Bobbi Pritt, M.D. (00:04):

Welcome to “Answers From the Lab,” a podcast from Mayo Clinic Laboratories where we explore recent trends, dive deep into emerging innovations, and unpack development shaping clinical diagnostics. Hello, I'm Dr. Bobbi Pritt, a clinical microbiologist and laboratory leader at Mayo Clinic and your host for today's episode. Today, I'm looking forward to having Mayo Clinic Laboratories CEO and president, Dr. Morice, join me for both a look at some hot topics and a deep dive into creating successful collaborations. Bill, welcome back.

William Morice II, M.D., Ph.D. (00:37):

It's good to be back. I like being officially introduced. It's kind of fun.

Bobbi Pritt, M.D. (00:41):

Yeah, I like doing it. We're gonna start off with a segment on the news, talking about what's new and noteworthy in clinical diagnostics. And I thought a good topic would be viruses. They're making appearances closer to home, and two of them are measles and chikungunya. I thought we could start with measles. You've probably been hearing about them, Bill.

William Morice II, M.D., Ph.D.  (01:03):

Yes. It has been really since the summer with the outbreak in Texas something that's kind of been in the news. And it's interesting to flashback even to COVID because I remember when we were talking about aerosol transmission and the example of a viral illness that was highly transmissible through aerosolization was measles. And here we are.

Bobbi Pritt, M.D. (01:22):

It is one of the most contagious viruses we have. So, over the weekend, Mayo Clinic had a case of measles diagnosed in our Rochester campus. Our staff responded really quickly, helping to protect the safety of our other individuals living in the community. But this is really a reflection of a broader trend across the country and the way people should protect themselves is really vaccination. It is a highly effective and very safe vaccine.

William Morice II, M.D., Ph.D. (01:50):

Yeah. Of course, I'm old enough that I learned about measles in medical school quite a bit because it was a real scourge prior to the widespread vaccination. It's an illness that can have serious sequelae, including pan subacute panencephalitis, which is lethal and is untreatable. So, I mean, it's really important to protect yourself.

Bobbi Pritt, M.D. (02:10):

Yeah.

William Morice II, M.D., Ph.D. (02:11):

It's not just a rash. And you're protecting others too, right? You get vaccinated, you're protecting others from you being a vector that could transmit it to other people. And also, talking with Dr. Binnicker, our colleague, about your division’s foresight to actually develop a test and have a test available. That's become really important.

Bobbi Pritt, M.D. (02:31):

That's very important. We have a measles PCR that we've highlighted before on the show. And the PCR is perfect for that acute diagnostic stage when someone is acutely ill. And we've been getting a lot of requests lately. Now, it's funny, Bill, you spoke of vectors because the other virus I wanna talk about is transmitted by a vector, a mosquito, and that's chikungunya virus.

William Morice II, M.D., Ph.D.  (02:54):

Yeah, another one, which I've not thought about nearly as much as measles or learned as much about, but also a real cause for concern. My understanding is that we have had cases in the U.S., which I believe is unusual.

Bobbi Pritt, M.D.  (03:06):

It is very unusual. It's been transmitted in the U.S. for the first time in years in New York City. We haven't had a locally acquired case since 2019. Usually, we think about this in tropical regions, although right now they're having a large outbreak that's spreading in southern China. But, we do have the mosquitoes in many parts of the U.S. that will transmit the virus. We just don't happen to have a lot of the virus circulating in those mosquitoes, thankfully, but this is a concern.

So, there was this patient that came with very severe joint and body pains. It's been described as having very severe arthritis. You feel like you have arthritis in all of your joints. You get a fever. Most people will recover after one to two weeks. But some people have symptoms for months or even years. And that's what happened with this person. This person's been experiencing symptoms since August and was only just diagnosed. We know the person had traveled outside of the metropolitan area of New York City, but we don't have more information of where that person went. But, they did not go outside of the United States. So, this was locally acquired.

William Morice II, M.D., Ph.D.  (04:11):

Yeah. It is important for us to raise awareness as laboratorians and for providers to be aware, especially in Northeast U.S. You might be thinking about Lyme disease if you're thinking about an infectious cause for prolonged arthritic complaints or arthritis as close to vector-borne viral illness. So yeah, really important that there's an awareness out there and that people follow their ABCs even as we're getting into the fall.

Bobbi Pritt, M.D. (04:34):

Yeah. Avoid, bug spray, and cover up. Thankfully, at this time of year, the risk is relatively low. We're going into winter; the mosquito populations are declining. It's really more now going to be thinking about that if you're traveling and going to some warm tropical setting over the winter. What I really liked about both these viruses is thinking about the impact the lab can make in diagnosing them. So, we have our PCR tests for chikungunya and measles, and then we also have serology. Like COVID and many infectious diseases, PCR is really helpful in that first acute stage, and then serology would be used later, seven days or so after when someone's developed a detectable immune response.

William Morice II, M.D., Ph.D.  (05:18):

Yep, and it’s important to understand how they're used and to keep them front of mind to the healthcare organizations and providers that you're serving, because they really need the help of the laboratory sometimes to think about these things.

Bobbi Pritt, M.D. (05:32):

Yeah, so those were the viruses to talk about. Now, we're going to go into our deep dive, which is a topic near and dear to your heart and mine, and that's creating successful collaborations. And so Bill, you're spending a little extra time with me today. That's great. You're joining me for the deep dive and we're going to explore the increasing importance of collaboration and how to establish strong relationships that benefit your organization and patients. So, thanks for sticking around, Bill.

William Morice II, M.D., Ph.D.  (06:06):

Of course, I'm delighted to, as you know.

Bobbi Pritt, M.D. (06:08):

I have a whole host of questions for you.

William Morice II, M.D., Ph.D.  (06:11):

Fire away.

Bobbi Pritt, M.D. (06:12):

Alright. Mayo Clinic Laboratories is forging new relationships that I find very exciting, and it's across the diagnostic sphere. Can you tell us a little bit about what is driving these collaborations?

William Morice II, M.D., Ph.D.  (06:25):

The primary driving force, if you will, or impetus, really was born out of COVID, or at least something that COVID illustrated I think to all of us. And you and I talked a lot about this. This is kind of where our podcast really started to take off. And that was the need for patients and for individuals to have access to testing that's holistic. Meaning not just a test, but a test offered in a way that really provides them and their providers an understanding of what's going on or what might be going on with them.

And so, if you look at the testing that's available both at hospitals and outside of hospitals, the term that comes to mind is very fragmented. There's a lot of different ways that patients can get tests and different labs that provide tests. Really, the thought of this next iteration of Mayo Clinic Laboratories is not just providing people access to experts like you and me, but also providing patients access to other tests, which we may not offer, or might even be offered more locally, but that they're offered in a way that is part of an integrated offering for patients and for the providers. One piece of this is to how do we start to approach our patients that aren't on our campus the same way that we approach our  patients on our campus? And that is really trying to use all the tests that are available to provide the best answer for them and for the doctors or nurses or providers that are treating them.

The other thing that's kind of driving this, and you and I both have a real passion for, is innovation. There's a lot of great innovation that happens at Mayo Clinic Laboratories, or really in DLMP, that we make available to people on the outside through Mayo Clinic Laboratories. But the pace of innovation is such that we can't do it all. And starting to think about what are some other innovative offerings that are being created that might actually augment what patients can get access to through Mayo Clinic Laboratories.

A great example of that is the Alzheimer's disease diagnostic C2N. We do have our own immunoassay, which has been bought up within the department by Dr. Algeciras with our thought leaders. It plays a really important role both at the Mayo Clinic practice and through Mayo Clinic Labs. But then there's also this company, C2N, which has a mass spec-based approach to measuring some of those proteins. It has some subtle differences, and there are some neurologists and others that want access to that test. Now, they can get access to that test through Mayo Clinic Laboratories in a way that's not just a test, but it's really getting access to the Mayo Clinic neurology expertise on the back of that. It's really kind of a combination, but with the overall intent of just providing the most complete offering to patients and their providers to help answer the questions that they have.

The other piece of this is that a lot of these are really great tests that have been created, but particularly after COVID, there's a lot of cynicism or skepticism about new diagnostics. It's difficult for some of these companies to actually raise investment that allows them to get their tests out to patients. This is a way for us to kind of catalyze some of those companies and help their survivability and growth when we really think that they're offering something that's beneficial to patients.

Bobbi Pritt, M.D.  (09:23):

Yeah, that makes a lot of sense, Bill, and I know we've talked about platform models before. This sounds a little bit like a platform model to me. Is that what you're thinking?

William Morice II, M.D., Ph.D. (09:31):

Yes, it is. It's very much a platform model. And the challenge with that term is it's relatively nonspecific. It can mean a lot of different things. In the example of Amazon, those are truly just kind of connecting a provider, or someone who has something that someone wants, to someone who wants it in a virtual environment. So this is in that same family where we're helping patients and people get access to tests and services that we might not offer in our department but are offered by someone else and we really think that those have value collectively. And as you know, our own Mayo Clinic physicians work with our department but also work with outside companies, so it's not foreign to us as Mayo Clinic. But, it's much more focused in this case. I mean, not just opening a door and saying anyone who has a test, come and get on our Mayo Clinic Labs platform.

We're taking a much more thoughtful approach just as we have with the growth of Mayo Clinic Labs and DLMP together in terms of finding ways to have this more open architecture, if you will, which I think is probably a more accurate description of our business. We can bring other tests to market in a way that really benefits patients and ultimately benefits our practice. Because again, as you know, there's a lot of pressure on our department to stay abreast of everything that's happening in diagnostics. And sometimes we can, and sometimes we can't. And this is a way really for the department and Mayo Clinic Labs to work together so that we're really thinking about this in the context of how Mayo Clinic thinks about diagnostics and driving patient care.

Bobbi Pritt, M.D.  (10:56):

Yeah, I really appreciate that thoughtful approach. I think it makes sense, and I think our clients and our patients would benefit from this collaborative approach.

William Morice II, M.D., Ph.D. (11:04):

If you think about it as you and I have talked about for a long time, it's incumbent on us when people have questions about these different tests and how they can be used. That's, I think, our calling as laboratorians to help provide that clarity. Now, we have a setting where we can not only provide that clarity, but provide access if we really think it's the right thing to do.

Bobbi Pritt, M.D.  (11:25):

Absolutely. Collaborations, you know, I think of them as allowing organizations to invest in different areas and then combine strengths. Based on your experience, what do you think is most important in selecting good collaborators?

William Morice II, M.D., Ph.D. (11:40):

Whenever you're working with someone else in collaboration, the most important thing, number one, is to have a shared vision of success, even in our integrated practice. That’s why for us, Mayo Clinic, the needs of the patient come first. I mean, that's our collective shared vision of success, and that's how we have this integrated, highly collaborative practice model that revolves around that. In this setting, it's number one, making sure that you're viewing success the same way that we are, and that is really trying to benefit patients. Sometimes, the business is important, the win-win is important, but the number one is to have a shared view of success. Number two is you have a common set of values, right? That you're ethically aligned with your collaborator.

It doesn't mean you have to be one-to-one. It doesn't mean I expect them to incorporate the Mayo Clinic’s Franciscan values into their business. But you want them to have the same kind of value and see the same value that we bring to the table as Mayo Clinic in terms of how we want to use diagnostics to promote patient care. Those are the two, I would say, table stakes.

And then from there, you really look for things that are complementary for us, right? There are certain things that we know that people in particular come to Mayo Clinic Laboratories for. If it's something you have that can augment that, that's kind of what we look for at the medical and scientific level. But we only get to that phase if we've checked the boxes on a shared view of success and philosophical alignment. Then for me personally, and you've known me for a long time, it's very important that anyone I collaborate with ― whether they're in DLMP; in the Mayo Clinic Research, Practice or Education shields; or on the outside ― always knows that I am as invested in their success as I am to mine. That's what makes a good collaborator, and hopefully they would feel the same.

Bobbi Pritt, M.D.  (13:20):

Yeah, I agree. I think that really seems reasonable. And so now moving forward, once you have a relationship, could you explain how you manage that relationship once you bring on a new collaborator?

William Morice II, M.D., Ph.D. (13:35):

It's another great question and it depends on the intent of the collaboration. As we've talked about in our newsworthy items, there are pathogens that are emerging in parts of the world that we might not be thinking about here. And there's also healthcare conditions that are more prevalent in different parts of the world, so some of our collaborations are more focused around innovation, right? Others are more focused on helping people get access to what we think is a really useful technology. Once you agree on those things, for the way you manage it, I go back to the Mulally method. Alan Mulally has this philosophy, profitable growth together, which is another way to say the win-win. If any of you need inspiration, Alan Mulally has got a lot of content out there, and he's a very inspirational individual, former CEO of Boeing and Ford Motor Company. And there’s a great book about his time there. But his thing is the shared vision and plan. You come up with a plan. What does success look like? How do we get there?

And then you have to have the data. Once you're setting up a collaboration, you have to make sure to go that last mile to say, “Okay, what do we want to achieve and how are we going to measure success?” You have to have agreed upon measures of success. We spend a lot of time with that, and then you watch it. If you are successful, you celebrate it. If you're more successful than you anticipated, you don't just celebrate it, but you try and understand why so that you can reinforce the value that you're creating.

And then if you're not achieving success, you also need to step back and take a very humble and thoughtful approach as to why things are not going as anticipated in the negative direction so that you can course correct. Sometimes that course correction means doing things a little differently. Sometimes, unfortunately, the things that you saw with a collaborator as potential, you just realize that for a variety of different reasons.

Then, the last thing you need is real honesty, right? You need to honestly agree upfront what you're gonna be measuring for success. And then if you can't achieve it, you just have to make sure it's data-driven so it doesn't feel emotional or personal, and then you just make active decisions around that data that are best for both parties.

Bobbi Pritt, M.D.  (15:41):

Yeah, makes sense. Well, great discussion, Bill, and thank you for joining me for both parts of this episode. With that, I will say goodbye for now, and I'll look forward to talking to you on our next episode.

William Morice II, M.D., Ph.D. (15:52):

I look forward to it as well.

Bobbi Pritt, M.D.  (15:59):

Let's wrap up with the top takeaways and how to learn even more of the topics we discussed.

In the news summary, we talked about circulating viruses, and as they get closer to home, it's a good reminder to take steps to keep ourselves safe. And also, it's important to remember how laboratory testing is key to supporting patient care and public health in responding to these events. If you want more information, I strongly recommend the websites from the Centers for Disease Control and Prevention.

And then we went into our deep dive, and Dr. Morice offered valuable insights into the power of collaboration and how we engage with our partners at Mayo Clinic. One of my biggest takeaways was the importance of setting clear expectations and then having transparent data-driven conversations. If you'd like to dive even deeper into these themes with Dr. Morice and our chief administrative officer, Mary Jo Williamson, check out the show notes where we've linked articles in past podcast episodes.

Thank you for joining us today. Our next episode will feature Dr. Trish Simner. She's my colleague in clinical microbiology, and I'm excited to talk to her about metagenomics. I hope you'll join us.