017;2:41. [Crossref]
2. Watine J. Overusing laboratory tests: why is it unethical? J Lab Precis Med 2017;2:47. [Crossref]
3. Roche Diagnostics. Cobas® 6000 analyzer series-Operator’s Manual Software Version 05-02. Roche Diagnostics GmbH, Mannheim, Germany.
4. Lippi G, Bovo C, Ciaccio M, et al. Inappropriateness in laboratory medicine: an elephant in the room? Ann Transl Med 2017;5:82. [Crossref] [PubMed]