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So, it looks like our friends in the rads forum think path has a bright future. What do you guys think?
Pathology is the Future?
- Thread starter KeratinPearls
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SSSHHHHHHHHHH!!!!!!!!!!!!
don't let the secrets out before match season ends, damnit
anyone else have a recent visit from the CAP president, Jared Shwartz? i enjoyed his talk, it was nice to hear someone talk about getting down to business and being keen on what you are worth as a pathologist.
anyone else have an opinion - if you've had the same visit recently?
don't let the secrets out before match season ends, damnit
anyone else have a recent visit from the CAP president, Jared Shwartz? i enjoyed his talk, it was nice to hear someone talk about getting down to business and being keen on what you are worth as a pathologist.
anyone else have an opinion - if you've had the same visit recently?
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Of course I think path is the future, but I am biased. However, if you look at whats going on I think we have a much better idea of where the field is headed:
1. recent appeal of the medicare lab competitive bidding demo.
2. Pathologists have won several lawsuits over unpaid PC of clinical path and there is currently a big class action lawsuit pending.
3. numerous reports have been contracted by gov agencies ( lewin group for IOM, Adva for CDC) outlining the state of path and lab medicine, all of which have called for a restructuring of the reimbursement schedule.
4. Industry has invested an ENORMOUS amount of money into molecular diagnostic/IVD and other new technology(telepath).
5. a new bill (H.R. 6761) was just introduced that would overhaul the medicare lab fee schedule.
6. Antimarkup laws that were just put in place have shut down POD labs.
1. recent appeal of the medicare lab competitive bidding demo.
2. Pathologists have won several lawsuits over unpaid PC of clinical path and there is currently a big class action lawsuit pending.
3. numerous reports have been contracted by gov agencies ( lewin group for IOM, Adva for CDC) outlining the state of path and lab medicine, all of which have called for a restructuring of the reimbursement schedule.
4. Industry has invested an ENORMOUS amount of money into molecular diagnostic/IVD and other new technology(telepath).
5. a new bill (H.R. 6761) was just introduced that would overhaul the medicare lab fee schedule.
6. Antimarkup laws that were just put in place have shut down POD labs.
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Correct me if I'm wrong, but...
POD labs are labs set up by clinicians that basically exploit pathologists. They have labs outside of their office and basically try to take a juicy piece of the pathologists' prime rib.
Uropath (a pod lab) shut down, but was bought out for like 8 mil by another company. If anyone could comment on the Uropath situation that would be great. It seems as if another lab (not owned by clinicians) which has anatomic path labs as part of its company, bought out Uropath. So, this company is just another Ameripath-type factory mill. The end result being that these urologists can no longer profit off pathologists, but still the bizness is being shunted off to another factory-type setting.
See Lab Soft News for a recent commentary:
http://labsoftnews.typepad.com/lab_soft_news/2008/08/signs-of-proble.html
http://labsoftnews.typepad.com/lab_soft_news/2008/08/signs-of-proble.html
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looks like a lot of problems the field has faced in the past may be resolving.
http://www.cap.org/apps/cap.portal?...ent_2.html&_state=maximized&_pageLabel=cntvwr
from the cap today
http://www.cap.org/apps/cap.portal?...ent_2.html&_state=maximized&_pageLabel=cntvwr
A couple of days ago I took a look at Dr. Schwartz's presentation posted on the CAP website: http://www.cap.org/apps/docs/pathology_residents/emerging_developments.ppt
He encourages changing the role of pathologists in anticipation of the changes in medicine, in order to make pathologists indispensable in the future (are they dispensable now?)... I think the predicted changes in medicine are pretty exciting (like personalized medicine and digital path), but what does this mean for pathology trainees and new pathology graduates who will be in the midst of this change?
The presentation recommends that residents and new graduates lead the way by familiarizing themselves with emerging technologies, and becoming more visible in patient care by reviewing charts, rounding with teams, and talking to patients. Seems like a lot to do while also trying to learn or practice pathology... but I'm just a med student in the middle of her 3rd year who's looking into pathology as a possible career, so I probably have a very limited perspective...
Resistance to change? https://www.cap.org/apps/docs/membership/transformation/ask_a_question.html
He encourages changing the role of pathologists in anticipation of the changes in medicine, in order to make pathologists indispensable in the future (are they dispensable now?)... I think the predicted changes in medicine are pretty exciting (like personalized medicine and digital path), but what does this mean for pathology trainees and new pathology graduates who will be in the midst of this change?
The presentation recommends that residents and new graduates lead the way by familiarizing themselves with emerging technologies, and becoming more visible in patient care by reviewing charts, rounding with teams, and talking to patients. Seems like a lot to do while also trying to learn or practice pathology... but I'm just a med student in the middle of her 3rd year who's looking into pathology as a possible career, so I probably have a very limited perspective...
Resistance to change? https://www.cap.org/apps/docs/membership/transformation/ask_a_question.html
As I've mentioned in other threads, clinicians have moved beyond POD labs. There's no law against clinicians setting up their own histo lab in their basement and putting a hired pathologist in an available closet to sign out their biopsies.
CAP won't address the pathologist oversupply that makes these arrangements possible.
CAP won't address the pathologist oversupply that makes these arrangements possible.
Whenever I read these statements from CAP, I am glad I stopped sending them money.
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Indeed...suggesting we round or otherwise make cameos on the floors is ridiculous. Perhaps the surgeons should spend half of their days double scoping with us too. I'm sure they have the time.
Additionally, while I'm all for us in the next generation being up on the emerging technologies, this ignores the fact that we often lack the institutional and political power to effect significant change. It's the well established, like the leaders of organizations like the CAP that have this influence.
Additionally, while I'm all for us in the next generation being up on the emerging technologies, this ignores the fact that we often lack the institutional and political power to effect significant change. It's the well established, like the leaders of organizations like the CAP that have this influence.
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this thread is idiotic and so is the speculation.
In this country, the healthcare system is literally on the brink of revolution. Media is barraging the public with anti-physician and anti-entrepreneurship propaganda on a daily basis. The future will be defined by COST not technology.
In this country, the healthcare system is literally on the brink of revolution. Media is barraging the public with anti-physician and anti-entrepreneurship propaganda on a daily basis. The future will be defined by COST not technology.
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then i guarantee you that a circulating tumor cell assay is less costly than a PET scan
go path!
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Many of you will probably think I'm an idiot for this, but I like the way that statement sounds. I know time is a hot commodity in the field of medicine, but I plan to get some patient face time whenever possible. Rounding with a team? I think that's a little much, but popping in to explain results to a patient when you get the chance sounds like a good opportunity to use some of the Pathology skills that are learned throughout residency and beyond. Who better to explain a disease process to a patient (or anyone)? Pathologists.
I'm young in my medical career, but I've found by far, the thing that makes patients appreciate you most...no, it's not all that frufru empathy caring stuff (patients see right through that if it's not of the utmost sincerity), but it's when you treat them like an intelligent human being who is worthy of understanding their health problems to the best of their ability. It takes a skilled person to explain the complexities of disease in a way that a person can understand, and further skill is needed to assess each individual on the fly to know how in depth you can go or how in depth the patient even wants you to go. Contrary to what many ill-informed people may think, I think many Pathologists are perfect candidates for this type of communication. Pathologists do it for other doctors, why not for patients by just modifying how you explain things?
Anyway, as I said rounding is a little much...nor would I ever want the field to progress to the point where Pathologists are expected to round/meet with patients...Heck, some people go into Path to AVOID pt contact. The great thing about the field, is that's always an option and pathologists shouldn't be required to do that stuff. I hope it stays that way.
If other hospital staff/docs laugh when Pathologists come up to talk to patients? HA! We get the last laugh since we aren't the ones who HAVE to get out of bed at 3AM to admit a crashing patient from the ED. (Ok, not like Pathologists don't have call, but yeah).
From my point of view the field is all about options and relative control over those options. That's one of the most attractive parts of Pathology in my opinion.
Ok, rambling off.
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[FONT=Georgia, Times New Roman, Times, serif]Pathology and Radiology Must Prepare for Personalized Medicine
.[FONT=Georgia, Times New Roman, Times, serif][FONT=Verdana, Arial, Helvetica, sans-serif]January 20, 2009..
[FONT=Verdana, Arial, Helvetica, sans-serif]If there is one healthcare trend that will be truly disruptive to pathologists, it is personalized medicine. The concept behind personalized medicine is simple: understand the genetic and metabolic differences unique to the individual patient. Then use this knowledge to tailor a custom program of therapy, including prescription drugs, that offers the maximum potential for success while minimizing possible side affects.
Personalized medicine is closely linked to the emerging field of companion diagnostics. In combination, these two new ideas have the potential to revolutionize how laboratory testing services are used in developed healthcare systems. For one thing, clinical laboratories and anatomic pathology groupstraditionally the go to source for information to drive diagnostic, prognostic, and therapeutic decisionswill have serious competitors in the world of personalized medicine and companion diagnostics.
One keen observer of the personalized medicine trend is Bruce Friedman, M.D., Professor Emeritus of Pathology at the University of Michigan Medical Center in Ann Arbor, Michigan. In his popular LabSoft news blog, he defined companion diagnostics in this manner:
Briefly stated, [companion diagnostics] is a strategy pursued by some IVD companies, Roche Diagnostics in particular, whereby the company develops a gatekeeper biomarker assay. This is a lab test that serves to qualify a patient for treatment with a particular drug. The most common example of such a test is the HER-2/neu assay that is required prior to treatment with Herceptin.
Friedman, like your Dark Daily editor, recognizes that advances in genetic science and molecular technologies are making it possible for other medical specialties to crowd into the diagnostic field. He believes that the current, commonly-used definition of companion diagnosticsas primarily measurement by use of serum biomarkersis outdated. He thinks the definition should be widened, writing in his blog that: I personally have begun to routinely assume that diagnostics, unless otherwise qualified, should be more broadly defined to include both the analysis of serum and tissue biomarkers as well as medical imaging procedures. I have posted a number of notes about molecular imaging, which is defined in the following way in the Wikipedia:
[Molecular imaging] differs from traditional imaging in that probes known as biomarkers are used to help image various targets or pathways, particularly. Biomarkers interact chemically with their surroundings and in turn alter the image according to the molecular changes occurring within the area of interest. This is markedly different from previous methods of imaging which primarily imaged differences in qualities such as densities or water content.
Friedman continues, saying: I think that we now need to broaden our definition of companion diagnostics to include both the measurement of serum/tissue biomarkers as well as medical imaging and particularly molecular imaging. Such an approach also echoes my belief, expressed in a number of previous notes, that pathology, lab medicine, and radiology are becoming much more closely aligned and should now merge into a new discipline of diagnostic medicine. This broader definition for companion diagnostics also suggests that Roche, GE, and Siemens are embarking on very similar strategy in the pursuit of personalized medicine.
All pathologists and radiologists should track this trend, which is poised to disrupt long-standing practices in their respective medical specialties. Friedman will speak on this topic at the upcoming Molecular Summit on the Integration of In Vivo and In Vitro Diagnostics in Philadelphia on February 10-11, 2009. Location is the Sheraton Society Hill Hotel in Philadelphia, Pennsylvania. Joining Friedman is a faculty of 27 other leading national and international experts in molecular imaging, molecular diagnostics, and healthcare informatics.
Speakers from such organizations as Massachusetts General Hospital, Stanford University Medical Center, MD Anderson Medical Center, UCLA Medical Center, Siemens, and the Institute for Systems Biology will provide the latest innovations in the integration of in vivo and in vitro diagnostics. Last years Molecular Summit attracted 225 attendees, along with editors and reporters from 15 healthcare publications. This upcoming Molecular Summit has compelling case studies of how molecular diagnostics, when integrated with molecular imaging and other data sets, is giving clinicians powerful new insights for making diagnoses, identifying appropriate therapies, and monitoring patient progress.
.
.[FONT=Georgia, Times New Roman, Times, serif][FONT=Verdana, Arial, Helvetica, sans-serif]January 20, 2009..
[FONT=Verdana, Arial, Helvetica, sans-serif]If there is one healthcare trend that will be truly disruptive to pathologists, it is personalized medicine. The concept behind personalized medicine is simple: understand the genetic and metabolic differences unique to the individual patient. Then use this knowledge to tailor a custom program of therapy, including prescription drugs, that offers the maximum potential for success while minimizing possible side affects.
Personalized medicine is closely linked to the emerging field of companion diagnostics. In combination, these two new ideas have the potential to revolutionize how laboratory testing services are used in developed healthcare systems. For one thing, clinical laboratories and anatomic pathology groupstraditionally the go to source for information to drive diagnostic, prognostic, and therapeutic decisionswill have serious competitors in the world of personalized medicine and companion diagnostics.
One keen observer of the personalized medicine trend is Bruce Friedman, M.D., Professor Emeritus of Pathology at the University of Michigan Medical Center in Ann Arbor, Michigan. In his popular LabSoft news blog, he defined companion diagnostics in this manner:
Briefly stated, [companion diagnostics] is a strategy pursued by some IVD companies, Roche Diagnostics in particular, whereby the company develops a gatekeeper biomarker assay. This is a lab test that serves to qualify a patient for treatment with a particular drug. The most common example of such a test is the HER-2/neu assay that is required prior to treatment with Herceptin.
Friedman, like your Dark Daily editor, recognizes that advances in genetic science and molecular technologies are making it possible for other medical specialties to crowd into the diagnostic field. He believes that the current, commonly-used definition of companion diagnosticsas primarily measurement by use of serum biomarkersis outdated. He thinks the definition should be widened, writing in his blog that: I personally have begun to routinely assume that diagnostics, unless otherwise qualified, should be more broadly defined to include both the analysis of serum and tissue biomarkers as well as medical imaging procedures. I have posted a number of notes about molecular imaging, which is defined in the following way in the Wikipedia:
[Molecular imaging] differs from traditional imaging in that probes known as biomarkers are used to help image various targets or pathways, particularly. Biomarkers interact chemically with their surroundings and in turn alter the image according to the molecular changes occurring within the area of interest. This is markedly different from previous methods of imaging which primarily imaged differences in qualities such as densities or water content.
Friedman continues, saying: I think that we now need to broaden our definition of companion diagnostics to include both the measurement of serum/tissue biomarkers as well as medical imaging and particularly molecular imaging. Such an approach also echoes my belief, expressed in a number of previous notes, that pathology, lab medicine, and radiology are becoming much more closely aligned and should now merge into a new discipline of diagnostic medicine. This broader definition for companion diagnostics also suggests that Roche, GE, and Siemens are embarking on very similar strategy in the pursuit of personalized medicine.
All pathologists and radiologists should track this trend, which is poised to disrupt long-standing practices in their respective medical specialties. Friedman will speak on this topic at the upcoming Molecular Summit on the Integration of In Vivo and In Vitro Diagnostics in Philadelphia on February 10-11, 2009. Location is the Sheraton Society Hill Hotel in Philadelphia, Pennsylvania. Joining Friedman is a faculty of 27 other leading national and international experts in molecular imaging, molecular diagnostics, and healthcare informatics.
Speakers from such organizations as Massachusetts General Hospital, Stanford University Medical Center, MD Anderson Medical Center, UCLA Medical Center, Siemens, and the Institute for Systems Biology will provide the latest innovations in the integration of in vivo and in vitro diagnostics. Last years Molecular Summit attracted 225 attendees, along with editors and reporters from 15 healthcare publications. This upcoming Molecular Summit has compelling case studies of how molecular diagnostics, when integrated with molecular imaging and other data sets, is giving clinicians powerful new insights for making diagnoses, identifying appropriate therapies, and monitoring patient progress.
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That's an interesting read. Do you think that molecular imaging would become so routine that it would be integrated into the field of radiology somehow? Also, under a combined medical diagnostic field, I wonder if IR would branch off as a specialty of its own.
I like the cut of your jib, sir!
These threads always present a problem for me--do I plunge in and dash youthful optimism or do I hold back and just let the profession disclose its wonders naturally?
Perhaps it would be useful to readers to compare attitudes of medical students/residents/fellows with those of attendings and then draw their own conclusions.
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Haha, yeah try visiting the pre-allo forum once in awhile.
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I could have sworn half the people in this forum commented on the fact that they thought pathology was going no where in a previous fail thread and attached forum.
pathology is the future...the future is pathology
the only problem we will have is...if Obama manages, amongst all the hype, to actually be able to cure cancer...then...we are all effed
pathology is the future...the future is pathology
the only problem we will have is...if Obama manages, amongst all the hype, to actually be able to cure cancer...then...we are all effed
1
112641
naa that won't be a problem.. we'll still have to diagnose it so the cure can be administered
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Comparing the relative costs of up and coming technology makes this statement idiotic. I appreciate and attending coming onto Student
Doctor network and bashing the discussions of medical students and residents, but could you refrain from the harsh language in the future? And for God's sake lighten up.
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You could dash the hopes as it were, or just let it be. Give us our time to become as cynical as everyone else and in the mean time, just sit back and watch :-D
Dude, take your toys and go home. LA has a reputation on this forum... You are just a kid who strayed into an unfriendly neighbourhood after dark...
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I wasn't quite sure what to make of this when I first read it awhile back. I've just spent the evening hanging out/posting there and I think spontaneous brain implosion is imminent.
Now I get it.
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Let me be very clear. The idea of personalized medicine, as the lay person envisions it to be, (e.g. GATACAA [Thurman and Hawking movie), is centuries away. GWAS studies are generating "predictive" loci for complex diseases that at best have an Odds Ratio of 1.15 with questionable confidence intervals after validation studies are performed. Nature Reviews genetics has issued a number of reviews trying to reign in the investigators who are statistically challenged in this regard.
Are you kidding me, an Odds Ratio of 1.15, what physician is going to base sound medical judgement on that sort of diagnostic. The cost to benefit to wasting your fricking time ratio is absurd. The days of linking a disease to a Mendelian loci is over. Enter the days of confusion.
I can just see the legislators now. "We completed the human genome project, why hasn't personalized medicine arrived." Because, suprise, surprise the human body is so fricken complex when it comes to common ailments, personalized medicine will not arrive unless we have some sort of fundamental/conceptual change in the way we develop diagnostics for the future.
As LADoc surmized. Personalized medicine for Mendelian traits does not reimburse well, and complex trait diagnostics that are worth anything do not yet exist. And won't for some time.
Are you kidding me, an Odds Ratio of 1.15, what physician is going to base sound medical judgement on that sort of diagnostic. The cost to benefit to wasting your fricking time ratio is absurd. The days of linking a disease to a Mendelian loci is over. Enter the days of confusion.
I can just see the legislators now. "We completed the human genome project, why hasn't personalized medicine arrived." Because, suprise, surprise the human body is so fricken complex when it comes to common ailments, personalized medicine will not arrive unless we have some sort of fundamental/conceptual change in the way we develop diagnostics for the future.
As LADoc surmized. Personalized medicine for Mendelian traits does not reimburse well, and complex trait diagnostics that are worth anything do not yet exist. And won't for some time.
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I don't know how I let that comment slip by...
Yeah.. ok right. "cure cancer"
Milestone (1971): President Nixon declares war on cancer
http://www.dtp.nci.nih.gov/timeline/noflash/milestones/M4_Nixon.htm
January 1971 State of the Union address: "I will also ask for an appropriation of an extra $100 million to launch an intensive campaign to find a cure for cancer.."
How is that war going....
A whole generation of oncologist have made their career after we started "the war on cancer". None of them lost their jobs because we cured cancer...
