10,000 Slides and a Substack

Brittani Riddle:

Good afternoon. It's day two at the College of American Pathologists House of Delegates and Pathologist Leadership Summit. I'm Brittani Riddle and here joining me today is Bruce Mehlman of Mehlman Consulting. Thank you for joining me today.

Bruce Mehlman:

Well, thanks for talking to me after I just talked to everybody for 60 minutes.

Brittani Riddle:

Well, we enjoyed you and like you said, you just got off the podium. For our members who weren't able to attend, tell us a little bit about what you spoke about today.

Bruce Mehlman:

Yeah, summarize 10,000 slides in 45 minutes. I tried to help people understand where our political system is, how we got to here and where it's going. Why I'm ultimately, believe it or not, optimistic. I tend to think the American political system fundamentally reflects of populist voters who feel disrupted by technological, geopolitical, and cultural changes. The people, voters feel like we can't keep up and we don't know who's got our back and we're looking for somebody to kind of ride in on a white horse and modernize the systems, the governments, the policies, the institutions so that we feel somebody's looking out for us. We keep voting for change because we haven't gotten there yet. But the last point I made to try to be optimistic was that history teaches us every 60-80 years America goes through these very tumultuous periods of low trust and high stress, and we have always come out the other side a stronger, better nation with more appropriate policies and institutions for the new times we're in.

Brittani Riddle:

You talk a lot about things that are disruptions and that are risk. What are some of the biggest risks you think that pathologists are facing today?

Bruce Mehlman:

Like all the rest of us, there's lots of risks. I mean, you'll start with technology, which is both a risk and an amazing opportunity, but there's no reason that the practice of pathology is safely immune from what artificial intelligence systems can do. We're going to find, maybe it means fewer pathologists are needed to do more work or that digital systems can be more reliable or that individuals are suddenly going to be able to do some kind of weird home testing with AI systems that lead to whether it's false diagnoses or even less trust right now, pathology, nobody thinks they understand it, so we all rely on our doctors, but the more it feels like it's accessible, the more we all think we can be there. That's one big challenge. Globalization has a big impact on things that are available and the costs for labs, so if we're in trade wars, that's going to make for a supply disruption similar to, we all live through in 2022 with the pandemic, which is not fun. And then there's the, I dunno if you call it political or economic, but there's the challenges of the US is $37 trillion in debt. Everybody's looking to squeeze something and the largest part of the economy and the largest part of the budget are health programs, and that makes them a big juicy target. But if you want more research, if you want the highest quality people doing the best possible medicine, you can't pay bargain basement rates.

Brittani Riddle:

Absolutely. You also talked about pathologists needing to stay engaged. What are some of your tips so pathologists can remain engaged as we continue to navigate the changing climate?

Bruce Mehlman:

Yeah. What I urge the group here today is to first be patient. Only 4% of elected officials have a background in medicine, and that's not bad. There are people who are soldiers and there are people who are in the energy sector and there are people who have tech backgrounds or teachers, but it means we can't and shouldn't assume the people we're talking to understand things and aren't with us because they have decided against us. Most people don't know what pathology is. Most people don't understand the dynamics. They don't know how it affects their lives and why it matters. So you got to be be patient. You also have to be persistent. We are, I think I showed on the chart, 17% of the $4.4 billion that were spent on lobbying were spent for healthcare and even within healthcare, health professionals are competing against health insurers and hospitals, and so we have to be persistent and making our case and making it again and understand that the people we're trying to convince every day are hearing from every other interest, every other group that says, no, you got to spend the money on my thing and you got to do it this way, and then finally you need to make it personal.

Pathology. Medicine. Generically it doesn't, sure everybody's affected by it, but it's very different. It's why you see so many of the lobbying efforts in healthcare lead with disease groups. Everybody knows somebody who's got, say, Alzheimer's, and every single member of Congress wants to fund Alzheimer's research. Now, at some point you run out of dollars, but nobody wants to be against that. Whereas generically we are just a word and a complicated word at that. And for that matter, truly uninitiated, the first thing that would come into their mind is pathological liar, which is not anything related to what we do, but who's going to educate people about who we are, what we do, and why we matter to their community and to their family. It's got to be us.

Brittani Riddle:

You talked about patience, persistence, making it personal, but you also mentioned optimism to give us one or two takeaways about how we can remain optimistic moving forward.

Bruce Mehlman:

Well, I tend to be more optimistic about technology than not, and I base that not least on so many things that are now easy and I take for granted in my life didn't exist 10 or 20 or 30 years ago. Particularly when you study innovations that are happening in healthcare, the marriage of genomics and artificial intelligence and big data. I think we'll be looking at a world, it's not crazy to think in 20 or 30 years, the diagnosis will be these wireless Star Wars equivalent of a tri-quarter, and they'll be able to take your specific individual DNA and biome or whatever the right word is and put it into an AI system and come up with, here is something that's exactly right for you. And one thing I've always observed is that so many drugs that get rejected because they're not safe and effective, aren't safe and effective broadly, but there are always these subpopulations for whom they were effective. They're just too dangerous for too many people. I think we're going to start finding a way to peel those layers and to understand, hey, it's really effective for people from the Caribbean. It'll kill you if you're from Asia, but it will cure you if you're from the Caribbean right now. We throw that away, it's on the shelf, and I think we're in a future where all of our lives are going to be longer and healthier and improved thanks to things that are happening.

Brittani Riddle:

Thank you again for joining us today. Can you tell us where we can connect with you on social media?

Bruce Mehlman:

Oh, first you have to assume people want to be on social media. Yeah, I'd recommend find my Substack, which is a weekly newsletter. It's not a social media site like a Facebook or a Twitter where everybody's yelling at everybody. Mine is free. There are a lot of people who write. I've kind of curated my own almost newspaper where maybe I get a weekly, in my case, you get a weekly three to five minute read, Six Chart Sunday where I just try to find what I think are interesting and infographics about what's happening in the political world. The good news is for something that's free, you don't have to give a credit card to me or a lot of the people, other people make a living on it. It's my weird hobby. It's why my golf handicap is in the high twenties.

Brittani Riddle:

Well, thank you so much for being with us again today, and I hope you have a great rest of Six Chart Sunday.

Bruce Mehlman:

Thanks very much. You as well.