Professor Howard Morris is Professor of Medical Sciences at the University of South Australia and a Clinical Scientist in Chemical Pathology at SA Pathology, South Australia. In this interview with Diagram magazine, Prof Morris talks about the role of laboratory medicine and his vision for the International Federation of Clinical Chemistry and Laboratory Medicine (IFCC) when he takes up the role of President in January 2018.
1. What made you enter the field of laboratory medicine?
I started as a fundamental bio-chemist in university and was drawn to the application and usefulness of biochemistry for healthcare. I enjoyed the philosophy of this exact science being translated into what we can do, and taking a rational approach to make changes in healthcare to change peoples’ lives.
2. Your wife also works in the same field. Is work off limits at the dinner table?
Not at all – we discuss issues that we encounter in our respective work environments. For many years, she worked in the private sector, and I worked in the public sector and that was a source of lively debate. We both enjoy a very fruitful relationship in terms of an exchange of ideas.
3. You start as the President of the IFCC in January 2018. Can you talk about your journey, or your path to this position?
I’ve been fortunate to work closely with clinicians over the last 20 years working in Adelaide, Australia. I would attend ward rounds in the endocrine ward and sit and discuss patients with their physicians. I did this to ensure that there was a seamless relationship between the test result and its application to patient management.
This experience led me to be involved in the national association and later on, the IFCC, initially in the scientific division. The scientific division focused on standardisation and harmonisation of assays. Over the years, this has led to improved patient outcomes and care.
This focus has seen standard tests like cholesterol much more effective as we are now in a place where any laboratory using any major system will receive the same result for the same patient. Prior to this, there was huge variation. We have made a major contribution. This journey has led me to where I am now, taking up my new role as President of the IFCC.
4. As President of the IFCC, how will you strengthen the position of laboratory medicine?
I hope to enhance the work for evaluating the value of individual tests to provide a sustainable and affordable service to the community. That means adopting automation and implementing point-of-care testing where that is the most cost effective way. We need appropriate laboratory management and basic business principles so that we’re not wasting our valuable resources. We need evidence based laboratory medicine to ensure we’re adopting tests that actually contribute to patient outcomes and there is evidence for that. We need to put those together, through a tool that is leveraging the value of laboratory medicine, and that could be the value proposition. If you can’t measure it, you can’t manage it.
5. What was the catalyst to writing your recent manuscript?
Well, my own personal thinking arose out of the local system in South Australia where we are in the process of transforming healthcare. There’s a new 2.86 billion dollar hospital construction and many of the hospitals are becoming specialised. This is causing great anxiety amongst the medical professionals. However, within all of this, laboratory medicine is not even in the discussion. To be able to develop a healthcare system that is financially sustainable, I believe there has to be a paradigm shift. I would like to see laboratory medicine professionals being able to contribute to discussions about the healthcare system.
6. What do you think is the most underestimated aspect of diagnostics and how can this be addressed?
The way in which diagnostics can change the patient pathway is underestimated. We’ve heard how specialist colleagues ignore a result because they don’t understand where it fits in. We need to define the clinical pathway of a patient, and then evaluate the role of laboratory testing in modifying or enhancing that pathway.
We would like to see more laboratory medicine professionals providing leadership for clinical trials – thinking about the use of their tests, collaborating with their colleagues, and then conducting those trials and providing the evidence so people can make decisions based on this evidence.
Our clinical laboratory professionals need to play a bigger role in initiating clinical trials in order to demonstrate their value.
Clinical laboratory professionals need to play a bigger role in initiating clinical trials in order to demonstrate their value.
7. Whose role is it to advocate the value of diagnostics?
There will be opportunities for individuals in the laboratory to advocate for the value of their tests. Within the hospital, or the healthcare system, if the funding changes to one based on patient outcomes, the individual laboratory professionals will have to be there to advocate for the value of their performance. In a larger scenario, laboratory professionals and leaders could be initiating clinical trials on the usefulness of tests, and conducting those in conjunction with clinicians to be able to write academic papers. This will provide the evidence for the big payers, such as health insurance companies or governmental departments, when they make decisions for reimbursement of testing based on those data.
8. Are you concerned about the future of laboratory medicine?
I think the crises facing the healthcare system are there whether we like them or not. What we can do is educate and arm ourselves with processes so that we can take part as equal partners in the debate. If we were to stick to our old ways of thinking that we just provide this service, the risk is we will move further and further away from the decision-making about healthcare delivery. I’m a glass half-full kind of person. If we apply ourselves to addressing these problems and working on solutions, I believe we’ll have success.
9. What are you reading, or what have you read recently that has left an impression on you?
I’m reading a book by Annie Proulx entitled ‘Barkskins’. It’s a significant book, tracing the development of Canada, from the 16th to the 20th century. It is highly thought provoking in terms of the short sightedness of humankind coming into a new environment, seeing and acting on the immediate, with no concern about the deeper implications. In the Canadian environment, it’s about deforestation without considering the human as well as the environmental costs. It is profound in terms of global warming and what that all means for us now.
10. What inspires you and keeps you going?
Understanding the fundamental properties, particularly of life – I find life and its complexity, intriguing. I love to hear stories about the intricacies of biology. I just heard a lecture from Maurizio Ferrari on the new findings in molecular genomics, and a plenary lecture last night on lung cancer. These lectures highlighted being able to understand fundamental molecular and basic changes and their implications. For instance, now a single base change in an epidermal growth factor receptor, produces all the horrors of lung cancer in an individual. Looking at the complexity of that system, being able to identify its individual parts and tell a story is inspiring.