WHO heme classification politics

[allopathdoc]

Anybody know more about what happened with the WHO heme classification. Apparently a top editor at WHO blue book kicked out all the people who put together the last three heme classifications and brought in fresh blood and perspectives (PhD cytogeneticists, basic scientists, digital imaging/AI poseurs with no clinical experience!). The old experts (who are all very close to retirement) did not like the snub, refused to take part in the WHO anymore and came up with a competing classification called the ICC. Not sure who will prevail. Hemepath has always been a bellwether for trends in pathology so would not be surprised if this happens in other fields as well.

What, how, and when for the WHO: will the clock be turned back for the next hematolymphoid tumor classification? - Journal of Hematopathology

link.springer.com

https://onlinelibrary.wiley.com/doi/full/10.1002/ajh.26503

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[LADoc00]

Comical. The entire field of academic pathology is set to be a dumpster fire once the current Boomer generation of tenured staff are gone.

 

[Spikebd]

Comical. The entire field of academic pathology is set to be a dumpster fire once the current Boomer generation of tenured staff are gone.

One thing about Boomers is that they were competent, and often exceptionally so, at their work. They just did a horrible job passing the torch to the next generation.

 

[cmz]

Hey, what about the "Power List"? The Power List 2021

 

[LADoc00]

Hey, what about the "Power List"? The Power List 2021

I cant tell, is that mockery like an Onion list?

That entire thing is a total embarrassment. Its worse than the cousin you follow on Instagram who probably needs to lose 30 lbs but continues to post unflattering bikinis pics..

Their bios are worse than many private practice websites...for "showstoppers" I expect see more than "is a pathologist in Saudi Arabia.."

LADOC "showstopper" bio: Is a pathologist who consumed MORE alcohol at the music festival than Nancy Pelosi's husband but still managed to make it home without being arrested. I consumed over 100 alcohol beverages over 3 days, easily a showstopper level of accomplishment.

LOL.

 

[pianoguy05]

The WHO is absolutely political. I'm practically abandoning it in Endocrine. The new edition is ridiculous...

 

[Alteran]

I don't know what everyone else's experience with academic hemepath is, but of all the path specialties I've found them to be the most exclusionary, arrogant, and "invite-only" type crowd that I've yet run into. They'll name drop carpet bomb style before you can even make perfunctory pleasantries after which they'll size up your academic pedigree and decide whether you're worth talking to any further. Of the ones that I can think of, they won't even give you the time of day unless you're a colleague of equal academic standing in their eyes.

So it doesn't surprise me that some folks of the WHO had a falling out with the previous authors, or vice versa.

 

[Nilf]

I cant tell, is that mockery like an Onion list?

That entire thing is a total embarrassment. Its worse than the cousin you follow on Instagram who probably needs to lose 30 lbs but continues to post unflattering bikinis pics..

Their bios are worse than many private practice websites...for "showstoppers" I expect see more than "is a pathologist in Saudi Arabia.."

LADOC "showstopper" bio: Is a pathologist who consumed MORE alcohol at the music festival than Nancy Pelosi's husband but still managed to make it home without being arrested. I consumed over 100 alcohol beverages over 3 days, easily a showstopper level of accomplishment.

LOL.

I beg to differ.

 

[Nilf]

I don't know what everyone else's experience with academic hemepath is, but of all the path specialties I've found them to be the most exclusionary, arrogant, and "invite-only" type crowd that I've yet run into. They'll name drop carpet bomb style before you can even make perfunctory pleasantries after which they'll size up your academic pedigree and decide whether you're worth talking to any further. Of the ones that I can think of, they won't even give you the time of day unless you're a colleague of equal academic standing in their eyes.

So it doesn't surprise me that some folks of the WHO had a falling out with the previous authors, or vice versa.

This was the exact description of dermpath folks when I was in training.

 

[LADoc00]

I beg to differ.

What are we judging here? I see what you did...

 

[LADoc00]

Yes I think WHO covering up for whatever did happen in China pretty much ruined their reputation so this a fairly blah at any rate.

 

[cmz]

Damn, and wasn't Jaffe on the Pathology Power List, too?

 

[allopathdoc]

Look at the names of the authors of the recent article about the ICC/CAC lymphoid classification and it lists a bunch of well-established WHO people like Elias Campo, Elaine Jaffe, and Steve Swerdlow. Apparently in the planning for the new edition of the WHO they weren't given as much power and instead chapter assignments were to be based on recent publications for that particular entity determined by a computer algorithm. These senior pathologists weren't happy and revolted. The myeloid article hasn't come out yet but I heard it includes Dan Arber, another senior hemepath guy previously involved with WHO. This could all be wrong, but its what I heard. There are young people involved in the ICC/CAC thing too though. Personally I'm not opposed to competing classifications. Obviously given recent events the WHO is not infallible.

I see merit in the new WHO approach to democratize the process. The previous WHO heme classification was monopolized by a very clubby group of people for 20 years. Their membership and authorship procedures for writing the WHO chapters were very opaque. They have done great service but time for them to step away gracefully without dividing the community.

 

[DoctorInQuotations]

Myeloid classification came out a couple days ago. They made some very odd changes: MDS-EB-2 is now "MDS/AML". I can't imagine how many phone calls I would get if I used that terminology...

 

[Alteran]

Myeloid classification came out a couple days ago. They made some very odd changes: MDS-EB-2 is now "MDS/AML". I can't imagine how many phone calls I would get if I used that terminology...

If possible, can you link? I can't seem to find it.

 

[DoctorInQuotations]

Hmm, I guess I was reading an advance copy; it's going to be in Blood but it's not officially out yet. I'll send you a DM...

 

[cmz]

Myeloid classification came out a couple days ago. They made some very odd changes: MDS-EB-2 is now "MDS/AML". I can't imagine how many phone calls I would get if I used that terminology...

I've been reading things regarding MDS/AML with particular attention at the requisite cut-off of "20% blasts". To boil it down as concisely as possible, the experts are questioning whether to change the classification taking into account the molecular/cytogenetic data. One example I read was, "NPM1-mutated myeloid neoplasm." So, instead of relying on a blast count to make the call between MDS-EB2 vs AML, you might consider revising your dx to the above (as an example). Oncologists will treat MDS-EB2 differently than they do AML and in a subset of patients with certain key molecular/cytogenetic alterations, perhaps instead of using standard MDS therapy, they should be given the standard AML-type induction therapy.

Things are definitely getting more complicated. I do not normally test for NPM1 mutations in MDS. I will order the NPM1/FLT3/CEBPA panel in AML cases with normal cytogenetics or if I suspect it up-front if I see certain key morphologic findings among blasts. Sounds to me like all MDS/AML patients need NGS, conventional karyotype and an extensive AML/MDS FISH panel run, right? I've even read some articles ("A predictive model for bone marrow disease in cytopenia based on noninvasive procedures", Blood Adv (2022) 6(11): 3541-3550) essentially reporting that NGS can predict the presence of abnormal bone marrow morphology in patients with unexplained cytopenia. All aboard the NGS train, right?

 

[octopusprime]

I enjoy hemepath about as much as i enjoy a swift kick the nuts so this will only further my resolve to turf everything to people that know/care.

 

[k_sheep]

You already can't classify the majority of the DLBCL subtypes outside of a few highly resourced countries. You are taking away the ability to classify in resource-poor areas once they are all genetic-driven subtypes.

Renal tumours are looking to go the same way.

 

[LADoc00]

What do you get for signing out a bone marrow now? Less than an Italian dinner for a family of 6?

Perhaps CMS will begin paying for Hemepath in Breakfast Taco Coupons per Jill Biden.

 

[Alteran]

What do you get for signing out a bone marrow now? Less than an Italian dinner for a family of 6?

Perhaps CMS will begin paying for Hemepath in Breakfast Taco Coupons per Jill Biden.

In professional charges at CMS rates, ~$170 for the morphology (PB smear, aspirate, core and clot). IF you throw in the flow and FISH, maybe ~$300 if CMS doesn't argue the necessity of the FISH. Some insurers reimburse the heme codes at commercial lab rates, sometimes being as low as 60% of Medicare. Considering the amount of nuance and clinical correlation you have to do to successfully sign out bone marrow biopsies, you really could do much better and exert far less brain power signing out simple biopsy specimens.

 

[mike-sheree]

What do you get for signing out a bone marrow now? Less than an Italian dinner for a family of 6?

Perhaps CMS will begin paying for Hemepath in Breakfast Taco Coupons per Jill Biden.

Who knows? But, it WILL be less next year and the year after. And, medicare tax is going up on S corps and PC’s with >$400,000 income. Keep boiling that frog. I honest-to-god think that the most attractive opportunity in medicine today is a 3 yr family practice residency then open a zero insurance, zero medicare concierge practice. You would have to locate carefully perhaps with some expert demographic consultation. Minimum effort and bs for maximizing reward.

 

[KeratinPearls]

In professional charges at CMS rates, ~$170 for the morphology (PB smear, aspirate, core and clot). IF you throw in the flow and FISH, maybe ~$300 if CMS doesn't argue the necessity of the FISH. Some insurers reimburse the heme codes at commercial lab rates, sometimes being as low as 60% of Medicare. Considering the amount of nuance and clinical correlation you have to do to successfully sign out bone marrow biopsies, you really could do much better and exert far less brain power signing out simple biopsy specimens.

Tubular adenomas and benign GI all day everyday baby.

 

[Med Director New England]

Tubular adenomas and benign GI all day everyday baby.

At least until a G code is set up for multiple GI biopsies from one patient endoscopic encounter.

 

[cmz]

At least until a G code is set up for multiple GI biopsies from one patient endoscopic encounter.

It's gonna happen.

 

[Alteran]

It's gonna happen.

If ever there was a poster child for over utilization and medical waste, look no further than urology as a whole and we can thank them for a lot of our reimbursement cuts. However, the GI lobby seems smarter and less greedy than the urology lobby. In my area, the GI docs are, as incredulous as it sounds, conscientious of their biopsy utilization. I've only ever gotten a series of more than three biopsies in cases of Barrett's esophagus with hx of dysplasia, known IBD surveillance, and those rare patients with tons of colon polyps. They don't generate anywhere near the number of 88305s per patient encounter that the urologists were doing back in the day.

As for the purpose of this thread, hemepath - it has no lobby that I'm aware of. Hence the garbage level reimbursement for a highly technical field with very nuanced and increasingly granular diagnoses.

 

[Allegri]

You think reimbursement for a marrow is bad, a medical renal biopsy with all the associated clinical correlation, nuance, and required expertise is 88305.

 

[cmz]

If ever there was a poster child for over utilization and medical waste, look no further than urology as a whole and we can thank them for a lot of our reimbursement cuts. However, the GI lobby seems smarter and less greedy than the urology lobby. In my area, the GI docs are, as incredulous as it sounds, conscientious of their biopsy utilization. I've only ever gotten a series of more than three biopsies in cases of Barrett's esophagus with hx of dysplasia, known IBD surveillance, and those rare patients with tons of colon polyps. They don't generate anywhere near the number of 88305s per patient encounter that the urologists were doing back in the day.

As for the purpose of this thread, hemepath - it has no lobby that I'm aware of. Hence the garbage level reimbursement for a highly technical field with very nuanced and increasingly granular diagnoses.

In my neck of the woods, I see the exact opposite with regards to GI biopsies. I see over-utilization of services to the nth degree. If what you're saying is true, then I am pretty sure that the GI group (6 man team with multiple hospitals covered) that seems to churn out 300-400 jars/day will be in the news soon.

 

[mike-sheree]

Heme seems to have gone the way of lots of brain tumors- - - the “ name” is almost meaningless. It is the molecular genetics that dict tx and prognosis. i guess most neoplasms will go that way. some are. morphology seems less important.