What About China?

In the business world, the rearview mirror is always clearer than the windshield – Warren Buffett

Since the inception of whole slide imaging pathologists have been concerned about two things. First, that our work would be done overseas. Professional pathology opinions derived from glass slides, now digitized, could and would be viewed overseas by pathologists who would provide the service for less, thus giving the overseas pathologists a competitive advantage. And secondly, that in turn, fewer pathologists would be needed in the United States since much of the volume would be read in China or India. Never Europe or Australia or South America. China or India. I don’t recall now from nearly 20 years ago if European pathologists felt as threatened but I think this fear did impede the adoption of whole slide imaging in the US.

Even starting my career at the turn of the millennium I thought that if the work could be done for less (with the same or better quality assumed), then large corporate commercial laboratories such as LabCorp, Quest, Clarient, NeoGenomics, Miraca Life Sciences and others would have figured out a way to process tissue in a 757 overnight from New York or Los Angeles to Bombay or Beijing. And just as Nike says, Just do it. Slides would be available for lower cost pathologists (with equal or better quality of work) to read in time for 8 AM reports on the East Coast.

To my knowledge, that hasn’t happened. And neither has outsourcing with digital images either.

Many individuals and institutions on the other hand, looked at insourcing cases from overseas, mainly China, the world’s largest economy with over 1 billion people and a burgeoning middle class of over 300 million people, nearly totaling the population of the US, who could potentially afford a pathology read from a pathologist in the US with expertise that was respected by his/her peers.

And since tissue could not leave China due to their regulations, the business case for digital pathology was strong. Scanners could be deployed to some 16,000 hospitals, some with 2,000 beds and private laboratories and we could essentially export our pathology knowledge to an area with a shortage of pathologists and perhaps a shortage of subspecialty pathologists for cases that required such expertise.

Many large and small laboratories, academic institutions, private groups and even individuals have tried to hang up their virtual shingle outside our borders.

But this has not happened either. Maybe several thousand cases a year but not a large scale for a country with more than 16,000 hospitals.

Why?

What about China?

The market that we in the US thought existed simply doesn’t.

The consumer or patient in the healthcare business model apparently hasn’t asked for this service. Nor has the provider, the pathologists, apparently. Nor have the government leaders in China demanding that services that are needed and can be provided elsewhere at a reasonable cost (comparable for the sake of argument to what private insurers pay in the US) be purchased.

Sessions at digital pathology meetings have been held on “Insourcing”. How to sell and market your brand overseas. What to think about in terms of histology to network issues.

It is not for a lack of effort on the part of US laboratories and pathologists. For many years, well-known academic centers have looked at this as an opportunity for an additional revenue stream, perhaps even as a service that would lead to referrals to their institutions for definitive surgeries, particularly for cancer care.

It seems then there is neither a threat nor an opportunity and I don’t think this is going to change anytime soon.