Biography & Career With which professional societies/organizations (e.g. AACC) are you involved? How did you get started in these organizations and what advice do you have for young people wanting to get involved? What area(s) do you specialize in and what initiated your interest in this (these) area(s)? What, in your opinion, has been the most important contribution you have made to the field of laboratory medicine? What were some of the most rewarding and/or challenging moments of your career? How would you recommend achieving an optimal work/life balance? What are your predictions for advances in laboratory medicine and/or your area over the next ten years? What do you see as the challenges facing young scientists in laboratory medicine? What specific goals would you recommend that young scientists in your discipline set for themselves? Any suggestions on how to achieve them? Do you have any other specific comments or advice that you like to provide to the members of SYCL? Can you provide a tip for interviewing job candidates? If you could start your career again, what would you do differently? What is an average day like in your life? What is your most effective time management skill? How did you know that your recent career change was right for you? What is/will be the impact of personalized lipid testing profiles on chronic disease management? What is your opinion on the role of patient-based access to medical records, including lab test results, on disease prevention and management? Biography & Career With which professional societies/organizations (e.g. AACC) are you involved? a. American Association for Clinical Chemistry (Lipoproteins and Vascualr Diseases Division, Nutrition Division, Proteomics Division)b. National Academy of Clinical Biochemistry c. American Society for Clinical Pathology d. American Heart Association e. American Association for the Advancement of Science f. American Porphyria Foundation g. Sigma Xi, The Scientific Research Society h. International Federation of Clinical Chemistry i. National Lipid Association. How did you get started in these organizations and what advice do you have for young people wanting to get involved? a. Involvment in professional organizations can be one of the most rewarding parts of an individual’s career. It provides a means of networking and an opportunity to interact with other professionals who are interested in making advancements in areas that you are also interested. Many of my current colleagues, associates, collaborators, and employees I met because of active participation in professional societies. b. Getting started is easier than you might think and it often makes the best sense to begin at the local level. The local sections of the AACC are almost always looking for volunteers to help with existing programs or to create new programs for members at the local level. This is often times a pathway into more involvement at the national and ultimately international level. Be creative, get involved, and you’ll almost automatically progress to bigger things. My participation in the local level resulted in a term as local section chair, which brought me to the national level as a House of Delegates member. Subsequently because of involvement, I was elected to Chair of the House of Delegates, which included involvement with the Board of Directors of AACC, as well as a number of other activities that keeps me connected with colleagues and has provided rewarding and invaluable interactions that enhance progress and development in my own laboratory and career. c. Of course, there is also SYCL, which is a great place for the new generation of clinical chemists to get a start. This group has been involved in the development of a number of new and innovative programs for AACC. Findings ways for SYCL members to interact with local sections or divisions can be very rewarding. The key is, get involved! I guarentee it will be a rewarding experience both personnally and professionally. What area(s) do you specialize in and what initiated your interest in this (these) area(s)? a. My specialty area is lipoproteins and cardiovascular disease (CVD. The focus is on development of laboratroy tests that enable us to determine why CVD is occurring in each individual, allowing tailored therapy to halt or reverse disease progression. I have always been interested in this field, as I have a significant family history of early atherosclerotic disease. My grandparents all passed away when I was very young (between the ages of 3 and 7). All were lost to cardiovascular or related disorders. My Father died from a myocardial infarction when I was 26 years old and at that time, my mother indicated to me she did not expect to live much longer, as her two older brothers had recently passed from CVD, so she told me to hurry up with the grand kids. From that point on I was dedicated to getting her the best care and focused on her risk factor management. I am proud to say that she is now 74 years old, in good health, and she has been a significant and positive influence in my childrens lives. I tell this story, because it is what drove me to the successes I have achieved. I had, and still have a great passion for working and making advances in this field. We can make a difference! b. If I only make one recommendation regarding choosing a specialty, make sure it is one that you have a true passion for. Your passion will drive you to make new discoveries and allow you to forge new and better practices in your specialty area. What, in your opinion, has been the most important contribution you have made to the field of laboratory medicine? This is a very thought provoking question. One ponders the many publications, new tests developed, contributing to the development of new treatment algorythms, and the development of new professional programs. But thinking more deeply, I realize the most important contribution is really related to the number of people I have touched along the way who are now further contributing to the field. This includes not only to clinical chemistry fellows, many of whom I interacted with while I was chair of the fellowship program at the Mayo Clinic, but with all health professionals in the field, including laboratory technologists, laboratory assistants, physicians who are seeking to better understand laboratory testing, and many others. By sharing our knowledge with others, bringing new people into the field, and by educating them in our practice, we stand to achieve much more than any one individual can accomplish alone. What were some of the most rewarding and/or challenging moments of your career? a. After learning of the field of clinical chemistry during my medical technology internship, it became my goal to obtain a Ph.D. in clinical chemistry, do post-doctoral trainong at a reputable institution, and obtain a position as a laboratory director at a prestegious institution. So it was very rewarding to be chosen to the fellowship program at the Mayo Clinic and later to serve as the Director of Cardiovascular Laboratory Medicine at Mayo for 12 years. The Mayo Clinic is a fabulous institution and I owe much of my success to the quality individuals who took me under their wings and taught me much about the field of Clinical Chemistry and the importance of education and contribution to the field through their examples. I cannot mention all the many individuals who contributed to my education and mentorship, but I would be remiss if I did not thank those who were very intimatley involved with my early career and education at Mayo; Drs. Thomas Moyer, John O’Brien, and Mary Burritt. b. The mentorship I received from them and others is in part what allowed me to embark on my most challenging entrepenurial expereince, which is the co-founding, with colleagues in the field, of a new cardiovascular disease management laboratory in Richmond Virginia; Health Diagnostic Laboraotry Inc.. The goal now is to build HDL into another inovative institution with commitment to quality, and a focus on making a differnce in patient lives through Laboratory Medicine. How would you recommend achieving an optimal work/life balance?I’ll make this answer short. Work hard and play hard. Commit to creating an environment of excellence with fun in laughter both at home and in the workplace. What are your predictions for advances in laboratory medicine and/or your area over the next ten years?The field of cardiovascular disease and medicine has advanced at a rapid pace over recent years. Interventional cardiology has seen the development of new drugs, angioplasty, stent placement, cardiac transplantation, mechanical heart valves and even significant work towards development of mechanical heart replacements. The net result has been a decrease in cardiovascualr deaths per capita in the United States. That said, I expect that we will see a shift from interventional medicine practices, to preventative medicine in the next 10 years. The idea being to identify individuals early and determine the best and least expensive therapeutic management to avoid disease progression and downstream events like heart attack and stroke. Low cost, laboratory testing will play a significant role in preventative medicine, with both biochemical testing and genetic testing being involved. The areas of pharmacogenetics, proteomics, metabolomics and nutrigenomics will all likely be involved, with the focus being individualized therapies and specific lifestyle changes tailored to the genetic and biochemical make-up of each individual. If done correctly, the net results will be a healthier population and reduced cost to the medical care system. What do you see as the challenges facing young scientists in laboratory medicine? If clinical laboratorians wish to continue to advance the field, they need to become more involved in disease management. The primary focus of labs in the past was to aid in diagnosis, providing laboratory results that a physician can interpret and use to make diagnoses and subsequently make appropriate treatment decisions. Laboratory scientists will make the most contributions in the future if they can integrate themselves into the disease management process. There is so much new information being generated on a daily basis in the field of medicine, not any one person can keep it all in their heads. Interpretive reports which discuss clinical management options for physicians will be very important. In addition, the development of interactive physician and patient portals where participants can log on and review lab results and treatment algorithms would be a much needed and sought after technology. We must become an integral part of the medical decision making team. Many think of lab folks as those that are socially challenged “geeks” if you will, who would prefer to stay behind their books and equipment and crunch numbers for others. That mold needs to be broken as there is significant opportunity for laboratorians to become leaders in management of informed medical decision making. What specific goals would you recommend that young scientists in your discipline set for themselves? Any suggestions on how to achieve them?a. Recommending specific goals is tough and maybe even dangerous. Each individual must set their own goals. Those goals should be based on each individual’s particular passion. Therefore, some more generalized recommendations follow. b. Make time to think. c. Generate ideas and research them. d. Set goals based on the ideas, and act to achieve the goals. e. Observe that not all of your goals and ideas will be successful and many will fail. f. Accept failure and learn from it. Don’t let fear of failure or previous failures stop you from acting on other ideas and goals. g. We learn most from our failures and many times, failures provide us with building blocks for our next successful venture. Do you have any other specific comments or advice that you like to provide to the members of SYCL?The key to success in any institution is the people. Become an effective leader of people and help your people to become effective members of your team. Effective leaders do not rule with an iron fist. They do set high expectations and expect outcomes. They then provide services, education, tools, resources, and help to their people so that they will grow and strive to reach the goals and objectives set by the leader. Encourage your people to be innovative, to make suggestions for improvements, and to think out of the box. If you can accomplish this, your team will be unbeatable. Can you provide a tip for interviewing job candidates?I always ask any individual I interview what is their passion. What are they really passionate about? It does not have to be related to work or the job I am looking to fill. It could be wood working, or fishing, or nuclear physics, but I’m looking for their eyes to light up and to see the drive that they posess. Once you find it, you can use that to help motivate them in the future or to put them on a specific project that is consistent with their motivation. If the person is not able to show me real passion for any subject, I am less enthusiastic about bringing them to my team. If you could start your career again, what would you do differently?Life and career are really a series of experiences that one learns from as he/she develops. I don’t think I would change anything really, as both the good and the bad have influenced me and made me what I am today. That said, one of the key turning points in my life was when it was suggested to me that I learn more about leadership, people management and attitude. If you can master people management and leadership and keep a good attitude, you will go far. A good place to start is with John C. Maxwell short books, like “Leadership 101”, “How Successful People Think” and “Attitude 101”. These books may lead you to other resources which can help you develop better “people skills”. What is an average day like in your life?a. Every day is different and unique. I can’t actually remember any average days recently.b. If there is one thing that is constant, it is change. This is particularly true when starting a new and rapidly growing venture. If you are in a large institution I recommend that you take the time to learn and understand all aspects of the laboratory business. This includes billing, CPT and ICD9 codes, logistics, client services and sales, as well as the more typical science, research, services, and quality systems we typically think of in association with Laboratory Medicine. What is your most effective time management skill? a. Time management is a real challenge for all of us. Wouldn’t it be better if we all had about 10 more hours in each day? There is a general tendency, at least with me and many others who I have talked to on this topic, to think we can accomplish more than what is physically possible in a day. Therefore, we must develop the ability to prioritize and work towards our stated goals. b. Set daily weekly and montly goals, as well as long termgoals, but remember what has been referred to as the 20/80 rule. That is 20% of your priorities will give you 80% of your production. c. Prioritize your goals: There is a general trendency to do the easiest things first, regardless of their importance and urgency. Prioritize goals and projects based on importance and urgency. Those listed as high importance and high urgency should be done first. Tackle those early in the day by carving out time to work on them. Low importance and/or low urgency items may include busy work like filing, checking e-mails, making travel arrangements, etc., which you may elect to delegate to others. d. Delegate. Don’t try to do everything yourself. Form a team and deligate specific tasks to team memers that have an aptitude to for completing the task at hand. Effective people management will promote effective time management. How did you know that your recent career change was right for you?a. Making a move from a very secure position at a large and prestigious institution like the Mayo Clinic to start up a new enterprise was a huge and very tough decision to make. It ivolved much thought, and the decision was ultimatley made based on a multiple number of factors, both personal and professional. I will say that since making the move, I have not had any regrets. b. How do I know the decision was right for me? Every morning when I get up I am excited to get to work and see what new challenges await. The opportunity is here to build a new culture in our organization; one that is team focused with a commitment to make a positive difference in the lives of our patients. What is/will be the impact of personalized lipid testing profiles on chronic disease management?a. The idea we operate by at Health Diagnostic Laboratory is that not all pateints are created equally. We are all designed in a unique and marvelous way. Therefore, we cannot expect that every individual will progress in their disease in a specific way, respond to therapy in a specific way or have their cardiovascular risk correctly predicted by measurement of a single parameter using defined cutpoints. Almost all of us (80-95%) have some atherosclerosis and cardiovascular disease, however, the mechanism by which my disease has developed is likely different than that of yours, because of a number of biochemical and genetic differences. Data was recently published demonstrating that 49.6% of pateints admitted to US hospitals with a diagnosis of coronary heart disease (n = 136,905) have optimal LDL cholesterol levels. There is significant residual risk beyond traditional lipid measures. Advanced, personalized cardiovascular testing can identify that residual risk.b. The idea is to use low cost, laboratory testing to determine the root cause of disease, provide interpretive reports indicating the best options for therapy (lifestyle changes, pharmaceutical, or other), and provide access to health care professionals (health coaches including registered dieticians, exercise physiologists, diabetes educators, etc.) to help the patients achieve the goals that have been set for them by their physicians. The net is integrated healthcare involving the entire health care team, including laboratory professionals. If we do this right, we can beat cardiovascular disease while simultaneously reducing the cost of health care. What is your opinion on the role of patient-based access to medical records, including lab test results, on disease prevention and management?Pateints are becoming more informed about their personal health care as access to information becomes more readily available through the internet, and other rapid information sources. All patients should take the responsibility to insure that they receive the best possible medical care. That said, I believe it should be the health care providers who have been adequately trained and educated in appropriate medical decision making that determine what tests should be ordered and the appropriate response to results. Direct access to pateint laboratory testing may be something that is utilized in the future, but this should be reserved for specific areas and should always include access to and guidance from the approptiate medical personnel. Many are trying to develop such programs, all of which should be properly vetted and if possible, approved by a certifying organization. Until such time as apporved programs are developed and vetted, my recommendation is that persons seeking medical care should see physicians and other appropriately trained medical personnel for health care and laboratory services.