Charles Strom on the Diagnostics Industry

Bloomberg Radio host Barry Ritholtz speaks with Dr. Charles Strom, who has spent the past 30 years in the fast-changing field of genetic testing. The CEO and co-founder of Liquid Diagnostics, which uses new technology to analyze ultra-short DNA fragments in saliva and blood, Strom previously served as medical director for genetic testing at Quest Diagnostics, did groundbreaking work in pre-implantation genetics while at the Reproductive Genetics Institute, and served as a faculty member at the University of Chicago, where he also earned his doctorate and medical degrees.  

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Episode Transcript

Speaker 1 (00:00):
M. This is Mesters in Business with Very Renaults on
Bluebird Radio. This week on the podcast, I have an
extra special guest. His name is Dr Charles Strom, and
he is the CEO and co founder of Liquid Diagnostics,
an advanced testing company. He has several decades of experience

(00:25):
in the field of genetic testing. He ran Quest Diagnostics
Labs for sixteen years, and we really just began to
scratch the surface of his mark. I didn't get to
the sixty Minutes episode he appeared on, or or his
appearances on Oprah, but we did talk about COVID testing

(00:45):
and why we're not looking at antibodies. Dr Strom thinks
we should be. If you want to decide whether you
need a booster or a second booster, wouldn't it be
helpful to know if you're actually at a high level
of antibodies or a low level of anybodies. When we
talk about that early detection for certain types of lung
cancers and how the world of genetics is just rapidly

(01:09):
changing the way we not only detect potentially dangerous diseases,
but some of the treatments we do, it's really quite fascinating. So,
with no further ado, my conversation with Liquid Diagnostics Dr
Charles Strom. This is Mesters in Business with very renaults

(01:31):
on Bloomberg Radio. I'm Barry Hults. You're listening to Masters
in Business on Bloomberg Radio. My special guest this week
is Dr Charles Strom. He is the CEO and co
founder of Liquid Diagnostics. Dr Strom has pioneered the use
of DNA testing for forensic and paternity applications before joining

(01:54):
Quest Diagnostics, where he was the medical director for genetic testing.
His work has led him to appearances on such shows
as Sixty Minutes and Oprah. Dr buck Strom, Welcome to Bloomberg.
Thank you for having me, Baron my pleasure. So let's
start a little bit with your educational background. You graduate

(02:15):
University of Chicago with both a PhD in biology and
a medical degree. Was the plan always to work in genetics. Yes,
from the time I was in seventh grade, I knew
I wanted to be a scientist, and as an undergraduate
I became interested in prenatal diagnosis in particular. And when

(02:39):
I was an undergraduate, I did research and found that
one of the centers to do that research was at
University of Chicago. In one of my early mentors. Albert
Dorfman had published paper on prenatal diagnosis for Hunter syndrome.
So I actually sent him a letter. Uh, typed it

(03:01):
out on my Smith Corona electric typewriter, send it to him,
and lo and behold. A month later, I got a
packet of information saying how would you like to come
work on my lab over the summer, and uh, that
led to my entering an m D pH d program
that was called the Medical Scientist Training Program. Was a

(03:22):
federally funded program paid for my tuition and gave me
a living stipend as a six year program turned my
m D and PhD. So yeah, I was always my
plan to be a medical scientist. And you worked under
biochemical geneticist William Nihan, who's kind of legendary in that field.

(03:44):
Tell us a little bit about working with Dr Nihan
and what you learned from him and what that experience
was like, Yeah, well that was fabulous. So again this
was a cold call. I started out in between my
freshman and stophmore year of college, and um, my advisor
and the master of my college was a scientist named

(04:08):
Richard Goldslee, and UH said, Hey, I have a buddy,
Dr William Ihan out in San Diego. Uh, maybe I
could send a letter and you could go out and
work for him over the summer between your freshman sophomore
year in college. And it was like, you know, somebody
asking me if if I wanted to work for the pope,
and I said, yes, sure of course I do. And

(04:31):
same thing. He welcomed me. He had me in the
laboratory and he and and his partner Larry Sweetman got
me hooked on biochemical genetics. And then after I you know,
went to medical school got my MDI got my PhD. Uh.

(04:51):
The obvious choice for me to do a residency was
at University of California, San Diego, where Dr and I
had had become the chairman of the department. So that
was just the no brainers. So I ended up doing
my residency there and for the three years of my
residency and fellowship, I worked with William Nihan, who has
an encyclopedic knowledge of biochemical genetics, and it was just

(05:15):
a fabulous experience for me. Yeah, I can imagine. So
tell us about some of the grants to pursue genetics
of growth disorders that you were working on at the
University of Chicago. They seem really quite fascinating. So from
a very early age, I was interested in developmental biology,
which is the science studying the mechanisms by which we

(05:38):
go from UM an embryo in which all cells are
identical UH, to an adult where we have hundreds of
difference of specialized cells. And Albert Dorfan my mentor University
of Chicago, was working on the differentiation of cartilage in chickens. UH.

(06:00):
So I was cutting off them buds from nine dozen
chickens a week UH and growing up in tissue culture
and UH they would differentiate into mature contraslits, into mature
cartage cells and tissue culture. And so I worked on that.
And then when that was all before DNA sequencing DNA

(06:21):
analysis was available. And then when cloning started, gene cloning UM,
I got a grant to UH to clone the gene
for humans cartless specific collagen and to see how that
got turned on during development. It was very exciting. So

(06:41):
how does that lead to pioneering DNA testing for forensic
and paternity applications? So I've always been what I call
an applied scientist. You know, the scientists out there really
come in two forms. One is the basic scientists, the
person that really wants to delve incredibly deeply, UH into

(07:06):
one particular problem. UH. There used to be a thing
about the medical practitioners that the general practitioner knows nothing
about everything, that the specialist knows everything about nothing, and
the pathologist knows everything about everything, but it's too late
to do any good. So the basic scientists delves very

(07:27):
deeply into a single subject. I always was more interested
in how are we going to use these developments to
help people, in particular the medical aspects. Now they would
call it translational medicine, but how are we going to
take what we learned at the lab bench and put
it into practice? So I was the professor at University

(07:50):
of Chicago. DNA testing for forensics was just in its infancy.
There was the Blooding I don't know if you remember that,
where an entire village was genotyped UH in England to
find a rapist, and forensics DNA had not yet been
admitted into courts in UH. In Illinois, I was approached

(08:13):
by several different prosecutors who had very difficult cases and
asked if I could you know, if I could do
DNA testing to support their cases, and being in academics
and having some academic freedom, I I said yes and
did the did some DNA testing and UH in UH

(08:38):
in legal in Illinois. I don't know if this is
around the United States. There's something called a fry hearing
where before UH laboratory evidence can be introduced in court,
it has to pass a certain amount of standards, um,
whether it's generally accepted in the scientific community, whether it's reliable,

(09:00):
those sorts of things. And so I participated in several
pry hearings in Illinois to allow the admission of DNA
testing and forensics. And my famous case, the one I
published about, was a gentleman who had actually murdered his
wife and then burned her body to UH near completion

(09:28):
in the steel drum in his garage. UH. Then he
went to the police station and decided to confess, and
then when he got an attorney, he withdrew his confession.
So the prosecutors kind of knew that he had done it,
but I had no way. There was nobody to h

(09:49):
to be identified. So we were able to actually to
identify his wife from the charred remains in UH the
steel drum. UH and you know, the pry evidence was
accepted and he was convicted. So that was basically my
my moment in the sun in forensics, and I never
really did anything after that. Quite fascinating. So you work

(10:14):
at QUESTS for a couple of years where you're head
of the research labs, and eventually, um you're working with
Dr David Wang tell us about Imperial technology and what
Dr Wang had created. So I had worked in QUEST
Diagnostics or sixteen years basically running all the genetic laboratories.

(10:36):
And after I left, I took a temporary position to
be the director of the molecular pathology laboratories at u
c l A. This was because of they were trying
to recruit a permanent director. I was in semi retirement
and so you know, I took a temporary job working

(10:57):
out for u C l A for a couple of
days a week. Then one day my boss calls me
in and she says, um, buck, we have a problem.
There is a dentist in the dental school by the
name of David Wong who has just gotten a grant,
and part of the grant was that our laboratory would

(11:18):
validate the test. As a laboratory developed test so it
could be offered clinically. Um, the pathologist who had co
written that Grant had left the left the institution, and
so she says, you've got to go up and see
what's going on and see what we can do. So
I take the elevator up to the seventh floor the

(11:39):
Basic Science Building at U C l A. And I
go up to meet with Dr Long and it was like,
oh my god, that's the guy, because I had met
him about ten years previously when he had given a
talk at Quest Diagnostic and he had dedicated his life
to saliva based diagnostics. And when he gave a talk,

(12:03):
I was blown away and said to myself and came
home and said to my wife, you know, this guy's
a visionary. And we had lunch afterwards and we had
a wonderful talk and it was like you know, a
rom com. We saw each other in the hallway and
it was Bucked. It was David Uh and he said,
let me show you what I got here. And Um.

(12:25):
He had developed a platform which at that time was
called e Firm we now call it Imperial, which could
do UH diagnostics of anti biomolecule including d n A,
including antibodies including protein on saliva UH as an open
platform UH, and he had used this UH to actually

(12:51):
UH demonstrate that he could UH detect circulating tumor DNA
in patients with early stage lung cancer, something that had
never been done before successfully. UM and I looked at
this data and it knocked my socks off, and I said,
you know, baby, I want to work with you here.

(13:11):
So it began a wonderful collaboration UM and I became
blown away by the potential of this platform. The problem
is that Dr Long is an academic. He had no
idea of how to commercialize anything. I had come from
sixteen years in the diagnostic industry, so my expertise was

(13:33):
it was complimentary to his. I knew how to make
essays that could be used hundreds of thousands of times
and give accurate results. So I was very excited. But
in order to commercialize the intellectual property has to be
in order. There has to be an organization, there has
to be funding. And then I reached out to friends

(13:56):
of mine who were also UH leaders in their deal
Bob AGNERN, who was an executive in Amaco for many years.
I was a lawyer and ran businesses for Amaco, Jeff Weisberg,
who started uh Atina Diagnostics, one of the major neurology
diagnostics companies and was a financial guy. And my friend

(14:21):
Rich Bender, who was a medical oncologist. All of these
people I knew from from past life. Bob, where I
knew from from little e Um, and the other two
I admit a quest diagnosis and full disclosure. I met
you through Bob Agdern, who is my brother UM, and
I was so intrigued by the work you guys have

(14:41):
been doing. We've been talking about this for a couple
of years. Before we move on to COVID, I have
to you know, you kinda buried the lead about the
lung cancer. The key thing about those early indicators is
that this is very difficult to diagnose, and if you

(15:02):
catch it early, it's very treatable, and if you catch
it late, it tends to have a very bad outcome.
Is that a fair way to describe it. Absolutely, About
eight lung cancer now is diagnosed. That stage is three
to four where it's not curable. Um, you know, you
can be treated, it can prolong your life, but basically

(15:24):
you're going to die. A lung cancer stage one and two,
which is what we call early stage lung cancer. It
is still potentially curable with both surgery and chemotherapy or
a combination of both, and that's why it's so important
to diagnose this early. But eight percent of the time
it's not. There is a screening test now that's available,

(15:46):
which is a spiral CT scan for people who have
long histories of smoking and UM. The problem with with
spiral CT scanning is that you get these things called
terminate nodules. So some people have you do the CT
scan and it's, oh, this has got to be cancer.
Sometimes you do the CT scan and it's negative. But

(16:09):
about thirty of the time you do the CT scan
and there's something there, but you don't know whether it's
cancer or not. UH. And we have an NIH funded
study to use our platform to look at these patients
within determinate nodules using either saliva or plasma or both
to see if we can inform the decision about who

(16:32):
needs a biopsy UH and who doesn't need a biopsy,
and how the results have been so far, we're in
the middle of it. We have not yet done any
of the data analysis we're right now. We're collecting, we're
collecting samples and they'll be analyzed actually next year. So
I can't tell you how it's going, uh, but we're

(16:54):
hoping that it's it's going to give us positive results.
So that was the original plan. When you form liquid
diagnostics and then you know COVID and the pandemic starts
and we go into lockdown, how did you guys pivot
to using this technology to either detect COVID or look
at antibodies or both. So interesting story. So, Uh, doctor

(17:19):
Wong is a dentist and he had an incredible interest
in a disease called Schogrin syndrome. Schogrin syndrome is an
autoimmune disease where the body attacks itself and it causes
dry mouth and dry eyes. Uh. There's actually four million
people who present to their physicians every year with that complaint,

(17:41):
either dry mouth, dry eyes or false um. It was
known that some of these patients who present with dry
mouth and dry eyes actually have a disorder called chogrin syndrome,
which is where the salivary glands make anna where antibodies
are made that attack the salivary glands. UM. The the

(18:02):
diagnosis of chagrin syndrome was incredibly difficult because the blood
based antibodies, UH, we're not particularly sensitive or specific for
the disease, so people often had to have biopsies UH,
and most people didn't want to have a biopsy of
a salivary gland. UH. So he began to use our platform,

(18:22):
Imperial platform, to look for antibody in saliva. And it
turns out that that is a much better way of
diagnosing chagrin syndrome than in blood. So we knew that
we could use this platform for antibodies. So I remember
it was mid February and the beginning of the pandemic,
and I said to our group at Liquid Diagnostics, you know,

(18:45):
I think we could use this to measure covid antibody.
And I remember Bob said, well, you know, how much
is that going to cost? And they said, well, you know,
maybe you know, five or ten thousand dollars to buy
the re agents or things, um, and the rest they
say is history. We were able to make a saliva
based diagnostic, which is quantitative, which is very different from

(19:07):
almost all other antibody measuring tests available that can measure
your unoglobulin g R I d T levels to U
Sorrow's c O G two which is the virus that
causes UH COVID nineteen. So so let me interrupt you
and just translate that into English for a second. Most
of the tests, either the rapid test or the PCR

(19:29):
test is going to give you thumbs up thumbs downy,
either you're showing this or you don't. You're able to
do a measurement that quantifies shows you your levels of COVID.
Anybody's am I saying that? Right? That's correct. They'll very
PCR doesn't measure antibodies. PCR measures viruses. But yes, most

(19:49):
most of the well all of the home tests are qualitative.
They're not quantitative, which means they tell you positive or negative.
The laboratory tests are what's called semi quantitative. They give
you a number that's pretty meaningless. It says, you know,
three point one or three point two, and you don't
really know what to do about it. Our test actually
gives you the level of your antibody, and then we

(20:12):
also tell you how you stand with respect to you know,
several thousand samples that we have from individuals who have
been vaccinated. So they'll say, Barry, your level is four
point two. An anagrams per m L when you say
what does that mean? Then we tell you you're in
the eightieth percentile for all patients who have been vaccinated

(20:34):
against COVID, so you know you've got good, healthy levels.
On the other hand, you could get a level that says,
you know, it's ten managrams per m L and this
is at the tenth percentile, which means you know that
you are you're low on the scale. UH. The other
beauty of this test is because it's saliva base, you
don't have to have your blood drawn, and it's relatively inexpensive.

(20:56):
You can have multiple tests. So, for example, we have
a clinical trial going which I'm a participant, where we
looked at people's levels every two weeks UH for for
six months. And when we looked at that, we could
see that that most people's levels went up after their
second vaccination, but then they slowly came down so that

(21:19):
by from four to six months they were almost back
down the baseline, which would mean that we could have
probably predicted that you're going to need a booster after
six months. That that sounds like it's really useful given
that there's been a pretty big push to not only
get people to get boosted, but then to get a
second booster. So I'm vaccinated, I'm boosted. I would like

(21:41):
to know if I should get a booster now heading
into the summer or in the fall, when I usually
get my flu shot, because that's when when we move indoors.
These viruses seem to be spread around the most in
at least in the cooler areas of the country. Yeah. Right,
that's a great point. So you know, the issue is,

(22:03):
you know, I know now that after my third booster,
the third shot, so the first booster, that my levels
now eight months out are the same as they were,
uh two weeks after my third booster. So I don't
feel that at this moment I need a fourth booster.

(22:25):
And you know, there's no dated to say that that's
good or bad. Unfortunately, FDA says that a person of
my age could get a fourth shot if I wanted,
But there's no reasonable way for me to make that
decision right now. A lot of my friends that said
I'm going to take I'm going to take the fourth shot. Um.

(22:47):
Your point is is well taken that if you take
the fourth shot, who knows if you're gonna be able
to get a tip shot. UM or when? So you know,
we have that luxury of those who have participated in
our trial of knowing that our levels are stable over time.
Um again, you know this is this is the personal

(23:10):
decision that I'm making, you know, with myself and my position,
and I can't say that you know that there's a
recommendation about this sort of thing, But this is the
kind of data that we need. The beauty of our
tests is that we could actually get the data that
would inform these kinds of decisions. So we could look

(23:31):
at a whole bunch of people, say, you know, everybody
in a city, or everybody in a large company, and
we could test people every month for their quantitative antibody levels,
and then we can follow them and see who gets COVID,
who doesn't get COVID, who goes into the hospital, who
gets long COVID, you know, who dies, and then correlate

(23:55):
that with our antibody levels and see if our hypothesis
are correct. The problem is, as far as I know,
nobody is doing these sorts of tests because the blood
tests are only semi quantitive at quantitative At the moment,
the quantitative tests are expensive to do, and this study
would be very expensive to perform. So it frustrates me.

(24:18):
Is I believe we have a tool we published on
this Imperaview Publications where we could do these sorts of studies.
We could get the information because COVID is not going away.
That's the one thing that's sure. Uh this is going
to be part of our lives for the foreseeable future,
and we need to start getting information that will allow

(24:39):
physicians and people to make informed decisions about things like vaccines.
For example, what if your vaccine level, your your antibody
level is very low, and you've already gotten your four
uh M R and a booster as well. Now there's
gonna be a new vaccine this summer. I hear that's
based on the old technology of antagine technology. So maybe

(25:02):
that would be someone who would want to get that
vaccine because they're not responding very well to the m
RNA vaccines. Now, one of the issues, you know, in
public health, everybody is treated like they're the same, and
what we're finding in terms of antibody production and antibody
affinity is that everybody is not the same. Um. For example,

(25:26):
with all macron, some people's i g G antibodies that
were made with the the original visor M dinner vaccines.
They cross react, you know, nearly, so that the antibodies
that these people make are just as good against A
macron as they were against the original virus. On the

(25:49):
other hand, some of the people their antibodies have less
than fifty of the affinity. Uh, then thanking for the
wild type. So sort of uh. And we're able to
make that assett because it's an open platform. We can
make an asset for O macron within weeks of when
O macron is first identifying. So I think that these

(26:13):
sorts of these sorts of studies could really help inform
on what's going on. Some of the you know, critics
of antibody testing say, well, we don't want people doing
risky behavior because they know they have antibodies. My response
to that is, well, if you don't you have antibody
and you've been vaccinated, you should feel free to do

(26:34):
everything that the CDC says a vaccinated person should do.
But I'm looking at the flip side. What if your
antibodies are low, Uh, then maybe you should not do
everything that a vaccinated person could do, or you should
and you should talk to your doctor about maybe doing something.
Either a booster with the same vaccine or a different vaccine, uh,

(26:58):
to try to get those levels up. So again, there's
not enough data to make any real recommendations at the moment.
And I would like to, you know, I would like
people to think about using our tests to um to
either do the research or or to make their own
informed decisions. So you mentioned the c d C, Um,

(27:22):
what are they doing about the entire space of anybody's?
Is this something that they're just not paying attention to
do they really think people with high anybody's are going
to go out and be reckless? What does the CDC
say about knowing what your anybody levels are? Yeah, well,

(27:43):
the CDC and FDA boats have made public statements that
they don't think that measuring antibody levels have any role
in the pandemic. Uh. And you know, I can see
the point, you know, to them, as I said in public,
tell everybody is a human being and everybody is the same. Uh.

(28:05):
So you know that's been their position, and we're gonna
we're gonna make recommendations, you know, for everybody, and and
it will work for most people. So the issue about
whether or not to be vaccinated or not, that's a
political issue about whether you can force vaccinations on people.
I think a more interesting question is that, certainly internationally, Uh,

(28:28):
there is the problem with vaccine card counterfeiting, right, so
that there are people who have not been vaccinated who present,
you know, and you know what your vaccine card looks like.
I mean, how difficult would that be to cornerway? Uh. Yeah,
it's it's ridiculous. And there's no centralized database, you know,

(28:49):
in this modern age. That's ridiculous. The fact and when
I went to uh, the tennis tournament out in the desert,
the b NB Puribous Open, Uh, they made a big
deal of how everyone would be vaccinated. And there was
an app. An the app you know, proved that you
were vaccinated. But the way the app proved you were
vaccinated and you took a picture of your vaccine card,

(29:11):
you took a picture of your your driver's license, and
they you know, validated that you've been vaccinated. Well that's
not really because if I had a fake vaccine card,
that would not establish anything. Again, with a saliva based
quantitative test, you could actually make sure that people had
antibodies who you're hiring again in Florida, that would be

(29:34):
legal most likely, But as I said, that's a political decision,
that's not a medical decision. And the saliva test seems
to be far less invasive than the swab. How does
it compare in terms of the time for the turnaround
and the cost relative to other forms of testing. The

(29:54):
cost to do the test is similar to what you'd
have in a blood test. But the thing about alo
a test is that there is a cost associated withdrawing
the blood. People don't really calculate that that in the
ease of testing is amazing. You just put plastic wand
with a sponge on the end of it into your

(30:15):
mouth between your cheek and gums for two minutes. Uh.
So it can be done in the office, it can
be done at all. That can be done in a
nurse's office, and then it can be mailed in using
the appropriate biohazard containers. So cost is is low. Um,
obviously we're a company where you know there will be

(30:37):
some markup, but certainly the cost is reasonable and you know,
we feel that people may want to know. Let's talk
a little bit about the work you did as med
director at QUEST. They're a big fortune. What sort of
work do they do and tell us a little bit
about your role there. Okay. I arrived at QUEST in

(30:59):
a year two thousand. It was, as you said, a
large commercial laboratory, actually the largest libortary in the United States,
and I believe ester was true, and they were just
beginning to do DNA tests. And when I got there
in two thousand, they were using technologies that you know,

(31:19):
I had been using at the University of Chicago that
we're really designed you know, to do ten or twenty
tests at the time. They were not designed to do
thousands of tests at the time. And so when I
got there, I made it my business to try to
find other ways of doing this test thing that would
be you know, one high throughput, two extremely high accuracy,

(31:44):
and three cost efficient. Because Quest Diagnostics was a business
and we were able to do that. We found initially
what was interesting is that we invented something called a
one thousand sample comparison and that before we would introduce
a new platform, we would look at a thousand samples

(32:06):
with the old technology and the new technology. Uh, if
there were any discrepancies, we would resolve that discrepancy with
a third technology to see what we were doing, which
would be the best platform and because a lot of
people were using a hundred samples. Well, what we found
is a lot of times for the hundred samples there
was complete agreement, but as you got to a thousand samples,

(32:27):
there would be three, four or five discrepancies between the
two platforms. No one had ever shown that before, and
we were able to show actually that the old technology
was not as good as the new technology. And so
with a lot of confidence and we published about this,
we were able to move from the older technologies to
the newer technologies. Then we were able to to start

(32:51):
really doing high through foot high quality testing, and then
we just started increasing our menu. Uh So, because a
lot of people when I was practicing genetics, a lot
of the frustration was that people couldn't get the genetic
tests that I wanted them to get because often these
tests were done in specialty laboratories, They were expensive laboratories

(33:14):
did not have a relationship with the insurance companies, and
so basically people had to either pay out of their
pocket or not have the tests. And it was very, very,
very frustrating. I remember there would be people who had
drive their portion into my office and I'd say, you know,
you really need to have cystic fibrosis carrier testing and
they say, does insurance coverment? And I'd say, well, let's

(33:36):
check and know your insurance doesn't cover it. And they say, well,
then I don't want to have it. And you know,
I felt like shaking them, saying, you know, get the tests.
You know. One of the reasons I went the Quest
Diagnostics because of the Quest Diagnostics had relationships with all
the major insurance companies, and so what I wanted to
do is make these tests available to the general public.

(33:59):
And I very proud that I was able to accomplish that.
And we moved to sequencing, and we moved to uh,
you know, all the major platforms, and uh. It was
a great experience. I I learned pathologists. You know, in general,
it's interesting there there have been wars between pathologists and
geneticist because pathologists feel that they own the rights to

(34:23):
all testing that's done on humans. Uh. Geneticists said, hey,
you guys don't know how to do the specialized things
that we do. And so every hospital had this kind
of give and take between who is going to do carriatypes,
kicking of chromosomes, who is going to do DNA testing?
Was it going to be the pathology department wasn't going

(34:45):
to be the genetics department. And when I got the
Quest Diagnostic, which is the pathology company, I learned from them.
I learned about quality assurance, quality control, how to what
you have to do to UH to do hundreds of
thousands of tests in an accurate way, and how you

(35:08):
need to have methods in place to make sure that
nothing has gone wrong. So for me, it was an
eye opening experience. And the last thing I learned was
that this is a business. How do you make a
business decision? How do you try to balance health of
the nation versus business? For example, what if I want

(35:29):
to do a test that you know won't make a profit,
but that could help people. How are we going to
make those decisions? Do we make those decisions those kinds
of very difficult situations? You know? I learned a lot.
Let's stick with the issue of of both the test
menu and the cost benefit analysis of these testings. I

(35:54):
have to imagine that cystic fibrosis is an expensive, complix
headed disease to test, Isn't it in the insurer's interest
to anyone who is indicated to test for this to
pay for that rather than you know, a later stage
treatment after it's going to be further developed, more complicated,

(36:17):
and more expensive to treat. But one of the great
ironies of modern medicine and healthcare is informatics. And I've
had discussions with with insurers about about aspects like this,
and some insurers will say, well, we know that people

(36:37):
change insurance companies every two and a half to three years,
so why should I do this task if it's going
to prevent a heart attack in a patient five or
ten years down the line, which is incredibly shortsighted, I
have to say, and not all insurance companies have this
kind of attitude. But I would also say that in

(37:01):
publicly traded companies, one of the things that I've seen
is they're pretty myopic. They're looking at the next quarterly
earnings report, they're looking at the stock price. UH, they're
not necessarily looking at the long term. And in this country,
insurance companies are for the most part profit. UH, they're

(37:23):
not nonprofit, and they have to deliver value to their shareholders,
and so sometimes they make short sighted decisions. In the
early days of DNA tests that the real problem was
that the insurance companies didn't have relationships with companies that
did it, and those UH tests were very expensive, so

(37:44):
it's easier for them to say this is research, we're
not going to cover it. In terms of system fibrosis,
the Emertant College of Etcentrics and Gynecology and the Emertant
College of Medical Genetics both came to a to a
recommendation that you know, every want at certain races should
be tested for assistic fibrosis carrier status when the woman

(38:06):
became pregnant, when we knew, and and we had been
given fair warning for that when I was a Quest Diagnostics,
so we knew that volume was going to increase, and
the business people in Quest Diagnostics knew that it would
become profitable because insurers would have a difficult time saying
its research if the professional societies had recommended it. So

(38:28):
that was kind of a no brainer decision. Some of
the other decisions that we had to make were not
so easy. Pardon my naivete and asking this, but if
people are changing insurers every two and a half three years,
then the flip side of we don't want to test

(38:48):
because this person is going to end up elsewhere is
what about the person who wasn't tested? Five years ago,
who shows up as you're insured and has that expensive
heart attack. Wouldn't you want a uniform approach across all
the insurers so that the preventative, less expensive treatment and
testing was taking place before. Yeah, this guy is leaving

(39:12):
your insurance company, but someone else who wasn't tested is
going to end up at your company. It seems like
the better approach would be to agree on a uniform
testing process. Verry, it's so logical, you don't think I

(39:32):
didn't scream that. But the problem is two things about that. Is,
first of all, if all the insurance companies are gonna
get together and decide that they're gonna do something like that,
that would probably be considered collusion. What if it comes
from the medical community, or the research community, or or
god forbid, actual legislation that says you should have to

(39:56):
pay for these sort of testing. Yeah. Well, interestingly enough,
just because the professional organization say that this is standard
of care and should be done, does not mean that
insurance companies will pay for it. Basically, insurance companies role
in life is to not pay for things. Our new

(40:17):
CEO of Quest Diagnostics you used to say, you know
what other business do you have where you give your
services a way for free and then you hope and
pray that you're going to get paid for it. And
that's what lab testing is all about. The test is
sent in, we send out the results, and then we
hope that insurance is going to reimburse us for those

(40:38):
It's not a great system. Um, you can be denied
for a whole bunch of reasons because the ordering physician
put the wrong diagnosis code. Even though a person needed
the test, the test was sent, the test was pre authorized,
and the test was performed, a result was given, and

(41:00):
then all of a sudden you're told you're not going
to get paid for this because the doctor coded this
as a routine office visit and not as a office
visit because there was a breast lump found. So you know,
there is a huge part of the industry which you
know basically has to take into account to fact that

(41:22):
you're not going to get paid for a certain percentage
of what you do, and they're actually when I was
a quest there were, um, there were people who are
trying to work on just improving the percentage because you know,
you didn't have to do any more testing if you
could improve your percentage of reimbursement, you know, from to

(41:46):
or whatever it was. And so you know, obviously in
a single payer system you don't have those kinds of issues.
You can make those decisions easily. Uh. And that's you know,
in in Canada, that's it's a much easier thing to do.
You can simply say the public health and system is
going to be paying for this testing, and then pretty

(42:07):
much everybody gets it covered and paid for. Here you
could say, yeah, I think we need that everybody should
be paid for this testing, but insurance companies don't have
to Listen, let's talk a little bit about the work
you're doing at the children's hospital. Tell me the sort
of patients you focus on and what do you try

(42:27):
and do for them? So very you know, I was
in semi retirement and I got a call from a
children's hospital Los Angeles saying, you know, we have such
a backlog of patients that need to see clinical geneticists,
and especially my subspecialty, which is biochemical genetics. Back from
the days with with William nine hand, you know, could

(42:50):
you please, you know, come work for us at least
part time. And this was actually right before the pandemic
and Dr Randolph, the chair in of the department, is
such a wonderful woman, you know that. I said, yes, um,
because you know, if somebody asked you to help out,
you help out. And I was really dreading it because

(43:13):
I was going to have to drive up to Los
Angeles and I live in the South Orange County. And
then COVID hit. And one of the interesting things that
happened with with the COVID epidemic, there's been you know,
can you say, have there been any positive things? Well,
one of the positive things that's actually we now have
mRNA vaccines, where before COVID they asked me it was

(43:35):
it was going to be five to seven years before
we had mRNA vaccines. But the other thing interesting thing
that's happened is that telemedicine has become reimbursable two reasonable levels.
So when COVID hit, I said, you know, I'm of
an age I don't really feel comfortable driving up and uh,
you know, working in a hospital. And they said, wow,

(43:57):
would you see patients, uh remotely by tele medicine? And
I said sure, And it's surprisingly good. You know, yes,
I cannot touch patients, but I can see patients. And
I've been seeing patients UM in clinical genetics that very tremendously.

(44:18):
Most states have what's called newborn screening. Newborn screening is
one of the most amazing phenomenon for disease identification and
early treatment that nobody knows about. It's the heel stick
that all your children, grandchildren and great grandchildren have when
they're born. And this is analyzed in California for about

(44:40):
fifty different what we call inborn errors in the tables,
and so these children are identified, and these children need
to be cared for by physicians who know how to
care for these children with these extremely rare genetic diseases.
But it's been phenomenal. For example, there's a disease called

(45:01):
who terrag aciduria type one where every patient I ever
saw back when I was working with Dr Nihan was horribly,
horribly brain damage. Uh. These kids were almost in vegetative states.
I now have a child in my practice who is
identified by newborn screening, who is placed on a specialized diet,

(45:25):
is now three years old and completely normal. Every time
I see this kid, I want to scream, how wonderful. Uh.
Newborn screening is started out with general keaton nuria. Again,
these are children who would have been horribly horribly mentally deficient,
deficient who are put on specialized diets and they're normal.

(45:48):
So these are the kind of kids I see. I
also see children who have autism, children who have other
forms of birth defects. You know, now we can get
specialized DNA sequencing tests for these children UH to identify
their disorders and perhaps treat Now we have these been

(46:10):
called the whole x own sequence, which allows where the
laboratory basically looks at every gene UH known in the
body and compares that with both parents to see about
whether or not a child has a disease. Well, I
did a test like that on a child that was hypotonic,

(46:30):
who couldn't walk, he was eighteen months old, had spastic movements,
had been diagnosed with cerebral palsy. I did that test.
It turned out he had a treatable inborn error metabolism
called congenital disorder of like constellation, and we started to
treat him and he's getting better. So you know, it's

(46:50):
these kinds of things were used to be very very rare.
It's almost like a revival meeting are becoming you know,
pretty common. But in order to do that, you have
to be able to get the testing done. And that's
the great frustration you had mentioned previously that the insurers
are sometimes none too keen about paying for some of

(47:13):
these um screening tests or preliminary tests. The heel stick
is that best practice was that mandated by law? How
did that come about? And and what sort of headaches
do you run into when you want to test in
The insurers says, um, we're not interested. Yeah, well, there's
there are two questions in there. The first is newborn

(47:33):
screening is legislatively mandated in all fifty days, and the
beauty of the legislative mandate is that the follow up
is covered. So these children who you know, test posit
for newborn screening, their treatments are covered. Any follow up
genetic testing is covered. So that's at least in California,

(47:54):
is a great system. When people that kids that fall
through the cracks are the kids that don't have one
of the diseases that is screened for in the newborn
screening program. And these are children who for example, Medical
which is the state sponsored health insurance, doesn't cover whole
excellent sequence. So the kids who are covered by medical

(48:17):
can't have the task which might identify a treatable cause
of their illness, and that is extraordinarily frustrating. And sometimes
even private insurance will say, you know, I don't want
to cover this test, even though you know, I want
to scream at them, this kid needs this test. And
that's the greatest frustration in medicine right now, at least

(48:40):
in genetics, uh, for me, is not being able to
get the tests I need for my patients. Um. And
again that's because there's no uniformity and insurance coverage for
these sorts of genetic testing. I can see the you know,
the position of the insurance companies are these are expensive
tests and um, you know again error they want to

(49:03):
be profitable, and if they their fear is that if
they start having to pay for these very expensive tests,
that's going to eat into their profits. So I mean,
I do understand it, but it is extremely frustrating for
our practitioner. I can imagine and you sort of see
the medical industry, both the practice and the commercialization from

(49:26):
both ends of the business, both as a doctor who
is a practitioner and someone who's working in what's essentially
a biotech start up looking at it from the complete
opposite end. How do we get this through the CDC,
through an I H, through f DA, How do we
get this approved? How do we get insurance to start

(49:48):
paying for this? How do we get practitioners to start
using it? How does that sort of unique perspective of
seeing both ends of the elephant affect how you view
the practice of medicine and the United States. Wow, what
a question. We could probably talk for an hour about that,
I think. Um, you know, the short answer is it

(50:10):
has become amazingly complicated to introduce anything new in medicine.
So back in the day, somebody would find something, they
would publish it, and then if it was good, it
would be reproduced, and then everybody would do it, and
medicine progressed that way. Nowadays it's completely different. So you

(50:35):
make a discovery, you talk to the Technology Transfer office
at your university, they patented, uh. Then you spin off
a biotech company. Then you have to get venture capital
funding for your biotech funding company. Then you shop it
around and then nobody trust what you're doing because you're

(50:57):
a private company. And then you have to get people
to will interact with the governmental players, people who will
interact with private payers. People who will work on the
CPT codes. It is amazing complex process. I have a talk,
actually a power point that I can and I talk

(51:18):
about somebody who invents the best test. I call it TBT.
So somebody invents a test that can use your blood
and decide with sensitivity and specificity whether or not you've
got prostate cancer, for example, and I I lead the
people through the person who invents that test to the

(51:40):
point where a quest diagnostics is no, no, thank you,
we don't want this test. And it is perfectly plausible.
And that's because the whether or not a test will
be profitable depends on so many different interchangeable parts, and
if the parts don't all fit together correctly, it won't

(52:02):
be a profitable test. So that's the way the industry
is now. It's frustrating as a to be a physician
in the system can get extremely frustrating because of course
we feel we know everything so that if I say,
if I say it must be so, it must be so.

(52:24):
But seriously, uh it can. It can be extremely frustrating.
And my problem is that I have started a company.
I believe I have a game changing technology, but the
chances of it actually changing the game are pretty small,
and one of the problems that my company has is,
you know, we're underfunded. I don't have the ability to

(52:46):
go out and hire a marketer, or to hire a
sale at salesforce, to hire people, uh, to deal with
insurance companies. So I felt if I built a better
mouse trap, that the world would come to my door.
But that has not happened. And so now you know,
I'm sitting trying to figure out what we're going to
do with this technology. You know, I know it's good,

(53:07):
I know it works. You know, I just need to
figure out how to do it from a business standpoint.
So that's been my frustration. So we've seen over the
years a lot of large either pharma or diagnostic companies
go through a series of acquisitions and roll ups and mergers.
It seems like scale is something that's really significant in

(53:31):
this space. Is that just a function of how unique
and somewhat backwards the U S system is. Between the
hospitals and the insurers and the practitioners, everybody seems to
be operating at a cross purpose, to say nothing of
the patient and the outcome of their visits. Is this

(53:51):
a uniquely American problem? Or do we see other issues
like this elsewhere. What happens here is evolutionary and the
way we evolved, of course, you know, the way evolution
occurs as with natural selection. So we're in a completely
capitalist system here in the United States. And the way

(54:12):
the laboratory industry evolved is it started out with I
guess you'd call a mom and pop started out that
every hospital had a laboratory. That laboratory was run by
the local pathologists. They drove the fanciest cars I can
tell you. You You know, they were charging two and three
for tests that cost them two or three dollars to run,

(54:35):
and they were happy. The insurance industry didn't know any better.
They were reasonably happy, and then a revolution occurred. Revolution
occurred firstly with a laboratory called net path that decided
that they were going to be a commercial laboratory. They
were going to compete with the mom and pop local pathologists,

(54:56):
and so they started buying up laboratories. Then Corning, who
was making Corning wear but also fiber Optics, was also
making laboratory flasks in pirates. They were making graduated cylinders,
they're making flasks. So they decided that they were going
to diversify and get into the laboratory industry, and they

(55:19):
spun off and they started with Corning Clinical Labs and
then they spun it off as Quest Diagnostics. Quest Diagnostics
with their original CEO, who was a visionary, decided that
he was going to consolid try to consolidate the laboratory
and industry, so he bought met Death, he bought other
laboratories UH and basically got to a point where they

(55:42):
were close to eight percent of the total laboratory market share.
But it's still a very fragmented market. You have the
huge players, the lab corps, the Quest bioreference people, but
still the majority of laboratory testing is done by in
the dual hospitals. So then how did individual hospitals No

(56:03):
longer could they's charge two hun or fifty dollars for
tests that they uh then only took them four hours
to make. So they had to come down with pricing.
And so now hospitals are working with among themselves. So
now you have hospital chains buying up other hospitals running
the laboratories from the central laboratory. So you have that

(56:25):
going on, and then insurance companies love that because now
there's competition. So they can say, well, I can get
this from Quest Diagnostic, or should I tell you this?
And then you all know the story about United Healthcare,
and they went from quests the lab corps and now
they're in both. But insurance companies began to wield an

(56:46):
increasing amount of power over healthcare and they still wield
that amazing kind of power because in many ways, your
insurance company decides what tests your doctor can order and
from what laboratory. Right in the early days of when
pap smears went to something called thin prep, you know,
there was no question that the thin prep was better

(57:11):
in terms of of what it could do. But in
when patients would come to our clinic, there was a
big boltin board saying if the patient had this insurance,
they could get thin Prep. But the patient had that insurance,
they could only get a regular PAP smear. So what
people don't understand is that their insurance companies in many

(57:32):
ways are determining what they you know, what kind of
testing they can have, what kind of medical care they
will get. And most people don't pay any attention to that.
They don't pay any attention to whether or not holds
excellent coverage. Is you know, is covered by their insurance
until they have a child that has autism, or until

(57:52):
they have a child that, uh, you know, that has
developmental delay, and now all of a sudden, their geneticists
wants to order that test and their insurance company doesn't come.
But one of the problems is that you would really
want an informed consumer, But in healthcare are consumers are
not informed? You know, you look at these things when

(58:12):
there's open enrollment, and mostly everybody's looking at what the
code pay is, what this is, what that is. And
it's not reasonable for people to understand whether or not,
you know, they can have a cardiac authorization, or whether
or not they can have a treadmill for certain indications,
you know, because you don't know what the future is
going to hold. So the paradigm of, you know, an

(58:35):
informed consumer in a capitalist system with free enterprise, I
think doesn't work very well for healthcare. But the centralized systems,
you know, are not that great in some places too.
I mean, everybody points to Canada as being the best
a good example of a single party pair, but I

(58:58):
know a physician in Canada and he needed his wisdom
teeth out, and he had waited two and a half
years to have his wisdom team, and a lot of
people in Canada actually drive over to Buffalo to have
CT scans because you know, the whole city of Toronto
has two CT scanners or something and something. You know
there there's a limited number of you know, CT scanners

(59:22):
for population, and so there's a long waiting list for
those kinds of things. So it's not like single party
payer is the panacea. Then if you ask, how are
you going to fix the system as it currently exists,
it's a nightmare and I have no idea of how
I would fix it. So I know I only have
you for a couple more minutes. Let's jump from our

(59:46):
medical discussion to our favorite questions that we ask all
of our guests. I wanted to start with something like,
tell us what you've been streaming over the past couple
of years. What what has kept you entertained during the
pandemic lockdown? Well, yeah, I stream a lot. I guess
I can also combine, and so I during the pandemic

(01:00:09):
started reading Michael connelly novels Ronymous Bos The Detective. He's
written over twenty novels, and of course then I streamed
a Lincoln lawyer which is also from Michael Connolly, and
I will be streaming The Bush Legacy right now. I'm
watching Judy Queen of Jerusalem, which is an incredibly interesting

(01:00:30):
Israeli film about the early days of in Jerusalem. Watching
gas Lit with Martha Martha Mitchell Uh and a real
cool one is Servant of the People. I don't know
if you've been seeing that. Barry Uh, that's uh the
President of Ukraine, his original comedy show. Do you know

(01:00:51):
about that? You know, I've I've heard all about it,
and it's supposed to be tremendous, um fantastic. Yeah, I mean,
and first of all, it's you talk about art imitating
life and life imitating art. I mean, you know, he's
President of Ukraine, and you know, the whole the whole
TV series is based on, you know, him going off

(01:01:13):
on a rant about the corruption and government and getting
elected to be President of Ukraine. I would highly recommend that.
That's on my let's on my list. Let's talk a
little bit about some of your mentors we mentioned them earlier.
Tell us who helped to shape your career. You know,
I was very lucky that whenever I needed somebody, they

(01:01:34):
were there. The first one was, of course Albert Dorfman,
who was my doctor advisor. He was an m D, PhD.
He worked on on inborn eraism, metabolism, and he taught
me one very important thing. He called me in one
day and he said, you know, when I designed an
experiment and I think I know what the results should be,

(01:01:58):
and I get that result, I don't trust it. You know,
what he was basically saying is that that science and
discovery is about what you're not expecting. Just as Alexander
Fleming discovered penicillan not looking for penicillin. He discovered penicillin

(01:02:20):
because of an accident that mold started growing on his plates.
And we've lost that in science. I'm afraid we've lost that.
You know. Right now science has managed it as a business.
You know, we're gonna make a vaccine. We're gonna do
this step, this step, this steps, this step, and make
a vaccine. No one is saying, let's look at how

(01:02:43):
he anybodies are formed. Let's look at what's going on
and see if there's anything anomalous, something that we don't understand.
My next mentor was Dr Sam Specter. Dr Sam Specter,
I guess you could call you know, was one of
the fathers of modern pediatrics. He worked with Benjamin's Bock
writing h writing the famous book on childcare um and

(01:03:05):
I was fortunate enough to have him as a professor
at the University of Chicago Medical School, and then he
moved to University of California, San Diego. So when I
went to do my residency, he was there for me too.
And what he taught me is that the best way
to be a pediatrician is to be with the child.

(01:03:26):
He said, I want you to go hold babies. You know,
if you if you're not an older brother and older sister,
hold babies, walking around with babies, see how they feel.
And you can tell simply by being with a baby,
by holding a child, whether this is a child who's
just fussy and can be discharged, where this is someone

(01:03:46):
who is seriously ill. And those were the days afford
the meningitis vaccine, and we were really concerned about meningitis.
Then my boss and my chairman of my department I
was at a community hospital in Chicago's name was John Barton,
and he was a cowboy, and he taught me two things.
He first taught me that to be a leader, you

(01:04:10):
have to want what's best for your people more than
you want what's best for you. He got such joy
in our successes, and he did everything possible so that
we could be successful, even though sometimes that made him
unpopular with the management. And the last one was William

(01:04:31):
Nihan uh And and Bill taught me that you have
to know the basic science if you're going to treat patients.
For example, he could give a lecture on diarrhea where
you learned about what causes the diarrhea, not just how
to treat the diarrhea. And so those are my mentors,

(01:04:53):
and I thank god that I had. Sounds like a
hack of a list. Let's talk about books. You mentioned
some already. Tell us what you've been reading lately and
what are some of your favorites. Okay, well, my favorite
book is Field of Dreams. My father was a baseball catcher,
and it's one of the only books I've ever cried

(01:05:13):
while reading. I think it's a better book than it
is a movie, but I love the movie. Also, there's
also a fabulous book called The Goldbug Variations by Richard Powers.
I don't know if you've heard of it, but he
combines genetics, music, and a couple of love stories together.
More recently, as I told you, I've been reading all

(01:05:34):
the detective Runo Sposh novels by Michael Connolly, and that's
what I do for recreation. Sounds like fun. Our final
two questions starting with what sort of advice would you
give a recent college grad who was interested in a
career in either medicine or genetics. Well, I would say

(01:05:54):
that there's been a sea change from in just the
past ten years in genetics. Uh, and it's going to
be in medicine too, And that is you need to understand. Informatic.
When I was even a quest diagnostics, my expertise and
what we call wet work, it was in making essays,

(01:06:16):
you know, making methods to detect things and doing it
in a better way. We talked about that a little earlier.
Now pretty much everything goes on the DNA sequencer, on
the next generation sequencers, and so the wet work is
almost irrelevant. But what isn't irrelevant is the analysis of

(01:06:37):
the tremendous, the humongous amount of data that comes off
those sequencers. And so I would say to someone who
wants to go into genetic you have to get a
handle on the informatics. Whether or not you need to be,
you know, a computer major or whether you're not to
need to be a programmer that I don't know, but
you need to be able to because the computer folks

(01:07:00):
know the medicine and you need to know where the
weaknesses are in the computer algorithms or else you're going
to start, you know, being let off on blind alley.
So that would be my advice to anyone who's getting
into modern medicine is to understand the informatics, Understand how

(01:07:20):
these algorithms work, understand where their strengths are, where their weaknesses,
or even become involved in the analysis because it's incredibly powerful.
I mean, there's an algorithm that basically looks at sales
of kleenex in um in pharmacies that predicts blue epidemics

(01:07:43):
better than anything else. It's the same kind of algorithm
that they use to map the craters of the moon.
So you know, this is you know, we live in
an age where basically privacy has gone. But the up
the other side of it is there is so much
data out there that could be used for good. You know,

(01:08:05):
people are always worried about how it could be used
for the bad. But you know, people are listening to
our phone conversations. They're paying attention to what we buy.
You know, that's the negative part. But on the other hand,
I just turned on my computer and on Google there
was something that I wanted, you know. It was like,
I think, how did you know? How did the algorithm

(01:08:27):
know that this would be something that I would be
looking for because it wasn't obvious. Uh and yet there
it was. So it can be used for good um
as well as for for bad and uh So I
think that that, yes, there there is reason for concerns
about privacy. I would also say that the kids today
they don't care about privacy, right They put everything on

(01:08:49):
Facebook as soon as it happened, So maybe we're moving
into a different era. Quite interesting. And our final question,
what do you know about the world of genetics and
testing in medicine today that you wish you knew forty
years ago when you were first getting started. I guess

(01:09:10):
what I'd say is one of the most important things
that I've learned is unintended consequences. So I lived through
the original Medicare guidance when the diagnostic related groups were formed,
So this was in probably the seventies or eighties, probably
the eighties, and basically the way that medicine was reimbursed

(01:09:32):
was changed inalterably. So hospitals were paid not by what
was done to a patient or for a patient. They
were paid a single amount based on the diagnosis of
that patient when they entered the hospital. So you would
get the same amount of money for admitting a patients

(01:09:55):
with down syndrome for pneumonia, whether or not did two
hundred thousand dollars worth of work on them or whether
it did twenty dollars worth of work on him. So
that changed medicine incredibly. And you say, well, you know
Medicare was Medicare, but then you know the insurance company
used Medicare as a model, and that that irremically altered

(01:10:19):
the way medicine was practiced. The other thing about those
Medicare regulations is they had better reimbursement for procedures. So
specialties which did a lot of procedures, colon oscarpies, cardiac
cathorizations became more powerful because the reimbursement was better and
basically you could make more money in that era of

(01:10:43):
the general practitioners, the pediatricians, you know, all got less reimbursement,
and it became harder for them to make a living.
Then all of a sudden, somebody says, well, these primary
care people are not doing well. So then they changed
reimburse sent to favor primary care, and that, again, you know,

(01:11:05):
changes the equation. So I guess what I would say
is be careful when you legislate anything that has to
do with medicine. I don't know if I would become
a physician if I were uh a young person today. Um,
it's much harder. So, you know, let me tell you

(01:11:26):
what you know. One way that costs is being controlled
in medicine is with scheduling. So our hospital was purchased
by another hospital, they introduce a scheduling program. Well, I
noticed that they were going to schedule me fifteen minutes
to see every patient. And I said, wait a second,
I'm a geneticist. I can spend an hour with the patient.
I can spend an hour and a half of the patients.

(01:11:47):
They said, Tosh, They said, you know, if you do that,
then your patients are gonna be waiting in the waiting room.
They're not going to be happy. So, you know, a
simple thing like a scheduling program from someone who you
know has done an analysis and says that you know,
we want doctors to see patients every fifteen minutes and

(01:12:08):
get a ten minute break for coffee and and that
sort of thing has made you know, being a doctor,
being a physician less enjoyable, You have less freedom, Your
people are feeling more like they're they're just employees, uh
than they have a vocation. Really quite interesting. Thanks back

(01:12:29):
for being so generous with your time. We have been
speaking with Dr buck Strom. He is the CEO and
founder of Liquid Diagnostics. If you enjoy this conversation, well,
be sure and check out any of the previous four
hundred such discussions we've add. You can find those at iTunes, Spotify,
or wherever you regularly get your podcasts. We love your comments,

(01:12:51):
feedback and suggestions right to us at m IB podcast
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thank our crack team who helps put these conversations together
each week. Mohammed Rumaui is my audio engineer. Paris Wald

(01:13:14):
is my producer. Sean Russo is my director of research ATKO.
Valberon is our project manager. I'm Barry Rihalts. You've been
listening to Master Some Business on Bloomberg Radio.