Pathology in the Era of Personalized Medicine

Sep 01, 2013
By Pharmaceutical Executive Editors

In its present form, healthcare is largely reactionary. The limited knowledge of the external factors that lead to various diseases has led to a "one-size-fits-all" approach to care. But personalized medicine, the idea of tailoring treatment of a patient based on his or her unique physiological characteristics, is poised to change the practice of medicine. It will allow healthcare providers to detect susceptibility to disease and potentially preempt or prevent disease progression by considering genetic and environmental factors that may increase predisposition.

Pathologists will have an integral role in this new era of care. Personalized medicine relies on new methods of molecular analysis to determine predilection toward certain diseases, but also the likelihood of a certain treatment's efficacy. Relying on these types of precision diagnostics makes the pathologist more visible to physician colleagues, says Gene Siegal, MD, Robert W. Mowry endowed professor of pathology and director of the Division of Anatomic Pathology at the University of Alabama at Birmingham (UAB). Siegal is also the executive vice-chair of Pathology in the UAB Health System, and a member of the American Society for Clinical Pathology (ASCP) Board of Directors.

"Pathologists are absolutely critical to companion diagnostics," said Siegal. "Companion diagnostic tests reside in the lab. Pathologists have total familiarity with the tests and they are best able to report test results to the clinician who is providing the therapy to the patient."

Pathology and the future of personalized medicine

James L. Wisecarver, MD, medical director for Clinical Laboratories at The Nebraska Medical Center (TNMC), where he is also the director of both the Histocompatability Laboratory and the Human DNA Identification Laboratory, said pathologists have been making personalized diagnostic interpretations for decades.

"Pathologists follow new therapies. We've been doing that for many years," Wisecarver said. "Pathologists have to stay familiar with new therapies and learn about certain genetic differences in patients to determine who will respond to which drugs."

The full scope of personalized medicine has not yet come to fruition, but it is already influencing cancer care.

Appropriate therapeutic regimens for various cancers are being determined by molecular testing. Tumors might present as a textbook example of a certain type but with molecular techniques like florescence in situ hybridization (FISH) technology, might actually be revealed as a completely different type of lesion.

"This can especially happen with soft-tissue tumors," said Wisecarver. The ability to understand such differences is a critical skill possessed by pathologists, aiding in effective diagnosis.

Personalized medicine in a customer service culture

Patients are now more involved in their own medical choices. They are knowledgeable of many medical conditions and options for care; this change requires physicians to work more closely with patients not only as a healthcare provider, but as a partner in treatment and care.

Customer satisfaction is a common metric by which businesses measure their performance. Pathology services, which are largely unseen, do not normally make patient and client satisfaction a priority.

As personalized medicine spreads, however, pathologists play a more intricate and visible part in patient care. This new transformation requires more attention to the "business" of pathology, and leading with customer service.

Pathologists no longer solely perform tests and interpret results—they are directly involved in improving the efficiency and quality of care. Improving patient care is done largely through appropriate test utilization, and pathologists and laboratory professionals are heavily involved in the development of guidelines for both the appropriate use of laboratory tests and advanced laboratory diagnostics.

In February, my group, ASCP, the world's largest professional membership organization for pathologists and laboratory professionals, released a list of five tests that physicians and patients should question as part of the American Board of Internal Medicine's (ABIM) Choosing Wisely campaign. Our society was one of more than 50 that identified often inappropriate and potentially harmful tests that are frequently used by healthcare professionals. The goal of the campaign is to promote quality and efficiency in healthcare.

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