What y'all think molecular genetic pathology fellow

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If you are willing to do generals too then I think there are some progressive private practices that would view it as an asset. The demand in academics is weird primarily based on the volume of molecular studies that are performed at whichever particular institution. Many places only need one molecular pathologist and if they already have one then you are SOL. However, that is where all the growth is these days so if things progress how they are now there will be increasing volume and demand in the future. If you like it go for it. It certainly will not hurt you to have done a molecular fellowship.
 
"Weird" is a reasonable term. On the one hand it's considered a growing field, and in some ways has really exploded in the last 10~15 years. On the other it's often being treated like most other CP lab tests -- give it to a tech and see what comes out, maybe throw a PhD in there to oversee the lab, but don't bother wasting money on an MD. Some large centers, or smaller centers who want you to do more than just molecular, may have a job for an MD molecular pathologist. But even large academic centers are filling these positions with PhD's who can oversee the lab, which is run day to day by technicians, while they also bring in grant money for other projects they're working on. So...my impression is that it would be a tough market.
 
The professional fee for molecular tests is next to nothing. The technical fees barely cover the fees for the machines or the licensing. I don't know if this will change. I suspect not - I think molecular testing is moving more towards individual machines running individual tests in an automated fashion with very little tech input (thus, all they require is putting material in and printing out the results). This is because so many tests are patented so you can't create you own home brew for many things anymore.

So this is unlikely to be a lucrative field unless you patent your own test.
 
lipomas said:
The professional fee for molecular tests is next to nothing. The technical fees barely cover the fees for the machines or the licensing.
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That's true, but if a hospital is spending a boatload of cash sending out certain high volume molecular tests, bringing them in house can result in significant savings even if the testing itself isn't profitable.
 
Parts Unknown said:
That's true, but if a hospital is spending a boatload of cash sending out certain high volume molecular tests, bringing them in house can result in significant savings even if the testing itself isn't profitable.
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Yes, that is true. But the issue for molecular tests is that they are not that high volume. Even something common like BCR-Abl or JAK-2 is not ordered to a huge extent even at high-volume cancer centers. You have to start batching them. And when you batch them then you usually extend turnaround time, which makes people upset since sending it to a reference lab can get the turnaround time faster. I talked to a guy at Yale, which likely is pretty high volume, and they were considering not doing JAK-2 anymore.

I am not even sure what molecular tests would be considered "high volume."
 
This is interesting since molecular was supposed to take over everything and now even Yale is having a hard time getting enough volume.
 
Thanks for the frank discussion of the job prospects and general usefulness of a molecular fellowship.

I was a molecular cell biology major back in undergrad, so I find studying the molecular basis of disease pathogenesis and diagnosis really fascinating. I've been thinking that I might want to do molecular genetic fellowship after residency, but my main concern has been what kind of jobs would be available. I certainly don't have the research chops to compete with PhDs for jobs at the really big, research-oriented labs. I was hoping that the trend might be toward smaller hospital systems offering a limited menu of tests in-house, such that I could direct their molecular lab and do some AP signout as well...I guess I'll just have to wait and see how things go in the next few years.
 
The pathology group my first training program was affiliated with was what I would consider a moderate sized private group, covering multiple regional hospitals (one academic center), and they had fairly recently opened a small molecular lab directed by that sort of person -- molecular genetic certified, ran the molecular lab, but spent a lot of time signing out AP too. Dunno how profitable it's been over time, though; appears that that part of the lab is still running, anyway.
 
lipomas said:
I am not even sure what molecular tests would be considered "high volume."
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It's all relative. Right now the only ones that might qualify for medium sized hospitals are probably microbiology-based.
 
complete and utter waste of time and I already have well explained this in the past 5 years on SDN.
 
That BRCA-related lawsuit is going to bear watching. I imagine there will also be lawsuits about the ability to patent things like the JAK-2 mutation. I am sure courts will get heavily involved over the next few years in clearly defining what is or is not patentable. Can you patent the JAK-2 mutation, for instance? Why should that be allowed? NPM mutations in leukemias are patented too - can you really patent a naturally occuring genetic mutation? Patenting methodology is fine but there are different ways to analyze DNA. It's hard to know what will happen now. And what will happen as direct gene sequencing becomes easier and cheaper?
 
Following the drift of the thread...My opinion is that one can't patent a naturally occurring gene or mutation any more than one can patent a caucasian male, or someone with trisomy 21. By implication, if you patent/"own" a given gene or mutation, then you "own" a part of any individual who has it. Yes, you TOO are the property of BioLabs-R-Us. Please return to base. Your functions have not been authorized.
 
KCShaw said:
Yes, you TOO are the property of BioLabs-R-Us. Please return to base. Your functions have not been authorized.
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:laugh:

Agree completely. I understand the point about companies not wanting to research this stuff if they can't make lots of money. But that being said, it just seems ridiculous to be able to patent something that you discover, not create.
 
Do you guys ever wonder if pathologists ever sat around and discussed the merits of running expensive newfangled tests like quantitative sodium levels?
 
KCShaw said:
Following the drift of the thread...My opinion is that one can't patent a naturally occurring gene or mutation any more than one can patent a caucasian male, or someone with trisomy 21. By implication, if you patent/"own" a given gene or mutation, then you "own" a part of any individual who has it. Yes, you TOO are the property of BioLabs-R-Us. Please return to base. Your functions have not been authorized.
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That may be true,but I don' think it's decided yet. You can't create your own assay to analyze certain things (like JAK-2 for one) without the company that owns the patent coming down hard on you. It may be because they see a short future for profiting off of such patents, but I am not sure.

No doubt there are lawyers working furiously to attempt to patent lots of genes in the advent that they become profitable for something - like say, for example, patenting a gene for congenitally high HDL. It will be interesting to see what happens over the next few years.

Currently, FISH (like for Her-2 and urine) is somewhat profitable for labs to run if you have a reasonable volume. But who knows if that will change also.

Most of our esoteric molecular tests do not come through us - they are put in the EMR if they are legitimate tests. I don't know what happens with random bizarre tests, the kind of thing that quacks would order, are ordered. Maybe the reports go right to the physician. If molecular tests are attached to surgical or cytology specimens usually we have to approve the block or material being sent out, so we get a report and we make a small addendum report reflecting the results.
 
zao275 said:
:laugh:

Agree completely. I understand the point about companies not wanting to research this stuff if they can't make lots of money. But that being said, it just seems ridiculous to be able to patent something that you discover, not create.
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Imagine if Watson and Crick had the foresight to patent DNA. They would have made hundreds of billions. People weren't that financially savvy back then.
 
It's also like patenting creatinine, and then preventing anyone from testing creatinine levels in any way without paying you. Or patenting carbon monoxide, and preventing anyone from testing for it without paying. Nah, I'll patent MRSA and not let anyone test for that, or do research on it, without sending me a check. Much like happened with SARS; as the story goes, someone patented SARS then no-one else was willing to do research on it for fear their results would be claimed under patent. It's not a small problem, and the distance between what has happened, what is currently happening, and what seems absurd appears quite superficial to me right now.
 
Back to the OP, I think that job-wise it's a luxury. As most people have stated you are a square peg looking for a square hole. The jobs just doing molecular are rare and usually in research or large academic institutions. Most of us are signing out AP cases in addition to being in charge of the molecular lab. As a fellowship it is a bit of a waste, we would be better off if we boosted the molecular training in residency, maybe even adding a research year.
 
GeoLeoX said:
As a fellowship it is a bit of a waste, we would be better off if we boosted the molecular training in residency, maybe even adding a research year.
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I'll be doing a molecular path fellowship next year, and I'm getting a kick out of these replies....

First of all, why do you want to do this fellowship? Positions in running a molecular lab are scarce, as many have pointed out. They are generally restricted to larger academic centers- and even then I'm not sure it's a full-time job. There just isn't enough volume unless you are at Mayo. There are also those mills out there, which I know little about. However, smaller academic centers, who want a "molecular lab" to be trendy may hire you to be director of their lab that signs out a paltry number of tests in addition to other duties (or maybe to get good at solitaire on your downtime). I have seen this happen to most trainees in mol path who are straight MDs and not interested in research. I think that it's a niche market and novel enough that it may help you land a job- although it may not be the job you want.
If you are interested in research... you still don't need to do it. In fact, most directors of molecular labs at academic institutions are NOT boarded in molecular. I don't even know any that are (ok, maybe one). But that's because it is a new field, and it may be that in the future, licensing will be required. But who knows?
 
KCShaw said:
It's also like patenting creatinine, and then preventing anyone from testing creatinine levels in any way without paying you.
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I'm pretty sure you cannot patent a gene. That was the big fuss in 2000 when Venter and Collins collaborated on the human genome project. You can patent the techniques for assaying the information (protocols, technology) or any novel reagents (like plasmids or primers).
 
gbwillner said:
I'll be doing a molecular path fellowship next year, and I'm getting a kick out of these replies....
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I did one last year. This is why I feel free to speak my mind about it.

The issue about patenting genes goes beyond the protocols and reagents. Just try to run FLT3 ITD or TKD testing - make up your own protocol, your own primers, etc. You could even develop the same test that has been published in the peer-reviewed literature. Invivoscribe's lawyers will find you. I can't claim to know whether the gene itself is patented or the legal nuance that allows for such, but it is more complex than just patenting a novel assay. Similarly for Jak2 now and is more likely the reason that many labs are getting out testing it in house. At least with Jak2 you can test, you just have to pay the ransom to Ipsogen.
 
This fellowship is similar to 20 years ago when you could do an immunohistochemistry fellowship. It will either not take off enough to be a significant component of daily practice for a pathologist or (more likely) it will become so commonplace that everyone is expected to know how to do it.
 
2121115 said:
This fellowship is similar to 20 years ago when you could do an immunohistochemistry fellowship. It will either not take off enough to be a significant component of daily practice for a pathologist or (more likely) it will become so commonplace that everyone is expected to know how to do it.
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Good point. I have often wondered if it will go in the latter direction, as you suspect. I have heard the same reasoning used, and it makes sense to me. Either it will go the way of immunos or the way of electron microscopy, perhaps? Or it will become so complex that a fellowship is required maybe? We will see...
 
gbwillner said:
I'm pretty sure you cannot patent a gene. ...
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IMO you "can't" but it has been done, and fairly extensively. I didn't know how well those patents stood up to challenge in court, but I also didn't know of any challenges -- except the big current one, which I only read briefly about just now. (Federal judge basically ruled that patents on genes are, yes, absurd, but of course it's under appeal. The counter-argument seems to be that removing DNA and isolating a gene magically transforms it into something patentable -- not the process/methodology for gene isolation, not drugs which act on the gene/gene expression, not identification methdologies, but the actual gene sequence itself. http://www.nytimes.com/2010/03/30/business/30gene.html) It seems to be that, until now, no-one really bothered to challenge this area of patent practice, either for fear they would fail and a real legal precedent would be set, or because those who might have interest in someone else's gene probably have gene patents of their own they didn't want to jeopardize.
 
2121115 said:
This fellowship is similar to 20 years ago when you could do an immunohistochemistry fellowship. It will either not take off enough to be a significant component of daily practice for a pathologist or (more likely) it will become so commonplace that everyone is expected to know how to do it.
Click to expand...

I think there is a dividing line in training programs- those that agree with the above and will avoid setting up a molecular path fellowship for fear that it will be integrated into common proactice, and those that think it is too complex too rapidly evolving for a general pathologist to understand. While interviewing for residency positions a few years ago I good a good taste of both sides.
Ultimately it may be serendipity that decides... but do think it will be the latter. Just think how complex pathology is today... and add in 20 different kinds of assays to test DNA, RNA, Protein, chromatin status, genomic hybridizations, etc. It will be more that seeing cytoplasmic/nuclear brown staining.
 
In some ways it may depend on how mature the technology becomes (and more importantly, the post-hoc analysis). In some ways this is a double edge sword; too difficult interpretability=no clinical use but too easy interpretability=no value added for interpreting.

If the interpretation of molecular tests becomes binary or at least categorical, you will be able to have average clinicians use these tests (thus no need for specialized training). At this point, you can have your genome sequenced, but as Craig Venter pointed out, the experts could not even figure out his eye color.

If the analysis and integration of molecular data remains esoteric, but shows significant clinical value that would probably be the best case scenario for molecular to take off.
 
Freak said:
In some ways it may depend on how mature the technology becomes (and more importantly, the post-hoc analysis). In some ways this is a double edge sword; too difficult interpretability=no clinical use but too easy interpretability=no value added for interpreting.

If the interpretation of molecular tests becomes binary or at least categorical, you will be able to have average clinicians use these tests (thus no need for specialized training). At this point, you can have your genome sequenced, but as Craig Venter pointed out, the experts could not even figure out his eye color.

If the analysis and integration of molecular data remains esoteric, but shows significant clinical value that would probably be the best case scenario for molecular to take off.
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There are both modalities in molecular testing. On one hand there's the binary testing - e.g., ID testing. On the other hand there are tests of complex multifactorial disorders like cancers which will require statistical analysis (post-test probabilities/Bayesian analysis). Somewhere in between are the genetic disorders (diagnostic - binary, carrier screening - probabilities).

Companies like Cepheid with their GenXpert are going after the low-hanging fruit - plug and play modular testing for mostly infectious disease applications. Anyone could run a GenXpert test. These are the tests where the input of a molecular pathologist will likely be lost. And it's the companies like Genomic Health (and don't get me started on the DTC genomic testing folks) that apply this binary thinking to testing that needs to be interpreted in a statistical fashion. This is where the molecular pathologist should focus. Interaction between medical genetics and pathology in interpreting these tests for clinicians is where the value is. Now to just figure out how to get paid for it....
 
They could market it like that "cancer treatment centers of america" hogwash and make you think you're getting some kind of special extra attention paid to your cancer by doing a bunch of meaningless extra tests.
 
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