(wondrous music)
- This is Lab Medicine Rounds,
a curated podcast for physicians,
laboratory professionals, and students.
I'm your host, Justin Kreuter, the bow tie bandit of blood,
a transfusion medicine pathologist at Mayo Clinic.
Today's a special treat,
we're rounding with Dr. Bill Morice,
Professor of Laboratory Medicine and Pathology,
Chair of the Department of Laboratory Medicine and Pathology
here at Mayo Clinic,
and also President of Mayo Clinic Laboratories.
Also, really relevant for today's conversation,
he is chair of the American Clinical Lab Association.
Today, we're talking about laboratory's role
in health and equity and why it's so important.
So thanks for joining us today, Dr. Morice.
- Oh, thanks for having me, Dr. Kreuter,
Justin, and thanks.
A really very timely topic,
so I'm delighted to be talking about it.
- Absolutely, so this might be
kind of a little bit of a perspective shift,
something that we're not used to thinking about as much
in laboratory medicine, or maybe at some levels,
it's something that's been
very much part of the conversation for some time,
but this is, the audience is very wide.
We've got clinicians, we've got students,
we've got laboratory professionals,
that tune into this podcast,
so could you start us off with why is health equity
important for laboratory medicine and pathology?
- Well, it's first of all, why it's important,
I mean, health equity is an issue
that was a real boilerplate issue prior to the pandemic,
but the way the pandemic, the COVID-19 pandemic,
of course, has played out, has really highlighted
the dramatic inequities in healthcare distribution,
both within this country and in globally.
And so, the important role of diagnostics, of course,
in managing and responding to the pandemic
has really highlighted the role of diagnostics
as part of that equation, which we can get into.
The interesting thing is that it's not a new topic.
If you go back and look, one of the,
the person that many of us think of
as sort of the godfather of modern pathology,
which is Virchow,
actually was very passionate about this issue.
He did a study of,
I think it was a typhus outbreak in upper Silesia.
part of Poland that was more, was a miners,
coal miners, they were kind of the lower socioeconomic group
and that country
had really dramatic impact there because of
the living conditions and their access to care.
And so he started writing about this and becoming passionate
about this well over a hundred years ago.
So interestingly enough,
it might be the new topic right now,
but it really goes back to the founding of pathology.
- I love how you tie this in really to the birth
of our specialty, right?
So this is something that is entwined in.
And I like also you're highlighting that it's really
this diagnostics effort.
So this has been around for a long time.
You're saying even before the pandemic,
this was a boiler plate issue.
The pandemic has really heightened a lot of these issues.
So what are we learning about how as a laboratory,
we may better advocate for health equity?
- Well, there's a few really important lessons
that we are learning,
like many of the lessons taught by COVID, difficult lessons,
but ones that we really have to pay attention to.
So one is, and I actually wrote a blog post
about this, in the T3 blog post,
I think on ASU's website, Arizona State University.
But if you look by zip code and in places like in Boston
and New York City, where they've actually studied this,
you can see an inverse proportion or an inverse relationship
between poor outcomes for COVID-19
and access to diagnostic testing,
'cause they were tracking by zip code,
the frequency of testing.
And you can see that in areas that had poor outcomes,
there was less testing.
And of course those tend to be lower socioeconomic groups.
Why this is so important is that if you think back to when
we really were first responding to COVID
and thinking about tracking, testing,
tracking, and isolation as a key public health approach,
imagining the pandemic,
what that meant was that in areas that probably had closer
living conditions also had more people in service industries
that couldn't work remotely.
You actually had less testing.
And so then you have more spread of disease
and also in areas where they had less access to healthcare.
So it really just showed how the lack of good access
to testing was really undermining what we wanted to do
to protect those who were actually most vulnerable
to poor outcome from COVID.
So I think that has really catapulted the whole issue
of testing and how we use testing back
to the kind of the forefront of
the healthcare disparities discussion.
- Now, if we unpack this a little bit,
it seems like this data you're talking about,
it highlights the lack of testing and then how that's
so central and it's such a driver of many
of aspects of health and equity.
Where do you, it seems like it's a,
I don't know if it's one of those wicked problems.
It's very complex.
It's not just more testing,
but what's the nuance there that we need
to kind of grapple with.
Not just more testing, but I guess better testing.
- Yeah, yeah, and access to testing.
I think there's really two things that we have
to start thinking about as a laboratory community.
That one is with COVID and the big push for home testing,
just look at the last wave with Omicron,
and the massive investment in angio testing,
is that and thinking about app based,
apps that you can use and companies like Q,
where you can have a box in your home,
is that to really be thinking about not just getting those
to where there's a cool business case,
but to where there's a social case
for access to those tests.
How can we start thinking about it in a digital world where
there's more access to diagnostics?
It really falls on our profession to be the voice of where
those, just like every laboratory in the hospital,
we think about where we need hospital clinical labs
to support care.
When we start thinking about the digitization
and the building of remote diagnostics,
we need to be really thinking about where those diagnostics
are gonna have the biggest impact
and really advocating for that.
Case in point, you think about those,
why do some of those lower socioeconomic groups
have poor outcomes to COVID?
Because they have a higher frequency of comorbidities,
like diabetes and things that really could
be managed effectively if there
were better diagnostics early on.
So you didn't have patients with end stage disease.
So really thinking about what can diagnostics do
to help people as we go forward,
in terms of prevention and wellbeing,
becomes them really important
because we have to advocate for that for our patients.
That's number one,
the other is just really understanding why people wouldn't
wanna use a test.
And again, and that means how that information's used,
because what we found is that even when some of these
testing clinics were set up and we've seen this both
in the US and globally, as I've been participating.
And the other thing I did,
I actually worked with the World Economic Forum
on a group looking at access to COVID diagnostics globally
in low and middle income countries.
And you talked to a lot about, hey,
we could use these tests to keep people from going to work
when they're sick.
Well, if they're people that depend on,
they might have a whole household,
depending on them going and being able to drive a truck
across the border, they're not gonna wanna get tested.
So really also thinking about how do we influence policy
in a way,
and that's where the American Clinical Lab Association
is important for me.
So how do you think about policies
that can help support people wanting to actually get access
to the test?
Because it's a whole milieu but going full circle
is our profession is really,
it's not just about doing testing,
it's about thinking about all
these issues that surround testing.
- You bring in a lot of really neat opportunities.
You've been able to see this problem from a couple
of different perspectives.
You're talking about changing this from a business case.
And I think that's what a lot of us
are typically thinking about.
'Cause we're justifying our actions,
to switching ourselves to thinking about it
from a social case.
That that might be kind of new for some of these efforts,
I guess, are there other,
are there examples of how we can do this better
from other professions that we can learn from?
- Well really other professions and other,
really other groups, right?
So like one of the things that was really gratifying for me
was Walé, from our Diversity Equity Inclusion Group,
Elegbede, I was gonna,
I didn't wanna mispronounce his last name,
actually is very active,
I think even leads the local chapter of the NAACP.
So getting out there with community groups,
as a laboratorian, talking about how tests work,
what they can tell you, what they can't.
So really actually I think a real opportunity for us is
to think about community engagement,
which is not something we typically think about
in lab medicine, right?
There's a lot of groups that are really good with this
because it's really A, understanding,
what in those different communities and cultures,
how testing is perceived and then being able to help
advocate for that.
So I think that's one area.
And of course, actually your area transfusion medicine,
probably any area in DLNP with blood drives
and other things,
it kind of, that community engagement's more part of
the fabric of your division.
We have to start thinking about that,
not just for transfusion medicine,
but really for laboratory medicine.
And how do we do that?
I think that's a really important one.
- So switching also to the policy,
you mentioned to really kind of untangle some of these, you,
I love the take on the take of that negative perspective
on that of like,
why wouldn't somebody do a lab test and then how that really
gets to some of those policy challenges that we have.
Is that something that's kind of,
you feel like that your previous experience as
a pathologist, as a hematopathologist
has kind of prepared you for, or are these
additional skills that you've kind of picked up
along the way?
- I think a little bit of both.
I mean, I think in essence,
it really all derives from what drew me into lab medicine.
And that is how do we create information that's accessible
and actionable for patients and providers.
That's really the mindset.
And how do you make sure that's high quality?
How do you make sure that it's understood?
That part is natural.
Now thinking about how people outside
of our profession,
and we spend a lot of time just in medicine explaining this,
even to people that are using the labs that are other
physicians and providers.
So then you have to take that and think
from an even bigger scale,
how do you make that understandable for people
that aren't in healthcare?
It's a big challenge.
So I think things like your podcast,
things that, thinking about how you
communicate issues outside of healthcare
is an acquired skill and one that you can learn.
And you can learn by doing.
So that's probably the new skillset.
Everything in life is,
one thing I've learned in leadership,
it's all about timing.
The timing is critical.
'Cause for the first time,
really there's an awareness in the highest levels
of policy makers of some of these issues
and a desire to address it.
So they're looking for, their ear's attuned
to a voice.
Case in point, going back,
there was massive investments.
There have been massive investments.
You read in the papers
about the White House buying 500 million anti tests.
And I read that and think about what difference
is that really gonna make?
I mean, if it's just people that can afford to go
to Walmart and buy the tests
and know what they wanna do with the results,
it's not gonna get us where we need to go.
And I think there is a frustration from policy makers
about why isn't this making a difference.
I think going back, I mean,
we've always been about the why,
we just have to make sure we're helping
with the right questions,
but we're the right people to do it.
I'm convinced of that.
- I love this.
So what are these,
you've mentioned a couple barriers that kind of
have been in the way.
Can you kind of take the listeners through,
what are two or three ways that we here
are trying to navigate this
for increasing healthcare equity?
- Yeah, well, I think one, there are a couple ways.
One is some of the community engagement work through Wale
and others, it's just getting out there.
I mean, and I don't wanna say it really
is listening before talking.
So really listening and understanding.
I mean, that's goes back to our Franciscan values.
Of course, St. Francis was, that was his, it's better
to understand than be understood.
So I think getting out there,
hearing voices of people that maybe aren't showing up
to a Mayo Clinic,
aren't showing up to healthcare facilities,
understanding why, understanding what some
of those barriers are.
I think that's one thing that we're,
a lot of us in Mayo are doing,
a lot of people in healthcare are doing.
I think that's really first and foremost
because it's really,
we have to be just like when we're in the lab,
we are really thinking about the patient.
We're the person in the lab and at our microscope
or in getting a product ready,
that's thinking about what does that patient need?
We're the voice for the patient in that process.
And now we have to be the voice for the community
in this process, too.
So that's one thing that we're doing.
The other is that through, with Mayo,
is really one of the things that we've been very active with
is actually forming partnerships
with diagnostic manufacturing industry,
with companies like Thermo, because ultimately,
the manufacturers of these products have
to understand how they're gonna be used or not used.
And again, if we are,
don't have a great sensitivity to that,
many of those companies even less.
So I think it being, stepping outside of our offices,
stepping outside of our walls and really starting to think
about a whole ecosystem that has to exist,
from digital tools to the right test,
to the right kind of follow up actions that are needed,
we have to do all this.
And there's different areas of lab medicine
infectious disease has always had.
And clin micro always has had a strong presence
in public health.
So thinking about the things that are natural connections
and how do we start to amplify them?
I think that's the other thing
that we're really thinking about now
that we weren't a couple years ago.
- Unpacked, as you brought up kind of partnering
with these, the industry
that's developing diagnostic testing.
How can we, what does that look like?
Can you kind of unpack that for a little bit?
'Cause I can mention some of our listeners might,
they hear you say those words, but
what does that look like?
What kind of feedback can a pathologist provide
that helps them kind of build a better test?
- Sure, a couple,
I'll give you a couple real tangible examples.
So one of these things that have been around,
really, I think started right around when
I started my job in 2015,
as department chair, which is hard to believe
I've been in this role that long, but was
these things, the devices that could draw blood without
a needle that you could send to someone's home.
There are a few companies that are out there.
Early on in the pandemic,
we thought about the potential for serologic testing.
So we actually just talked to the company, said,
can you send us some?
And we can test them.
And we had a group including Dr. Pritt,
and some others that actually tested a few of them
and just found some things that would make
it really problematic to use them.
And you start thinking about,
especially if they're complicated,
you can give that feedback back.
And some of these companies now are thinking about, wow,
you know, we can't just make this device,
we might have to have a call center.
We might have to have a video link that can help someone
understand how to use it.
And then also saying what you actually need from
a specimen type to be able to use it.
So if we need to quantify, a dry blood spot
is something we have, been around for a long time,
it's very difficult to get like a quantitative serology
off of a dry blood spot.
So you start talking about with those companies
about how you'd wanna use it,
and then they can start a whole conversation.
And so those are some of the things
that I think, that's kind of how that goes.
Like, but you'll find out that
oftentimes they just don't have a lot
of those conversations naturally.
So they're often very appreciative,
even if it's just like, we wanna use this in our community.
Can we get some exposure to the technology?
Can we talk to someone on your end?
Like if we wanted to roll it out, say, to work with it,
a lot of this is again, very, very specific.
So it might be like work we've done in the past
with migrant workers.
So you start to think about some of those things.
- It's really great.
I love how I think you're helping
our listeners kind of,
don't short change this role of the pathologist,
where we have expertise, where we got one leg, you know,
firmly planted in laboratory
and the other leg firmly planted in the clinical practice.
And to understand that we often hear
what are those pain points on getting a test accomplished.
And that's something that's very valuable to manufacturers
and that collaboration is what I'm also hearing
in your answer is, actively reaching out,
helping to develop this will hopefully result in something
that's gonna be much better for patients in the long run.
- Oh, absolutely, and thinking about that.
We have that expertise and how do we start to apply it
for the long term?
So it makes a real difference in these issues.
And I'll take you back to one of the early days.
So it's probably late March of 2020,
and I'm sitting in my office at SDSC right around midnight,
just trying to get through things
and get through my emails 'cause of the onslaught.
And one of the emails that I get is from someone from a,
one of the native American tribes here
in the state of Minnesota
with a desperate plea, can we get some COVID testing?
We have a lot of elderly.
We have a lot of people with healthcare conditions
and we have a lot of communal living and just really,
and no testing whatsoever.
And so I brought that back to Scott Beck,
we got really passionate.
John Heywood at Mayo Clinic Labs has helped a lot with this,
but you realize it takes us a sustained effort.
I mean, it's not something that can be built over night
and we can't lose that now.
We're all gonna wanna forget about COVID,
but now it's been two years.
And everyone's burned out on COVID.
But the reality is for us in the labs,
we have our foot on both sides, as you say,
and we know the issues and it's just applying those
in a different setting.
And it's, I think it's more long term work,
but overall all it's the right thing.
And it makes such a,
it can make such an impact for people,
even just simple tests
and having access to them.
So that's this experience I'll certainly never,
that's really, after meeting. I was like,
wow, that's important.
And I think if there's one thing I can share with
the listeners is that is making
that experience relatable for them.
'Cause it is easy.
It's easy to become sort of a immure to it
because we're two steps removed,
but we're so important in terms of coming up
with the right solution.
- Absolutely, absolutely, right.
And one of the, what I'm hearing in your answer too,
is this concept of it's we don't just learn
from experience, but we learn by reflecting on experience.
And I think what I hear you say is, you know, yeah,
everybody's excited to get past and hopeful
to get past COVID and to kind of close a chapter.
But like you're saying,
there was a lot of innovation that came out
of this period as well,
and lessons learned and it would be a shame not to learn
those lessons and carry that forward into the future.
- Yeah, I agree.
And yeah, I mean, just for the listeners,
just about everyone listening,
you probably know more than you realize
and have more to contribute to the solution
than you realize.
Just, I mean, that's certainly, for me.
They're just very what we would almost think of
as simple questions that really need to be addressed.
So don't underestimate your ability to really make an impact
on this, even though it seems like, wow,
lab testing and healthcare equity,
how am I ever gonna effect that?
That's such a huge problem.
So, and I think the pandemic means
that there's a receptive year
and there's a real chance to make a difference.
- So let's just zoom out.
I've got one final question about
kind of based on what we discussed here,
like, taking this optimistic, future view,
what is the future of health equity look like?
What does that laboratory support
of health equity look like,
in the coming years?
- I think that, well, how it will evolve
I don't know.
I think that the ideal future state that we should
be working towards is that no matter
what community you're living in,
that there is enough education and awareness of
the kind of tests that you need to be doing
to understand your health
and the knowledge around that result
to help you turn it into something actionable,
whether it's even something as simple as you might have
pre-diabetes, here are some healthcare choices you can make.
Here are some things you're doing in your community.
Maybe even go back to community groups and say,
we need more healthy food options in this area
as a for instance.
So it's a system whereby an individual can create data
around their health,
that's really actionable in helping them lead healthier
and more fulfilling lives.
And at the same time,
we're taking all that information and understanding
where we need to make societal changes
or policy changes that give people
a more healthy environment to live in.
- That's awesome, we've been rounding
with Dr. Morice on the laboratory's role
in health and equity.
Thank you so much for being here with us today.
- Oh, it was my pleasure, anytime.
- So we're definitely gonna link,
Dr. Morice mentioned that he wrote a blog.
We're gonna be linking that in the show notes.
And if you'd like to hear more on this topic,
be sure to register for the Phlebotomy 2022 conference,
Performance, Public Health,
and People In a Post COVID World.
Dr. Morice will be presenting on this topic
at this year's virtual conference
that's gonna be on April 21st and 22nd of 2022.
And for more information,
please visit MayoClinicLabs.com/2022Phlebotomy.
To all of our listeners, thank you for joining us today.
We invite you to share your thoughts
and suggestions via email.
Please direct any suggestions to MCLEducation@Mayo.edu.
As always, if you've enjoyed Lab Medicine Rounds podcast,
please follow or subscribe.
And until our next rounds together,
we encourage you to continue to connect lab medicine
and the clinical practice through insightful conversations.
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