Noted pathologist encourages pathology profession to step up and assert leadership in clinical diagnostics as it enters the era of genomics-based medicine
Lundberg is well known to pathologists in America. A board-certified pathologist himself, Lundberg served 17 years as Editor in Chief of the Journal of the American Medical Association (JAMA). He continues to write and blog for a variety of healthcare publications and Web sites.
That means Lundberg has watched the evolution of medicine from a unique perspective for an extended period of time. The fact that he recently issued a clear and unambiguous call to action for the pathology profession means that pathologists and clinical laboratory managers should take heed.
Traditional Knowledge Will No Longer Be Enough for Pathologists
“Pathologists have always been the leaders in cancer research and practice,” Lundberg stated in a recent opinion piece published by MedPage Today. “But our knowledge of gross pathology and microscopic patterns that have led to histopathologic diagnoses that lead to best therapeutic options is no longer enough.”
According to Lundberg, pathologists essentially have two options for the future. They can either become “flunkies” who do the bidding of clinicians on the front end of the brain-to-brain loop. Or, they can become informed scientist-clinicians who provide interpretation and clinically actionable information.
He acknowledges that there will always be a role for an academic pathology group because of its role in research and advanced patient care. Lundberg’s message is directed primarily at pathologists based in community hospitals and local medical laboratories.
On that point, Lundberg stated, “…pathologists in community hospitals and local laboratories do have a choice. They may choose to be shipping clerks on the front end of the brain-to-brain loop, doing the clinician’s bidding, and [then serving as] clerical transcribers and recorders on the interpretation and action end of that patient care lab test loop. Or, pathologists may become clinical molecular specialists on the front end, determining what molecular tests, if any, should be done on each cancer, where they should be done, and at what cost.”
Lundberg continued by stating, “And, on the back end, pathologists can become knowledge engineers, blending the wonders of artificial and real intelligence with automated and human expert systems, the Internet, and molecular oncology to determine the best action for each cancer patient.”
Will Pathologists Remain Diagnostic Leaders in the Genomic Era?
Lundberg’s voice is one in a growing chorus of credible experts who urge pathologists to seize the lead in transforming the field of pathology to better meet the needs of the rapidly evolving era of genomics. For example, Curt Johnson, Vice President of Sales and Marketing at Orchard Software Corporation, cautioned that tomorrow’s clinical laboratory may look unfamiliar to many of today’s pathologists. He was quoted in a story on the company Website. Orchard is a Carmel, Indiana-based laboratory information system company.
Consultants from McKinsey Global Institute recently reported that disruptive technologies—such as next-generation sequencing and whole-genome analysis—can shift “pools of value.” “Leaders need to plan for a range of scenarios,” they stated. “[They may need to abandon] assumptions about where competition and risk could come from, and not be afraid to look beyond long-established models.”
Pathologists at Risk of Losing Pre-eminent Position in Diagnostics
In 2010, a group of pathologists and healthcare experts gathered at the Banbury Conference Center in Cold Spring Harbor, New York. Their goal was to examine opportunities and challenges facing the discipline of pathology and its role in the future.
|Here is an opportunity to watch the video where George D. Lundberg, M.D., speaks to the opportunities the pathology profession has to step up and assume leadership in the coming era of genetic medicine, particularly in the field of oncology. (Video copyright MedPage Today.)|
The result was a call to action. The American Journal of Clinical Pathology (AJCP) published the paper under the title, “A National Agenda for the Future of Pathology in Personalized Medicine.”
The “Agenda” presented a future vision of pathology functioning as a primary-care discipline. “A paradigm shift in clinical laboratory testing from disease diagnosis and treatment to wellness presents the discipline of pathology with an unprecedented opportunity to reinvent itself,” declared the authors.
The authors—themselves pathologists—urged their pathologist colleagues to take the lead in demonstrating the value of genome-based clinical laboratory testing in reducing costs and improving patient care. Further, they wrote, this will help to position pathologists as the curators of genomic information going forward.
Lundberg says the opportunity is there for pathologists, if they will step up to seize it and develop it. “[P]athologists may become clinical molecular specialists on the front end, determining what molecular tests, if any, should be done on each cancer, [along with] where they should be done, and at what cost,” stated Lundberg in MedPage Today. “On the back end, pathologists can become knowledge engineers, blending the wonders of artificial and real intelligence with automated and human systems, the Internet, and molecular oncology to determine the best action for each cancer patient.”
European Pathologists Issue Similar Call to Action
Pathology leaders abroad are also waving the alert flag to their colleagues in the field. “[T]he pathology community has to be mobilized for stronger engagement in the future of personalized medicine,” urged Swiss pathologist Fred T. Bosman, M.D., Ph.D., former Chairman of the European Society of Pathology.
Bosman’s comments were part of a presentation, titled “Is there a future for anatomical pathology as we know it today.” It was given during his tenure at University Institute of Pathology in Lausanne, Switzerland.
Bosman’s closing comments may most succinctly express the core message from Lundberg and others for today’s pathologists and clinical laboratory managers:
“If we do not respond, others will take over… [W]e might end up as Latin as a language: historically essential, intellectually challenging, but no longer in dynamic evolution.”
—Pamela Scherer McLeod