William Morice, II, M.D., Ph.D., Chair of the Department of Laboratory Medicine and Pathology at Mayo Clinic in Rochester, Minnesota, and President of Mayo Medical Laboratories (MML), talks about technology trends in laboratory medicine with Kelley Schreiber, Social Media Marketing Manager at MML. Connect with Dr. Morice on Twitter @moricemdphd to let him know what you would like to hear next.
Kelley Schreiber: Hi, I’m Kelley Schreiber, Social Media Marketing Manager for Mayo Medical Laboratories, and I am here with Dr. Morice. Hello, Dr. Morice. How are you doing?
Dr. William Morice, II: I’m doing great. How are you?
KS: Good, thank you. Today, we’re going to talk about technology trends in laboratory medicine.
KS: Great, well, let’s kick it off with this question: How has technology changed lab medicine from the early part of your career to now?
WM: Well, first of all, it’s a little depressing to think my career has now hit the phases that I’m old enough to have done that. So, there’s now an early phase, but I think that really the most dramatic change since I was a trainee, and really I’ve only been on staff since 2000 (so 17 years, which you’d think in the span of time is really not that dramatic), there has been a really dramatic impact of technology on the practice of laboratory medicine, in particular. When I started, pretty much the pace of technological innovation was such that, typically a piece of equipment, if it came into the laboratory and was new, took a long time to perfect. They were big and bulky, and there was about a 15-year life cycle. So once you bought a piece of equipment, you knew you were going to be working on that “state-of-the art equipment” for about 10 to 15 years before you’re really looking to move onto a new technology or different technology. That really defined the pace of lab development and the introduction of new tasks. Since I joined the faculty of Mayo Clinic to now, that life cycle is now probably a 3- to 5-year cycle. So the way technology has changed is it’s really almost like we have seen societally where technologies have become so advanced so quickly, and they cycle so quickly, that it’s really had a pretty dramatic impact on the practice of laboratory medicine. So that, to me, is the most dramatic change because our field is not one that’s really designed for rapid adaptation, you know, in terms of knowledge and how we make diagnoses. Most laboratorians really want those tools for diagnosis to be well-established. We develop a familiarity with them, and now they’re coming at us fast and furious.
KS: Extending beyond that, what technology do you think has had the largest impact on lab medicine?
WM: The largest impact on laboratory medicine actually has been not an instrument but an algorithm or a computer. So, what do I mean by that? I guess the one thing I didn’t realize—and this was happening when I started my career—was the Human Genome Project. And the Human Genome Project was really where the technology was created to create massive amounts of data and then use a computer to assemble a puzzle that the human mind could not assemble because it was too big and too complex. That was the only way they were going to sequence an entire human genome was to develop this technology. Well, it’s happened, and that has had a huge impact on laboratory medicine. If you think back—if I think back—or we collectively think back about 15 to 20 years, every test that we did was a single analyte, so you would design an assay, typically, for a single analyte. I want to know what someone’s hemoglobin and white blood cell count is. They were very singular analytes, and that’s really how we thought about developing tests. That’s how we thought about delivering tests into the medical record. And so now, we have a technology that can take literally hundreds of thousands of analytes, simultaneously analyze them, and reassemble them into a single “result,” which 15 years ago would have been 15,000 results—but it's now a single result. And because of that, the technology has really changed. We really haven’t changed; the health care system hasn’t really changed. It’s had a huge impact, and we don’t really even fully understand it yet because, really, the health care system as a whole has not entirely adapted to this technology change. There are some doctors who would like to see this technology used to produce massive amounts of data around every patient. There are others who feel that this is really inappropriate, that really it’s an "over-wealth" of data that most patients don’t need or will ever understand, and payers don’t know what they’re paying for either. I mean, when it’s a single test, single analyte, single result, it’s very easy for an insurer or government payer to say, "Yep I can pay for these things and not for those," and now they don’t. Now, there’s one massive machine with one massive test that generates lots and lots of information, and yet, you can’t really decipher if it’s really adding value to the patient-care episodes, and they’re reticent to pay for it. So, that’s come out on a lot of different things that we see in terms of patients having to pay more out-of-pocket for these tests and the annual out-of-pocket or the preauthorization process that was never a thing in laboratory medicine before, when a patient now has to receive "preauthorization" for lab tests like they would for an expensive procedure. So, it’s had a lot of ramifications that are just unfolding and will continue to unfold during the majority of our careers.
KS: Definitely. While going back to your career, Dr. Morice, can you describe a specific scenario of technology in action that you experienced?
WM: Well, streaming radio made my office a little bit more enjoyable to be in [laughs]. I guess, in my own personal experience, with my background in flow cytometry, it's been seeing the power of the flow cytometer increase so dramatically. Over the course of my first 10 to 15 years of my career, where we could take a single cell and learn 2, 3 or 4 things about that cell per flow tube to now where we could take a single cell and learn 15 or 20 different ways to interrogate a single cell in solution. That’s had a big, big impact on the ability to actually detect abnormalities and determine what cells are normal and abnormal and to get a much better footprint, if you will, or "fingerprint" of an abnormal cell. And that’s, again, true of flow cytometry and a lot of these technologies, and the power really is actually changing our paradigm of how we think about many diseases. On the one hand, let’s say if you take cancer, for instance: Between the ability to create drugs that are more effective in treating cancer as well as now, our ability to use things like a high-power, multicolor flow cytometer to detect very small numbers of abnormal cells, we can get to the point where we start thinking about cure of a disease.
Same for HIV, right? With HIV and with these really high-sensitivity molecular methods. I mean, gosh, when I was in college and even when I started my career as a physician, HIV was considered pretty much a chronic disease that most people were eventually going to die from to now, where we have drugs that are effective in really controlling the growth of the virus and actually eradicating the pool, and now, we have tests that are sensitive enough to say, "Yes, you really have no detectable HIV RNA or no detectable cancer at a level that we can, as we start to study longitudinally, we can say is really most likely not going to come back." So, you know, I don’t think we can say that we’ve cured cancer or cured HIV yet, but between the combination of those two technologies, they have really changed how we think about the use of a laboratory and how we actually think about these diseases.
And I think going forward, one of the things that’s really going to be exciting is understanding, through laboratory tests, the interaction of the environment with our bodies and how they contribute to diseases in ways we never thought. And, I think that’s some of the exciting work that I’m just starting to experience in the area of the microbiome where you can look and say, based on a person’s flora, intestinal flora, or even skin flora, we can now find that there are ways that a person’s body is responding to his or her own internal environment that are actually driving disease conditions. There’s certain microbiological compositions of flora that would make someone prone to actually develop cancer or might make someone prone to develop heart disease, and these are things that we never thought of. Actually, it’s ironic to me because I liked to spend time—when I had more time to spend—wandering over to the Mayo Clinic Plummer Building, the Library of Antiquity, and reading some of the older literature just for fun. That was when I was feeling particularly nerdy. From the turn of the century, there was a whole body of literature about how cancer arose in areas where patients had an infection or trauma, and if you read that as a resident in, you know, circa 2000 or 1995, well, that was debunked. They had no idea what they were talking about, and now it’s coming back around to, yeah, maybe cancer is, in part, driven by “infectious disease” and not just where there’s friable infected cells that become malignant but just the organisms that we live in and around are somehow shaping our immune system in a way that makes us susceptible to get other diseases. So, those are the things I’m experiencing right now that I think are particularly impactful and kind of exciting to see fold out.
KS: Thank you for sharing, Dr. Morice. Well, that’s all that I have for you today. Is there anything else that you want to share with us?
WM: I think it’s going to be really important for us in our profession to really understand and embrace the technological change because it will come. I mean there’s lots of technological changes, and we could go on and on. I mean, what’s going to happen to laboratory medicine with the miniaturization of technology? What kinds of things that we currently use as big instruments in a central lab will happen at the bedside or happen without ever procuring a blood specimen? There’s all sorts of things. What will happen when we have digital pathology that’s cheap enough that most slides will be digital, and there will be artificial intelligence software programs that will screen slides for conditions? These are all things that are out there, and I, as a professional, trained in the mid-phase of my career and even at early-phase, think they’re intimidating and they’re scary. And so, the thought I think that we need is not to be afraid of this change but to really embrace it. And if you think about it (I'm taking kind of a stretch here), but if you think about another industry that’s facing the same exact set of issues, it’s the auto industry. Between the autonomous car and the car as a "biometric device," there are all sorts of things that are happening. And, five years from now, we will move away from people actually owning cars.
I mean, there’s going to be a generation of people coming up that it will be more convenient for them to just summon a car that they don’t actually own, and they won’t actually even have to know how to drive to take them from point A to point B. There’s a lot of fear in the auto industry that, you know, is Ford going to be irrelevant? Are we going to be buying cars from Google and Apple? Really, if you look at that industry, those that are most poised to adapt to the changes and to guide the changes in a way that’s appropriate for society are actually the automakers, but that means they just have to really be open to continually rethinking how a car is purchased in society and how a car is used in society. I think our field in medicine, in particular, which is so technology-driven and so personal and generates so much information about patients has to take the same mindset. All of us need to have this mindset, but particularly me, in this leadership role where I’m expected to be someone who is standing at the front of the boat seeing where we should be headed. So, that’s the kind of thought I would leave everyone with because we could talk on and on about the technologies, but the important thing is how we respond to them, how we embrace them, and how we make sure that, as laboratory professionals, they are used for the betterment of patients.
KS: As always, it’s been a pleasure talking with you, Dr. Morice. Thank you.
WM: Thank you.