Latest / Becker’s Healthcare Podcast / How Microbiome Science Is Advancing Personalized Care and Early Cancer Detection with Dr. Michael Bass

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How Microbiome Science Is Advancing Personalized Care and Early Cancer Detection with Dr. Michael Bass · Becker’s Healthcare Podcast

• 0:00
  - This is Scott Becker with the Beckers HealthCare
• 0:03
  - podcast.
• 0:04
  - I'm thrilled today to be joined by a
• 0:06
  - brilliant
• 0:07
  - gastroenterologist
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  - who's also a scientist,
• 0:10
  - who spends time
• 0:12
  - translating the microbiome
• 0:14
  - into clinical practice, the microbiome science. Doctor Bass,
• 0:18
  - you're... I know you're one of the original
• 0:21
  - founders or the founding medical director of OSHE
• 0:23
  - Health, which one of my
• 0:25
  - closest friends relies on so greatly and has
• 0:28
  - had just great results with. And and I
• 0:30
  - know you're now,
• 0:32
  - working as a leader, global medical director at
• 0:35
  - Viome.
• 0:36
  - Tell us about yourself and your career,
• 0:39
  - and how you got so deeply into the
• 0:41
  - microbiome space.
• 0:43
  - Definitely. First of all, Scott, it's a honor
• 0:46
  - to speak to you. I've been reading your
• 0:49
  - publication
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  - for for probably going going on about fifteen
• 0:52
  - years right now. So thank you again
• 0:55
  - for having me on. But... So I'm a
• 0:57
  - I'm a practicing gastro doc in Delaware, and
• 1:00
  - a lot of the work I do grew
• 1:01
  - out of gaps I was seeing in everyday
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  - clinical practice.
• 1:05
  - So that was especially true for patients with
• 1:07
  - functional gastro issues,
• 1:09
  - which are basically issues where there's no structural
• 1:11
  - damage like an ulcer or cancer.
• 1:14
  - But the problem is with how the gut
• 1:16
  - itself functions,
• 1:17
  - like IBS or irritable bowel syndrome.
• 1:21
  - So we would typically do all the tests
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  - like an EEG, Colo, CAT scan,
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  - MRIs. We'd rule out serious processes,
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  - but we... We'd still had patients who wasn't
• 1:31
  - getting... Who were not getting better. So they
• 1:34
  - were coming back to us with the same
• 1:35
  - pain, the bloating or or bowel
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  - issues. And we've done all the testing, but
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  - we hadn't
• 1:42
  - necessarily helped them get their life back. So
• 1:45
  - that experience helped lead me to Oshi Health
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  - where where I became the founding medical diet
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  - director.
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  - At Oshi, I helped build a model that
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  - brings GI medical care, diet, and gut brain
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  - health
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  - with high touch support between visits.
• 2:00
  - So it addressed the gap that I was
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  - seeing firsthand.
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  - So Viome felt like a natural extension of
• 2:05
  - that work.
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  - Once you're delivering more comprehensive care, the next
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  - question is how to make that care more
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  - personalized.
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  - So two patients can have the exact same
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  - gnosis, but very different underlying biology.
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  - So can we get better info about those
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  - differences and use it meaningfully?
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  - So broadly, that's what we're trying to offer
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  - doctors through ViomePro
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  - where I currently serve as a global medical
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  - diet director.
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  - Our microbiome tests look at what the microbes
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  - in your gut are actually doing,
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  - and our goal is to make that info
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  - useful
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  - within an actual clinical
• 2:41
  - visit.
• 2:42
  - So our main distinction is the use of
• 2:44
  - metatranscriptomics.
• 2:46
  - So other stool microbiome companies use metagenomics,
• 2:50
  - which simply look at microbial
• 2:52
  - DNA.
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  - So it tells us which organisms organisms
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  - are present,
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  - and what they could do, but doesn't tell
• 2:59
  - you exactly what they are doing. So metatranscriptomics
• 3:03
  - looks at the RNA.
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  - So we can see which genes are actually
• 3:07
  - being expressed at the time of sampling,
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  - and that tells us what they're actually doing.
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  - But how we deliver that info to a
• 3:15
  - provider is equally important.
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  - So a doc shouldn't have to become a
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  - microbiome
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  - researcher to use it. So some reports from
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  - from other companies are 60 pages long and
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  - give a long list of bacteria, but very
• 3:28
  - little help deciding what matters for the patient
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  - that's sitting in front of you. So our
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  - approach is to organize that info around functional
• 3:36
  - pathways and clinical context, giving a personalized nutrition
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  - recommendations that could help manage current disease states
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  - or even prevent those disease from occurring in
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  - the first place. And that's powerful. For for
• 3:49
  - example, looking at gene expression related to methane
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  - or or bile acid can help frame more
• 3:55
  - focused clinical talk about IBS.
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  - So those findings still all need to be
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  - in... Interpreted along the history and standard eval.
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  - But I want us to bring more clarity
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  - to a space that has been heavily shaped
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  - by the wellness
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  - industry.
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  - So doctors have reasonable questions about what is
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  - established and what remains uncertain,
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  - but we need to answer those questions clearly.
• 4:17
  - So there are published studies reporting symptom improvement
• 4:20
  - with Viome's personalized new nutrition approach
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  - including
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  - IBS.
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  - And and that's extremely encouraging, but we definitely
• 4:28
  - need more. So I want us focused on
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  - symptoms, quality of life, and in general, better
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  - clinical choices.
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  - A better score on a report is only
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  - useful if it translates into something meaningful for
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  - the patient.
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  - The other part of our work is earlier
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  - cancer detection,
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  - including cancer detect
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  - pancreatic.
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  - It's a blood test that measures enzymes made
• 4:49
  - by a pancreatic tumor called
• 4:52
  - proteases.
• 4:53
  - So these
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  - proteases bury a hole in the in the
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  - surrounding tissue and allow the cancer to actually
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  - spread.
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  - So we licensed the the underlying tech from
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  - Oregon Health and Sciences University
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  - and revalidated the data in our CLIA certified
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  - lab.
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  - So our val... Our validation data is promising
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  - especially in early stage pancreatic cancer.
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  - It's crucial because if you catch pancreatic cancer
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  - in in early stage, the the five year
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  - survival rate is forty four percent.
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  - If it spreads, that rate drops down to
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  - three percent.
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  - So what ties all of this together for
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  - me is the gap I foresaw in practice.
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  - We need to do more with the information
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  - we collect, whether that means personalized and care
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  - for someone with persistent GI symptoms or pursuing
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  - an earlier signal of pancreatic cancer, my work
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  - is about helping doctors make a useful next
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  - choice and making sure that choice helps the
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  - patient.
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  - I I wanna touch on two things that
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  - you said, doctor Bass, and and just fascinating
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  - body of research and work.
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  - The first thing is... And this will be
• 5:55
  - a quick
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  - issue discussion,
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  - is you mentioned the 60 page report.
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  - Is there anything more useless
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  - than giving somebody who's busy a 60 page
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  - report?
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  - Scott, I I really cannot think of of
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  - of a useful... Useless thing. I'm just... You
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  - know, in in a in a standard clinical
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  - visit, a doctor probably has ten or ten
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  - or fifteen minutes with that patient.
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  - So, I I mean, frankly, some of these
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  - reports, it just creates more stress
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  - stress for the patient, stress for the doctor
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  - because the, you know, doctor feels the responsibility
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  - of going over every aspect of that test.
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  - So it it could actually be
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  - detrimental to the actual care process.
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  - No. A 100%.
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  - And talk about... I mean, you're a great
• 6:45
  - constant learner. And and one of the beauties
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  - of yourself is not just a practicing gastroenterologist,
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  - but you're constantly trying to connect dots and
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  - learn.
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  - Talk to me about a few of the
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  - most interesting things that you have learned
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  - in the last several years. Like, what stands
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  - out to you that was not... If not
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  - an moment,
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  - it could be a gradual moment,
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  - but something that you learned about
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  - the biome, that you learned about care, taking
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  - care of patients
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  - that really connected with you or resonated with
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  - you? What are the few of the things
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  - you've learned over the last several years that
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  - really sort of were
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  - instrumental in how you think about things?
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  - Yeah. So, you know, when I finished,
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  - fellowship... So so, you know, this is back
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  - in 2014.
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  - So, you know, I came I came right
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  - out of standard standard medical training. So I
• 7:34
  - was a medical resident at Georgetown,
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  - a, you know, fellow at
• 7:39
  - at SUNY Downstate.
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  - And so we were given a very detailed
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  - protocol about, you know, what should happen in
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  - in standard clinical practice. So what tests we
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  - should be ordering, what what imaging imaging studies
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  - we should be getting.
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  - So
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  - when I actually started
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  - practicing practicing on on my own, I saw
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  - that a lot of the standard things we
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  - were doing didn't didn't really work.
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  - And, you know, so that's that's really kind
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  - of prompted me to start to to start
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  - thinking outside of the box.
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  - You know, we're
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  - in
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  - in general great at telling you whether you
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  - had cancer or or, you know, you know,
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  - major structural problem.
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  - But, you know, we're we're not great at
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  - at prevention
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  - and, you know, we're we're we're not great
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  - at... In GI at least at at telling
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  - you how do you manage
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  - issues when when all of our standard test
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  - test come out clear. So I mean, probably
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  - probably one of the biggest moments for for
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  - me was seeing that there... There's a lot
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  - more work that needs to be done to
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  - adequately treat patients in our field.
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  - Thank you. And and and and talk for
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  - a second about...
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  - As you look towards 2027,
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  - what are you most focused and excited about
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  - as we head into this next year?
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  - Yeah. So, I mean, as of now, currently,
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  - there there are four trends that I'm that
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  - I'm really watching closely. So first, it's the
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  - it's the move towards combining different kinds of
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  - patient data into personalized care. So we have
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  - the medical
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  - record, medication history labs, imaging studies. We have
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  - wearables tracking sleep activity, heart rate, and even
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  - glucose. So the genomic and and microbiome
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  - data add a whole separate layer to that.
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  - So this data helps care remove from being
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  - reactive to preventative.
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  - So
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  - AI is beginning to help us interpret
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  - those strengths altogether.
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  - So so the broader opportunity is to identify
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  - patterns over time and help clinicians
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  - tailor follow-up or treatment.
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  - So integrating all this reliably into routine care
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  - is still an an evolving issue,
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  - but I'm interested in systems that can tell
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  - me what changed for the patient and how
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  - that data really matters.
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  - So second is care moving from doctors visits
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  - and into the home. So remote monitoring makes
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  - it possible to follow blood pressure, glucose, or
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  - weight without waiting for your next appointment.
• 10:05
  - For for example, a a hypertension program can
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  - use a series of home readings to to
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  - support a medication review,
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  - but the delivery model itself has to include
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  - a team that reviews the info and a
• 10:17
  - clear threshold for contacting that patient. So that's
• 10:20
  - a step that actually turns a connected
• 10:22
  - device into into ongoing care. So the third
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  - is AI becoming part of the clinical workflow.
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  - So ambient
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  - documentation is already being used to draft visit
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  - notes and randomized trials are showing to... Are
• 10:35
  - beginning to measure the... Its effects on documentation
• 10:38
  - time and overall
• 10:39
  - clinician workload. So the next applications I'm watching
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  - include chart prep, re... Full coordination,
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  - and following up on incomplete tasks. For a
• 10:49
  - GI practice, that can mean helping the team
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  - identify
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  - missing prep
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  - instructions or an unresolved
• 10:57
  - pathology follow-up. So I judge all of these
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  - tools by the time, save the accuracy and
• 11:02
  - whether fewer patients fall through the cracks.
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  - So fourth is the continued migration of per...
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  - Procedures that we typically perform in the hospital
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  - into the ASCs.
• 11:12
  - I think ortho and and and joints are
• 11:15
  - are are probably the biggest
• 11:17
  - example of this. Medicare's 2026 policies expanded the
• 11:21
  - the ASC covered
• 11:22
  - seizure list and the... And began removing
• 11:25
  - procedures from the inpatient only list.
• 11:28
  - So for operators, that creates real real opportunity,
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  - but it also changes what the center needs
• 11:33
  - to do well. So patient selection and
• 11:36
  - estisia planning, home support, and follow-up become even
• 11:39
  - more important as as case complexity increases.
• 11:43
  - So, a successful outpatient ASC program has to
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  - take responsibility
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  - for the whole recovery process including the cleared
• 11:49
  - escalation plan when someone needs more help. So
• 11:52
  - I think centers that build that that capability
• 11:55
  - in will be in a strong spot.
• 11:57
  - Thank you. And and and love that. You've
• 11:59
  - had this great career as a physician, a
• 12:02
  - scientist,
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  - a a lifelong learner.
• 12:05
  - What advice do you give to people coming
• 12:06
  - out of medical school today
• 12:09
  - about enjoying their career, thriving, having an impactful
• 12:13
  - career, leaning into it?
• 12:16
  - What advice would you have to
• 12:18
  - evolving physician, evolving leader?
• 12:21
  - Yeah, Scott. So so the first piece of
• 12:23
  - advice I would give is to stay close
• 12:25
  - to clinical practice for as long as you
• 12:27
  - can. So continuing to see patients really gives
• 12:29
  - me a perspective I wouldn't get from a
• 12:31
  - product meeting or leadership the discussions alone. So
• 12:35
  - it keeps me aware of what people are
• 12:37
  - actually struggling with and what a busy clinical
• 12:39
  - team can realistically do. So if your role
• 12:42
  - takes you out of practice,
• 12:43
  - both that contact into your schedule,
• 12:46
  - Sit in on clinics, re... Review patient messages,
• 12:49
  - and ask the staff where the processes keep
• 12:51
  - breaking down. When you're evaluating a a new
• 12:54
  - tool, follow one patient all the way through
• 12:56
  - it from ordering to the result to the
• 12:59
  - follow-up. So you'll learn a lot about whether
• 13:02
  - it works in in the real world.
• 13:05
  - Second, keep learning. So when I first moved
• 13:07
  - into digital health, I had to learn about
• 13:09
  - delivering care through a completely different model. It
• 13:12
  - was hard at first, and my old and
• 13:14
  - great tendencies kept drawing me back. And now
• 13:17
  - working in
• 13:19
  - a diagnostic field, this has required me to
• 13:21
  - understand more about underlying science and how evidence
• 13:24
  - becomes a clinical product. My medical training gave
• 13:27
  - me a a foundation, but each step required
• 13:29
  - a new skill set. So my practical advice
• 13:32
  - is to pick something important to your work
• 13:35
  - that you don't understand well enough. Spend time
• 13:37
  - with the person who actually does. Ask the
• 13:39
  - basic questions. If you're working with AI, learn
• 13:42
  - how the system is evaluated and where it
• 13:44
  - fails. If you're bringing a test into practice,
• 13:47
  - learn the difference between accurately measuring a signal
• 13:50
  - and showing how acting on that result actually
• 13:52
  - helps your patient.
• 13:54
  - And then finally, be willing to reinvent
• 13:56
  - yourself and reconsider how things should be done.
• 13:59
  - My my career moved in in directions I
• 14:02
  - wouldn't have predicted
• 14:03
  - because I kept following the problems I was
• 14:05
  - seeing in practice.
• 14:07
  - And that sometimes meant meant considering a model
• 14:09
  - outside the conventional
• 14:11
  - path for a GI doc.
• 14:13
  - So health care is changing quickly. And if
• 14:14
  - you're unwilling to learn or to question an
• 14:16
  - existing approach because it's worked for you in
• 14:18
  - the past, you will get left behind. So
• 14:21
  - just be flexible and have a clear reason
• 14:23
  - for what you believe and be willing to
• 14:25
  - change your mind when the evidence or experience
• 14:27
  - changes.
• 14:28
  - Stay committed to helping patients while remaining open
• 14:31
  - to a better way of doing it.
• 14:34
  - Doctor Bass, it's so inspiring to visit with
• 14:36
  - you. It it... It's truly a pleasure. I
• 14:38
  - love what you're doing.
• 14:39
  - I wanna thank you for joining us today
• 14:41
  - on the Becker's Healthcare Podcast. What an absolute
• 14:43
  - pleasure with a remarkable career. Thank you for
• 14:46
  - joining us. Scott, thank you so much.