Thank you, Dr. Dark, unfiltered and uncensored talk from young alumni of historically Black College universities. We got tipped out to be thrown off the show for sure. Hang with Hughes, Fred Ballerick, Lambert, KD, Winston, get them in the school. Let's get into it because I think in some form we always discuss COVID and the impact on HBCUs, right? And so it would appear that all that the epidemiologists have predicted for this winter is coming true in the form that they said it would. And the only thing that is staying the same in a regrettable way is that HBCUs are still, I guess, quiet on what the plans would be for the spring. And I'm not just talking about athletics. I'm talking about academics as well. While most schools or some schools have announced intentions of coming back to in-person instruction or hybrid instruction with online, the numbers of hospitalizations, deaths, infections continue to increase. So we will go around the horn and ask the obvious question, what do you think is going to happen in the spring when we're already pretty much at home and cases are going to go up by the time we return following the winter break? So we will start with, actually with Winston Gettenham in the school because this is going to continue to have significant impact, particularly as most schools have rolling admissions. And some folks actually start in the spring. What kind of trends are you seeing with young people thinking about what to do about school selection in the spring semester? Yeah. You know, it's interesting because I think this 2021 class that we're working with is a little bit more used to this whole navigating the pandemic and school thing more so than 2020. So I think at least the conversations that I've had preliminarily, I think some of them are prepared for the possibility of not being on a physical campus initially or at least preparing themselves, having the conversations about, you know, realistically, they may or may not be able to be on a physical campus right away. And I think they've kind of sided with that a little bit more than the last class did. I think 2020 was kind of, you know, living under the illusion or not illusion, the reality at their time was that they wouldn't end up on a campus. So it hasn't been as difficult a conversation to have about the possibility of them not being on a campus. So they seem to be siding with a little bit better and kind of navigating a little bit better. I think the realities of what we'll see in the spring are probably very similar to what we saw in the fall.  And then those are kind of waiting to see. And I actually kind of applaud the HBCUs for taking the position of, we're not going to speak too early until we're in a position to be definitive about what it looks like. I think that speaks to leadership and to, you know, just kind of getting a pulse of where we are when it's time to make final decisions that they're trying not to cause too much of a stir before they have to and really making sure that they evaluate and vet what makes sense for young people. And as we see, you know, as far as athletics, you know, folks are already making decisions about what they think is the best interest and the health of the student bodies coming to campus. So, Tiffany, we we're just a few months out from actually being a year into life with COVID, right? So you would think you would think from, I guess, from an enrollment management perspective, from an operational perspective that it's like, okay, you've seen this before. But in actuality, you haven't seen it before. Because, you know, we started at a certain point, which was bad, went down a little, now we're really bad. And they're saying it's going to get worse from really bad. So how do you think that the the campus, for lack of a better term, administrative culture, or should consider life what was once bad when it first started is now really bad? Is it the same? Is it the same set of rules in your opinion? Yes and no. Because we know that I don't want to answer it like that. Okay, yes and no. And I say yes and no, because there are some instances where some students have done well, have have been able to adjust and perform like they would in any other perform well, like they wouldn't any other semester. But then we also see that there are some students that just can't get it. I've also noticed that, you know, on a lower level of things, given what my new position is, that, you know, on the high school level, students are definitely struggling and thinking about that next step in talking to the high school administrators about getting their students to this next step. They don't know either. And one thing that one high school administrator said to me, like last week was that they have trouble getting their kids to show up to zoom class. And so I said, Yeah, I feel that I understand, you know, students need to be together. And one thing that I've noticed about at least where I am now is that we've had our students here and we've had them together. And I think that's been a saving grace for them for the most part. But you know, you can't do that on a lower level. And even still, there was still some some risk in doing that here. Because Corona was still on campus. So it's it's a yes and a no. Katie, do you think that people at this point are taking it seriously? Or taking it? I think people always took it seriously. But do you think they're taking it gravely seriously? Like we, we have to stay indoors, whatever we were doing within person, we have to more strictly enforce it. Remember at the beginning of the fall semester, even though we had restrictions and guidelines, students were still standing around outside, they probably was gathering. But now that you see the condition now, do you think people are saying, Okay, students are saying, we're going to buy by non gathering rules and and administrators are probably going to say we're going to be stricter about police and people standing around and being more more closely guarded about the new rules. In other words, are we just as seriously as we were about it before? Are we are we likely to be more serious now in the spring? I think the best way to answer that question is to say that it will be regional. So for schools down south who can hang outside in the wintertime, maybe not as much. But you know, northeast in the cold where it gets cold in the cold months and winter months here, probably a little more so, especially in New York, Maryland, DC, where we are now used to our hospital systems being overwhelmed. There's some of the best in the country. And so I think when you see that when you see the inability to go to the doctors for just a regular ailment, you'll find that people are like, okay, I want like to get back to normal. I want to be able to see my doctor under normal circumstances. What do I have to do? And our governors for the most part are taking it a little more seriously, which I think helps. I think as long as leadership takes it seriously, the citizens will take it seriously. But then you got stuff like I think the mayor of San Francisco got caught on vacation. And so when you see that it's like you're saying one thing doing the exact opposite. And that is with the terrorist progress in this case. And like you said, we're getting into the dark of months. The prediction is what 400,000 deaths due to COVID by February. So, you know, it doesn't in the sad thing about Americans is that we don't take anything serious until it affects us.  Eric, do you think that it's it continues to be a wise move on the administration's part to kind of slow walk what they're going to do? Because I think Winston made a good point that it's wise to not rush and say, all right, no in-person instruction, especially when we don't know what the deal will be with the vaccine. We assume it's like six to nine months out before everybody can get it. Who knows what the conditions will be on that being mandatory to even enroll in school, which we talked about before. But do you think that administration is doing is doing the right thing in terms of operation and infrastructure by saying, hey, we are where we are. You know, we got to follow these rules and this is what we're going to have to do. And I think it's a mixed bag in the sense that you could be in Maryland and there's a set of rules in North Carolina, there's a set of rules and in Florida, there's a set of rules and all of them are different, but you're still vying for students who can go to one of the three, any one of the three. You know, you're still trying to buy to keep faculty and they're, you know, you're thinking about, okay, I could have a rash of retirements based on what the rules are. Are they in good position now in your in your perspective, the administration on how they're handling looking ahead to the next the next semester? So you on mute, bro. So put a short no. It's going to sound really bad, but because when you're sitting out, when you're sitting back and waiting, right? Some people are sitting here saying like, oh, well, we're trying to dislike gage things as it goes. But the unfortunate thing is, is that with the world we live in, if you're still, if you're kind of sitting back waiting for somebody else to make a decision that can impact you, you're still going to be late because what happens is that, and I'm speaking from a perspective of an academic advisor, I've worked at two different schools in the last three months. I was transitioning jobs and everything, but the amount of students that are sitting here asking questions like, okay, so what are the plans for the spring? What are the plans for next summer? Because I don't, I don't know if I want to register for classes because I don't know what's going to happen soon, right? And then anybody who's who works with enrollment, works with academic advising, you know how difficult your job is as far as getting numbers. When you literally have to be honest with students, you can say here and tell them, I don't know. And I think a lot of schools are going to run into that issue sooner than later, especially now that we're in this place where, you know, I work at a school that at the beginning of the academic year, they said that they were going to have online courses only for the entire school year. So there's no question, like there's no question of what's going to happen until May at the very latest, right? So now students just know if you're, if you're applying to go to school, you just know what the situation is, you know the decision that they made and faculty can plan, advisors can plan, administration can plan. Everybody's somewhat on the same page because at least there's that one constant. When you don't have any constants and everybody's all over the place, you have chaos. So I don't, our school, we want to get students who might, we want to make sure that we're getting that money coming in because it's such an important thing. But at the same time, when you can't plan, when there's, when everything is fluid, you don't put anybody in a good situation. So that's just, that's just my perspective. Great, Katie. One thing to note, especially for freshmen that may stumble across us having this conversation, that spring date is not actually the spring, that's late January, early February, when we'll be at the peak of, or at probably the worst point of this pandemic. So planning for that is key for all of us. Now, parents may know that, but the students don't. So when they hear spring, they be thinking March, April, when really it's January, February. And so that's just something to keep in mind. And I'll actually add to this a little bit. So the UK just approved the Pfizer vaccine, right? Really? They just approved, I think was that either yesterday or the day before. So now, so now everybody's saying there's pressure on the FDA to do the same thing. But my whole thing, so my whole thing is two things that are popping up now. One, if the FDA rushes it, then what, then what are schools going to do? Are they suddenly going to say, okay, we're back on campus with us not knowing, I mean, every single year the flu morphs and it's a new strain. You think COVID is not going to do the same thing? And the second thing is, is that where I work today, we just had a conversation and I can't believe we had it. But the question was, should we instill a rule that you can't come back on to the campus physically unless you get the vaccine? What do you do then? Because now we're sitting here talking about with all the history that we as people have when it comes to medical racism and things of that nature. If you, what if North Carolina as a state with the public system, with all the HBCs that our public school says, oh yeah, we're going to be back on campus physically, but everybody is required to go and get the vaccine. What does that look like for us? And that's something to think about because with the amount of black folks who are not going to trust the early stages of that vaccine distribution, but there's going to have to be something because you, you might have kids, you might have relatives where they say, okay, K through 12, y'all ain't coming back without a vaccine is mandatory. So that changes the game when something becomes mandatory, right? You might have to unwillingly take it, but it could be that you just, you're right. You could say, well, Maryland doesn't have that guideline. I don't want to take it, so I'll just transfer it to a school in Maryland. But you know what? I'm just thinking about how there are some vaccines that are mandatory. And is the, is the apprehension history not being a factor here? Is the apprehension around a COVID vaccine because it's come out quickly? Yes. Or just, okay. We're not anti-vaccine here. We're not anti-vaccine. I'm not saying that at all. But what I am saying is that, and I will just talk, my girlfriend works in public health, I will just talk to her about this. I was like, I have a problem when you're trying to, when you're trying to push through a vaccine and you can't tell me where a disease comes from. Right, right. If you can't tell me where it started and like what causes it, then you can't tell me that this vaccine fixes it. Like that doesn't make sense to me. So with it being pushed through so soon, I have no problem with everybody being like, yeah, now I'm gonna wait until it's actually tested out before I even touch that. Yeah, that's fair. And so the other thing to keep in mind is that at best case scenario, it's not a battle with everybody until June. So we're not going to even have to even have to have this conversation until April May because of the way the vaccine is set up. It needs like these incredibly cold storage temperatures. And again, only a few people can make the vaccine effectively.  So really we. But y'all are actually segwaying into an important point that I want to raise in part two. Let's take a quick break and we're going to touch on this in the next part because all the questions that we're talking about here, this is going to be mixed in with a lot of HPC presidents and chancellors saying, I'm out. I'm not dealing with it. So that is at the dark. We'll be right back. That is at the dark. And we're back back. Endorsing the power of breast milk as a COVID salvation. Let's come back to a conversation. This actually extends to the previous to the previous section about how we're handling COVID-19 and what's what's what are the likelihood measures or what's the likelihood of sound operability in spring 21. And this introduces another interesting conversation about present or HPC leadership. So yesterday, we had Alabama A&M University president Andrew Uginni announced his retirement effective June 21. That he's a really you may not have heard of him if you're out here listening. But in the HPC you can't be on he's somebody who's highly respected highly respected for his political his political savvy, particularly in in in red states. Highly respected for for building enrollment building academic profile. This is a this is a good president. And he's saying goodbye. Now I talked to him yesterday. He said COVID had nothing to do with him wanting to leave. But he did go on the record and say. This delayed my desire to leave by a year. I was going to announce this in June. And now I'm going to stay one year. To not only one help the university get through COVID and what that's going to look like, but also to give the board an opportunity to have an effective presidential transition. So I'm asking y'all.  Some folks are going to leave. In 21. Um, some big names and some small names. But I don't mean small in that way, but that they're not as large as some of the other ones.  And and part of the reason is that the uncertainty of COVID and what that will mean for their contracts, what that will mean for their then possibly getting extensions and what it will mean just for their their their comfort level. Some folks have just been at it at a while and they're like, I don't want to work this hard for some. I don't even know what to do. It would be one thing if this was a hurricane. I may have seen that before. It would be one thing if I had a campus shooting. I've seen that before. I've never seen nothing like this. So now I'm going, I'm I'm doing something new that may impact my retirement, may impact my pension, may impact my legacy. So what do you think the prospect is? But again, not divulging too much. What do you think the prospect is? When we see a rash of HBCU presidential defections, retirements, force outs, a bunch of other stuff. Eric, I start with you because you look skeptical about it. First and foremost, and this I don't feel sorry for anybody who's talking about, well, this is something that I've never seen before. And this is why we were on this podcast months ago. And I said, and I said, if you're smart about it, COVID could be the opportunity to really cement your legacy because we as HBCUs, we have this problem of doing what we've always done and expecting different results. Now you have a reason to do something that you've never done and get better results. And what do you do? Nothing. So like, I'm sorry, like the thought process of everybody sitting here talking about, oh, well, like I'm staying on to kind of help. And I'm like, no, like what's your track record right now? I don't know who I don't know which names. I'm not going after anybody in particular. There's some people, like if they're offended, it's not because I don't, I don't like you.  Like it's just, this was one of those things where I'm sitting here like, things happen every single year. There's always something for anybody who's ever been a president of anything who's ever been a director of anything, manager of anything. Things always happen that you never see coming. The question is, how do you react and respond in those moments? Now, if you don't get an extension because you didn't respond properly, you were going to blame COVID because if that's the case, then let's say you're in your fifth year, right? And this was your fifth year. Then that means you didn't do nothing in the first four years and make them want to say, oh, well, give them another try because this last year was kind of a wash. So it depends. And I'll give you a perfect example. So 2011, 2012, nobody saw that parent plus thing coming. We should have seen it, but nobody saw it. And a lot of people lost their job because the government changed a financial aid policy. Students didn't come back.  And the board looked at them and said, somebody got to go. And it ain't going to be me. I'm going to give you an example. And this is not talking about anybody in particular. But if it hit dogs holler, so if it happens to be your school, that's not my fault. We're talking about a respiratory disease that we don't know the inception of. And you, as a president, didn't say anything. You, as a president and or chancellor, didn't say anything about your school continuing to have sports this fall. That's you, dog. That's not the government making decisions for you. That's you, dog. Like I'm saying, it's not the same situation, right? So I'm not, I'm sorry. Like every last person that's on this call, every last person who's listening to this podcast, their life has been dramatically changed by COVID. So I'm supposed to feel different about you and how you responded in that moment and how you didn't step up in that moment when you had the ability to, because you're a president at an HPCU. If we know anything as black folks is that anything that deals with us doing well for us is going to be impacted negatively by some other people or some other factors that we can't control. This is more, this is what we know. So I'm sorry. I don't, I don't have any empathy in this situation.  If you were to retire, if you were to retire in 21, would you say, okay, job well done? Or would you say, oh, COVID rang you up out of it? Jared, Jared, Jared. Everybody knows I was like, oh, David, that ain't no way. That's a little bit of both for him. I mean, to be fair, he has not run necessarily a bad operation. He just hasn't pleased all of his people. That's why I'm referring to that. I don't even know why you put that on me. You know, I guess it's a case by case basis. I'm not going to fault anybody for being in their mid 60s and 70s. And finally wanting to rest, especially with so much unknown going on. I, I, I'm not going to sit there and imagine anybody because as somebody who works in K-12, we're facing the same issue, right? A lot of our principals are baby bombers that a lot of them, far more than the system is comfortable with. They're scared because on our level, students like to touch each other. There's nothing you can do about that. They're teenagers, they're children, children, they just touch each other. That's what they do. And so it is very easy to see an outbreak happen within our system. So like people taking that health first, you know, considering that health first doesn't bother me at all. The thing that scares me is that we got a hundred and what, three hundred and two HBCUs or whatever, and let's say 25 retire. That is a, that leaves our entire system in limbo, right? That's a lot of students out there that haven't made a choice and won't be able to make a choice because there's no leader at the top. It makes it difficult to recruit, it makes it difficult to hire, it makes it difficult to state systems to give you money because there's nobody sitting in that space that is somewhat of a permanent fixture. And that's the thing that scares me. What happens in 2021, 2022, 2023 during all of this transition? Because it might be that many, it might not be, but even if it's just 10, that's a lot for us. So let me ask this question.  Is she really? Instagram would say otherwise, but Tiffany is an aspiring president. Would you, if you were in position to apply for presidencies tomorrow, look at someone who is leaving or has recently announced, let's say Alabama A&M, which is in good condition. Enrollment's fine, money's fine, profile fine. Would you say with COVID included in it, I'm eager to go get that job. Now keep in mind, now throw the traditional, you shouldn't follow a longstanding president logic out, out, out, away, which is a general practice. You don't follow a, you don't follow a king or a queen.  Because nobody wants to follow somebody who's beloved or at least respected for the job that they did. But let's say you were in a position to get a presidency and COVID is sitting on the doorstep. And COVID is going to dictate how many students you have, what your money looks like, what your construction looks like, what your personnel looks like, what your legislative agenda looks like, what your legislative lobbying looks like. Would you be eager to jump into a job like that? First, thank you for the question. I'm going to answer that question last. First, I would like to suggest that it's more than HBCU presidents who were put on hold in terms of leaving their positions or taking other opportunities. So I think that's very important. Yeah, fair. Yeah, I got you. I got you. I got you. Okay. Yeah. So like, so in that regard, if we have HBCU presidents taking leave or going wherever, and other cabinet level, folks who are about to be a body here, then we might have a bigger issue because you don't have a leader and then you don't have a leader of a division. What are we doing? So I think that's something to be nervous about because when you don't have people in place, you can't make all the decisions you need to have. But in light of COVID, that might be a good thing because we all need to be in our rooms. Okay, cool. We ain't got to do nothing anyway because we shouldn't be in, we don't have leadership right now. Okay, cool. Your second question, I think you're very funny. But to that, it would be more along the lines of what Eric was saying. What can you do now to cement your legacy? Like, we know what we're doing. We know what we've been forced into doing and that's becoming more hybrid-based, accessible, making things accessible in terms of our coursework and making sure that our students have what they need. But that's only because of a pandemic, not because we made plans to be operate like that in the 21st century. Like, we don't have campuses that could readily just transition to hybrid or fully online. So I think that's something that's very important to expand. So if I was in that position, I would concentrate on doing that because anything is possible. That's interesting. If I was able, I fully believe that we should be, part of our emergency planning should be if we're told we got to shut down, we can get everybody off campus within a couple of hours, depending on the size of the campus. And in transition, have Blackboard ready, have whatever platform the university uses have it ready to accommodate what we now have to shift to do. And honestly, sad reality is the only reason why we're here now in figuring that out is because of the pandemic that we had no idea was going to be this long. So things that we should have been exploring in the first place, but... HBC presidents and chances, if they're good at nothing else, they are excellent timekeepers. They know how to watch a clock. They know when certain debt and mortgage on construction is coming due. They know when certain accreditation issues are likely to rise, you know, on a five to a 10-year increment. They're excellent timekeepers and they know how to count money. And they know when they can say, I got it or I don't got it. And how those two things converge. And so, and you know this and without calling any names, look at how many new presidents face intense criticism from alumni and faculty about one or two years in. Usually they're getting that kind of heat because their predecessor left something behind that nobody knew about. And when it's time to do something about it, the new brother or the new sister is the one that got to deal with it and deal with the fallout. I'll give you a perfect example. Early in because he's not there anymore. Kevin Roman Fisk. He was laying people off. He was cutting programs. He was doing a bunch of stuff when he first got there and people couldn't stand him for it. Get him out of here. He's trying to destroy Fisk history. Nobody knew what the last president left behind in terms of how many bills you got coming and how much money is coming due on stuff and how much debt we have. Nobody saw that coming. And so Kevin, when it was time to react to those bills, he got to blame. So I just say that to say, keep in mind, think about how many presidents and chancellors catch heat from their stakeholders early in their tenure. That shows what happens when somebody left. Well, that would say where they're... Why you bring up him? Why don't you bring up Frederick? Because even though I... Because not because I dislike Frederick, but because I know that he was put in a tough situation. If anybody knows the history about what Rambo did in his time that was there. Right? So like because... I tried to be nice. But I'll flip it on. I mean, and it's not even a personal dig because at some point all this stuff is public record. Right? But I'll put it on the opposite end. You also had those situations where there is a president and or chancellors hint-hint that they were not liked for the things that they were doing because they had a vision that was going beyond what people were thinking about. And it only came to fruition after they left. So the new person came in. They really didn't have to do much to get a whole bunch of credit for things that they didn't put together. And then what happened? Then you get in a situation where it's three, four, five years in and all those things that the predecessor had did start to like be old and you don't see the food or the labor of the person that's currently there. And you're like, oh, he just hit for a photo op. Right? So like at some point, the president, like at some point you're saying the excellent timekeepers, the excellent at watching their money, the excellent no one deaths. That's all going to be good. My ultimate question is, how well are presidents, and these are the questions they got to answer for themselves, how good are they and being able to adjust on the fly? Because that's ultimately where it comes down to. Five year plans are great. You got to get to five years. The problem is that most of our presidents only get to five years. And it depends on your skill set. So for example, if you and that's on the board, Winston, I'm going to come to you in a second.  This brother and sister knew how to make money or at least to account for it. We didn't have a lot of waste. We didn't have a lot of theft. We paid off our bills. We're good.  And that person comes in and then you have a financial crisis for some reason, like COVID, like parent plus. You got a student affairs expert there, but you need a financial expert. But that student affairs person has five year contract or three year contract. They don't have the skill set to deal with that crisis. Or for example, you have a financial person coming in to follow a student affairs person and you got a student on campus or you got a rape on campus.  See what I'm saying? So it's always difficult to deal with what, and as you said in the first segment, something is always going to happen. Something is always going to happen, but it's the way that people leave things, maybe not even in a bad way. Maybe they just say, this is a long-term project that I'm down to deal with. But Winston, I will come to you because you're in an organization in midnight golf that has a leadership structure like most. If your executive director, your CEO tomorrow said, I'm out, I'm tired of dealing with this. What kind of upheaval does that create for the organization? Yeah, no, that's that. So to what we're talking about, if enough for us, it would be probably drastic because you're talking about the heartbeat of what we do and the founder of what we do, which would be pivotal to the direction of the program, which is what we're talking about in general, the direction of the schools. I think it's just like being a president of the United States of America. To me, it's like you have to also be comfortable with surrounding yourself with the people that you know can do things well that you can. So to your point, if you are the person who boosts enrollment, you got to have the other people around you who know how to do the things that you don't do well to make sure that the structure is balanced. It's up to you as a good leader, a good leader is going to put talent to people. In some cases, they'll argue people more talented than yourself to be able to do other things. Those roles of cabinet are imperative roles.  They have to be able to deal with the board. They have to be able to deal with you. They have to be able to do their job. These are, there's no substitute for having quality people around you to be able to have a ship and run a ship the right way. You make an excellent point, but I will give you something Ruth Simmons said on the podcast not too long ago. Your goal as a president is to have good people. When you have good people, people come and take them.  That's not a diss. That's not a diss. Because Ruth has had two people who only become presidents since he been there in two, what, three years, three or four years. So Ruth knows how to identify talent, but she said, I can't, I can't keep them. But you got to keep doing that because you need to quit. You also have to keep fostering talent.  There's conversations about that, and not just as a presidency, but even athletics and coaching and all other things dealing with our institutions. That's all those are also imperative roles. You have to be nurturing those other great minds behind you. You need to be, you should be facilitating those minds in your cabinet and on your campuses and those things because it's imperative. Again, like to your point, that's part of that comes with the territory that you know, you're going to get hopes. You know, you're going to lose talent. So you need to be able to foster the talent as well. That's also imperative measures that you have to take into consideration in that role as a leader, as a president. Tiffany, looking sassy for some reason, I guess that's a move to go to the next conversation. We're going to have an extended conversation about respectability politics. Is it okay to twerk during brunch? Is it okay to twerk and dance during commencement? I just have to do it. We'll be right back. Let's get into the conversation. The overarching theme is Black Respectability Politics. It stems from a recent case of folks in Dallas. I forget the name of the restaurant. It starts with a K. True Kitchen and Cocktail. It starts with a K. I don't know. I think that that's, you know, that's Kappa-esque to me. So I, you know. Who's in it? Who's in it? Izzy? So I have, you know, no twerk and during brunch. No twerk and during brunch. This calls the uproar online. Obviously a lot of HPC alumni have reaction to it. We came back into this conversation. We talked about brunch culture in, brunch culture in the DMV, particularly at DC. And what turned it into a twerk ready event? Anywhere in DC. Eric is positing that Howard students did it. We made a correction. We made a correction. This is how I'm going to. Okay. The old school generation X, like go-go crowd is literally like where the brunch turn up came from. But when it became a socialite event where, because it was like, it was one of those things where it's like, we would go to brunch and just like do what we, like people been going to brunch here forever. We just sat here and talked about it. My father went to brunch in DC. The first time I went to a DC brunch, that was like a bottomless like food brunch. And my folks had drinks and mimosas. I was seven. Like it just is what it is, right? So, but when it became a socialite event, where people started to put on their outfits and get and bring out the Chelsea boots and the random, oh, like how you getting like, like done, like you about to go to the club or when like brunch has started to get merged with day part. That's yeah. That did not start until I want to say the advent of the smartphone mixed with the boom that was like Howard on you, like in that influence. And I want to say that that's our generation. That's us that did that. Yeah, that was definitely my annual thing. That's the point that I was going to bring up because brunch is an extension of places. And I don't mean this term in a disrespect way at all. In a social media area, your cloud is built on your performance.  But whatever I can catch on film and it's good content, that's your performance. Brunch is the place where you capture the energy and your performance, right? All together. So I don't think that it's the college crowd that did it. Because and I say that even though the college crowd kind of drives the social media conversation, I don't think one, they could afford it. And two, I think that it's driven by more so young alumni than you would be the actual students. I'd say that out loud because that shouldn't be the same. It depends on the school. No, no, no, no. Because these are young adults. I'm talking about late 20s, mid 30s. Like these are young adults. Right. Listen. Mid 20s, mid 30s drives Brunch. Yeah. Fact. Fact. You agree? You agree. You're right. And one of the periphery of that are singles who are 35 and up. Listen, I don't know where y'all were at when they said to be this DC-based Groupon type website called Capital Deal, where you can go on there and buy our Brunch deals with the bottomists and be in there. Why nobody tell me these things when I get invited to these Brunchs? Why I always pay the full price? It's a thing, bro. Listen, I've been to a bottomist Brunch in DC that was down southwest that cost me literally $21, including the drinks. But to bring this full circle it might have been people who may have been either went to HPCUs. I don't think I'm not going to put it on us because we get blamed enough as this. But if our campuses have been restrictive, if you will, then is it possible that when we leave our restrictive respectability politics laden, we have to look a certain way because they're already looking at us because we're black campuses that we leave our campuses and we are now dabbling in performative blackness. I cannot believe we let them get away with that. Here's why I would disagree with that. I'm asking a question. I think it's legitimate. But here's why I think that I don't agree with it. I understand it, but I don't agree with it because a school like Hampton is socially restrictive. Going to union on Thursday, Howard is restrictive in a lot of ways, by some measures, the best homecoming. So you know what those HPCUs do is they give you a lane and say, go buck wild in this lane.  Don't go buck wild on the yard. Like they give you a lane. It's college. It's college. I think they have to do that. But I think that when we cross the line, again, and it goes back to the performance art, I want to perform when I want to perform. Right. And so this brings it this and it's my body. I have agency over my body. I don't care if I'm in your establishment. I'm spending money in here. I have. And I've had five mimosas. What do you expect? How do you think I'm going to do next? So you lecturing yourself now, right? What you mean? You know what I mean? Oh, yeah. Okay. Because you said it. I don't know what you mean. Oh, no. Because we went viral because we had drum majors that actually performed during commencement and you were like, what? What is this about? But wait, what's the issue? I'm not saying I agree with you. I'm talking about our conversation. He know what I'm talking about. Now, I will also thank you. I'm not saying I agree with it. And we're going to get to that. That's why I made this part 30 minutes. But I think you were going to you were going to make a point about self-agency. Yes, I was. And this is something that I've long said. And it really is very, very simple. If you want to oppress somebody, oppress yourself. Like, that's literally what I think about what I see. Like, okay, sis is twerking.  That is sis. That's not necessarily what I'm going to do at any given time. But if this is over here doing that. In a circle. She got it. What are you going to do? I'm going to say my mama. My boomer mama. This is what I say to her. Because she if she if we ever were out somewhere and somebody walks in wearing something that they should not wear. I know I ain't even got to look at her. I can feel her bristling like. Let me tell you. Hold up. And I totally respect that. Because it's not her generation. Let me say this. We are on the eve of our beloved Founder's Day. Katie can vouch for this. I'm sure Eric can vouch for this. When you have been in an alpha event. And they play music that is geared towards younger brothers. Older senior brothers. Y'all move on. They frown. Their wives grab their bag like Viola Davis. And there's exit. As you did. And then when they exit they go home and hand write a letter. I didn't. I didn't like that. You're not running back your membership. You got to move off the way. You're not going to be here. I didn't like that. But here's the point. Here's the point. I'm going to get to you, Katie, right there. Because I want to make these connections to what my feelings about self-agency and commencement and all that. That is what I was talking about when I wrote years ago. At some point you got to have. I can understand expression in self-agency is celebration. Particularly when you're somebody who's coming from a circumstance where you statistically weren't supposed to make it. That's not brunch. I'm talking about commencement now. And respectability. Respectability is a joy that you enjoy. In your own space. Respect myself. However, come on. I do think that there is something that administrators have to consider when you have lawmakers, donors, influential people in the crowd who frown. And they wipe clothes up that fur and say, we're leaving. And then you have to answer for that. Because they have to write. They write the letter that says, you, president or chancellor, ought not allow that. I know you got your hand raised on this. Katie, go ahead. But that's not what you have to consider. The young person only has to consider their time on stage. The president or the chancellor, the board has to consider everybody that's coming across the stage. And what that means. Like what may happen. Great, Katie. And I think we just, it's such a thin line here between the self-agency and the thing that we want to project. Because I think the conversation that large is that black people want to be seen for who we are. And we want to normalize all of our behaviors. Not just one, but all of it. And not be seen as a buffoon because we've had five emotions and there's twerk music playing and I start twerking. Like that, I mean, I understand the natural reaction.  I'm friends with an entirely too many black women to try it, right? I would get checked at the door. So it's not even that conversation. The conversation really is time and place. When do we designate a time and place for these things?   Why? You have to record everything. Because the unfortunate part is, dude went viral, right? Because somebody was trying to sabotage his operation. And the thing that scared me more than the thing that bothered me the most was not that he said those words. It was that he had a tag restaurant in the midst of a pandemic. Like, my God. There was not a mask in sight. I'll give it about that young woman's work and don't mess up his furniture. I'll get that part. But why are they, why are we in restaurants packed with no mask? I don't care about any of them. That was a big issue. And this is, he brings up the point that I it's a lot going on here, right? It's just a whole lot here. It's a lot to unpack. It's a whole lot to unpack because, and I've said this too. I was just like, if that man came out and said, listen, I want y'all to have a good time. But please respect those who are around you trying to eat and don't stand up on the furniture and don't stand up to the furniture and dance. If he has said that. Well, I think he did, but that's not what got recorded. So, so, okay. So little small piece right here. We have a front brother who is the nephew of the owner who gave a little small insight on to the fact that he had reached his wits in because he had been asking nicely. And then he was getting stolen from and there was other things that were happening in the midst of all that that he got to a point where he just went off the handle. That's not about getting to that right now. My issue is this. Don't make it about women twerking as a way of saying they're not respecting themselves. True, fair. Because that's where it went left. That's where it went left. If it was about people standing up on your furniture dancing. Cool. Cool. I have no issue with that because personally speaking, as somebody who could not stand modeling troops walking, like strutting through the cafeteria and DJs playing music in the cafeteria and people thought it was a good time to stand up on roofs and whatnot. Listen, I cringe when I see grown men boots on basketball courts. It's just certain things in my head. To your point, Jerry, and I think the larger conversation is that when we start saying our unapologetic blackness, we have to recognize that for each one of us, that means something different. Something different. Right? But the central thing is that your unapologetic blackness can be inappropriate in a moment. I'm not going to sit here and say squirking is inappropriate, but I can sit here and say that when people are sitting there eating food in a restaurant, if that's what's going on. Granted, it was a sports bar and he also had like a space, like an event space, but if people are sitting around eating food and whatnot, I don't want you to sit down and rock it over my waffles. I'm just going to call it what it is. Right? It's not the moment for that in that moment, right? But that's the larger question. Like I think that that's where we got to break it down. And I think that HBCUs are kind of central to that because our young people drive the culture. And so it's it's it's Winston, I thought to you, I believe that it's, yes, everybody has time and space and autonomy over their time and space. But we're in different quarters. Is that still our space? Are we leasing it for the moment from somebody else who is the proprietor of that spot?  You know what I mean? Like there, I heard somebody say to me one time you know, dancing on the stage at commencement, for example, or doing certain things on a college campus, you know, you don't see that. You don't see them dancing at Hampton. You don't see it at Fisk because those young people, they party hard, but they say, we respect that here's where my time and space is and here's where it's not. And I'm not saying that's right or wrong. I'm just saying that's part of the culture. So in the in the sense that people own a restaurant, own a bar, or, you know, we're running a student union or we're running a dorm lobby or whatever the case may be, are people leasing their time and space or do they own it wherever they stand? I think it kind of stemmed similar from the leadership conversation we were having because I think those things trickle down. You know, you mentioned a Hampton or a Fisk in the culture that's created there. You know, you also think about the kind of students who get accepted to those institutions. A private institution that can be a little bit more on the costly side for a young person. You know, maybe there, you know, it's already a certain level that you have student and young person or experiences that you have at institutions like that, as opposed to, you know, something that's maybe a VUU that's not the same. Virginia union maybe is not the same environment, the same type of students holistically that you're getting, you know, across the board. So it creates, it does lend to a certain culture, to a culture of young people who believe a certain air about themselves, you know, and so in following following line with with the leadership proposals that those young people, the way they should behave, the kind of students that they intentionally recruit, you know, that continue to have interest in those institutions that can play a role in those things. So, I mean, whether it's tough to say, you know, if we're leasing the space or we own the space in those instances, I think it's kind of like a case by case basis. When you hire a DJ and you have bottomless mimosas, for me, you're running no risk of me having a good time. Maybe I dance, maybe I'm gonna get up and do a little jig for the Detroit people. I mean, it's just, it just is what, you know, it creates the culture that you are accustomed to. And I think to Eric's point, you, I mean, you know, there's people who may not agree with that, who may not think just because there's a DJ there, just because most of that you don't, that doesn't mean you need to be doing those things. But there's another group or set of people who is almost like a natural bodily function in certain, in certain circumstances that this is what I'm, this is my go to. I just wondered like if the reaction would have been the same if a group of young gentlemen hit the quad and it got recorded. That is, that's part of my, it's like, yo, I don't think you know that actually, you know, that's an interesting question because if me, you and Eric started strolling in any given bar between here and Baltimore, people would probably clap. Yeah, they would embrace it. Depending on the time of day, they were probably like, okay, they go to Alfa's, was cool. But if I'm just saying, I'm just saying, but if sister started twerking in that same environment, they probably like, Oh, and so, you know, to the to the point that that's that's sexist, and we got to deal with that. And to the point that that's doing it. Don't put that on just men, women. Okay, you're going to be sexist. Listen, women can have sexism. I'm gonna say this, the whole conversation, though, the one part that he was getting said that I, you kind of brought it up. So I'm gonna keep in that lane, Jared, a certain song being played or a certain DJ being played does not control bodily functions at some point, because I'm gonna let you know right now, every single time I hear wipe me down, you will not see me strolling, right? Like, listen, listen, it don't matter. Listen, lead from the front.  Yes, they do. Like, if you, if you got liquor, you're supposed to cool. But like, okay. And my, you know, to, I will bring it up this way.  You don't. I don't. I just don't. I mean, maybe, maybe it's why I don't. Maybe I don't hang out with Sigma's. Maybe that's what it is. But it's what it is, right? But you're right. It's a conscious decision either way. But I think, I think, I think most will choose this at the same time, right? Like, yes, even for our schools, there's a time and place. But with our schools, when these some of these events are going on, guess what? If I was a president, I would say, are you going to write a check for the amounts of money that this event that had this cultural norm that we've established here brings in so that when you come here, you don't have to see it. Are you gonna write the check because I guarantee you right now ain't nobody got enough money to stop Howard Homecoming's Yardfest from being Howard Homecoming's Yardfest because for what it does for Howard, you're not going to stop that. So you can complain all you want to but keep that complaint to yourself. But I would just say this and I would say this for an establishment. I would say for a school.  So for example, if I own a restaurant or a bar and I'm going to say and I'm and I'm planning on having a DJ because that helps bring in the money. I'm going to say, okay, from 10 to 10 to one, this is a gospel branch and then from one to four or one to five, this is the day party. So every, every patron type, I'm just, I'm just throwing out stuff. I'm just saying every patient would be aware like this is what you're going to get. Now, if you choose to torque the gospel, some people, that's what you know what I'm saying is patrons are aware that this is the situation here and this is I'm trying to section off and prevent anyone from being offended by anything. It's the same thing for HBC commencement. Like I would tell my students, you can get up there and dance if you want to dance.  Do you know the bill that I'm going to send you for the insurance premium that you, that this is going to come from here, that transcript is out. Do you know, do you know that when I get letters from the lawmakers and the donors that I'm going to personally put your name in an open letter in the next No, play it. Play it.  Yeah, you're not getting that. You ain't never seen that degree. You ain't going to never see that degree. That's what I'm saying. But, but you see, like just be transparent, like young people can handle it. Young people can handle a conversation. You may want to dance and make it about you and you shoot it. And listen, that is not a concert stage. And the moment you do that is the moment you bring heat to the school. You individually bring heat to the school. Your moment brings stress and attention for the school. So you think it's just 30 seconds of you praise dancing. That's going to be 30 angry letters that I'm going to get. We can, these are young adults that we can have this conversation. And let me be very clear. If it was just me dancing, all you want to dance, brother or sister, you might be the first person in your family to go to college and graduate. You probably been through some tough times where you didn't think you were going to make it.  You just can't do it on this stage. You can't do it on stage because it goes on a waiver. Call it a day. All right. Listen, if anything should happen to you in the process of you doing whatever you want to do, doing a commencement, we are not financially liable and you may have to pay if you cause any damage. I see absolutely no issue with that. It's a culture. I think you set the stage. It goes back to that leadership thing of you to your point, Jared. I'm setting the culture there. I mean, I think about here in Detroit, the auto show was a thing. He's always a big thing here. And, but, and it was an unknown rule. It wasn't a said rule, but like you knew you left before seven o'clock when I'm scally-wag kids was coming in and it was getting dark. You knew to get those stuff, to get out of the trach over the hall and before seven o'clock because it was going to be program. We was them. We were the kids that was coming in at seven o'clock to get reckless. And you knew to get out of the party.  Oh, you get all the numbers.  That's when it got dark in the auto show. It's like a D for cars. Like the point that our young people drive the culture. And I'm, I'm looking at this through the eyes of literally through the lenses of an old man. Not that I'm against it. I'm actually for it. I'm actually for the, but what I'm saying is, but what I'm saying is I also understand as the business for driving, when I'm leaving, I'm not coming back. That hurts. Yes. Yes. Especially when a patron did it. So I'm just trying to figure out like where, where do we make, how do we find the happy medium here? Where you still feel like the water is transparency, transparency, transparency. We find the happy medium in people doing their own work. And doing your own work, as I've said before, means if you want to oppress somebody, you oppress yourself.  Why do you think it's inappropriate that somebody else is using their body how they want to use it? Like, I get it. We might be, you know, at a commencement, we might be at a restaurant, we might be somewhere else. But like, why does it bother you that much to where you would write a letter? Like, and I'm somebody that write letters and send emails. If you do write the letter. Oh, I've already looked your stuff up. I did it at Crow Grounds Thanksgiving. Definitely was righteous, but not not one. I'm hating because you over here freeing. I'm not like, do your work. I'm going to do my work and try to self-moderate my criticism of catsuits, attracting cues on Instagram. And that concludes that just for the dark. I want to thank everybody. Doing that. That's serious one for the two exit, serious exit one for the two HPC radio. Hopefully we'll be back next week, depending on if HPC is actually doing something. I appreciate your listening. We appreciate it. Love you guys. Thank you.


Dr. Furuki from LabCorp will tell us how LabCorp implements genomic testing now, before and in the future. Thank you for coming. Okay. Thank you very much for inviting me. It's a privilege for me to address this group and really talk about LabCorp's experience and perspective on the implementation of genomic testing. And I'll start off with a few comments about who is LabCorp or what is LabCorp. This is our headquarters building in Burlington, North Carolina, which is about 45 minutes from Research Triangle Park. We're a large diagnostic laboratory company with 30,000 employees, approximately 1,500 patient centers. These are our draw stations around the country. We serve 220 customers. They are doctors, physicians, hospitals, medical centers, academic institutions, et cetera. We offer about 4,000 different diagnostic tests ranging from simple things like a CBC and a urinalysis all the way up to the most sophisticated sequencing, SNP for Rays, copy number variants, et cetera. And we have a complicated infrastructure to collect close to 400,000 specimens a day and deliver over a million results every single day. So in order to meet that objective, we employ about over 750 MDs and pathologists. We have 150 or more genetic counselors who support our operations. There are 10 centers of excellence scattered throughout the country that have specialized expertise, 38 primary testing locations and stat centers. And obviously, we need an infrastructure of couriers and corporate jets to move all those specimens around. So just looking across a map of the United States, all the light blue are the draw centers, and they're concentrated primarily in the population dense areas. The darker blue are our regional labs, and then the yellow circles are actually the centers of excellence that have unique expertise. Lab Corps operates with a spoken hub sort of where specimens are collected regionally. They go through a branch and then to a regional lab and for specialized testing to those centers of excellence. That allows us economies of scale and to offer some very specialized services as well. We also operate a global clinical trial service and capabilities and have labs gathered throughout the world. We have a recent acquisition of Clearstone, so we now also have a CAP accredited lab in Beijing and a variety of other interactions with various other countries in South Africa and Australia, in India, in Abu Dhabi, and so on. Lab Corps also has a companion diagnostics program, and we have been instrumental in the introduction of many of the companion diagnostics tests that are out there today. And Lab Corps serves in a capacity sometimes in the early development stages such as with some of the HER2 studies way back many years ago. But also in a clinical trial capability to support a lot of the validation and submission for those assays and drugs to the FDA. So whether it's on the science, on the regulatory or on the commercial aspects, Lab Corps has provided a lot of support for many of the companion diagnostics that are out there today. We like to maintain scientific leadership and to do that we need to continually review new opportunities. So we review probably over 400 new opportunities for diagnostics a year. And we introduce every year over 100, close to 130 new diagnostic tests. They're not only genomic, they span the whole range of diagnostic offerings. But they often involve collaborations with pharma, with universities, with biotech companies, with academic centers, with the government, etc., to make that actually happen. So where do these new diagnostic opportunities come from? Many of them come from academic institutions and Lab Corps has developed good relationships with many of the tech transfer offices at most of the major universities so that we can be in their mind when they develop new diagnostics and want to want assistance in getting it out into the clinic. The biotech companies often seek Lab Corps hoping for access to the market through Lab Corps infrastructure. Through our clinical trials and companion diagnostics, we often get a first look at diagnostics long before they're useful in the clinic. But in the early stages of development, drug development, or development of a diagnostic. We, I mentioned our PhDs and MDs, and we have many connections to the scientific literature, to meetings, presentations, and our peers who also bring all kinds of new ideas to us. Lab Corps is active in the acquisitions and mergers, and sometimes we acquire technology from companies. And we also monitor our send-out requests so that when we do have send-outs and we see it growing to a certain volume, that necessitates bringing a certain assay in house. So what do we look for? Scientific and clinical evaluation is key, and that's one of the first things that we do. And I work with a group of scientists at Lab Corps in looking at these new opportunities. We look at analytical validity and clinical utility. So the basic things like sensitivity, specificity, positive predictive value, negative predictive value. But key also is, does it lead to improved outcomes? Does it lead to decreased health care costs? Is there a therapy that's guided by that diagnostic? Can we avoid a toxicity? If we diagnose something earlier, if the sensitivity is increased, does that impact the outcome? We're looking for an actionable result, something that actually changes management. Not just that looks good in a chart, but that actually changes management. And finally, we look for evidence, and that could be publications or guidelines, professional society endorsements, endorsements from the government like the Department of Health and Human Services or CMS. And even if those things are not in place at the time that we license or look at an opportunity, we are thinking about are these things that we could anticipate in the future? Or how far off might those guidelines be? Because they're critical to, as I'll show you in a few minutes, to reimbursement and to growth and acceptance of the test. So for financial and other considerations, we also explore what's the reimbursement outlook for that particular opportunity, for that licensing or that diagnostic? How will we get paid, and how much will we get paid? Is there intellectual property associated with it, and will we have freedom to operate? And is there a licensing? Is there a need to have a license? And if so, what's the royalty burden for that license? What will it cost us to actually bring it to market? And that's what additional validation will be needed. We have to sponsor the study to do that. Will it require, are the specimens available? Do we have enough annotated specimens to do that with? So all of those things are part of the cost of actually bringing it to market. And then those are weighed against what's the likely reimbursement, thus what's the return on the investment? Is the assay feasible given our platform? And here there's a few things that we might not be able to engage in, such as very an analyte stability issue, where it's really not amenable to our sort of infrastructure. Or potentially a requirement for the result within minutes. We do have some stat facilities, but again that's not available in every location across the U.S. The regulatory landscape, which Deborah Leonard touched on briefly, but practically all the molecular tests, with very few exceptions, are laboratory developed tests. And we've been able to react to the changing environment, the developing scientific information, et cetera, by being innovative and by creating these laboratory developed tests. So if there's movement to restrict our ability to do that, I think that will have an impact on our ability to react to the changing environment. And finally, some market dynamics and competition that we also look at as we evaluate new opportunities. So what is success? And so we've modeled this, because we've looked at, and I've been at LabCorp now for over 10 years, and we've seen many test adoptions, and we kind of have a pretty good feel of what creates success. So we've modeled this, and this particular modeling was done in the context of HLAB5701, the association with the Bacovir allergic reaction. But it really is mirrored in a number of other examples which I'll share. But there's typically a several year process early on in which the markers first identified and early publications support its use, and people like LabCorp actually develop a lab developed test and bring it on and put it on the menu. And then there's some key studies, and in each one of these examples I could probably name the key studies that were drivers. In this case it was the predict study and shape to study sponsored by Glaxo that led to a clinically established test with clear clinical utility. And what happens with that is, following that is just a very dramatic test acceptance period during which all of these other players fall into place. So the clinical utilities established, the payer reimbursement coverage happens shortly thereafter. Professional society guidelines are happening at the same time, and all of those together drive a huge increase in volume. Now that, and then that increase in volume goes over a short period of time, a few years during which there's logarithmic growth of the particular test. And I can tell you at LabCorp we often struggle during those periods trying to meet demand, you know, trying to have enough people trained and enough people in place to meet the demand for a particular test. Okay, so, and I've mentioned, historically we've seen many, many examples of this, HIV guidelines that followed Viradapt and GART studies in 2001, the ALT study with HPV testing, the HCV genotyping after the ribovirin interferon trials and that data, the CF testing after the ACMG guidelines, et cetera, and each one of those cases, that's the event that drives that huge increase in volume. And we've also looked at it in some of these oncology markers, and I can say the pattern is pretty much the same in the Herceptin, is this working or not? Yeah, I guess the Herceptin approval here, both the diagnostic and the test, in 2003-2004 was quantitative BCR-ABLE and the GLEVEC monitoring and NCCN guidelines and ASCO guidelines, et cetera, to support that. And then the KRAS story, which happened really between 2007 and 2008, again with publication of guidelines, a rapid adoption coverage policy, et cetera. And then I'll point out these two here at the bottom, the green and the purple, our UGT-1A1 and 2D6 with tamoxifen, where coverage policies are not favorable with where guidelines have not included it, and where the definitive studies we're still waiting for. So I've already mentioned UGT-1A1 and cytochrome P450-2D6 in the setting of SSRIs, EGAP has published on that. In the setting of tamoxifen, I know UNC is working towards creating the clinical utility story around that, but it's an emerging area and we still have very low volume. And let me say also that warfarin and the coumogen studies and so on relating to warfarin, pharmacogenetics, again, very low volume at LabCorp for those applications. So I can't emphasize enough the clinical utility impact. If the clinical utility is not well established, and that could be because it's a non-actionable result, it could be because there's conflicting studies of clinical utility, and I'll show you a very good example of conflicting studies. It could be simply because there's limited availability of well-annotated samples to conduct the study. The end result is lack of endorsement, coverage and reimbursement denials, and low utilization, and those three things all happen together. So this is a really good example of conflicting studies, and I want to show you what's going on with Plavix 2C19. This is not published, this is just internal data that we have. But it's an interest of mine personally about what constitutes and why is it that certain tests are adopted and some aren't. So if we look back, again, the early markers that support the use of this go back many years. In 2009, early in 2009, there were two papers published in the New England Journal of Medicine, both of them supportive of the use of 2C19 in the management of patients on Plavix. And we, shortly thereafter, actually, Labqur had been doing 2C19 testing for a while with very low volume. But in light of the New England Journal of Medicine papers, we actually in March of 2009 introduced a clopidogrel-specific test in which the interpretive language was supportive of that particular application and made certain recommendations based on the use of the what alleles were picked up. In any case, the FDA alerts happened shortly thereafter and there was a large increase in volume as a result of that. It's interesting though that shortly thereafter, so in June, the FDA alerts happened in November of 2009 and in March of 2010. In June of 2010, the American Heart Association and the cardiologists put out some guidelines that were very, very lukewarm about the use of the test and kind of leaving it up to the clinician and it may not be necessary and there may not be enough data, et cetera. And that followed by the Canadian study, again, that did not show, again, had a profound impact on utilization of that test. And you can see it and that controversy continues with volume relatively low compared to where it was at the peak. Now there are a variety of reasons for conflicting studies and many of them are legitimate reasons about the choice of patient population or the choice of the clinical setting in which a test is used. But that controversy is kind of lost on the masses and the masses choose not to use the test. So let me move on to payer reimbursement. Payor adoption and reimbursement has been, so for the last 10 years or so, we've had these existing molecular CPT codes, procedural codes. So provided that the scientific validity, the clinical utility was established, practice guidelines were there, coverage policy, we could immediately use those stacking codes to be reimbursed for the testing we're doing. That model is changing. So we are no longer going to be able to use those procedural codes and in 2013 there's a new coding system going in. And Deborah Leonard alluded to this briefly, but the new coding will allow greater transparency which is really a positive thing for everybody. In other words insurers, payers, billers, hospitals, et cetera, will be able to know what they're paying for in those tier one codes. And the tier one codes will really cover most of the diagnostic, the molecular diagnostic tests that we're doing today, virtually 95% or more. I think the problem is that the tier two, so those are tier one. And at least tier one, our understanding is that those will be, fee setting will be comparable to what's currently being reimbursed for those tests. Tier two are complexity-based codes and it's not clear yet whether payers will be denying those tier two or will be paying or will choose to deny those. So I think there's a lot of uncertainty about how we're going to get paid for the tier two which are kind of complexity-based codes. And finally, historically, getting a new CPT code was a multi-year process and I was just talking to someone during the break. I would be applying today for the code that would go into effect in 2014. So if that's the model we have for introduction of every new genomic test to get paid for it, I mean, obviously that's a huge problem for us. So it's not clear yet about how new codes and new genomic testing is going to be handled in this environment. And I'll just say one other thing, fee setting is usually a separate process from CPT coding. So 2014 is when I would get the code. I would still then have to pursue getting a fee set for that code. So and finally, licensing and royalty burden, which again, it's not clear what's going to happen in that arena. But when we start talking about multiple gene panels, we're also talking about multiple licensing agreements, multiple royalty potentially. And that stacking of licensing and royalty is really not, there's no CPT code for that. Nor is there a CPT code for another issue that was brought up earlier, which has to do with going back to sequence data and doing a reanalysis based on the latest scientific information. So other factors that might impact market adoption. And these are some analyte stability. And I mentioned some of these. And for most DNA based tests, this is not an issue. But I think for RNA expression, the use of FFPE, formal and fixed tissue and RNA expression, that is clearly an issue. Access limitations that can sometimes slow down test adoption if it's only available at a single site. That restricts access and slows down. Physician related modulating. And I call these modulating because the clinical utility story that I mentioned is the initial driver. But these can modulate adoption. Economic conflicts. So if a physician is paid for a certain procedure, but the test perhaps replaces a procedure that a physician can be paid for, there's some disincentive there. And despite everybody's best intentions, sometimes the adoption can be slower in those situations. This physician specialty group involved. The HLA, a back of your example, was HIV practitioners who are really very used to taking molecular information, resistance testing information, et cetera, and adjusting therapy and treatment. If we go into the psychiatrist realm or something like that, we're talking about a very different specialty group that's not at all used to an accustomed to incorporating that sort of information. So we need to kind of take that into consideration with how rapidly the adoption will occur. And then finally, physician education. Although I think this area, there is improvement with greater number of physicians being connected to the internet and dissemination of information is clearly happening a lot faster than it used to. I think this is an area where there's still a lot of room for improvement. So in conclusion, I want to just summarize the points that I made well controlled and adequately powered studies demonstrating analytical validity and clinical utility are key. We see these areas where there's clear actionable results. And I can tell you that LabCorp is currently engaged in multi-gene panels that address some of these areas. In other words, areas that prevent drug toxicity in the drug metabolism area. Multi-gene panels that identify a treatment path or select for drug. This is in tumor profiling. And the diagnosis of rare heritable disorders or carrier testing. I mean, these are three areas that we think are kind of ripe for prime time and where LabCorp is currently engaged in developing multi-gene panels using next generation sequencing to offer clinical services in this area. And then path to fair reimbursement is and freedom to operate be it from a perspective of intellectual property and or from the regulatory world. Thank you very much. I'll take questions. Thank you, Mark. And then Teri has a question. I really was interested in the adoption curves that you presented. I think those are fantastic. And again, these are the search of data that I think groups like this need. In my view is I think about the takeaways for the genomic medicine group. It seems to me that this if we could have access to data like this, it would be a really nice metric to look at some of the things that either come out of this group or other NHGI related activities to say, you know, when we have a publication that comes from a funded study or something else, what impact does that actually have on the adoption of a given test or technology? I think that would be a very interesting thing to do. The other thing I'll just notice about those types of curves is that Clay Christensen has noted in his study of innovation that that's the typical, of course, innovation adoption curve of the early adopters and then the rapid and then the holdouts at the end, the Luddites at the end. You can actually take that curve and integrate it so that you can actually say here is the point at which 50% of people will consider the standard of care and plot that on a timeline. So it would also be very useful to be able to use that prospectively in addressing what Sean had talked about for prioritization, saying, where do we need to put our efforts? Because these are going to be emerging sooner than those if we had regular access to those types of data. So we can talk about that further. I think in the past, Labquire has not disclosed publicly their actual volumes, although we can reconsider. That would be great. Maybe for those of us who aren't familiar with CPT, could you maybe give us two or three minutes on what they are, why they're important, and how one gets them changed? Yeah. OK, so the laboratory industry, CPT coding is kind of the basis for how laboratories get paid for their testing. And CPT stands for procedural terminology or current procedural terminology. And these cover all of the medical procedures that physicians do. And initially, in the molecular diagnostic space, initially, what happened is as molecular infectious disease testing got started with viral loads 10 or 15 years ago, the people like Labquire. In fact, I wrote some of those initial ones for resistance testing and so on. You would apply to the AMA, and you would fill out an application that had to do with how the test was being used and what procedures it included, et cetera, and request a unique CPT code. And then that application would go to a committee, and I think it's run by AMA if I'm not mistaken, that then evaluated it and decided, either yes or no, that they would give it a code. And within a couple of years, you'd have a code, and then you would follow that up with efforts with CMS, and et cetera, to get a fee set for that particular code. And so that's why I'm saying it used to be a several-year process to do that. And for the infectious disease applications 10 years ago, people applied, and they added each organism as a code. So HIV viral load got a code, and HPV got a code, and HCV got a code, and a quant had a different code than a qual, and a genotype had a different code than a quant, et cetera. Now, for molecular oncology and molecular genetics, although I have to say, 10 years ago I lobbied against this, but I was overruled, the group decided that they didn't want to have specific codes for specific genes, that they wanted to use procedural codes, things like an extraction or a hybridization or a sequencing reaction, et cetera. So each one of those procedures got a code, and then molecular testing labs were left to stack the codes as they saw fit based on their particular assay format. So what ended up happening is payers, and maybe the total dollars weren't significant enough for them to care at the time, but now as the volume of genomic testing is growing, there's an increasing need to be able to say, well, that hybridization and sequencing and probe and interpretation and et cetera, what was that for? Was that a K-RAS? Was that an oncotype? Was that a, you know, which test does it relate to? So this new effort is really to give unique names to a K-RAS test, to a CF test, et cetera, so that payers and everybody else has greater transparency. So is there, it does sound like a 90s construct for now a much more contemporary pursuit. So, I mean, is there a single CPT code for sequencing a genome? There is, no, there is a code for sequencing, and it's, I think, based on one intron or multiple introns or... That just seems absurd, right?  This is absolutely not gonna be generalizable to the circumstance we're gonna find here. I think there are many people on the committee who are familiar that this is not gonna work for the future, and I think that's been brought up several times on those calls. Let's have, Deborah, can you add your comment and then we're gonna move on, I think. So one of the issues here is that these stacking codes while they usually don't pay very well for single gene tests, if you actually stack them together, you talk about being able to do a genome for $1,000 or $3,000, you actually can get paid a million dollars for doing a genome. So, I'm sorry to tell the payers that, but... Yes, that's right. And the payers are aware from a practical perspective. So it's gotta be rationalized somehow for genomics. Okay, well, and I wanna add one other thing. Really, I doubt anybody's paying a million dollars because most payers have limits on how many times a recurrent CPT code will be paid. So Paul, Ricker, Kate, and then we're gonna move on to Howard. So two very quick comments and then a question for you. The comments are to go back to those curves. This is really important, I think, for Eric to sort of hear from, as someone who lives in this very translational end of this spectrum, and I'll have the opportunity to talk tomorrow more about this in length, but the x-axis is typically... You'll have 20 minutes tomorrow, not at length. It's 15, correct? Sorry. The x-axis is typically 15 to 20 years and you need to understand that and there's reasons for that that are very important. The second is, your very last slide appropriately showed not just laboratory utility, but the clinical utility piece and it's really hard and we'll come back to that. My question to you, though, is something a lab core, I don't know if they do it or not, but your view of it, how do you feel about the marketing of this? I mean, what's the role of your industry for selling these tests and the promotion of them because sometimes what we've seen, at least in my field, is things being promoted that probably aren't the right ones to promote and that doesn't help us versus things that we actually think work, not getting much promotion because perhaps they're not particularly cost effective for someone. And just your perspective on if that happens, what we do about it. Turn your microphone on please, I speak really into it. Yeah, I don't know if I can speak for marketing, but what I can tell you is that there's no marketing efforts that can achieve what the clinical utility can achieve and there's really no comparison. We're talking about orders of magnitude with any marketing effort versus what that clinical utility professional society endorsement guideline et cetera does. There's just no comparison. So I wanna point out that we're talking a lot about CPT codes but we're not addressing the issue of ICD-9 codes. And so I can tell you as a clinical geneticist the dearth of ICD-9 codes once you make a diagnosis is incredible impediment to getting care for patients. And I think that while it's not totally germane to this conversation that I think as you make additional genomic diagnoses, the lack of having ICD-9 codes even from known genetic diseases really actually makes it very difficult to do even follow NCCN guidelines for screening because we don't have those codes. I just wanna point that out. If I could just quickly respond to that. Of course, we'll be moving to ICD-10 next year, which is one of the reasons that the molecular codes got pushed back a year. That has better specificity but certainly not perfect specificity to address the question that was brought up. But this whole issue of the coding problems has been addressed in a number of publications including Secretary's Advisory Committee report on oversight. It's a huge issue. The ability to actually impact the codes is limited because of who actually maintains the codes. The AMA running CPT, groups like who and CDC are involving in the ICD-9 and 10. And actually having tried to interact in those systems to make these types of points that are being raised here is extraordinarily difficult. So that was a great, really great morning. We look forward to more discussion this afternoon. We're gonna change gears a little bit and sort of interspersed during the meeting will be reports from the current five or six. I can't even keep track. Working groups and Howard Jacob.


the challenge of the Yukon. On King, on your skin! The Wonder Dog King, swiftest and strongest of Eskimo lead dogs, blazes the trail through storm and snow for Sergeant Preston as he meets the challenge of the Yukon. Sergeant Preston was typical of the small band of North who preserved law and order in the new Northwest country where the greed for wealth and power led budget. But in spite of the odds against them, Sergeant Preston and his Wonder Dog King met that challenge and justice ruled triumphant. In a cabin on the outskirts of Dawson, Jeb Hawkins paced back and forth impatiently. His wife Lizzie threw venomous glances at him over her shoulder as she ventured her temper on the pots and pans cooking on the stove before her.  What is that mess you call supper going to be ready? Yukon, eat raw wild cat. Well, it's way past five tonight. Come, son, that black, sleepy devil-ass.  Well, how can I see her? Why do you have to have that sneaky and useless homely mother? That's enough out of you, Jeb Hawkins.   I'm ashamed to have my friends see her. That collar protects her throat from dogs. I don't mean dogs like Jonas. Miranda don't need protection from that kind.  Well, if you tend to your cooking the way a proper wife should and stop petting this old dog. Are you insinuating I ain't a proper wife? Well, you won't be till you get rid of that cat. That's all I can stand. I'm speaking to you till I get rid of that howler. Well, I'm a stubborn man. I'm warning you. And I'm a stubborn woman.  Can that be? Hello, Jeb. Well, Sergeant President, come on in. How are you? Fine, thanks. I, uh, bought a couple of letters for you from Selkirk. Letters from Selkirk? Yes, they were sent there. Whoever wrote them didn't know you'd moved up here to Dawson. But we've been here for five years, I don't know. Here's yours. I gave Liz hers outside. Well, thanks. Hey, sit down, Sergeant President. Thanks. Can't stay, Jeb, but I will have a cup of tea if you'll make some. A cup of Jupiter. Oh, what's wrong, Jeb? Why, it's from old Pete Hayes. Oh, who's he? He was an old sourdough we used to know in Selkirk when Liz and I was first married. Well, didn't he know you moved away? Well, he went away first and we never heard from him. Now he's dead. Dead? I thought the letter was coming. He left us our gold claim. Liz and I was always nice to him. He used to have them over for dinner and they always said it was the first happy home he ever knew. Nice of him to remember you on his well. Well, you don't look too happy about being left a lot of money. You look worried. Oh, no, I ain't exactly worried. He done it in kind of a funny way. He did? Yeah, he sent me half a map. Half a map? Yeah, and he sent Liz the other half. Oh, that was just his way of showing you. He wanted it equally divided. I'd say I wish it stentopias over would be pressed tonight. Well, I'll be back in a few days and by then you and Lizzie will know what you plan to do. We'll talk it over then. You see, the whole thing is kind of complicated. Well, there's nothing very complicated about inheriting a gold claim. I'll help you figure out the map when I come back. Congratulations on the sudden wealth. Bye, Jed. Yeah, goodbye, Sergeant, and thanks.   Though by golly, I ain't gonna do it. She likes money well enough to break down. She won't be able to resist speaking first. And that will still have our pride left. It was two days later. Jeb sat in the gold nugget bar alone, looking gloomily into space. When Jules Leclerc sat down uninvited at his table. Hello, Jeb.  Maybe you need company, huh? Hello, Jules. You do not drink your drink?  She's a pity to have such a fine thirst like mine, and no money. I just saved you. What? Would you like to earn some money? Me? Me, Jules. I need money always. I've got a job for you. At least work. She's not too hard. All you gotta do is put a cat in a bag and take her off into the hills and lose her. But some things are simple. You will pay me. I sure will. You come to my house tonight at midnight. I'll be watching for you. Your senses and clad of her so that we could start speaking again. I didn't wake you up just to talk to you. How the dice is broke, we can talk about getting rich, huh? You get your half of the map and we'll figure out what... You better get up and find Miranda. I'm confused. First you say that catchy is ruining your life. Now you must find her. Why? Because my life's even more ruined without her. Now, anyway, it's none of your business. First I have two, three, maybe six drinks, so I do not phrase on that three. Then I put the cat back in the bag. You had her out? We? You see, she was unhappy. Where'd you go? I go out the door. Which way did you turn? I turn. Then on I'm a little confused. But don't worry about her. I remember she's in beautiful place. On a big mountain with pretty lights behind it. I say to her, this is cat heaven. There's so much I remember. Sergeant Preston was cooking his supper over a campfire on the trail to Dawson that evening. King, sitting beside him, suddenly dashed off into a clump of trees nearby. King, what's wrong? Where are you going? What's wrong with you boy? What's in that tree? Oh, tree a wildcat, fella. Quiet, King. Boy, that's not a wildcat. It looks like Liz Hawkins' cat. How'd she get way out here? Now, come on, Miranda. You're going home with me. The following morning, Sergeant Preston stopped his dog team on the trail back to Dawson when he saw a dog running toward him through the woods. Well, King, how are you, Husky? Well, Thomas, what are you doing way out here? The jeb, jewels. What are you eating? We lost her. What's Jonas' father doing? Well, Jonas has found her. She's in that box on my sled. She smelled food cooking last night and came to my camp. Oh, thank heaven. We've been looking for her for two days. I bet we'd have 50 miles. Jewels could remember where he left her. Hey, Jay, are you sure it's Miranda? Yes. I think before that he was north, I take her out. But no, he must have himself. Yep, yep, Jonas, you're right. Miranda's in this box. Okay, I'll make sure. What? It is Miranda, isn't it? Yes, it's Miranda. It's gone. Her color? I didn't want the cat. I wanted the color. Sacre bleu. First you don't want cat. Then you do want cat. Now you don't want cat. It was the color that was important. No, no, no. Why you not tell me these? You know where the color is. Wee. I do not get the money for losing cat till she is loose. Now you think I get Sikh's drink to keep from freeze? I say these cats, you do not need color for leaving woods. So I tray the color to Barney for Sikh's drink. And we've been trapping 50 miles looking for that. When all the time it was right at Barney's bar. Barney, Jewels treated you with dog collar night before last. Would you mind selling it back to Jev here? Well sure, Sergeant. I'd sell it to him if I had it. If you had it? Well, I thought it would fit my kids. So I traded in at Pierre's for some sugar. Well, never mind, Jev. We'll go over to Pierre's. Well, Pierre's right over there at that table. Pierre, come here. Hello, Sergeant. Hello, Pierre. Hello, Jev. Hey, I say Pierre. I want to buy that collar that Barney traded you yesterday. The one you give me the sugar for, Pierre. We? What? I do not have it. What? Did you sell it? No. But my partner, Rosé, he sell it today. Who'd he sell it to? I do not know. Oh, where is Rosé? He's gone on hunting trip today. Huh? He will be back maybe one, two weeks. Well, Jev, I guess you're going to have to face the music. At least you can take Miranda back to Liz. Yeah. And tell her I found their captain lost off fortune. He led me right to her. Get me Sergeant Preston. Yes, I guess he did. Jonas always liked Miranda. Jev. Huh? I've got to ask you to forgive me. Forgive you? For doing what I did. What you did? Well, I thought you killed Miranda, Jev. Because today I saw a collar in Pierre's store. I bought it. It was a collar. You have it? Mm-hmm. And the math isn't there. Have you got it? Oh, the math. Well, that's what I have to ask you forgiveness for. What do you mean? I lied, dear Jev. The math was never under the collar. I just told you that to make you get Miranda back. Then when you brought her home without the collar, I was just plain ashamed of myself. Well, I'll be. You'd better drink some water, Sergeant. Jev. Can you ever forgive me for doubting you? Why, uh, well, sure, Liz. Just forget it. Well, uh, now that the map is found and there's a piece of the Hawkins household, I'll be going. See, I can't thank you enough, Sergeant. Come on, yeah, get outside. Pat that dog you was for me. Well, uh, I'll do that. Good night. Good night, Sergeant. Well, why did you tell him to do that, Jev? What did King do? Head, nothing. Head, it's just that I like dogs. And cats. One thing on your head. These copyrighted dramas originate in the studios and that's why is the Detroit. And all characters, names, places, and incidents used are fictitious. They are sent to you each week at the same time. Larry McCann speaking, this is the Michigan Radio Network.


And Marche Janowsky in the 24th. Just before the hit I was thinking what my coach is doing. I have just five points. But to be honest, I was ready. We did some changes in my bike and I was believing it was going to work. The tap mate was not too bad but not enough to set on the right position. So I decided to go to the outside and build the speed. On first lap, second corner, I built a nice speed. Then I do the same on the second lap on the first corner. So I go again, build the speed again, come back to the inside. And then I actually feel that I was close enough to go between Andreas and Robert. I was not thinking about another lap or another corner. I was just waiting for the right moment. And I think that was the right time. Speedway is hard. For sure I've been struggling with my starts. HGP series, if you don't have good starts, you are in big trouble. I have three very good riders in front of you and they don't like to leave any spot to build the speed. I think we are closer and closer to fix that. I hope I can prove that this weekend in Riga. We have four rounds, so 80 points to make. So I take it as a challenge. I will do my best, like always, and try to show the best speedway what I can. And definitely if I can improve my starts, then the scores will be much better.