Bobbi Pritt, M.D.  (00:04):

Hello, I'm Dr. Bobbi Pritt, a clinical microbiologist and laboratory leader at Mayo Clinic and your host for today's episode. I'm excited to be here today with Mayo Clinic Laboratories CEO and President, Dr. Bill Morice. We'll be discussing some recent topics in the news, and then we'll explore how clinical diagnostics are powering more personalized care during our deep dive. Thanks for joining me, Bill.

William Morice II, M.D., Ph.D.  (00:28):

Always a pleasure.

Bobbi Pritt, M.D.  (00:29):

Yeah, welcome back. So we're going to start by visiting what's new and noteworthy in the clinical diagnostic realm. And there's a number of things that I thought we could very briefly touch on. One is the very significant Ebola outbreak right now that's going on in parts of Africa, Uganda, and DRC. And the WHO is partnering with the African CDC and others to create a response to hopefully contain this. One of the things they're working on is point-of-care testing, and we've talked about point-of-care testing in the past, and I thought this would be just a good opportunity to reflect on point-of-care testing for outbreaks, for many other purposes. What are your thoughts on using point-of-care testing in this type of outbreak situation?

William Morice II, M.D., Ph.D.  (01:17):

Well, it's very interesting, right? I think there was a lot of interest in this too, because of the World Cup, which is here and there are travelers, there are central African teams that are participating. I think that was part of the concern. I was just visiting Toronto, and I think Toronto is hosting one of those nations, and there was concern there. And it really takes me back to some of our podcasts we were doing five or six years ago where this was really the topic de jure, if you will, of COVID. And so, thoughts are certainly, it can play a role in helping to contain outbreaks like this and helping to screen, but again, really have to be knowledgeable about what the test can and can't do and what a negative or positive result might mean, number one. And then number two, I was involved in a lot of conversations as you recall, with diagnostic manufacturers and others to kind of build up the global infrastructure to create these tests.

You know, and unfortunately that's something we talked a lot about at the time, but really has not come to fruition. And so, it makes me think that hard lessons learned maybe really haven't carried forward in some respects. So yeah, it just reinforces the need to really be vigilant on public health.

Bobbi Pritt, M.D.  (02:23):

I agree. And these point-of-care tests I think are just one more tool in our toolbox that we have to know how to use that tool. So, it's a good reminder and boy, you really bring me back with those COVID discussions.

William Morice II, M.D., Ph.D.  (02:34):

Yeah. It's almost like we need a playbook, right? And we had talked about that, about a playbook to how do you get the tests available and how do you make people knowledgeable about how you use them so we don't have to reinvent the wheel every time.

Bobbi Pritt, M.D.  (02:44):

Same. Yeah, absolutely. I agree. Well, another topic that's been coming up that people have been asking me to speak on is Lyme disease. I've done some work in that area. Borrelia mayonii was the pathogen, the second known pathogen, that causes Lyme disease in the U.S., and it has now been detected in New York state. So, that's also big news because Borrelia mayonii we thought was just in the Upper Midwest, but we have a bona fide case with a patient. Not only that, the local New York State Department of Health did tick testing. They collected ticks in the patient's backyard essentially, and found ticks that were infected with Borrelia mayonii. So there's this focus of Borrelia mayonii now outside of the Upper Midwest. So, you know, we're talking about emerging pathogens, outbreaks, now we have a relatively novel pathogen that's spreading its range, always interesting with these infectious risks.

William Morice II, M.D., Ph.D.  (03:42):

Yeah. Well, you're of course very humble since you were instrumental in the discovery and description of B. mayonii strain, I believe. So, you're more than just kind of an expert, and so it's interesting, right, just in terms of the spread of this pathogen and how is that occurring and you know, all those sorts of things. But also, is there any clinical difference in this between what we consider traditional Lyme disease?

Bobbi Pritt, M.D.  (04:04):

Yeah, from what we know, granted there's not a lot of cases so far, but it does appear that the cases can be more severe and the number of infectious organisms, the spirochetes, these spiral-shaped bacteria that we see in people's blood, is about a thousand times higher than what you see with regular Borrelia burgdorferi, which may explain the more severe symptoms. And thankfully, we have a test for that here at Mayo. That's actually how we detected it, was using some diagnostics we developed in-house.

William Morice II, M.D., Ph.D.  (04:34):

Yeah, it's fantastic. Makes Mayo so special, right? We're both so fortunate to work here and I'm fortunate to work with someone like you, and it goes back to the ABCs that you talk about, and we are in that season.

Bobbi Pritt, M.D.  (04:45):

Yeah, tick bite prevention, watch out for those ticks. It's just one other reason. Well, let's transition away from infections. I wanted to talk about PlatforMed. I know you recently spoke at Mayo Clinic Platform's annual conference, and it focused a lot on agentic AI, I believe. And maybe you could just tell us what some of your key takeaways were.

William Morice II, M.D., Ph.D.  (05:08):

The headline upfront was, this is the third time I've attended this conference. And it really, what the progress that has been made over that really short period of time is quite remarkable. Early on discussions were about what's the potential of AI — how do we start to test it in healthcare, how do we think about using these tools — to now, this conference is very much focused on the clinical use of AI and scaling from pilots to actually scalability. What is it going to take? It's already happening. Dr. Farrugia had some great comments around thinking about data and how we access data, which of course is near and dear to our heart. That's the main thing, is that we really are crossing the threshold from AI being discussed about being important in healthcare to AI really being woven into the fabric of healthcare over the next several years.

Bobbi Pritt, M.D.  (05:55):

It really has a place. I think we're all starting to discover in reality, not just hypothetically.

William Morice II, M.D., Ph.D.  (06:02):

Exactly.

Bobbi Pritt, M.D.  (06:02):

Well, I think that's probably all the time we have for the just brief “in the news.” Let's transition from this and then we can go into the deep dive.

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

Sounds good.

William Morice II, M.D., Ph.D.  (06:23):

I think the deep dive actually can leap right off of what we were talking about with PlatforMed, right? And you know, I had the opportunity to recently put some thoughts to paper or electronic paper around ways that diagnostics are changing with the advent of personalized medicine. Of course, you and I have been practicing long enough to know when that was really the buzz phrase, particularly pre-COVID, and thinking now about how diagnostics have changed. And I think a lot of that's being driven by some of the trends we saw before, as well as now you layer on top the fact of this advent of AI and thinking about healthcare data in different ways. And I think those are the important things to kind of be thinking about.

Bobbi Pritt, M.D.  (07:01):

Yeah. You know, let's dive into that a little bit more. Can you tell me your thoughts on, you know, as healthcare moves towards more personalized care and treatment and then we're incorporating AI, how does clinical diagnostics fit into all of that?

William Morice II, M.D., Ph.D.  (07:14):

Well, you know, one of the things that I think we both are experiencing, and we just talked about it in some respects in the news, is that we're really moved from diagnostics being when I trained, which is now in my training was 25 years ago, but really was focused on identifying conditions. Answering clinical question regarding what's the patient have, essentially, right? Where we really have gone from there to now is, diagnostics are increasingly embedded into the therapeutic decision-making process. And that can happen in a lot of different ways. One is you think about the advent of pharmacogenomics. I've been around for a while. I think we're really starting to see pharmacogenomic testing get traction because it's so important to understand how patients are going to respond to some of the therapies that they're going to be receiving. A lot of that's driven by how they metabolize those drugs. So, as the drugs become more available and become more complex and more expensive, understanding how people are responding to them, because some patients might need less, some might be at very high risk for adverse effects. A lot of that information is encoded into their genome, right, and pharmacogenomic testing is what tests for that. And so, I think that's one of the things that we're seeing more and more of here is pharmacogenomic testing as one piece of closing that therapeutic loop upfront for patients.

Bobbi Pritt, M.D.  (08:28):

Yeah, I agree. And it's, it's interesting. I always enjoy reading about what the latest advances are. So you kind of touched on this already, therapy selection, therapy management. Can you give us some more specific examples?

William Morice II, M.D., Ph.D.  (08:42):

Yeah, well, I mean a couple. First, as we've evolved to thinking about cancer during my career, from a genetic mutation cancer and an organ-based brain cancer or lung cancer or you know, lymphoma, which is a cancer of the lymphatic system and the immune cells, really going from that thinking to really cancer as a pathway disease, meaning that there are cellular pathways that get perturbed and get hijacked by cancer cells to allow them to become cancerous. And now there's drug-specific for those pathways that are being introduced into clinical practice, right? It was actually the first disease that I saw in my career, was actually shortly after I went on staff, the disease chronic myelogenous leukemia, is kind of a prototypic, one of the first genetically driven cancers. We knew about the Philadelphia chromosome. When I started, it was all nonspecific treatment and then within two or three years, the way that cancer was treated was by a drug targeting the actual abnormal enzyme that is produced by the Philadelphia chromosome, called BCR-ABL, and changed everything.

And so now, we're seeing that roll out of more and more and more. So, more is being asked from the laboratory in terms of identifying not just cancer and not just disease state, because we're now thinking about this in metabolic disease as well. Ironically, GLP-1s are pathway drugs as well, affecting a metabolic pathway. So, we're being asked more and more to create tests that will help guide the use of these drugs because they are very effective, but only if the pathway itself is abnormally perturbed. And also, the drugs are very expensive. And so really understanding who needs to get them becomes then critically important.

Bobbi Pritt, M.D.  (10:17):

Yeah. You know, my role on the CAP Board of Governors and on the Council of Scientific Affairs, we talked a lot about that. How do you actually detect that the patient has that specific gene or mutation or indication for this very expensive treatment? So as you said, trying to use laboratory testing to help guide therapy. So, it's great to see us so wrapped into the direct treatment of our patients.

William Morice II, M.D., Ph.D.  (10:42):

Yeah. And then of course, closing the loop between those two is between the pharmacogenomic testing and then delivering of the drug, is, of course, therapeutic drug monitoring. And that's another where we see a lot, a number of drugs that need to be monitored and the importance of maintaining patients in therapeutic range for these drugs. It has to come from lab testing. That's another area of real growth that I think we'll just see continue to grow. Personalized medicine is of course saying, "We're going to think about your disease state for you as an individual, which means we're going to give you the right drug. We're going to understand how your body's going to respond to that drug, and we're going to measure the amount of drug in your system to make sure that it's effective." So, it's a real paradigm shift.

Bobbi Pritt, M.D.  (11:24):

Yeah, it really is. And talk about training, back in my day, I remember AML was not a good outcome. And now it's like you said, it's a paradigm shift, and it's all these advances of our understanding. Now you had mentioned AI, just briefly, we were just talking about that. So, as that increasingly becomes a part of healthcare, how do you think that's going to impact our role in personalized care?

William Morice II, M.D., Ph.D.  (11:49):

It's almost like, how is it not going to impact our role in personalized care, right? Interestingly, at the platform conference, one of the examples that Dr. Farrugia showed was an AI algorithm that can run off of a bone marrow slide that in H&E, so just a routinely sustained bone marrow slide, on patients with myeloma, which is another kind of plasma cell cancer actually, and predicting what the outcome will be or you know, how malignant is this or what's the disease burden. And I realized as I was giving the closing for that day, you know, when I started my career, you would never even have imagined. The only way that someone could get access to say, can someone figure this out, was to put that slide in a box and send it to someone like me at Mayo Clinic. I would look at it, and then I'd have to write down what I thought and give it back to that person via fax, was probably the science of the time, right? The telecom science of the time. Whereas now, to be at a conference with the mind knowledge and that sort of knowledge can scale to so many people in parts of the globe that we never will even touch through the use of AI is really quite staggering and gratifying. Because ultimately, what we really want is to make our knowledge as accessible as possible to the people that need it. On the personalized, if we're starting there, getting actually access to knowledge that's going to drive the care of your patients. Think about the questions that I field to you around, when they reach out to me about I have this odd set of symptoms and could this be an infection? I mean that those sorts of things are now going to be available more widely, and that's really, really important.

And again, a lot of that observation, a lot of that data is coming out of the laboratory. So if that's how we're thinking about growing access to diagnostics, of growing access to healthcare, diagnostics has to be part. And the flip side, too, is also at the macro level, the data in healthcare will help, going all the way back to where we started with public health. Either looking at infectious disease trends, and finding them earlier. Looking at who can, you know, who in a population is going to be eligible for therapies without it having to be the doctor just knowing about it. So, I think there's population health things that will happen out of the data, too. It will require continued thought and thought leadership on the one hand to make the tools available, and on the other to make sure that they're responsibly used, right? Because we're talking about access to people's personal healthcare data here, and it doesn't get more personal than that.

Bobbi Pritt, M.D.  (14:11):

No, very good point. It's exciting that Mayo would have this opportunity to touch even more lives and even more patients through this platform and through the knowledge that we have amplified or augmented, as I like to say, through AI, responsible use of AI. So, it's exciting times.

William Morice II, M.D., Ph.D.  (14:28):

Agreed. A hundred percent.

Bobbi Pritt, M.D.  (14:30):

Yeah. Well, thanks Bill. This has been a really interesting discussion. As always, it's great to have you here with us, so I'll look forward to future discussions.

William Morice II, M.D., Ph.D.  (14:38):

Yeah, I always look forward to them as well. So, great to be here.

Bobbi Pritt, M.D.  (14:52):

Let's wrap up with the top takeaways and how to learn even more about the topics we discussed. In our news summary, we covered several topics, including a new type of Lyme disease, the use of point-of-care testing in the Ebola response, and Dr. Morice's takeaway from the PlatforMed Conference. In the show notes, you'll find a link to the podcast I did with my colleague, Dr. Thiel, where we spent the deep dive talking about ticks, related testing, and ways to keep yourself safe. And then in the deep dive, Dr. Morice stayed on with us, and we discussed the growing role of diagnostics in tailoring treatment and how that's elevating the expertise of laboratorians. If you'd like to learn more, we've also included links in the show notes to some previous podcasts I did with colleagues with specific use cases for personalized diagnostics and a recent article by Dr. Bill Morice on the topic. Thank you for joining us today. If you haven't already, make sure to subscribe so you never miss an episode. Next time, Jane Hermansen joins me to discuss the value of outreach programs. I hope you can join us.