September 2010: Volume 36, Number 9
Q&A with Bill Frist
Former Senate Majority Leader Dr. Bill Frist spoke at the AACC Partnership Presentation during the AACC Annual Meeting in Anaheim, Calif. in July, a special event supported by a grant from Beckman Coulter.
After his presentation, “A Heart to Serve, A Non-Partisan View of Solving the World’s Most Intractable Problems,” Frist offered his thoughts on the vital role clinical labs play in shaping medical care in an exclusive CLN interview. A nationally recognized heart and lung transplant surgeon, Frist is currently a professor of business and medicine at Vanderbilt University.
What is the lab’s role in tackling the problem of obesity and chronic disease?
The laboratory community will be instrumental in the fight against obesity. I would like to see the laboratory field put an increased emphasis on interpretation of data. They need to educate the public by providing very clear explanations of testing results and what they may or may not indicate, especially in the field of genetics. It will be absolutely critical for the lab to communicate with clinicians and in some cases, directly with patients, something that has not really been a part of the lab culture in the past. It is also critical for physicians and clinical scientists to collaborate to develop best practices for sample collection, test interpretation, as well as test delivery with more information.
How do you recommend that laboratory professionals, who often don’t see patients directly, tap into that zeal for service that is at the heart of medicine?
The passion to heal is powerful, inspiring, and motivating. For labs, this can come from a more integrated healthcare delivery system and personalized medicine. When there is recognition within the lab community that personalized, evidence-based, 21st century healthcare could not function without accurate, reproducible, dependable laboratory results, the linkage will be there.
As labs see more and more how they’re an integral part of the whole, I believe that passion will be reflected in closer affiliation between clinical lab scientists and clinicians who are actually hands-on with the patient. That integration is not there yet, but it needs to be and will be with this decade of integrated models for patient care.
Can you recall a personal experience where lab testing really stood out?
I have spent 20 years in the transplant field at a time when there was tremendous innovation and growth in pharmaceutical agents. My average patient was on 15 different medicines, and as we are acutely aware today, but we weren’t as aware 15 years ago, these medicines interact in ways that are predictable if they are studied and reported, but unpredictable if not studied and reported.
Very specifically, in the early 1980s, a new drug called cyclosporine, which is routinely used today, began to be applied, first to liver transplantation and then to heart transplantation. In those early days, we didn’t know what the long-time impact would be on renal function. And so the laboratory findings relating cyclosporine and creatinine as a measure of renal function became absolutely critical, because if we over-treated with cyclosporine, we had an effect on renal function and creatinine, and then that would affect the metabolism of every other drug.
When I came back to Vanderbilt in the early 1980s, we very quickly went to high-performance liquid chromatography in order to measure not just the absolute level, but also the metabolites, because we knew that the metabolites had both efficacious effects and detrimental effects, so in my field, lab testing was life or death. It meant whether or not patients would stay alive. I could do a successful transplant operation with 99 percent certainty, but if I couldn’t monitor cyclosporine and creatinine with all the metabolites, I couldn’t keep my patients alive.
How would you advise the lab community to help the public understand the value of diagnostics?
The laboratory community has to fully understand the important role it plays in a patient-centered, provider-friendly, integrated healthcare model that is built upon 21st century information. The public needs to understand the 3 percent, 80 percent rule. Meaning, the overall cost of healthcare is 3 percent in terms of the laboratory and the testing. This is a tiny percentage, yet it affects in a significant way nearly 80 percent of all clinical decisions being made, and the world needs to know that.