Quality of Laboratory Testing

Lessons from India: What performance data from the cradle of civilization is telling us

June 2026
Sten Westgard

We've spent decades benchmarking the performance of methods, instruments, and laboratories worldwide. But we seem to have found a lot of studies from India over the years. Here are just a sample:

An Erba XL-640 in West Guajarat, India
A perplexing study of an Erba XL-640 in West Bengal, India
An Erba XL-640 in Kolkata, India
An Erba XL-640 in India
An Abbott CELL-DYN Ruby analyzer in India
A Sysmex XN-1000 in Bengaluru, India
A Sysmex XN-330 in India
A Sysmex XN-350 in India, multimode analysis
A Vitros 5600 in India, before and after lockdown, multimode analysis
A Dimension RxI in India
An AU 5800 in India
An Erba 360 autoanalyser in India

If there's one theme in all of these articles, it's that the analytical performance is not great. Even the most well-established instruments don't come off looking good. But the instruments that are locally manufactured, like the Erbas, are even worse. Is there something wrong with Indian labs, or the instruments that operate there?

There's a famous book in the USA titled "What's the matter with Kansas?" by Thomas Frank, which attempts to explain how states that were once reliably Democratic changed into "deep red states" where conservatives took control. We take that catchy title as inspiration here, but we don't expect to fully explain why the studies do not show the same level of performance that we see in Europe or the USA. 

First, a proliferation of publications

India is of course the country with the largest population in the world, thus we should not be surprised that there are more hospitals, more labs, more laboratory professionals, and more publications. There is also the convenience that they publish in English, which we are able to read easily. (There are a lot of Chinese journals and Chinese publications, but they are rather difficult for us to access and translate). 

Next, extreme pressure to publish

Laboratory professionals must publish in order to maintain their positions or hope for advancement. This is not unusual, but in Europe and the USA, it's entirely possible to have a significant position in a laboratory and have no publications at all. That means, again, there are simply more papers out there.

There is also a question of focus. In Europe and the USA, labs are far more likely to publish on issues unrelated to routine performance. The journals that are most sought after discourage the publication of routine performance, and rarely even publish studies of novel method or new instrument performance. That data is often shunted off into conference abstracts and posters, which are less easy to access (many journals do not provide the contact details of poster authors, and the details in poster abstracts rarely contain all the data necessary to calculate analytical Sigma metrics). 

The other great difference is the popularity of measurement uncertainty. We are currently in a time of uncertainty supremacy, where MU dominates the scientific journals of Europe. Sigma metrics are discouraged by the small group of elites that control the editorial. In the journals where Indian authors are more likely to find a home for their papers, that preference (or bias) is not present. The journals, which are considered 

Challenges at every level of infrastructure

Indian laboratories can face challenges with reliable electrical supply and environmental conditions, clean water, a logistical supply chain that brings all the necessary materials to the laboratory at the right time in the right condition, staff with the appropriate level of training to implement the methods and operate the instruments. These challenges are not unique to India, but with more papers published, there will be more exposure of these challenges.

All that said, I have also seen excellent performance from laboratories in India. There are extremely well-resourced laboratories there, just as there are all over the world. Much of that good performance I have seen privately, not published in papers, so they don't end up in the scientific literature, or on the website here.

Should we discount studies from India?

It's impolite, to say the least, to dismiss all the papers from an entire country. If we see poor performance of an instrument in an Indian study, we can still find useful insights.  But a single study that shows poor performance of a method or instrument is not an ironclad verdict. It requires more papers and data to reach the conclusion that the method is bad, not the environment.

If we see problems with methods and instruments in a study out of India, we can pretend that it's all the fault of the country, or the environment, or the laboratory, but we can't be certain of that. If we see multiple studies of the same instrument, across multiple labs, even if they are all in India, that's a sign that there may a problem with the instrument, not just the place where the instrument is operated.