This post marks the 1000th for the Digital Pathology Blog in about 3 years time.  It is hard to imagine I would still be at this 3 years later on a nearly daily basis with the goal of informing and educating fellow pathologists and the laboratory community on issues related to digital pathology, telehealth, image analysis, industry news, research and development and topics related to the practice of and pathology and laboratory medicine mixed in with some general health news, current affairs and humor.

For post #1000 I have asked Dr. Ed Uthman who has embraced online pathology or Pathology 2.0 as I refer to it for more than a decade.  I asked him to provide his thoughts and opinions on where we have been and what we need to do as a community.  I have shared some of Ed's thoughts on this blog from the PATHO-L listserv he mentions as well as video from his YouTube channel.  He also regularly uploads high quality gross and microscopic images on Flickr and can be found on Twitter and Facebook.

Thank you Ed for your thoughts and insights and to the beginning of the next 1000 posts.

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In 1999, I wrote an article for Clinics in Laboratory Medicine, in which I presented an optimistic view of the future of online pathology. I predicted a paradigm shift from the ancien regime--a top-down flow of scientific knowledge--to a fully interactive network, where investigators who create most of the knowledge would have ready access to the pathologists in the field. The latter would provide valuable feedback that would help guide future research in the direction of efficiency and pragmatism. Eventually, the entire specialty could evolve into a worldwide colloquium of scientists and practitioners. At the time, I had been online (initially with a 300-baud modem) since around 1987. I started with GEnie, the information service run by General Electric. There was a "Medical Roundtable" in which I could discuss issues with other physicians, including the occasional pathologist. The medium was strictly plain text; data transmission speeds made the sharing of images impractical, video impossible. As we all know, steady progress in bandwidth availability, data storage, and client processing power led to the multimedia online paradise we enjoy today. So, just as those of us who grew up with the Jetsons might ask where the flying cars are, I have to ask, where is the online pathology paradise? Consider:

• Medical publishers, which used to be our major source of useful information, are now a clogged bottleneck for same. Although most journals have online editions, access to full text is prohibitively expensive. Just to view a single article, I have to pay almost as much as Medicare pays me to examine and report on a biopsy specimen. The other day, an academic pathologist told me that a publisher had complained when he made a PDF of one of his own articles available free for downloading. Keep in mind that these publishers do no scientific research, write no manuscripts, rely extensively on volunteer editors, and pay no royalties. Yet, one has the chutzpah to enforce its copyright agreement against its own contributor. All this in the era of Wikipedia, where you can find detailed information on the most obscure of topics, all free of charge.

• Traditional leaders in organized pathology have fallen far short of their potential. The American Society for Clinical Pathology has mutated into a retail storefront for (mostly mediocre) educational materials. The College of American Pathologists, which initially dragged its feet in meeting the challenge of the World Wide Web, finally sprang forth with an extensive Web presence. Unfortunately it has the most byzantine user interface imaginable, courtesy of third party vendors with apparently no understanding of the needs of pathologists. Fortunately, there is a bright shining star in this arena, the US and Canadian Academy of Pathology (USCAP), which makes all the educational materials for its annual meetings freely available for downloading, by anyone, with no password required. I will have to grant kudos with oak leaf clusters to USCAP executive director Fred Silva, who throughout his career has been three steps ahead of everyone else.

• The medieval academic system soldiers on. Hieratic figures, the published experts, remain confined to expensive journals, textbooks, and seminars. They are rarely or never seen in demotic online venues, such as PATHO-L, a free mailing list for pathologists, now with about 800 subscribers, which has enjoyed continuous vigorous traffic since 1994. Universities continue to use the same old-fashioned models in deciding faculty promotion and tenure, concentrating on publications accepted by paper journals. Any young assistant professor who would undertake an ambitious online project, such as a pathology-oriented Wikipedia (or even an immunostain Wikipedia), would have to weigh the likelihood that all that work would be ignored by a promotions committee.

By posting my complaints to a blog, I realize I am preaching to the choir. Still I would take this opportunity to entreat my colleagues to use their bully pulpits to shake up the status quo and move our specialty into the Information Age. We are way behind.

Ed Uthman, MD
Pathologist, Houston/Richmond, Texas, USA
Website: http://web2.airmail.net/uthman
Photos: http://www.flickr.com/photos/euthman
YouTube Channel: http://www.youtube.com/user/euthman
Downloads: http://public.me.com/euthman
Twitter: http://twitter.com/euthman