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Charles Strom on the Diagnostics Industry · Masters in Business

• 0:00
  Speaker 1: M. This is Mesters in Business with Very Renaults on
• 0:06
  Speaker 1: Bluebird Radio. This week on the podcast, I have an
• 0:10
  Speaker 1: extra special guest. His name is Dr Charles Strom, and
• 0:14
  Speaker 1: he is the CEO and co founder of Liquid Diagnostics,
• 0:19
  Speaker 1: an advanced testing company. He has several decades of experience
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  Speaker 1: in the field of genetic testing. He ran Quest Diagnostics
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  Speaker 1: Labs for sixteen years, and we really just began to
• 0:34
  Speaker 1: scratch the surface of his mark. I didn't get to
• 0:37
  Speaker 1: the sixty Minutes episode he appeared on, or or his
• 0:40
  Speaker 1: appearances on Oprah, but we did talk about COVID testing
• 0:45
  Speaker 1: and why we're not looking at antibodies. Dr Strom thinks
• 0:49
  Speaker 1: we should be. If you want to decide whether you
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  Speaker 1: need a booster or a second booster, wouldn't it be
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  Speaker 1: helpful to know if you're actually at a high level
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  Speaker 1: of antibodies or a low level of anybodies. When we
• 1:01
  Speaker 1: talk about that early detection for certain types of lung
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  Speaker 1: cancers and how the world of genetics is just rapidly
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  Speaker 1: changing the way we not only detect potentially dangerous diseases,
• 1:15
  Speaker 1: but some of the treatments we do, it's really quite fascinating. So,
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  Speaker 1: with no further ado, my conversation with Liquid Diagnostics Dr
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  Speaker 1: Charles Strom. This is Mesters in Business with very renaults
• 1:31
  Speaker 1: on Bloomberg Radio. I'm Barry Hults. You're listening to Masters
• 1:36
  Speaker 1: in Business on Bloomberg Radio. My special guest this week
• 1:39
  Speaker 1: is Dr Charles Strom. He is the CEO and co
• 1:43
  Speaker 1: founder of Liquid Diagnostics. Dr Strom has pioneered the use
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  Speaker 1: of DNA testing for forensic and paternity applications before joining
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  Speaker 1: Quest Diagnostics, where he was the medical director for genetic testing.
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  Speaker 1: His work has led him to appearances on such shows
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  Speaker 1: as Sixty Minutes and Oprah. Dr buck Strom, Welcome to Bloomberg.
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  Speaker 1: Thank you for having me, Baron my pleasure. So let's
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  Speaker 1: start a little bit with your educational background. You graduate
• 2:15
  Speaker 1: University of Chicago with both a PhD in biology and
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  Speaker 1: a medical degree. Was the plan always to work in genetics. Yes,
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  Speaker 1: from the time I was in seventh grade, I knew
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  Speaker 1: I wanted to be a scientist, and as an undergraduate
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  Speaker 1: I became interested in prenatal diagnosis in particular. And when
• 2:39
  Speaker 1: I was an undergraduate, I did research and found that
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  Speaker 1: one of the centers to do that research was at
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  Speaker 1: University of Chicago. In one of my early mentors. Albert
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  Speaker 1: Dorfman had published paper on prenatal diagnosis for Hunter syndrome.
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  Speaker 1: So I actually sent him a letter. Uh, typed it
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  Speaker 1: out on my Smith Corona electric typewriter, send it to him,
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  Speaker 1: and lo and behold. A month later, I got a
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  Speaker 1: packet of information saying how would you like to come
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  Speaker 1: work on my lab over the summer, and uh, that
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  Speaker 1: led to my entering an m D pH d program
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  Speaker 1: that was called the Medical Scientist Training Program. Was a
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  Speaker 1: federally funded program paid for my tuition and gave me
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  Speaker 1: a living stipend as a six year program turned my
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  Speaker 1: m D and PhD. So yeah, I was always my
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  Speaker 1: plan to be a medical scientist. And you worked under
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  Speaker 1: biochemical geneticist William Nihan, who's kind of legendary in that field.
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  Speaker 1: Tell us a little bit about working with Dr Nihan
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  Speaker 1: and what you learned from him and what that experience
• 3:49
  Speaker 1: was like, Yeah, well that was fabulous. So again this
• 3:52
  Speaker 1: was a cold call. I started out in between my
• 3:57
  Speaker 1: freshman and stophmore year of college, and um, my advisor
• 4:02
  Speaker 1: and the master of my college was a scientist named
• 4:08
  Speaker 1: Richard Goldslee, and UH said, Hey, I have a buddy,
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  Speaker 1: Dr William Ihan out in San Diego. Uh, maybe I
• 4:17
  Speaker 1: could send a letter and you could go out and
• 4:19
  Speaker 1: work for him over the summer between your freshman sophomore
• 4:22
  Speaker 1: year in college. And it was like, you know, somebody
• 4:24
  Speaker 1: asking me if if I wanted to work for the pope,
• 4:27
  Speaker 1: and I said, yes, sure of course I do. And
• 4:31
  Speaker 1: same thing. He welcomed me. He had me in the
• 4:34
  Speaker 1: laboratory and he and and his partner Larry Sweetman got
• 4:40
  Speaker 1: me hooked on biochemical genetics. And then after I you know,
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  Speaker 1: went to medical school got my MDI got my PhD. Uh.
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  Speaker 1: The obvious choice for me to do a residency was
• 4:54
  Speaker 1: at University of California, San Diego, where Dr and I
• 4:57
  Speaker 1: had had become the chairman of the department. So that
• 5:01
  Speaker 1: was just the no brainers. So I ended up doing
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  Speaker 1: my residency there and for the three years of my
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  Speaker 1: residency and fellowship, I worked with William Nihan, who has
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  Speaker 1: an encyclopedic knowledge of biochemical genetics, and it was just
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  Speaker 1: a fabulous experience for me. Yeah, I can imagine. So
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  Speaker 1: tell us about some of the grants to pursue genetics
• 5:22
  Speaker 1: of growth disorders that you were working on at the
• 5:25
  Speaker 1: University of Chicago. They seem really quite fascinating. So from
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  Speaker 1: a very early age, I was interested in developmental biology,
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  Speaker 1: which is the science studying the mechanisms by which we
• 5:38
  Speaker 1: go from UM an embryo in which all cells are
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  Speaker 1: identical UH, to an adult where we have hundreds of
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  Speaker 1: difference of specialized cells. And Albert Dorfan my mentor University
• 5:54
  Speaker 1: of Chicago, was working on the differentiation of cartilage in chickens. UH.
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  Speaker 1: So I was cutting off them buds from nine dozen
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  Speaker 1: chickens a week UH and growing up in tissue culture
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  Speaker 1: and UH they would differentiate into mature contraslits, into mature
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  Speaker 1: cartage cells and tissue culture. And so I worked on that.
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  Speaker 1: And then when that was all before DNA sequencing DNA
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  Speaker 1: analysis was available. And then when cloning started, gene cloning UM,
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  Speaker 1: I got a grant to UH to clone the gene
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  Speaker 1: for humans cartless specific collagen and to see how that
• 6:37
  Speaker 1: got turned on during development. It was very exciting. So
• 6:41
  Speaker 1: how does that lead to pioneering DNA testing for forensic
• 6:47
  Speaker 1: and paternity applications? So I've always been what I call
• 6:52
  Speaker 1: an applied scientist. You know, the scientists out there really
• 6:57
  Speaker 1: come in two forms. One is the basic scientists, the
• 7:01
  Speaker 1: person that really wants to delve incredibly deeply, UH into
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  Speaker 1: one particular problem. UH. There used to be a thing
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  Speaker 1: about the medical practitioners that the general practitioner knows nothing
• 7:15
  Speaker 1: about everything, that the specialist knows everything about nothing, and
• 7:19
  Speaker 1: the pathologist knows everything about everything, but it's too late
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  Speaker 1: to do any good. So the basic scientists delves very
• 7:27
  Speaker 1: deeply into a single subject. I always was more interested
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  Speaker 1: in how are we going to use these developments to
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  Speaker 1: help people, in particular the medical aspects. Now they would
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  Speaker 1: call it translational medicine, but how are we going to
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  Speaker 1: take what we learned at the lab bench and put
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  Speaker 1: it into practice? So I was the professor at University
• 7:50
  Speaker 1: of Chicago. DNA testing for forensics was just in its infancy.
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  Speaker 1: There was the Blooding I don't know if you remember that,
• 8:00
  Speaker 1: where an entire village was genotyped UH in England to
• 8:04
  Speaker 1: find a rapist, and forensics DNA had not yet been
• 8:09
  Speaker 1: admitted into courts in UH. In Illinois, I was approached
• 8:13
  Speaker 1: by several different prosecutors who had very difficult cases and
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  Speaker 1: asked if I could you know, if I could do
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  Speaker 1: DNA testing to support their cases, and being in academics
• 8:29
  Speaker 1: and having some academic freedom, I I said yes and
• 8:33
  Speaker 1: did the did some DNA testing and UH in UH
• 8:38
  Speaker 1: in legal in Illinois. I don't know if this is
• 8:42
  Speaker 1: around the United States. There's something called a fry hearing
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  Speaker 1: where before UH laboratory evidence can be introduced in court,
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  Speaker 1: it has to pass a certain amount of standards, um,
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  Speaker 1: whether it's generally accepted in the scientific community, whether it's reliable,
• 9:00
  Speaker 1: those sorts of things. And so I participated in several
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  Speaker 1: pry hearings in Illinois to allow the admission of DNA
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  Speaker 1: testing and forensics. And my famous case, the one I
• 9:14
  Speaker 1: published about, was a gentleman who had actually murdered his
• 9:20
  Speaker 1: wife and then burned her body to UH near completion
• 9:28
  Speaker 1: in the steel drum in his garage. UH. Then he
• 9:32
  Speaker 1: went to the police station and decided to confess, and
• 9:37
  Speaker 1: then when he got an attorney, he withdrew his confession.
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  Speaker 1: So the prosecutors kind of knew that he had done it,
• 9:45
  Speaker 1: but I had no way. There was nobody to h
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  Speaker 1: to be identified. So we were able to actually to
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  Speaker 1: identify his wife from the charred remains in UH the
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  Speaker 1: steel drum. UH and you know, the pry evidence was
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  Speaker 1: accepted and he was convicted. So that was basically my
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  Speaker 1: my moment in the sun in forensics, and I never
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  Speaker 1: really did anything after that. Quite fascinating. So you work
• 10:14
  Speaker 1: at QUESTS for a couple of years where you're head
• 10:16
  Speaker 1: of the research labs, and eventually, um you're working with
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  Speaker 1: Dr David Wang tell us about Imperial technology and what
• 10:26
  Speaker 1: Dr Wang had created. So I had worked in QUEST
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  Speaker 1: Diagnostics or sixteen years basically running all the genetic laboratories.
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  Speaker 1: And after I left, I took a temporary position to
• 10:42
  Speaker 1: be the director of the molecular pathology laboratories at u
• 10:46
  Speaker 1: c l A. This was because of they were trying
• 10:50
  Speaker 1: to recruit a permanent director. I was in semi retirement
• 10:53
  Speaker 1: and so you know, I took a temporary job working
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  Speaker 1: out for u C l A for a couple of
• 10:58
  Speaker 1: days a week. Then one day my boss calls me
• 11:02
  Speaker 1: in and she says, um, buck, we have a problem.
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  Speaker 1: There is a dentist in the dental school by the
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  Speaker 1: name of David Wong who has just gotten a grant,
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  Speaker 1: and part of the grant was that our laboratory would
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  Speaker 1: validate the test. As a laboratory developed test so it
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  Speaker 1: could be offered clinically. Um, the pathologist who had co
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  Speaker 1: written that Grant had left the left the institution, and
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  Speaker 1: so she says, you've got to go up and see
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  Speaker 1: what's going on and see what we can do. So
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  Speaker 1: I take the elevator up to the seventh floor the
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  Speaker 1: Basic Science Building at U C l A. And I
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  Speaker 1: go up to meet with Dr Long and it was like,
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  Speaker 1: oh my god, that's the guy, because I had met
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  Speaker 1: him about ten years previously when he had given a
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  Speaker 1: talk at Quest Diagnostic and he had dedicated his life
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  Speaker 1: to saliva based diagnostics. And when he gave a talk,
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  Speaker 1: I was blown away and said to myself and came
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  Speaker 1: home and said to my wife, you know, this guy's
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  Speaker 1: a visionary. And we had lunch afterwards and we had
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  Speaker 1: a wonderful talk and it was like you know, a
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  Speaker 1: rom com. We saw each other in the hallway and
• 12:18
  Speaker 1: it was Bucked. It was David Uh and he said,
• 12:22
  Speaker 1: let me show you what I got here. And Um.
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  Speaker 1: He had developed a platform which at that time was
• 12:28
  Speaker 1: called e Firm we now call it Imperial, which could
• 12:34
  Speaker 1: do UH diagnostics of anti biomolecule including d n A,
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  Speaker 1: including antibodies including protein on saliva UH as an open
• 12:45
  Speaker 1: platform UH, and he had used this UH to actually
• 12:51
  Speaker 1: UH demonstrate that he could UH detect circulating tumor DNA
• 12:57
  Speaker 1: in patients with early stage lung cancer, something that had
• 13:00
  Speaker 1: never been done before successfully. UM and I looked at
• 13:05
  Speaker 1: this data and it knocked my socks off, and I said,
• 13:08
  Speaker 1: you know, baby, I want to work with you here.
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  Speaker 1: So it began a wonderful collaboration UM and I became
• 13:17
  Speaker 1: blown away by the potential of this platform. The problem
• 13:21
  Speaker 1: is that Dr Long is an academic. He had no
• 13:24
  Speaker 1: idea of how to commercialize anything. I had come from
• 13:27
  Speaker 1: sixteen years in the diagnostic industry, so my expertise was
• 13:33
  Speaker 1: it was complimentary to his. I knew how to make
• 13:36
  Speaker 1: essays that could be used hundreds of thousands of times
• 13:40
  Speaker 1: and give accurate results. So I was very excited. But
• 13:45
  Speaker 1: in order to commercialize the intellectual property has to be
• 13:49
  Speaker 1: in order. There has to be an organization, there has
• 13:52
  Speaker 1: to be funding. And then I reached out to friends
• 13:56
  Speaker 1: of mine who were also UH leaders in their deal
• 14:00
  Speaker 1: Bob AGNERN, who was an executive in Amaco for many years.
• 14:07
  Speaker 1: I was a lawyer and ran businesses for Amaco, Jeff Weisberg,
• 14:11
  Speaker 1: who started uh Atina Diagnostics, one of the major neurology
• 14:16
  Speaker 1: diagnostics companies and was a financial guy. And my friend
• 14:21
  Speaker 1: Rich Bender, who was a medical oncologist. All of these
• 14:25
  Speaker 1: people I knew from from past life. Bob, where I
• 14:28
  Speaker 1: knew from from little e Um, and the other two
• 14:32
  Speaker 1: I admit a quest diagnosis and full disclosure. I met
• 14:35
  Speaker 1: you through Bob Agdern, who is my brother UM, and
• 14:39
  Speaker 1: I was so intrigued by the work you guys have
• 14:41
  Speaker 1: been doing. We've been talking about this for a couple
• 14:44
  Speaker 1: of years. Before we move on to COVID, I have
• 14:47
  Speaker 1: to you know, you kinda buried the lead about the
• 14:52
  Speaker 1: lung cancer. The key thing about those early indicators is
• 14:59
  Speaker 1: that this is very difficult to diagnose, and if you
• 15:02
  Speaker 1: catch it early, it's very treatable, and if you catch
• 15:06
  Speaker 1: it late, it tends to have a very bad outcome.
• 15:09
  Speaker 1: Is that a fair way to describe it. Absolutely, About
• 15:13
  Speaker 1: eight lung cancer now is diagnosed. That stage is three
• 15:16
  Speaker 1: to four where it's not curable. Um, you know, you
• 15:20
  Speaker 1: can be treated, it can prolong your life, but basically
• 15:24
  Speaker 1: you're going to die. A lung cancer stage one and two,
• 15:27
  Speaker 1: which is what we call early stage lung cancer. It
• 15:29
  Speaker 1: is still potentially curable with both surgery and chemotherapy or
• 15:34
  Speaker 1: a combination of both, and that's why it's so important
• 15:38
  Speaker 1: to diagnose this early. But eight percent of the time
• 15:42
  Speaker 1: it's not. There is a screening test now that's available,
• 15:46
  Speaker 1: which is a spiral CT scan for people who have
• 15:50
  Speaker 1: long histories of smoking and UM. The problem with with
• 15:56
  Speaker 1: spiral CT scanning is that you get these things called
• 16:00
  Speaker 1: terminate nodules. So some people have you do the CT
• 16:03
  Speaker 1: scan and it's, oh, this has got to be cancer.
• 16:06
  Speaker 1: Sometimes you do the CT scan and it's negative. But
• 16:09
  Speaker 1: about thirty of the time you do the CT scan
• 16:11
  Speaker 1: and there's something there, but you don't know whether it's
• 16:14
  Speaker 1: cancer or not. UH. And we have an NIH funded
• 16:17
  Speaker 1: study to use our platform to look at these patients
• 16:22
  Speaker 1: within determinate nodules using either saliva or plasma or both
• 16:28
  Speaker 1: to see if we can inform the decision about who
• 16:32
  Speaker 1: needs a biopsy UH and who doesn't need a biopsy,
• 16:36
  Speaker 1: and how the results have been so far, we're in
• 16:39
  Speaker 1: the middle of it. We have not yet done any
• 16:42
  Speaker 1: of the data analysis we're right now. We're collecting, we're
• 16:46
  Speaker 1: collecting samples and they'll be analyzed actually next year. So
• 16:50
  Speaker 1: I can't tell you how it's going, uh, but we're
• 16:54
  Speaker 1: hoping that it's it's going to give us positive results.
• 16:57
  Speaker 1: So that was the original plan. When you form liquid
• 17:00
  Speaker 1: diagnostics and then you know COVID and the pandemic starts
• 17:05
  Speaker 1: and we go into lockdown, how did you guys pivot
• 17:09
  Speaker 1: to using this technology to either detect COVID or look
• 17:13
  Speaker 1: at antibodies or both. So interesting story. So, Uh, doctor
• 17:19
  Speaker 1: Wong is a dentist and he had an incredible interest
• 17:25
  Speaker 1: in a disease called Schogrin syndrome. Schogrin syndrome is an
• 17:30
  Speaker 1: autoimmune disease where the body attacks itself and it causes
• 17:33
  Speaker 1: dry mouth and dry eyes. Uh. There's actually four million
• 17:37
  Speaker 1: people who present to their physicians every year with that complaint,
• 17:41
  Speaker 1: either dry mouth, dry eyes or false um. It was
• 17:45
  Speaker 1: known that some of these patients who present with dry
• 17:48
  Speaker 1: mouth and dry eyes actually have a disorder called chogrin syndrome,
• 17:52
  Speaker 1: which is where the salivary glands make anna where antibodies
• 17:57
  Speaker 1: are made that attack the salivary glands. UM. The the
• 18:02
  Speaker 1: diagnosis of chagrin syndrome was incredibly difficult because the blood
• 18:06
  Speaker 1: based antibodies, UH, we're not particularly sensitive or specific for
• 18:11
  Speaker 1: the disease, so people often had to have biopsies UH,
• 18:15
  Speaker 1: and most people didn't want to have a biopsy of
• 18:18
  Speaker 1: a salivary gland. UH. So he began to use our platform,
• 18:22
  Speaker 1: Imperial platform, to look for antibody in saliva. And it
• 18:27
  Speaker 1: turns out that that is a much better way of
• 18:30
  Speaker 1: diagnosing chagrin syndrome than in blood. So we knew that
• 18:35
  Speaker 1: we could use this platform for antibodies. So I remember
• 18:38
  Speaker 1: it was mid February and the beginning of the pandemic,
• 18:41
  Speaker 1: and I said to our group at Liquid Diagnostics, you know,
• 18:45
  Speaker 1: I think we could use this to measure covid antibody.
• 18:48
  Speaker 1: And I remember Bob said, well, you know, how much
• 18:51
  Speaker 1: is that going to cost? And they said, well, you know,
• 18:53
  Speaker 1: maybe you know, five or ten thousand dollars to buy
• 18:56
  Speaker 1: the re agents or things, um, and the rest they
• 18:58
  Speaker 1: say is history. We were able to make a saliva
• 19:01
  Speaker 1: based diagnostic, which is quantitative, which is very different from
• 19:07
  Speaker 1: almost all other antibody measuring tests available that can measure
• 19:12
  Speaker 1: your unoglobulin g R I d T levels to U
• 19:17
  Speaker 1: Sorrow's c O G two which is the virus that
• 19:20
  Speaker 1: causes UH COVID nineteen. So so let me interrupt you
• 19:23
  Speaker 1: and just translate that into English for a second. Most
• 19:26
  Speaker 1: of the tests, either the rapid test or the PCR
• 19:29
  Speaker 1: test is going to give you thumbs up thumbs downy,
• 19:32
  Speaker 1: either you're showing this or you don't. You're able to
• 19:35
  Speaker 1: do a measurement that quantifies shows you your levels of COVID.
• 19:40
  Speaker 1: Anybody's am I saying that? Right? That's correct. They'll very
• 19:44
  Speaker 1: PCR doesn't measure antibodies. PCR measures viruses. But yes, most
• 19:49
  Speaker 1: most of the well all of the home tests are qualitative.
• 19:52
  Speaker 1: They're not quantitative, which means they tell you positive or negative.
• 19:56
  Speaker 1: The laboratory tests are what's called semi quantitative. They give
• 20:00
  Speaker 1: you a number that's pretty meaningless. It says, you know,
• 20:03
  Speaker 1: three point one or three point two, and you don't
• 20:06
  Speaker 1: really know what to do about it. Our test actually
• 20:08
  Speaker 1: gives you the level of your antibody, and then we
• 20:12
  Speaker 1: also tell you how you stand with respect to you know,
• 20:16
  Speaker 1: several thousand samples that we have from individuals who have
• 20:20
  Speaker 1: been vaccinated. So they'll say, Barry, your level is four
• 20:23
  Speaker 1: point two. An anagrams per m L when you say
• 20:26
  Speaker 1: what does that mean? Then we tell you you're in
• 20:29
  Speaker 1: the eightieth percentile for all patients who have been vaccinated
• 20:34
  Speaker 1: against COVID, so you know you've got good, healthy levels.
• 20:38
  Speaker 1: On the other hand, you could get a level that says,
• 20:40
  Speaker 1: you know, it's ten managrams per m L and this
• 20:43
  Speaker 1: is at the tenth percentile, which means you know that
• 20:46
  Speaker 1: you are you're low on the scale. UH. The other
• 20:50
  Speaker 1: beauty of this test is because it's saliva base, you
• 20:53
  Speaker 1: don't have to have your blood drawn, and it's relatively inexpensive.
• 20:56
  Speaker 1: You can have multiple tests. So, for example, we have
• 21:00
  Speaker 1: a clinical trial going which I'm a participant, where we
• 21:04
  Speaker 1: looked at people's levels every two weeks UH for for
• 21:09
  Speaker 1: six months. And when we looked at that, we could
• 21:12
  Speaker 1: see that that most people's levels went up after their
• 21:16
  Speaker 1: second vaccination, but then they slowly came down so that
• 21:19
  Speaker 1: by from four to six months they were almost back
• 21:21
  Speaker 1: down the baseline, which would mean that we could have
• 21:25
  Speaker 1: probably predicted that you're going to need a booster after
• 21:27
  Speaker 1: six months. That that sounds like it's really useful given
• 21:31
  Speaker 1: that there's been a pretty big push to not only
• 21:34
  Speaker 1: get people to get boosted, but then to get a
• 21:37
  Speaker 1: second booster. So I'm vaccinated, I'm boosted. I would like
• 21:41
  Speaker 1: to know if I should get a booster now heading
• 21:45
  Speaker 1: into the summer or in the fall, when I usually
• 21:49
  Speaker 1: get my flu shot, because that's when when we move indoors.
• 21:52
  Speaker 1: These viruses seem to be spread around the most in
• 21:56
  Speaker 1: at least in the cooler areas of the country. Yeah. Right,
• 22:00
  Speaker 1: that's a great point. So you know, the issue is,
• 22:03
  Speaker 1: you know, I know now that after my third booster,
• 22:08
  Speaker 1: the third shot, so the first booster, that my levels
• 22:13
  Speaker 1: now eight months out are the same as they were,
• 22:17
  Speaker 1: uh two weeks after my third booster. So I don't
• 22:21
  Speaker 1: feel that at this moment I need a fourth booster.
• 22:25
  Speaker 1: And you know, there's no dated to say that that's
• 22:28
  Speaker 1: good or bad. Unfortunately, FDA says that a person of
• 22:32
  Speaker 1: my age could get a fourth shot if I wanted,
• 22:37
  Speaker 1: But there's no reasonable way for me to make that
• 22:40
  Speaker 1: decision right now. A lot of my friends that said
• 22:44
  Speaker 1: I'm going to take I'm going to take the fourth shot. Um.
• 22:47
  Speaker 1: Your point is is well taken that if you take
• 22:50
  Speaker 1: the fourth shot, who knows if you're gonna be able
• 22:53
  Speaker 1: to get a tip shot. UM or when? So you know,
• 22:57
  Speaker 1: we have that luxury of those who have participated in
• 23:01
  Speaker 1: our trial of knowing that our levels are stable over time.
• 23:06
  Speaker 1: Um again, you know this is this is the personal
• 23:10
  Speaker 1: decision that I'm making, you know, with myself and my position,
• 23:14
  Speaker 1: and I can't say that you know that there's a
• 23:17
  Speaker 1: recommendation about this sort of thing, But this is the
• 23:20
  Speaker 1: kind of data that we need. The beauty of our
• 23:23
  Speaker 1: tests is that we could actually get the data that
• 23:28
  Speaker 1: would inform these kinds of decisions. So we could look
• 23:31
  Speaker 1: at a whole bunch of people, say, you know, everybody
• 23:35
  Speaker 1: in a city, or everybody in a large company, and
• 23:39
  Speaker 1: we could test people every month for their quantitative antibody levels,
• 23:44
  Speaker 1: and then we can follow them and see who gets COVID,
• 23:47
  Speaker 1: who doesn't get COVID, who goes into the hospital, who
• 23:51
  Speaker 1: gets long COVID, you know, who dies, and then correlate
• 23:55
  Speaker 1: that with our antibody levels and see if our hypothesis
• 23:58
  Speaker 1: are correct. The problem is, as far as I know,
• 24:02
  Speaker 1: nobody is doing these sorts of tests because the blood
• 24:06
  Speaker 1: tests are only semi quantitive at quantitative At the moment,
• 24:10
  Speaker 1: the quantitative tests are expensive to do, and this study
• 24:14
  Speaker 1: would be very expensive to perform. So it frustrates me.
• 24:18
  Speaker 1: Is I believe we have a tool we published on
• 24:21
  Speaker 1: this Imperaview Publications where we could do these sorts of studies.
• 24:25
  Speaker 1: We could get the information because COVID is not going away.
• 24:29
  Speaker 1: That's the one thing that's sure. Uh this is going
• 24:32
  Speaker 1: to be part of our lives for the foreseeable future,
• 24:36
  Speaker 1: and we need to start getting information that will allow
• 24:39
  Speaker 1: physicians and people to make informed decisions about things like vaccines.
• 24:44
  Speaker 1: For example, what if your vaccine level, your your antibody
• 24:48
  Speaker 1: level is very low, and you've already gotten your four
• 24:52
  Speaker 1: uh M R and a booster as well. Now there's
• 24:55
  Speaker 1: gonna be a new vaccine this summer. I hear that's
• 24:58
  Speaker 1: based on the old technology of antagine technology. So maybe
• 25:02
  Speaker 1: that would be someone who would want to get that
• 25:05
  Speaker 1: vaccine because they're not responding very well to the m
• 25:09
  Speaker 1: RNA vaccines. Now, one of the issues, you know, in
• 25:13
  Speaker 1: public health, everybody is treated like they're the same, and
• 25:17
  Speaker 1: what we're finding in terms of antibody production and antibody
• 25:22
  Speaker 1: affinity is that everybody is not the same. Um. For example,
• 25:26
  Speaker 1: with all macron, some people's i g G antibodies that
• 25:30
  Speaker 1: were made with the the original visor M dinner vaccines.
• 25:37
  Speaker 1: They cross react, you know, nearly, so that the antibodies
• 25:42
  Speaker 1: that these people make are just as good against A
• 25:45
  Speaker 1: macron as they were against the original virus. On the
• 25:49
  Speaker 1: other hand, some of the people their antibodies have less
• 25:54
  Speaker 1: than fifty of the affinity. Uh, then thanking for the
• 25:58
  Speaker 1: wild type. So sort of uh. And we're able to
• 26:02
  Speaker 1: make that assett because it's an open platform. We can
• 26:05
  Speaker 1: make an asset for O macron within weeks of when
• 26:09
  Speaker 1: O macron is first identifying. So I think that these
• 26:13
  Speaker 1: sorts of these sorts of studies could really help inform
• 26:18
  Speaker 1: on what's going on. Some of the you know, critics
• 26:21
  Speaker 1: of antibody testing say, well, we don't want people doing
• 26:24
  Speaker 1: risky behavior because they know they have antibodies. My response
• 26:29
  Speaker 1: to that is, well, if you don't you have antibody
• 26:31
  Speaker 1: and you've been vaccinated, you should feel free to do
• 26:34
  Speaker 1: everything that the CDC says a vaccinated person should do.
• 26:38
  Speaker 1: But I'm looking at the flip side. What if your
• 26:40
  Speaker 1: antibodies are low, Uh, then maybe you should not do
• 26:45
  Speaker 1: everything that a vaccinated person could do, or you should
• 26:49
  Speaker 1: and you should talk to your doctor about maybe doing something.
• 26:53
  Speaker 1: Either a booster with the same vaccine or a different vaccine, uh,
• 26:58
  Speaker 1: to try to get those levels up. So again, there's
• 27:02
  Speaker 1: not enough data to make any real recommendations at the moment.
• 27:06
  Speaker 1: And I would like to, you know, I would like
• 27:09
  Speaker 1: people to think about using our tests to um to
• 27:14
  Speaker 1: either do the research or or to make their own
• 27:17
  Speaker 1: informed decisions. So you mentioned the c d C, Um,
• 27:22
  Speaker 1: what are they doing about the entire space of anybody's?
• 27:27
  Speaker 1: Is this something that they're just not paying attention to
• 27:31
  Speaker 1: do they really think people with high anybody's are going
• 27:35
  Speaker 1: to go out and be reckless? What does the CDC
• 27:37
  Speaker 1: say about knowing what your anybody levels are? Yeah, well,
• 27:43
  Speaker 1: the CDC and FDA boats have made public statements that
• 27:48
  Speaker 1: they don't think that measuring antibody levels have any role
• 27:53
  Speaker 1: in the pandemic. Uh. And you know, I can see
• 27:57
  Speaker 1: the point, you know, to them, as I said in public,
• 28:00
  Speaker 1: tell everybody is a human being and everybody is the same. Uh.
• 28:05
  Speaker 1: So you know that's been their position, and we're gonna
• 28:08
  Speaker 1: we're gonna make recommendations, you know, for everybody, and and
• 28:12
  Speaker 1: it will work for most people. So the issue about
• 28:16
  Speaker 1: whether or not to be vaccinated or not, that's a
• 28:18
  Speaker 1: political issue about whether you can force vaccinations on people.
• 28:23
  Speaker 1: I think a more interesting question is that, certainly internationally, Uh,
• 28:28
  Speaker 1: there is the problem with vaccine card counterfeiting, right, so
• 28:34
  Speaker 1: that there are people who have not been vaccinated who present,
• 28:38
  Speaker 1: you know, and you know what your vaccine card looks like.
• 28:41
  Speaker 1: I mean, how difficult would that be to cornerway? Uh. Yeah,
• 28:45
  Speaker 1: it's it's ridiculous. And there's no centralized database, you know,
• 28:49
  Speaker 1: in this modern age. That's ridiculous. The fact and when
• 28:53
  Speaker 1: I went to uh, the tennis tournament out in the desert,
• 28:56
  Speaker 1: the b NB Puribous Open, Uh, they made a big
• 28:59
  Speaker 1: deal of how everyone would be vaccinated. And there was
• 29:02
  Speaker 1: an app. An the app you know, proved that you
• 29:05
  Speaker 1: were vaccinated. But the way the app proved you were
• 29:07
  Speaker 1: vaccinated and you took a picture of your vaccine card,
• 29:11
  Speaker 1: you took a picture of your your driver's license, and
• 29:14
  Speaker 1: they you know, validated that you've been vaccinated. Well that's
• 29:17
  Speaker 1: not really because if I had a fake vaccine card,
• 29:21
  Speaker 1: that would not establish anything. Again, with a saliva based
• 29:26
  Speaker 1: quantitative test, you could actually make sure that people had
• 29:29
  Speaker 1: antibodies who you're hiring again in Florida, that would be
• 29:34
  Speaker 1: legal most likely, But as I said, that's a political decision,
• 29:38
  Speaker 1: that's not a medical decision. And the saliva test seems
• 29:42
  Speaker 1: to be far less invasive than the swab. How does
• 29:47
  Speaker 1: it compare in terms of the time for the turnaround
• 29:50
  Speaker 1: and the cost relative to other forms of testing. The
• 29:54
  Speaker 1: cost to do the test is similar to what you'd
• 29:57
  Speaker 1: have in a blood test. But the thing about alo
• 30:00
  Speaker 1: a test is that there is a cost associated withdrawing
• 30:04
  Speaker 1: the blood. People don't really calculate that that in the
• 30:08
  Speaker 1: ease of testing is amazing. You just put plastic wand
• 30:13
  Speaker 1: with a sponge on the end of it into your
• 30:15
  Speaker 1: mouth between your cheek and gums for two minutes. Uh.
• 30:18
  Speaker 1: So it can be done in the office, it can
• 30:20
  Speaker 1: be done at all. That can be done in a
• 30:23
  Speaker 1: nurse's office, and then it can be mailed in using
• 30:26
  Speaker 1: the appropriate biohazard containers. So cost is is low. Um,
• 30:33
  Speaker 1: obviously we're a company where you know there will be
• 30:37
  Speaker 1: some markup, but certainly the cost is reasonable and you know,
• 30:42
  Speaker 1: we feel that people may want to know. Let's talk
• 30:45
  Speaker 1: a little bit about the work you did as med
• 30:48
  Speaker 1: director at QUEST. They're a big fortune. What sort of
• 30:52
  Speaker 1: work do they do and tell us a little bit
• 30:55
  Speaker 1: about your role there. Okay. I arrived at QUEST in
• 30:59
  Speaker 1: a year two thousand. It was, as you said, a
• 31:01
  Speaker 1: large commercial laboratory, actually the largest libortary in the United States,
• 31:06
  Speaker 1: and I believe ester was true, and they were just
• 31:11
  Speaker 1: beginning to do DNA tests. And when I got there
• 31:15
  Speaker 1: in two thousand, they were using technologies that you know,
• 31:19
  Speaker 1: I had been using at the University of Chicago that
• 31:22
  Speaker 1: we're really designed you know, to do ten or twenty
• 31:25
  Speaker 1: tests at the time. They were not designed to do
• 31:28
  Speaker 1: thousands of tests at the time. And so when I
• 31:31
  Speaker 1: got there, I made it my business to try to
• 31:35
  Speaker 1: find other ways of doing this test thing that would
• 31:38
  Speaker 1: be you know, one high throughput, two extremely high accuracy,
• 31:44
  Speaker 1: and three cost efficient. Because Quest Diagnostics was a business
• 31:50
  Speaker 1: and we were able to do that. We found initially
• 31:53
  Speaker 1: what was interesting is that we invented something called a
• 31:58
  Speaker 1: one thousand sample comparison and that before we would introduce
• 32:02
  Speaker 1: a new platform, we would look at a thousand samples
• 32:06
  Speaker 1: with the old technology and the new technology. Uh, if
• 32:09
  Speaker 1: there were any discrepancies, we would resolve that discrepancy with
• 32:13
  Speaker 1: a third technology to see what we were doing, which
• 32:16
  Speaker 1: would be the best platform and because a lot of
• 32:19
  Speaker 1: people were using a hundred samples. Well, what we found
• 32:21
  Speaker 1: is a lot of times for the hundred samples there
• 32:24
  Speaker 1: was complete agreement, but as you got to a thousand samples,
• 32:27
  Speaker 1: there would be three, four or five discrepancies between the
• 32:31
  Speaker 1: two platforms. No one had ever shown that before, and
• 32:35
  Speaker 1: we were able to show actually that the old technology
• 32:37
  Speaker 1: was not as good as the new technology. And so
• 32:40
  Speaker 1: with a lot of confidence and we published about this,
• 32:43
  Speaker 1: we were able to move from the older technologies to
• 32:46
  Speaker 1: the newer technologies. Then we were able to to start
• 32:51
  Speaker 1: really doing high through foot high quality testing, and then
• 32:56
  Speaker 1: we just started increasing our menu. Uh So, because a
• 33:00
  Speaker 1: lot of people when I was practicing genetics, a lot
• 33:03
  Speaker 1: of the frustration was that people couldn't get the genetic
• 33:06
  Speaker 1: tests that I wanted them to get because often these
• 33:09
  Speaker 1: tests were done in specialty laboratories, They were expensive laboratories
• 33:14
  Speaker 1: did not have a relationship with the insurance companies, and
• 33:18
  Speaker 1: so basically people had to either pay out of their
• 33:20
  Speaker 1: pocket or not have the tests. And it was very, very,
• 33:24
  Speaker 1: very frustrating. I remember there would be people who had
• 33:26
  Speaker 1: drive their portion into my office and I'd say, you know,
• 33:29
  Speaker 1: you really need to have cystic fibrosis carrier testing and
• 33:32
  Speaker 1: they say, does insurance coverment? And I'd say, well, let's
• 33:36
  Speaker 1: check and know your insurance doesn't cover it. And they say, well,
• 33:40
  Speaker 1: then I don't want to have it. And you know,
• 33:42
  Speaker 1: I felt like shaking them, saying, you know, get the tests.
• 33:47
  Speaker 1: You know. One of the reasons I went the Quest
• 33:48
  Speaker 1: Diagnostics because of the Quest Diagnostics had relationships with all
• 33:52
  Speaker 1: the major insurance companies, and so what I wanted to
• 33:56
  Speaker 1: do is make these tests available to the general public.
• 33:59
  Speaker 1: And I very proud that I was able to accomplish that.
• 34:02
  Speaker 1: And we moved to sequencing, and we moved to uh,
• 34:06
  Speaker 1: you know, all the major platforms, and uh. It was
• 34:09
  Speaker 1: a great experience. I I learned pathologists. You know, in general,
• 34:14
  Speaker 1: it's interesting there there have been wars between pathologists and
• 34:18
  Speaker 1: geneticist because pathologists feel that they own the rights to
• 34:23
  Speaker 1: all testing that's done on humans. Uh. Geneticists said, hey,
• 34:28
  Speaker 1: you guys don't know how to do the specialized things
• 34:31
  Speaker 1: that we do. And so every hospital had this kind
• 34:35
  Speaker 1: of give and take between who is going to do carriatypes,
• 34:39
  Speaker 1: kicking of chromosomes, who is going to do DNA testing?
• 34:43
  Speaker 1: Was it going to be the pathology department wasn't going
• 34:45
  Speaker 1: to be the genetics department. And when I got the
• 34:48
  Speaker 1: Quest Diagnostic, which is the pathology company, I learned from them.
• 34:53
  Speaker 1: I learned about quality assurance, quality control, how to what
• 34:58
  Speaker 1: you have to do to UH to do hundreds of
• 35:04
  Speaker 1: thousands of tests in an accurate way, and how you
• 35:08
  Speaker 1: need to have methods in place to make sure that
• 35:11
  Speaker 1: nothing has gone wrong. So for me, it was an
• 35:15
  Speaker 1: eye opening experience. And the last thing I learned was
• 35:17
  Speaker 1: that this is a business. How do you make a
• 35:20
  Speaker 1: business decision? How do you try to balance health of
• 35:25
  Speaker 1: the nation versus business? For example, what if I want
• 35:29
  Speaker 1: to do a test that you know won't make a profit,
• 35:33
  Speaker 1: but that could help people. How are we going to
• 35:36
  Speaker 1: make those decisions? Do we make those decisions those kinds
• 35:40
  Speaker 1: of very difficult situations? You know? I learned a lot.
• 35:45
  Speaker 1: Let's stick with the issue of of both the test
• 35:48
  Speaker 1: menu and the cost benefit analysis of these testings. I
• 35:54
  Speaker 1: have to imagine that cystic fibrosis is an expensive, complix
• 36:00
  Speaker 1: headed disease to test, Isn't it in the insurer's interest
• 36:05
  Speaker 1: to anyone who is indicated to test for this to
• 36:09
  Speaker 1: pay for that rather than you know, a later stage
• 36:13
  Speaker 1: treatment after it's going to be further developed, more complicated,
• 36:17
  Speaker 1: and more expensive to treat. But one of the great
• 36:20
  Speaker 1: ironies of modern medicine and healthcare is informatics. And I've
• 36:26
  Speaker 1: had discussions with with insurers about about aspects like this,
• 36:33
  Speaker 1: and some insurers will say, well, we know that people
• 36:37
  Speaker 1: change insurance companies every two and a half to three years,
• 36:42
  Speaker 1: so why should I do this task if it's going
• 36:46
  Speaker 1: to prevent a heart attack in a patient five or
• 36:50
  Speaker 1: ten years down the line, which is incredibly shortsighted, I
• 36:54
  Speaker 1: have to say, and not all insurance companies have this
• 36:57
  Speaker 1: kind of attitude. But I would also say that in
• 37:01
  Speaker 1: publicly traded companies, one of the things that I've seen
• 37:04
  Speaker 1: is they're pretty myopic. They're looking at the next quarterly
• 37:08
  Speaker 1: earnings report, they're looking at the stock price. UH, they're
• 37:13
  Speaker 1: not necessarily looking at the long term. And in this country,
• 37:18
  Speaker 1: insurance companies are for the most part profit. UH, they're
• 37:23
  Speaker 1: not nonprofit, and they have to deliver value to their shareholders,
• 37:29
  Speaker 1: and so sometimes they make short sighted decisions. In the
• 37:33
  Speaker 1: early days of DNA tests that the real problem was
• 37:37
  Speaker 1: that the insurance companies didn't have relationships with companies that
• 37:40
  Speaker 1: did it, and those UH tests were very expensive, so
• 37:44
  Speaker 1: it's easier for them to say this is research, we're
• 37:46
  Speaker 1: not going to cover it. In terms of system fibrosis,
• 37:49
  Speaker 1: the Emertant College of Etcentrics and Gynecology and the Emertant
• 37:53
  Speaker 1: College of Medical Genetics both came to a to a
• 37:57
  Speaker 1: recommendation that you know, every want at certain races should
• 38:01
  Speaker 1: be tested for assistic fibrosis carrier status when the woman
• 38:06
  Speaker 1: became pregnant, when we knew, and and we had been
• 38:10
  Speaker 1: given fair warning for that when I was a Quest Diagnostics,
• 38:13
  Speaker 1: so we knew that volume was going to increase, and
• 38:16
  Speaker 1: the business people in Quest Diagnostics knew that it would
• 38:19
  Speaker 1: become profitable because insurers would have a difficult time saying
• 38:23
  Speaker 1: its research if the professional societies had recommended it. So
• 38:28
  Speaker 1: that was kind of a no brainer decision. Some of
• 38:31
  Speaker 1: the other decisions that we had to make were not
• 38:34
  Speaker 1: so easy. Pardon my naivete and asking this, but if
• 38:39
  Speaker 1: people are changing insurers every two and a half three years,
• 38:44
  Speaker 1: then the flip side of we don't want to test
• 38:48
  Speaker 1: because this person is going to end up elsewhere is
• 38:51
  Speaker 1: what about the person who wasn't tested? Five years ago,
• 38:54
  Speaker 1: who shows up as you're insured and has that expensive
• 38:58
  Speaker 1: heart attack. Wouldn't you want a uniform approach across all
• 39:02
  Speaker 1: the insurers so that the preventative, less expensive treatment and
• 39:08
  Speaker 1: testing was taking place before. Yeah, this guy is leaving
• 39:12
  Speaker 1: your insurance company, but someone else who wasn't tested is
• 39:15
  Speaker 1: going to end up at your company. It seems like
• 39:19
  Speaker 1: the better approach would be to agree on a uniform
• 39:24
  Speaker 1: testing process. Verry, it's so logical, you don't think I
• 39:32
  Speaker 1: didn't scream that. But the problem is two things about that. Is,
• 39:37
  Speaker 1: first of all, if all the insurance companies are gonna
• 39:40
  Speaker 1: get together and decide that they're gonna do something like that,
• 39:44
  Speaker 1: that would probably be considered collusion. What if it comes
• 39:48
  Speaker 1: from the medical community, or the research community, or or
• 39:52
  Speaker 1: god forbid, actual legislation that says you should have to
• 39:56
  Speaker 1: pay for these sort of testing. Yeah. Well, interestingly enough,
• 40:01
  Speaker 1: just because the professional organization say that this is standard
• 40:07
  Speaker 1: of care and should be done, does not mean that
• 40:09
  Speaker 1: insurance companies will pay for it. Basically, insurance companies role
• 40:14
  Speaker 1: in life is to not pay for things. Our new
• 40:17
  Speaker 1: CEO of Quest Diagnostics you used to say, you know
• 40:21
  Speaker 1: what other business do you have where you give your
• 40:23
  Speaker 1: services a way for free and then you hope and
• 40:26
  Speaker 1: pray that you're going to get paid for it. And
• 40:29
  Speaker 1: that's what lab testing is all about. The test is
• 40:32
  Speaker 1: sent in, we send out the results, and then we
• 40:34
  Speaker 1: hope that insurance is going to reimburse us for those
• 40:38
  Speaker 1: It's not a great system. Um, you can be denied
• 40:42
  Speaker 1: for a whole bunch of reasons because the ordering physician
• 40:45
  Speaker 1: put the wrong diagnosis code. Even though a person needed
• 40:50
  Speaker 1: the test, the test was sent, the test was pre authorized,
• 40:56
  Speaker 1: and the test was performed, a result was given, and
• 41:00
  Speaker 1: then all of a sudden you're told you're not going
• 41:02
  Speaker 1: to get paid for this because the doctor coded this
• 41:05
  Speaker 1: as a routine office visit and not as a office
• 41:09
  Speaker 1: visit because there was a breast lump found. So you know,
• 41:13
  Speaker 1: there is a huge part of the industry which you
• 41:19
  Speaker 1: know basically has to take into account to fact that
• 41:22
  Speaker 1: you're not going to get paid for a certain percentage
• 41:25
  Speaker 1: of what you do, and they're actually when I was
• 41:29
  Speaker 1: a quest there were, um, there were people who are
• 41:33
  Speaker 1: trying to work on just improving the percentage because you know,
• 41:37
  Speaker 1: you didn't have to do any more testing if you
• 41:40
  Speaker 1: could improve your percentage of reimbursement, you know, from to
• 41:46
  Speaker 1: or whatever it was. And so you know, obviously in
• 41:49
  Speaker 1: a single payer system you don't have those kinds of issues.
• 41:53
  Speaker 1: You can make those decisions easily. Uh. And that's you know,
• 41:57
  Speaker 1: in in Canada, that's it's a much easier thing to do.
• 42:02
  Speaker 1: You can simply say the public health and system is
• 42:05
  Speaker 1: going to be paying for this testing, and then pretty
• 42:07
  Speaker 1: much everybody gets it covered and paid for. Here you
• 42:11
  Speaker 1: could say, yeah, I think we need that everybody should
• 42:14
  Speaker 1: be paid for this testing, but insurance companies don't have
• 42:17
  Speaker 1: to Listen, let's talk a little bit about the work
• 42:21
  Speaker 1: you're doing at the children's hospital. Tell me the sort
• 42:25
  Speaker 1: of patients you focus on and what do you try
• 42:27
  Speaker 1: and do for them? So very you know, I was
• 42:31
  Speaker 1: in semi retirement and I got a call from a
• 42:34
  Speaker 1: children's hospital Los Angeles saying, you know, we have such
• 42:38
  Speaker 1: a backlog of patients that need to see clinical geneticists,
• 42:42
  Speaker 1: and especially my subspecialty, which is biochemical genetics. Back from
• 42:46
  Speaker 1: the days with with William nine hand, you know, could
• 42:50
  Speaker 1: you please, you know, come work for us at least
• 42:55
  Speaker 1: part time. And this was actually right before the pandemic
• 42:59
  Speaker 1: and Dr Randolph, the chair in of the department, is
• 43:03
  Speaker 1: such a wonderful woman, you know that. I said, yes, um,
• 43:07
  Speaker 1: because you know, if somebody asked you to help out,
• 43:10
  Speaker 1: you help out. And I was really dreading it because
• 43:13
  Speaker 1: I was going to have to drive up to Los
• 43:15
  Speaker 1: Angeles and I live in the South Orange County. And
• 43:18
  Speaker 1: then COVID hit. And one of the interesting things that
• 43:21
  Speaker 1: happened with with the COVID epidemic, there's been you know,
• 43:25
  Speaker 1: can you say, have there been any positive things? Well,
• 43:28
  Speaker 1: one of the positive things that's actually we now have
• 43:30
  Speaker 1: mRNA vaccines, where before COVID they asked me it was
• 43:35
  Speaker 1: it was going to be five to seven years before
• 43:37
  Speaker 1: we had mRNA vaccines. But the other thing interesting thing
• 43:41
  Speaker 1: that's happened is that telemedicine has become reimbursable two reasonable levels.
• 43:47
  Speaker 1: So when COVID hit, I said, you know, I'm of
• 43:50
  Speaker 1: an age I don't really feel comfortable driving up and uh,
• 43:54
  Speaker 1: you know, working in a hospital. And they said, wow,
• 43:57
  Speaker 1: would you see patients, uh remotely by tele medicine? And
• 44:01
  Speaker 1: I said sure, And it's surprisingly good. You know, yes,
• 44:07
  Speaker 1: I cannot touch patients, but I can see patients. And
• 44:11
  Speaker 1: I've been seeing patients UM in clinical genetics that very tremendously.
• 44:18
  Speaker 1: Most states have what's called newborn screening. Newborn screening is
• 44:22
  Speaker 1: one of the most amazing phenomenon for disease identification and
• 44:29
  Speaker 1: early treatment that nobody knows about. It's the heel stick
• 44:32
  Speaker 1: that all your children, grandchildren and great grandchildren have when
• 44:36
  Speaker 1: they're born. And this is analyzed in California for about
• 44:40
  Speaker 1: fifty different what we call inborn errors in the tables,
• 44:44
  Speaker 1: and so these children are identified, and these children need
• 44:48
  Speaker 1: to be cared for by physicians who know how to
• 44:53
  Speaker 1: care for these children with these extremely rare genetic diseases.
• 44:58
  Speaker 1: But it's been phenomenal. For example, there's a disease called
• 45:01
  Speaker 1: who terrag aciduria type one where every patient I ever
• 45:06
  Speaker 1: saw back when I was working with Dr Nihan was horribly,
• 45:11
  Speaker 1: horribly brain damage. Uh. These kids were almost in vegetative states.
• 45:17
  Speaker 1: I now have a child in my practice who is
• 45:20
  Speaker 1: identified by newborn screening, who is placed on a specialized diet,
• 45:25
  Speaker 1: is now three years old and completely normal. Every time
• 45:29
  Speaker 1: I see this kid, I want to scream, how wonderful. Uh.
• 45:34
  Speaker 1: Newborn screening is started out with general keaton nuria. Again,
• 45:38
  Speaker 1: these are children who would have been horribly horribly mentally deficient,
• 45:43
  Speaker 1: deficient who are put on specialized diets and they're normal.
• 45:48
  Speaker 1: So these are the kind of kids I see. I
• 45:50
  Speaker 1: also see children who have autism, children who have other
• 45:55
  Speaker 1: forms of birth defects. You know, now we can get
• 46:00
  Speaker 1: specialized DNA sequencing tests for these children UH to identify
• 46:05
  Speaker 1: their disorders and perhaps treat Now we have these been
• 46:10
  Speaker 1: called the whole x own sequence, which allows where the
• 46:14
  Speaker 1: laboratory basically looks at every gene UH known in the
• 46:19
  Speaker 1: body and compares that with both parents to see about
• 46:23
  Speaker 1: whether or not a child has a disease. Well, I
• 46:25
  Speaker 1: did a test like that on a child that was hypotonic,
• 46:30
  Speaker 1: who couldn't walk, he was eighteen months old, had spastic movements,
• 46:35
  Speaker 1: had been diagnosed with cerebral palsy. I did that test.
• 46:38
  Speaker 1: It turned out he had a treatable inborn error metabolism
• 46:43
  Speaker 1: called congenital disorder of like constellation, and we started to
• 46:46
  Speaker 1: treat him and he's getting better. So you know, it's
• 46:50
  Speaker 1: these kinds of things were used to be very very rare.
• 46:54
  Speaker 1: It's almost like a revival meeting are becoming you know,
• 46:58
  Speaker 1: pretty common. But in order to do that, you have
• 47:01
  Speaker 1: to be able to get the testing done. And that's
• 47:04
  Speaker 1: the great frustration you had mentioned previously that the insurers
• 47:09
  Speaker 1: are sometimes none too keen about paying for some of
• 47:13
  Speaker 1: these um screening tests or preliminary tests. The heel stick
• 47:17
  Speaker 1: is that best practice was that mandated by law? How
• 47:20
  Speaker 1: did that come about? And and what sort of headaches
• 47:23
  Speaker 1: do you run into when you want to test in
• 47:25
  Speaker 1: The insurers says, um, we're not interested. Yeah, well, there's
• 47:31
  Speaker 1: there are two questions in there. The first is newborn
• 47:33
  Speaker 1: screening is legislatively mandated in all fifty days, and the
• 47:38
  Speaker 1: beauty of the legislative mandate is that the follow up
• 47:42
  Speaker 1: is covered. So these children who you know, test posit
• 47:46
  Speaker 1: for newborn screening, their treatments are covered. Any follow up
• 47:50
  Speaker 1: genetic testing is covered. So that's at least in California,
• 47:54
  Speaker 1: is a great system. When people that kids that fall
• 47:56
  Speaker 1: through the cracks are the kids that don't have one
• 47:59
  Speaker 1: of the diseases that is screened for in the newborn
• 48:01
  Speaker 1: screening program. And these are children who for example, Medical
• 48:06
  Speaker 1: which is the state sponsored health insurance, doesn't cover whole
• 48:12
  Speaker 1: excellent sequence. So the kids who are covered by medical
• 48:17
  Speaker 1: can't have the task which might identify a treatable cause
• 48:23
  Speaker 1: of their illness, and that is extraordinarily frustrating. And sometimes
• 48:27
  Speaker 1: even private insurance will say, you know, I don't want
• 48:31
  Speaker 1: to cover this test, even though you know, I want
• 48:33
  Speaker 1: to scream at them, this kid needs this test. And
• 48:36
  Speaker 1: that's the greatest frustration in medicine right now, at least
• 48:40
  Speaker 1: in genetics, uh, for me, is not being able to
• 48:44
  Speaker 1: get the tests I need for my patients. Um. And
• 48:48
  Speaker 1: again that's because there's no uniformity and insurance coverage for
• 48:53
  Speaker 1: these sorts of genetic testing. I can see the you know,
• 48:57
  Speaker 1: the position of the insurance companies are these are expensive
• 48:59
  Speaker 1: tests and um, you know again error they want to
• 49:03
  Speaker 1: be profitable, and if they their fear is that if
• 49:07
  Speaker 1: they start having to pay for these very expensive tests,
• 49:10
  Speaker 1: that's going to eat into their profits. So I mean,
• 49:13
  Speaker 1: I do understand it, but it is extremely frustrating for
• 49:16
  Speaker 1: our practitioner. I can imagine and you sort of see
• 49:20
  Speaker 1: the medical industry, both the practice and the commercialization from
• 49:26
  Speaker 1: both ends of the business, both as a doctor who
• 49:31
  Speaker 1: is a practitioner and someone who's working in what's essentially
• 49:35
  Speaker 1: a biotech start up looking at it from the complete
• 49:39
  Speaker 1: opposite end. How do we get this through the CDC,
• 49:43
  Speaker 1: through an I H, through f DA, How do we
• 49:45
  Speaker 1: get this approved? How do we get insurance to start
• 49:48
  Speaker 1: paying for this? How do we get practitioners to start
• 49:50
  Speaker 1: using it? How does that sort of unique perspective of
• 49:54
  Speaker 1: seeing both ends of the elephant affect how you view
• 49:58
  Speaker 1: the practice of medicine and the United States. Wow, what
• 50:02
  Speaker 1: a question. We could probably talk for an hour about that,
• 50:06
  Speaker 1: I think. Um, you know, the short answer is it
• 50:10
  Speaker 1: has become amazingly complicated to introduce anything new in medicine.
• 50:17
  Speaker 1: So back in the day, somebody would find something, they
• 50:21
  Speaker 1: would publish it, and then if it was good, it
• 50:25
  Speaker 1: would be reproduced, and then everybody would do it, and
• 50:29
  Speaker 1: medicine progressed that way. Nowadays it's completely different. So you
• 50:35
  Speaker 1: make a discovery, you talk to the Technology Transfer office
• 50:39
  Speaker 1: at your university, they patented, uh. Then you spin off
• 50:45
  Speaker 1: a biotech company. Then you have to get venture capital
• 50:50
  Speaker 1: funding for your biotech funding company. Then you shop it
• 50:53
  Speaker 1: around and then nobody trust what you're doing because you're
• 50:57
  Speaker 1: a private company. And then you have to get people
• 51:00
  Speaker 1: to will interact with the governmental players, people who will
• 51:06
  Speaker 1: interact with private payers. People who will work on the
• 51:09
  Speaker 1: CPT codes. It is amazing complex process. I have a talk,
• 51:15
  Speaker 1: actually a power point that I can and I talk
• 51:18
  Speaker 1: about somebody who invents the best test. I call it TBT.
• 51:23
  Speaker 1: So somebody invents a test that can use your blood
• 51:27
  Speaker 1: and decide with sensitivity and specificity whether or not you've
• 51:31
  Speaker 1: got prostate cancer, for example, and I I lead the
• 51:36
  Speaker 1: people through the person who invents that test to the
• 51:40
  Speaker 1: point where a quest diagnostics is no, no, thank you,
• 51:43
  Speaker 1: we don't want this test. And it is perfectly plausible.
• 51:48
  Speaker 1: And that's because the whether or not a test will
• 51:52
  Speaker 1: be profitable depends on so many different interchangeable parts, and
• 51:58
  Speaker 1: if the parts don't all fit together correctly, it won't
• 52:02
  Speaker 1: be a profitable test. So that's the way the industry
• 52:07
  Speaker 1: is now. It's frustrating as a to be a physician
• 52:13
  Speaker 1: in the system can get extremely frustrating because of course
• 52:17
  Speaker 1: we feel we know everything so that if I say,
• 52:20
  Speaker 1: if I say it must be so, it must be so.
• 52:24
  Speaker 1: But seriously, uh it can. It can be extremely frustrating.
• 52:28
  Speaker 1: And my problem is that I have started a company.
• 52:31
  Speaker 1: I believe I have a game changing technology, but the
• 52:34
  Speaker 1: chances of it actually changing the game are pretty small,
• 52:39
  Speaker 1: and one of the problems that my company has is,
• 52:42
  Speaker 1: you know, we're underfunded. I don't have the ability to
• 52:46
  Speaker 1: go out and hire a marketer, or to hire a
• 52:48
  Speaker 1: sale at salesforce, to hire people, uh, to deal with
• 52:52
  Speaker 1: insurance companies. So I felt if I built a better
• 52:55
  Speaker 1: mouse trap, that the world would come to my door.
• 52:58
  Speaker 1: But that has not happened. And so now you know,
• 53:02
  Speaker 1: I'm sitting trying to figure out what we're going to
• 53:04
  Speaker 1: do with this technology. You know, I know it's good,
• 53:07
  Speaker 1: I know it works. You know, I just need to
• 53:10
  Speaker 1: figure out how to do it from a business standpoint.
• 53:12
  Speaker 1: So that's been my frustration. So we've seen over the
• 53:17
  Speaker 1: years a lot of large either pharma or diagnostic companies
• 53:22
  Speaker 1: go through a series of acquisitions and roll ups and mergers.
• 53:26
  Speaker 1: It seems like scale is something that's really significant in
• 53:31
  Speaker 1: this space. Is that just a function of how unique
• 53:35
  Speaker 1: and somewhat backwards the U S system is. Between the
• 53:39
  Speaker 1: hospitals and the insurers and the practitioners, everybody seems to
• 53:43
  Speaker 1: be operating at a cross purpose, to say nothing of
• 53:47
  Speaker 1: the patient and the outcome of their visits. Is this
• 53:51
  Speaker 1: a uniquely American problem? Or do we see other issues
• 53:55
  Speaker 1: like this elsewhere. What happens here is evolutionary and the
• 54:00
  Speaker 1: way we evolved, of course, you know, the way evolution
• 54:04
  Speaker 1: occurs as with natural selection. So we're in a completely
• 54:08
  Speaker 1: capitalist system here in the United States. And the way
• 54:12
  Speaker 1: the laboratory industry evolved is it started out with I
• 54:16
  Speaker 1: guess you'd call a mom and pop started out that
• 54:19
  Speaker 1: every hospital had a laboratory. That laboratory was run by
• 54:23
  Speaker 1: the local pathologists. They drove the fanciest cars I can
• 54:27
  Speaker 1: tell you. You You know, they were charging two and three
• 54:31
  Speaker 1: for tests that cost them two or three dollars to run,
• 54:35
  Speaker 1: and they were happy. The insurance industry didn't know any better.
• 54:39
  Speaker 1: They were reasonably happy, and then a revolution occurred. Revolution
• 54:45
  Speaker 1: occurred firstly with a laboratory called net path that decided
• 54:49
  Speaker 1: that they were going to be a commercial laboratory. They
• 54:52
  Speaker 1: were going to compete with the mom and pop local pathologists,
• 54:56
  Speaker 1: and so they started buying up laboratories. Then Corning, who
• 55:01
  Speaker 1: was making Corning wear but also fiber Optics, was also
• 55:05
  Speaker 1: making laboratory flasks in pirates. They were making graduated cylinders,
• 55:10
  Speaker 1: they're making flasks. So they decided that they were going
• 55:14
  Speaker 1: to diversify and get into the laboratory industry, and they
• 55:19
  Speaker 1: spun off and they started with Corning Clinical Labs and
• 55:22
  Speaker 1: then they spun it off as Quest Diagnostics. Quest Diagnostics
• 55:27
  Speaker 1: with their original CEO, who was a visionary, decided that
• 55:31
  Speaker 1: he was going to consolid try to consolidate the laboratory
• 55:34
  Speaker 1: and industry, so he bought met Death, he bought other
• 55:38
  Speaker 1: laboratories UH and basically got to a point where they
• 55:42
  Speaker 1: were close to eight percent of the total laboratory market share.
• 55:47
  Speaker 1: But it's still a very fragmented market. You have the
• 55:50
  Speaker 1: huge players, the lab corps, the Quest bioreference people, but
• 55:55
  Speaker 1: still the majority of laboratory testing is done by in
• 55:59
  Speaker 1: the dual hospitals. So then how did individual hospitals No
• 56:03
  Speaker 1: longer could they's charge two hun or fifty dollars for
• 56:05
  Speaker 1: tests that they uh then only took them four hours
• 56:09
  Speaker 1: to make. So they had to come down with pricing.
• 56:12
  Speaker 1: And so now hospitals are working with among themselves. So
• 56:17
  Speaker 1: now you have hospital chains buying up other hospitals running
• 56:21
  Speaker 1: the laboratories from the central laboratory. So you have that
• 56:25
  Speaker 1: going on, and then insurance companies love that because now
• 56:30
  Speaker 1: there's competition. So they can say, well, I can get
• 56:33
  Speaker 1: this from Quest Diagnostic, or should I tell you this?
• 56:37
  Speaker 1: And then you all know the story about United Healthcare,
• 56:40
  Speaker 1: and they went from quests the lab corps and now
• 56:43
  Speaker 1: they're in both. But insurance companies began to wield an
• 56:46
  Speaker 1: increasing amount of power over healthcare and they still wield
• 56:50
  Speaker 1: that amazing kind of power because in many ways, your
• 56:54
  Speaker 1: insurance company decides what tests your doctor can order and
• 56:59
  Speaker 1: from what laboratory. Right in the early days of when
• 57:02
  Speaker 1: pap smears went to something called thin prep, you know,
• 57:06
  Speaker 1: there was no question that the thin prep was better
• 57:11
  Speaker 1: in terms of of what it could do. But in
• 57:15
  Speaker 1: when patients would come to our clinic, there was a
• 57:18
  Speaker 1: big boltin board saying if the patient had this insurance,
• 57:21
  Speaker 1: they could get thin Prep. But the patient had that insurance,
• 57:24
  Speaker 1: they could only get a regular PAP smear. So what
• 57:27
  Speaker 1: people don't understand is that their insurance companies in many
• 57:32
  Speaker 1: ways are determining what they you know, what kind of
• 57:35
  Speaker 1: testing they can have, what kind of medical care they
• 57:38
  Speaker 1: will get. And most people don't pay any attention to that.
• 57:41
  Speaker 1: They don't pay any attention to whether or not holds
• 57:45
  Speaker 1: excellent coverage. Is you know, is covered by their insurance
• 57:48
  Speaker 1: until they have a child that has autism, or until
• 57:52
  Speaker 1: they have a child that, uh, you know, that has
• 57:54
  Speaker 1: developmental delay, and now all of a sudden, their geneticists
• 57:57
  Speaker 1: wants to order that test and their insurance company doesn't come.
• 58:02
  Speaker 1: But one of the problems is that you would really
• 58:04
  Speaker 1: want an informed consumer, But in healthcare are consumers are
• 58:09
  Speaker 1: not informed? You know, you look at these things when
• 58:12
  Speaker 1: there's open enrollment, and mostly everybody's looking at what the
• 58:16
  Speaker 1: code pay is, what this is, what that is. And
• 58:19
  Speaker 1: it's not reasonable for people to understand whether or not,
• 58:24
  Speaker 1: you know, they can have a cardiac authorization, or whether
• 58:26
  Speaker 1: or not they can have a treadmill for certain indications,
• 58:29
  Speaker 1: you know, because you don't know what the future is
• 58:31
  Speaker 1: going to hold. So the paradigm of, you know, an
• 58:35
  Speaker 1: informed consumer in a capitalist system with free enterprise, I
• 58:42
  Speaker 1: think doesn't work very well for healthcare. But the centralized systems,
• 58:48
  Speaker 1: you know, are not that great in some places too.
• 58:50
  Speaker 1: I mean, everybody points to Canada as being the best
• 58:54
  Speaker 1: a good example of a single party pair, but I
• 58:58
  Speaker 1: know a physician in Canada and he needed his wisdom
• 59:01
  Speaker 1: teeth out, and he had waited two and a half
• 59:04
  Speaker 1: years to have his wisdom team, and a lot of
• 59:07
  Speaker 1: people in Canada actually drive over to Buffalo to have
• 59:11
  Speaker 1: CT scans because you know, the whole city of Toronto
• 59:14
  Speaker 1: has two CT scanners or something and something. You know
• 59:18
  Speaker 1: there there's a limited number of you know, CT scanners
• 59:22
  Speaker 1: for population, and so there's a long waiting list for
• 59:26
  Speaker 1: those kinds of things. So it's not like single party
• 59:29
  Speaker 1: payer is the panacea. Then if you ask, how are
• 59:32
  Speaker 1: you going to fix the system as it currently exists,
• 59:34
  Speaker 1: it's a nightmare and I have no idea of how
• 59:37
  Speaker 1: I would fix it. So I know I only have
• 59:40
  Speaker 1: you for a couple more minutes. Let's jump from our
• 59:46
  Speaker 1: medical discussion to our favorite questions that we ask all
• 59:50
  Speaker 1: of our guests. I wanted to start with something like,
• 59:53
  Speaker 1: tell us what you've been streaming over the past couple
• 59:57
  Speaker 1: of years. What what has kept you entertained during the
• 1:00:00
  Speaker 1: pandemic lockdown? Well, yeah, I stream a lot. I guess
• 1:00:05
  Speaker 1: I can also combine, and so I during the pandemic
• 1:00:09
  Speaker 1: started reading Michael connelly novels Ronymous Bos The Detective. He's
• 1:00:15
  Speaker 1: written over twenty novels, and of course then I streamed
• 1:00:19
  Speaker 1: a Lincoln lawyer which is also from Michael Connolly, and
• 1:00:23
  Speaker 1: I will be streaming The Bush Legacy right now. I'm
• 1:00:26
  Speaker 1: watching Judy Queen of Jerusalem, which is an incredibly interesting
• 1:00:30
  Speaker 1: Israeli film about the early days of in Jerusalem. Watching
• 1:00:36
  Speaker 1: gas Lit with Martha Martha Mitchell Uh and a real
• 1:00:40
  Speaker 1: cool one is Servant of the People. I don't know
• 1:00:43
  Speaker 1: if you've been seeing that. Barry Uh, that's uh the
• 1:00:47
  Speaker 1: President of Ukraine, his original comedy show. Do you know
• 1:00:51
  Speaker 1: about that? You know, I've I've heard all about it,
• 1:00:53
  Speaker 1: and it's supposed to be tremendous, um fantastic. Yeah, I mean,
• 1:01:00
  Speaker 1: and first of all, it's you talk about art imitating
• 1:01:03
  Speaker 1: life and life imitating art. I mean, you know, he's
• 1:01:06
  Speaker 1: President of Ukraine, and you know, the whole the whole
• 1:01:09
  Speaker 1: TV series is based on, you know, him going off
• 1:01:13
  Speaker 1: on a rant about the corruption and government and getting
• 1:01:15
  Speaker 1: elected to be President of Ukraine. I would highly recommend that.
• 1:01:20
  Speaker 1: That's on my let's on my list. Let's talk a
• 1:01:22
  Speaker 1: little bit about some of your mentors we mentioned them earlier.
• 1:01:26
  Speaker 1: Tell us who helped to shape your career. You know,
• 1:01:30
  Speaker 1: I was very lucky that whenever I needed somebody, they
• 1:01:34
  Speaker 1: were there. The first one was, of course Albert Dorfman,
• 1:01:37
  Speaker 1: who was my doctor advisor. He was an m D, PhD.
• 1:01:40
  Speaker 1: He worked on on inborn eraism, metabolism, and he taught
• 1:01:46
  Speaker 1: me one very important thing. He called me in one
• 1:01:49
  Speaker 1: day and he said, you know, when I designed an
• 1:01:53
  Speaker 1: experiment and I think I know what the results should be,
• 1:01:58
  Speaker 1: and I get that result, I don't trust it. You know,
• 1:02:03
  Speaker 1: what he was basically saying is that that science and
• 1:02:07
  Speaker 1: discovery is about what you're not expecting. Just as Alexander
• 1:02:13
  Speaker 1: Fleming discovered penicillan not looking for penicillin. He discovered penicillin
• 1:02:20
  Speaker 1: because of an accident that mold started growing on his plates.
• 1:02:24
  Speaker 1: And we've lost that in science. I'm afraid we've lost that.
• 1:02:29
  Speaker 1: You know. Right now science has managed it as a business.
• 1:02:33
  Speaker 1: You know, we're gonna make a vaccine. We're gonna do
• 1:02:37
  Speaker 1: this step, this step, this steps, this step, and make
• 1:02:39
  Speaker 1: a vaccine. No one is saying, let's look at how
• 1:02:43
  Speaker 1: he anybodies are formed. Let's look at what's going on
• 1:02:46
  Speaker 1: and see if there's anything anomalous, something that we don't understand.
• 1:02:50
  Speaker 1: My next mentor was Dr Sam Specter. Dr Sam Specter,
• 1:02:54
  Speaker 1: I guess you could call you know, was one of
• 1:02:56
  Speaker 1: the fathers of modern pediatrics. He worked with Benjamin's Bock
• 1:03:00
  Speaker 1: writing h writing the famous book on childcare um and
• 1:03:05
  Speaker 1: I was fortunate enough to have him as a professor
• 1:03:08
  Speaker 1: at the University of Chicago Medical School, and then he
• 1:03:11
  Speaker 1: moved to University of California, San Diego. So when I
• 1:03:15
  Speaker 1: went to do my residency, he was there for me too.
• 1:03:18
  Speaker 1: And what he taught me is that the best way
• 1:03:21
  Speaker 1: to be a pediatrician is to be with the child.
• 1:03:26
  Speaker 1: He said, I want you to go hold babies. You know,
• 1:03:29
  Speaker 1: if you if you're not an older brother and older sister,
• 1:03:32
  Speaker 1: hold babies, walking around with babies, see how they feel.
• 1:03:36
  Speaker 1: And you can tell simply by being with a baby,
• 1:03:40
  Speaker 1: by holding a child, whether this is a child who's
• 1:03:43
  Speaker 1: just fussy and can be discharged, where this is someone
• 1:03:46
  Speaker 1: who is seriously ill. And those were the days afford
• 1:03:50
  Speaker 1: the meningitis vaccine, and we were really concerned about meningitis.
• 1:03:55
  Speaker 1: Then my boss and my chairman of my department I
• 1:03:57
  Speaker 1: was at a community hospital in Chicago's name was John Barton,
• 1:04:02
  Speaker 1: and he was a cowboy, and he taught me two things.
• 1:04:06
  Speaker 1: He first taught me that to be a leader, you
• 1:04:10
  Speaker 1: have to want what's best for your people more than
• 1:04:13
  Speaker 1: you want what's best for you. He got such joy
• 1:04:18
  Speaker 1: in our successes, and he did everything possible so that
• 1:04:23
  Speaker 1: we could be successful, even though sometimes that made him
• 1:04:27
  Speaker 1: unpopular with the management. And the last one was William
• 1:04:31
  Speaker 1: Nihan uh And and Bill taught me that you have
• 1:04:38
  Speaker 1: to know the basic science if you're going to treat patients.
• 1:04:42
  Speaker 1: For example, he could give a lecture on diarrhea where
• 1:04:46
  Speaker 1: you learned about what causes the diarrhea, not just how
• 1:04:50
  Speaker 1: to treat the diarrhea. And so those are my mentors,
• 1:04:53
  Speaker 1: and I thank god that I had. Sounds like a
• 1:04:56
  Speaker 1: hack of a list. Let's talk about books. You mentioned
• 1:04:58
  Speaker 1: some already. Tell us what you've been reading lately and
• 1:05:02
  Speaker 1: what are some of your favorites. Okay, well, my favorite
• 1:05:06
  Speaker 1: book is Field of Dreams. My father was a baseball catcher,
• 1:05:10
  Speaker 1: and it's one of the only books I've ever cried
• 1:05:13
  Speaker 1: while reading. I think it's a better book than it
• 1:05:16
  Speaker 1: is a movie, but I love the movie. Also, there's
• 1:05:19
  Speaker 1: also a fabulous book called The Goldbug Variations by Richard Powers.
• 1:05:23
  Speaker 1: I don't know if you've heard of it, but he
• 1:05:26
  Speaker 1: combines genetics, music, and a couple of love stories together.
• 1:05:31
  Speaker 1: More recently, as I told you, I've been reading all
• 1:05:34
  Speaker 1: the detective Runo Sposh novels by Michael Connolly, and that's
• 1:05:38
  Speaker 1: what I do for recreation. Sounds like fun. Our final
• 1:05:42
  Speaker 1: two questions starting with what sort of advice would you
• 1:05:46
  Speaker 1: give a recent college grad who was interested in a
• 1:05:49
  Speaker 1: career in either medicine or genetics. Well, I would say
• 1:05:54
  Speaker 1: that there's been a sea change from in just the
• 1:05:58
  Speaker 1: past ten years in genetics. Uh, and it's going to
• 1:06:02
  Speaker 1: be in medicine too, And that is you need to understand. Informatic.
• 1:06:07
  Speaker 1: When I was even a quest diagnostics, my expertise and
• 1:06:12
  Speaker 1: what we call wet work, it was in making essays,
• 1:06:16
  Speaker 1: you know, making methods to detect things and doing it
• 1:06:20
  Speaker 1: in a better way. We talked about that a little earlier.
• 1:06:23
  Speaker 1: Now pretty much everything goes on the DNA sequencer, on
• 1:06:28
  Speaker 1: the next generation sequencers, and so the wet work is
• 1:06:32
  Speaker 1: almost irrelevant. But what isn't irrelevant is the analysis of
• 1:06:37
  Speaker 1: the tremendous, the humongous amount of data that comes off
• 1:06:40
  Speaker 1: those sequencers. And so I would say to someone who
• 1:06:44
  Speaker 1: wants to go into genetic you have to get a
• 1:06:47
  Speaker 1: handle on the informatics. Whether or not you need to be,
• 1:06:50
  Speaker 1: you know, a computer major or whether you're not to
• 1:06:53
  Speaker 1: need to be a programmer that I don't know, but
• 1:06:56
  Speaker 1: you need to be able to because the computer folks
• 1:07:00
  Speaker 1: know the medicine and you need to know where the
• 1:07:03
  Speaker 1: weaknesses are in the computer algorithms or else you're going
• 1:07:09
  Speaker 1: to start, you know, being let off on blind alley.
• 1:07:12
  Speaker 1: So that would be my advice to anyone who's getting
• 1:07:15
  Speaker 1: into modern medicine is to understand the informatics, Understand how
• 1:07:20
  Speaker 1: these algorithms work, understand where their strengths are, where their weaknesses,
• 1:07:26
  Speaker 1: or even become involved in the analysis because it's incredibly powerful.
• 1:07:31
  Speaker 1: I mean, there's an algorithm that basically looks at sales
• 1:07:36
  Speaker 1: of kleenex in um in pharmacies that predicts blue epidemics
• 1:07:43
  Speaker 1: better than anything else. It's the same kind of algorithm
• 1:07:47
  Speaker 1: that they use to map the craters of the moon.
• 1:07:50
  Speaker 1: So you know, this is you know, we live in
• 1:07:52
  Speaker 1: an age where basically privacy has gone. But the up
• 1:07:58
  Speaker 1: the other side of it is there is so much
• 1:08:00
  Speaker 1: data out there that could be used for good. You know,
• 1:08:05
  Speaker 1: people are always worried about how it could be used
• 1:08:08
  Speaker 1: for the bad. But you know, people are listening to
• 1:08:11
  Speaker 1: our phone conversations. They're paying attention to what we buy.
• 1:08:14
  Speaker 1: You know, that's the negative part. But on the other hand,
• 1:08:18
  Speaker 1: I just turned on my computer and on Google there
• 1:08:20
  Speaker 1: was something that I wanted, you know. It was like,
• 1:08:23
  Speaker 1: I think, how did you know? How did the algorithm
• 1:08:27
  Speaker 1: know that this would be something that I would be
• 1:08:29
  Speaker 1: looking for because it wasn't obvious. Uh and yet there
• 1:08:33
  Speaker 1: it was. So it can be used for good um
• 1:08:36
  Speaker 1: as well as for for bad and uh So I
• 1:08:40
  Speaker 1: think that that, yes, there there is reason for concerns
• 1:08:43
  Speaker 1: about privacy. I would also say that the kids today
• 1:08:47
  Speaker 1: they don't care about privacy, right They put everything on
• 1:08:49
  Speaker 1: Facebook as soon as it happened, So maybe we're moving
• 1:08:53
  Speaker 1: into a different era. Quite interesting. And our final question,
• 1:08:58
  Speaker 1: what do you know about the world of genetics and
• 1:09:01
  Speaker 1: testing in medicine today that you wish you knew forty
• 1:09:05
  Speaker 1: years ago when you were first getting started. I guess
• 1:09:10
  Speaker 1: what I'd say is one of the most important things
• 1:09:12
  Speaker 1: that I've learned is unintended consequences. So I lived through
• 1:09:16
  Speaker 1: the original Medicare guidance when the diagnostic related groups were formed,
• 1:09:23
  Speaker 1: So this was in probably the seventies or eighties, probably
• 1:09:27
  Speaker 1: the eighties, and basically the way that medicine was reimbursed
• 1:09:32
  Speaker 1: was changed inalterably. So hospitals were paid not by what
• 1:09:40
  Speaker 1: was done to a patient or for a patient. They
• 1:09:43
  Speaker 1: were paid a single amount based on the diagnosis of
• 1:09:47
  Speaker 1: that patient when they entered the hospital. So you would
• 1:09:51
  Speaker 1: get the same amount of money for admitting a patients
• 1:09:55
  Speaker 1: with down syndrome for pneumonia, whether or not did two
• 1:10:01
  Speaker 1: hundred thousand dollars worth of work on them or whether
• 1:10:04
  Speaker 1: it did twenty dollars worth of work on him. So
• 1:10:07
  Speaker 1: that changed medicine incredibly. And you say, well, you know
• 1:10:11
  Speaker 1: Medicare was Medicare, but then you know the insurance company
• 1:10:14
  Speaker 1: used Medicare as a model, and that that irremically altered
• 1:10:19
  Speaker 1: the way medicine was practiced. The other thing about those
• 1:10:21
  Speaker 1: Medicare regulations is they had better reimbursement for procedures. So
• 1:10:27
  Speaker 1: specialties which did a lot of procedures, colon oscarpies, cardiac
• 1:10:32
  Speaker 1: cathorizations became more powerful because the reimbursement was better and
• 1:10:38
  Speaker 1: basically you could make more money in that era of
• 1:10:43
  Speaker 1: the general practitioners, the pediatricians, you know, all got less reimbursement,
• 1:10:50
  Speaker 1: and it became harder for them to make a living.
• 1:10:53
  Speaker 1: Then all of a sudden, somebody says, well, these primary
• 1:10:56
  Speaker 1: care people are not doing well. So then they changed
• 1:10:59
  Speaker 1: reimburse sent to favor primary care, and that, again, you know,
• 1:11:05
  Speaker 1: changes the equation. So I guess what I would say
• 1:11:08
  Speaker 1: is be careful when you legislate anything that has to
• 1:11:12
  Speaker 1: do with medicine. I don't know if I would become
• 1:11:17
  Speaker 1: a physician if I were uh a young person today. Um,
• 1:11:23
  Speaker 1: it's much harder. So, you know, let me tell you
• 1:11:26
  Speaker 1: what you know. One way that costs is being controlled
• 1:11:28
  Speaker 1: in medicine is with scheduling. So our hospital was purchased
• 1:11:32
  Speaker 1: by another hospital, they introduce a scheduling program. Well, I
• 1:11:37
  Speaker 1: noticed that they were going to schedule me fifteen minutes
• 1:11:39
  Speaker 1: to see every patient. And I said, wait a second,
• 1:11:42
  Speaker 1: I'm a geneticist. I can spend an hour with the patient.
• 1:11:45
  Speaker 1: I can spend an hour and a half of the patients.
• 1:11:47
  Speaker 1: They said, Tosh, They said, you know, if you do that,
• 1:11:50
  Speaker 1: then your patients are gonna be waiting in the waiting room.
• 1:11:53
  Speaker 1: They're not going to be happy. So, you know, a
• 1:11:57
  Speaker 1: simple thing like a scheduling program from someone who you
• 1:12:02
  Speaker 1: know has done an analysis and says that you know,
• 1:12:05
  Speaker 1: we want doctors to see patients every fifteen minutes and
• 1:12:08
  Speaker 1: get a ten minute break for coffee and and that
• 1:12:11
  Speaker 1: sort of thing has made you know, being a doctor,
• 1:12:15
  Speaker 1: being a physician less enjoyable, You have less freedom, Your
• 1:12:20
  Speaker 1: people are feeling more like they're they're just employees, uh
• 1:12:25
  Speaker 1: than they have a vocation. Really quite interesting. Thanks back
• 1:12:29
  Speaker 1: for being so generous with your time. We have been
• 1:12:31
  Speaker 1: speaking with Dr buck Strom. He is the CEO and
• 1:12:35
  Speaker 1: founder of Liquid Diagnostics. If you enjoy this conversation, well,
• 1:12:41
  Speaker 1: be sure and check out any of the previous four
• 1:12:43
  Speaker 1: hundred such discussions we've add. You can find those at iTunes, Spotify,
• 1:12:48
  Speaker 1: or wherever you regularly get your podcasts. We love your comments,
• 1:12:51
  Speaker 1: feedback and suggestions right to us at m IB podcast
• 1:12:56
  Speaker 1: at Bloomberg dot net. Sign up from my daily reading
• 1:13:00
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• 1:13:03
  Speaker 1: rid Halts. I would be remiss if I did not
• 1:13:06
  Speaker 1: thank our crack team who helps put these conversations together
• 1:13:09
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• 1:13:14
  Speaker 1: is my producer. Sean Russo is my director of research ATKO.
• 1:13:19
  Speaker 1: Valberon is our project manager. I'm Barry Rihalts. You've been
• 1:13:23
  Speaker 1: listening to Master Some Business on Bloomberg Radio.