Last month, pathology leaders gathered in San Diego for CAP '08-The Pathologists' Meeting, to discuss the latest developments in molecular testing and personalized medicine.

A new logo featuring a butterfly was prominent throughout the meeting, signifying the practice of pathology is at a transformation point. Molecular testing and the promise of personalized medicine will change the way patients are treated. Digital slides and other imaging technologies will change the way pathologists work. The College and its members are taking a leadership role readying the profession for the future as central members of the patient care team.

Hot topics include genetic testing and the impact of increased requests for clinical consultations stemming from those tests; the current and future uses of telepathology to increase the quality and efficiency of pathology services; and the changing role of pathologists on the patient care team.

Highlighted sessions included "Embracing the Future: An Introduction to Virtual Microscopy and Telemedicine," presented by Keith J. Kaplan, MD, FCAP, and Ronald S. Weinstein, MD, FCAP; "Current Issues in Breast Pathology," presented by Timothy W. Jacobs, MD, FCAP; "Testing for Human Papillomavirus in the Vaccine Era," presented by Teresa M. Darragh, MD, FCAP, and David C. Wilbur, MD, FCAP; and "Blood Management: Nuts and Bolts--The Role of Pathologists in Getting it Going," presented by Arthur W. Bracey, MD, FCAP, and Timothy Hannon, MD, MBA.

"We've created a outstanding meeting, that will emphasize new technologies and techniques that will transform the specialty of pathology over the next 5 to 10 years and will positively impact the delivery of quality patient care," said CAP President Jared N. Schwartz, MD, PhD, FCAP.

Personalized Medicine
Perhaps the most poignant session, however, was the special scientific presentation, where Mara Aspinell, MBA, former president of Genzyme Genetics, presented on "The Revolution," aka personalized medicine. While many fear personalized medicine and how it will change healthcare, Aspinell explained how this transformational approach can save lives and dollars on an impressive scale.

Introducing Aspinell, Dr. Schwartz said, "When fully implemented, personalized medicine will transform medicine as completely as antibiotics and vaccines. This is going to markedly improve how patients are cared for, making it less costly and safer for patients."

Personalized medicine tosses out the old paradigm of trial and error medicine, and replaces it with a new paradigm of linking tests to action and therapy, Aspinell explained. Diagnostics are the missing third leg to the stool supported by drugs and procedures, she noted.

This new paradigm is increasingly important in our struggling economy. "Saving lives is not enough," Aspinell stressed, "we also need to save money." The major cost savings with personalized medicine comes from identifying people who will not benefit from a treatment. If 100 patients have present with a condition and are tested to see who will benefit from the drug, if 75 out of 100 patients will benefit; then the 25 who will not benefit are not given the drug, saving the cost of that treatment. This also benefits the patient, as those 25 are flagged early and their caregivers can find another solution that will benefit them.

There are six areas where personalized medicine will come into play, Aspinell predicted:

1. drug selection,
2. drug dosage,
3. drug efficacy,
4. disease status,
5. recurrence risk, and
6. predisposition.

As an example of personalized medicine in practice, Aspinell illustrated how blood cancers went from being lumped together as "cancer of the blood" 100 years ago, to today, when diagnostics identify 90 different subtypes. And in those 100 years, survival rate has climbed from 0 percent to 70 percent.

Leadership
If pathologists are going to direct the show as personalized medicine becomes common practice, they will need to hone their leadership skills. The keys to leadership are knowing your organization, your business and your team, according to Richard C. Friedberg, MD, PhD, FCAP, who co-presented "The Pathologist as a Leader-Getting It Done." Dr. Friedberg certainly knows a thing or two about leadership, as he serves as chairman, Department of Pathology, Baystate Health, Springfield, MA; professor and deputy chairman, Department of Pathology, Tufts University School of Medicine, Boston; and member, Board of Governors, College of American Pathologists.

It's important for pathologists to step up and lead, he expressed, saying if you don't lead, someone else will. "If choices are to be made, priorities will be set ... by design, or by default."

That doesn't mean leaders should be dictators, Dr. Friedberg said. In fact, good leadership should "have the smell of a democracy-everyone can contribute, but at the end of the day, one person is on the line." The results will not be total approval, he cautioned. "Five percent of people are usually annoyed with me at any given time." And that's OK. If it were 25 percent, then that would be too many. But 0 percent would not be ideal either, Dr. Friedberg said.

Not everyone is designed to lead. While pathologists can be pushed into a leadership role because of their positions, Dr. Friedberg compared scientific knowledge as a background to leadership with a sports metaphor: some players who try to manage are terrible. Just because you have the skills to play the game doesn't mean you will be a great manager.