- How did you discover lab medicine/science?
My first mentor in Clinical Pathology was Dr. Geze Bodor, MD from the University of Colorado Health Sciences Center. He taught me the basics of laboratory assays and how they were run in the clinical laboratory and some of the issues in laboratory testing. When I interviewed for residency, I met Dr. Pete Rainey, MD PhD who impressed me with his approach to research in applied laboratory medicine. The rest of my exposure to laboratory medicine was during my residency, when I was mentored by more terrific mentors like Drs. Mark Wener, MD and Brad Cookson, MD PhD. Unfortunately, there are not many chances for medical students to be exposed to laboratory medicine, which needs to change.
- What is an average day in the workplace like?
I have a few different roles in our department that include directing the Clinical Mass Spectrometry Facility, helping to direct the Clinical Chemistry and Clinical Immunology laboratories, and mentoring residents and post-doctoral fellows in basic research and in the development of new assays using mass spectrometry. As a result, much of my time is spent with technologists troubleshooting assays, with residents, fellows, and graduate students reviewing data and co-developing research plans, and with a computer working on grants and manuscripts.
- With which professional societies/organizations (e.g. AACC) are you involved?
American Association of Clinical Chemistry
Academy of Clinical Laboratory Physicians and Scientists
American Society for Clinical Pathology
National Academy of Clinical Biochemistry
College of American Pathologists
- How did you get started in these organizations and what advice do you have for young people wanting to get involved?
My mentors told me about these organizations and suggested that I become involved if I found the science interesting. I agree, it is not worth being involved with an organization unless you get something out of it.
- What area(s) do you specialize in and what initiated your interest in this (these) area(s)?
My interests are in mass spectrometry and cardiovascular disease. My graduate thesis advisors, Drs. Natalie Ahn and Katheryn Resign, used mass spectrometry to answer very interesting biological questions. They passed on their knowledge and fascination with the method, which I realized could be very beneficial to the clinical laboratory. When I was doing my post-doctoral work during my residency, I worked with an endocrinologist interested in high density lipoproteins, Dr. Jay Heinecke. His excitement was also contagious. Now I collaborate with the nephrologists at our institution and other institutions to investigate the increased cardiovascular disease risk associated with chronic kidney disease and hemodialysis. My interests were initiated by being around fun people with fun ideas. Those fun experiences have led to very important collaborations in related but distinct fields.
- What, in your opinion, has been the most important contribution you have made to the field of laboratory medicine?
There are two things that I am proud of in this respect. The first is developing a tool that enables residents and fellows to keep track of their calls. As of right now, our database has accrued more than 15,000 calls, which helps avoid reinvention of the wheel. Once a question has been answered well, it can be quickly answered again. The second is applying the tenets of clinical chemistry to the quantification of proteins in complex mixtures by liquid chromatography-tandem mass spectrometry. My laboratory has now demonstrated the feasibility of these novel methods in the quantification of proteins in human serum and plasma with clinically useful results.
- What were some of the most rewarding and/or challenging moments of your career?
Some of the most rewarding moments have been hearing where residents and post-doctoral fellows that I have co-mentored have ended up practicing. The most challenging moments have involved personnel issues, because there is generally some fault on all sides, including the system. It is always painful to make difficult decisions in those situations.
- How would you recommend achieving an optimal work/life balance?
I still struggle with this. However, I try every day to say “no” to the things that have nothing to do with someone I care about (e.g. a family member or a friend), my career advancement (or that of one of someone working with me), or the health of a patient.
- What are your predictions for advances in laboratory medicine over the next ten years?
I stand with the rest of the world: mass spectrometry and genetics. I think that mass spectrometry will be proven time and time again to provide sensitive and specific detection of analytes and that one day the IVD industry or NIH will actually fund studies that will prove it. We will sequence more and more of the human genome and make the connections with clinical outcomes that matter. Both of these will take time.
- What do you see as the challenges facing young scientists in laboratory medicine?
Grant funding. Writing grants is time consuming and often not rewarded, which makes the whole process feel futile. As a result, I fear that young clinical laboratorians will not enter into basic science research. This is unfortunate since all of science relies on good assays and clinical laboratorians are some of the few people rigorously trained in the quantification of assay quality and performance.
- What specific goals would you recommend that young scientists in your discipline set for themselves? Any suggestions on how to achieve them?
1. Finding generous mentors who will guide their training and provide support for their growth.
2. Developing expertise in an area of medicine that they enjoy.
3. Establishing collaborations outside of the clinical laboratory that will keep them focused on the most important questions in diagnostic medicine and basic science.
Get out of the clinical lab, attend seminars and conferences in other disciplines, and find interesting people to bounce ideas off of.
- What is your favorite textbook or article that you’ve read?
I constantly refer people to the review by Dr. Eisenhoefer, et al. entitled “Catecholamine metabolism: a contemporary view with implications for physiology and medicine.”Pharmacological Reviews, 56:331-49. It is an amazing discussion of basic biology that has important lessons for the laboratory diagnosis of neuroendocrine tumors.
- Who has been the most interesting person you have met thus far in your career in laboratory medicine, and why?
This is a question that is impossible to answer. I have been surrounded by amazing people throughout my career that have helped me in many ways.
- How do you feel proteomics will ultimately change patient care?
I am not terribly optimistic that multiplexed panels of analytes will change the way we care for our patients, but I remain hopeful. The current approaches to identify novel biomarkers for diagnosis, prognosis, or therapeutic monitoring in disease are questionable. High-throughput multiplexed targeted assays using mass spectrometry will help change the way we tackle this different problem. There are a few groups developing these assays in large numbers, which will enable a novel way to find new useful analytes.
- Do you think mass spectrometry will ever be commonplace in all clinical laboratories? If no, why not? If yes, how long do you think this will take?
Yes. Instrument manufacturers will develop automated clinical analyzers that use mass spectrometry as a method of direct analyte detection. I am hopeful that the first iteration will be available in less than 5 years.
- Do you have any other specific comments or advice that you like to provide to the members of SYCL?