[Rhonda]: So the test that you played a role in developing, which is, I believe, used by
Quest Diagnostics and it's, like, based on physics, essentially, right?
Just throwing these particles through the air, and, based on their way they're going
through the air, you can figure out their density.
But why is that not used in medicine?
And can we get physicians to start adopting this?
[Ron]: Yeah, well, of course, I'll, you know, disclose here that along the way, because
of my interest in lipoprotein metabolism and where I've been able to do my work, initially
at the Lawrence Berkeley lab and now here at Children's Hospital, I've been able to
work with people that have had analytic capabilities that have led to methodologies, the most recent
is the one you mentioned, I'll come back in a minute to that particular method.
So we brought this to the public through industry.
And so, you know, we do have patents and they've been licensed to do this methodology.
So that's a disclosure.
But that's the way you get things out there, is through that kind of partnership.
And it has penetrated a certain segment of the preventative cardiology community.
There are lipidologists, in particular, who are proliferating, fortunately.
There's a lot of lipid education going on, and the people that are really skilled and
understand lipid metabolism are at least thinking about lipoprotein particles, not necessarily
yet about sub-fractions, but at least a particle versus the LDL cholesterol is taking you in
the right direction, because that's really the first step in terms of narrowing down
the focus on what you should be treating.
That's being understood, but it's still a relatively small percentage of the entire
medical community that would consider themselves lipidologists or cardiologists.
What about the rest of the physician community?
Well, they've been confused.
And a part of that is because there's been a number of methods that have been out there,
not just the ones that I developed and others that have used different systems and different
calibration, different ways of organizing the data, different ways of trying to educate
the public, a lot of it driven by the companies that have promoted these methods.
And so physicians were getting barraged, and still are, with competing claims for this
or that method, not as well standardized, certainly, as the LDL cholesterol measurement.
So it's been kinda given a backseat in part because of that confusion, in part because
a lot of people are still not convinced and even my colleagues, even the lipidology community
is not fully convinced that the smaller particles are that much worse than the larger particles
despite all the data we have.
So I'm always on the trail trying to sort of remind people of what the data show.
I give a talk called "Not All LDL Particles Are Created Equal," and people just need to
understand that.
So there's been a slow uptake because of the confusion, a scientific confusion, a methodological
confusion.
And at one point, it was a price issue, as well.
Is it really cost-effective to be using this test and, you know, hundreds of thousands
and millions of people, why did it cost an arm and a leg?
Well, this new method that we've...
It's not so new anymore, I've been working on it for, like, over 10 years, but Quest
did partner with us and has been now more actively engaged in supporting the development
of this methodology improvement and methodologies to be more refined, since it's one of the
more refined measurements...
In fact, it is the most refined measurement we have for lipoprotein analysis.
Using this technique called ion mobility, which sprays particles into air, and then
we count them as a function of size and it's really elegant, it's based on physics.
And it works, and it gives us data that is entirely consistent with everything we've
known from our previous methods.
Its standardization is in progress, but it's relatively easily standardized, and its cost
has come down to something, you know, that's not that much more than doing a standard cholesterol
panel.
So none of those things should be barriers anymore.
So I'm hoping that as time goes on, hopefully within my lifetime, that physicians will see
the role of this in their clinical practice, certainly when they're trying to make a treatment
decision, if they're considering a patient for some sort of intervention, I think that's
where the particle analysis really is important.
For screening the population, I think one can argue, the standard lipid tests do a fairly
good job.
But if you're having somebody, if you or, in my case, my patients, are on the cusp about
whether they should be dealing with their lipids, I think these measurements add enormously
to our ability to target those people who would benefit from certain kinds of treatments,
statins, diet, and then monitoring them as they're undergoing treatment.