Michael Laposata received his medical and doctoral degrees from Johns Hopkins University in Baltimore and completed his pathology training at Washington University in St. Louis, Missouri. Following his residency, he served as Co-Director of the Hemostasis Laboratory at the Hospital of the University of Pennsylvania in Philadelphia. He later went to Boston to become Director of Clinical Laboratories and the first Chief of the Division of Laboratory Medicine at MGH, where he remained for 19 years before moving to Nashville to serve as Pathologist in Chief at Vanderbilt University Hospital.
Laposata is the former Chair of the Department of Pathology and is now a tenured Professor in the Department at the University of Texas Medical Branch (UTMB) in Galveston, Texas. He is widely recognized for his research on coagulation disorders and his national leadership in clinical pathology. His widely used textbook, Laposata’s Laboratory Medicine, is now in its fourth edition.
Ivan Damjanov sat down with Laposata to discuss his academic career and commitment to promoting clinical pathology as a vital clinical specialty.
Why did you choose Johns Hopkins for both your MD and PhD, and why did you opt for this dual degree pathway?
I chose Johns Hopkins because I knew it would provide every possible option for my future career. I was confident that the training and reputation of the institution would help me stand out among other top candidates for advanced training and, eventually, an academic position. In retrospect, it proved even more valuable than I could have anticipated in shaping my opportunities.
The MD-PhD program was brand new when I entered Johns Hopkins as a medical student in 1974. While working in a research laboratory within the Department of Hematology, I was approached by the department chair – an influential figure in academic medicine – who told me I was exactly the kind of person who should become a physician-scientist. I certainly wasn’t going to argue with him. Soon after, I found myself interviewing for a place in the MD-PhD program. That experience opened the door to a lifelong research career; without it, I believe I would have become a physician, but not a scientist.
Was there a particular moment when you decided to become a clinical pathologist?
The same physician who introduced me to the MD-PhD program was the Chief of Hematology at Johns Hopkins. In 1984, I approached him for advice about pursuing a career in hematology. He explained that hematology was merging with oncology and predicted that most trainees in the new combined specialty would focus on oncology. He expressed concern that hematology in the US was likely to contract significantly.
He advised that, if I wanted a career involving both patient care and research in coagulation, the best path forward would be through clinical pathology, which offered opportunities to develop expertise in both areas. At that time, few clinical pathology programs existed, but one was at Washington University in St. Louis, where a distinguished young scientist was conducting pioneering work on platelets and coagulation.
As we spoke in his office, he placed a call to that scientist at Washington University. Before long, I was working in that laboratory as a postdoctoral fellow – an experience that led directly to my clinical pathology residency at Washington University.
You have held several significant leadership roles during your career – how have these positions shaped your vision of clinical pathology?
In the early 1980s, clinical pathology generated substantial revenue for hospitals, as insurance companies provided professional payments even for routine laboratory tests. This placed laboratory directors in a strong position – clinical laboratories were major revenue sources for both academic and non-academic institutions.
However, as it became evident that many routine tests did not require interpretation – since most physicians could readily act on results such as glucose or electrolyte levels – professional payments declined sharply, eventually to almost nothing. Clinical laboratories were subsequently viewed as cost centers, best managed by individuals with administrative expertise rather than diagnostic training.
This perspective was debated for more than a decade, until consensus emerged that there remained specific areas in which clinical pathologists, with the appropriate expertise, should provide patient-specific, expert interpretations of laboratory data in its clinical context.
Of all your accomplishments during the last eleven years at the University of Texas Medical Branch Galveston, which are you most proud of?
When it comes to innovation in diagnostic medicine, I am honored to have received a $9 million grant supporting our work in applying artificial intelligence (AI) to enhance the speed and accuracy of diagnosis. This effort enables institutions – of any size or setting – to adopt diagnostic AI with minimal training and achieve consistent, high-quality results. I am equally proud to have helped establish a doctoral degree program for clinical laboratory scientists, who have made vital contributions to advancing our diagnostic capabilities here in Texas.
I have also been fortunate to collaborate with McGraw-Hill on Laposata’s Laboratory Medicine: Diagnosis of Disease in the Clinical Laboratory, now in its fourth edition. I still remember, as a medical student, when Robbins Pathologic Basis of Disease reached its fourth edition and became the definitive textbook for pathology education worldwide. I hope this latest edition of Laboratory Medicine can serve a similar purpose for students and clinicians entering the diagnostic field.
Finally, I remain deeply grateful for the recognition from The Pathologist’s first inaugural Power List, where I was voted the top pathologist in the US and the third most influential pathologist globally – a distinction that, amusingly, even ChatGPT seems to agree with.
You’ve published extensively while holding major administrative, teaching, and clinical roles. How do you balance these responsibilities?
I’ve been asked this question many times, and I always start by saying that my family has been my first priority. I once asked my son, when he was in eleventh grade, if he could remember a time when I told him I was too busy to help him with something. He recalled one instance – in third grade – when I told him I was in the middle of something complicated (papers scattered across the table) and needed a few minutes. He said I got back to him in about five. His brother and sister would agree that was typical.
To perform at my best, I also need six to seven hours of sleep. I’m not one of those people who can sleep for three hours, go for a run, and head straight to work. Once my day starts, however, I treat five minutes as a unit of time. I keep a post-it note on my desk with the next five or ten things I need to accomplish and move through them methodically.
I’ve also learned that contributing meaningfully across research, teaching, administration, and clinical work requires shifting focus deliberately. At any given time, I emphasize one area more than the others – but never for so long that the rest lose momentum. When it’s time to pivot, that area moves to the top of the list.
What do you consider to be your most impactful research contribution?
The central theme of my basic research since establishing my independent laboratory in 1985 has been fatty acids. My work has consistently focused on questions and diseases relevant to their biological and clinical significance. I began by studying how fatty acyl-CoA is made available for eicosanoid synthesis, followed by investigations into how fatty acids become covalently bound to proteins through thioester linkages – a process now recognized as relevant to heart disease, an area where our early findings have gained renewed attention.
I then explored the effects of fatty acid ethyl esters (FAEEs), compounds formed after ethanol consumption. In these studies, we worked with volunteers who were catheterized and consumed alcohol to safe levels of intoxication, generating some of our most impactful publications. Among these, the study that received the greatest attention demonstrated that FAEEs serve as a long-term blood marker of alcohol intoxication, published in JAMA.
Later, I turned to a mouse model of cystic fibrosis, where a fatty acid abnormality had been identified. This led to a decade-long investigation into polyunsaturated fatty acid metabolism in cystic fibrosis, examining both the biochemical differences and the underlying mechanisms driving these changes.
In parallel, I pursued clinical research in coagulation diagnostics, producing numerous papers on the appropriate use and introduction of new coagulation assays in clinical practice.
Do you think medical students and residents receive enough training in coagulation disorders?
I’ve always believed it’s unrealistic to expect students to be walking encyclopedias – there’s simply too much to learn. What matters most is their ability to access and apply information when needed. A well-prepared student should be able to explain, for example, how the troponin test helps detect a heart attack or describe the clinical significance of an elevated red blood cell distribution width.
What role do you believe AI and machine learning will play in coagulation studies and the application of these discoveries in clinical practice?
I can say with certainty – based on my current clinical use – that AI has the potential to increase both the speed and accuracy of diagnosis by an order of magnitude. Not learning how to use large language models in clinical practice is, in my view, one of the greatest missed opportunities in modern medicine.
Are we making progress in reducing medical errors, and what can pathologists do to minimize both their own diagnostic errors and those of their clinical colleagues?
Diagnostic errors continue to claim the lives of tens of thousands of Americans each year. To address this, pathologists must take a leading role in integrative diagnostics. We can no longer limit ourselves to anatomic pathology alone.
The goal should be to consider all available diagnostic data – clinical laboratory results, genetic findings, tissue pathology, and imaging studies – and integrate these into a comprehensive diagnostic summary for the treating clinician.
Pathologists can no longer simply manage laboratories and report test results with the expectation that even the most capable clinicians will always interpret every piece of data correctly. Because we perform the tests, we must also help interpret them. When that becomes standard practice, diagnostic error rates will fall dramatically.
Our greatest challenge now is to change the culture of pathology to embrace this broader responsibility – one that will not be assumed by any other specialty.
What core principles have you emphasized most to pathology residents and students throughout your teaching career?
I’ve often been asked what makes a successful teacher. My answer is simple: make a point, then illustrate it with an example that students will never forget.
This approach takes time. For every hour of lecture, I typically spend about 20 hours preparing, refining examples that truly reinforce the lesson. Many assume effective teaching is a natural gift – but in reality, it’s the result of extensive preparation.
I can create a clear, well-received 30-minute presentation with about four hours of preparation. But if I want it to be exceptional, it takes closer to ten. I’m willing to invest that time because teaching large groups offers a chance to inspire future educators, helping them appreciate how great teaching in medicine can profoundly improve lives.
You’ve served on many professional committees and advisory boards. Do you think your work in these roles has helped shape the future of laboratory medicine?
I’ve had the opportunity to serve on many national committees, and at times I’ve felt a bit like an imposter in those roles. Sitting beneath the portrait of Abraham Lincoln and the founding members of the National Academy of Sciences in the Academy’s Washington headquarters, I couldn’t help but wonder if I truly belonged there.
When I was selected as the plaintiff in the lawsuit against the FDA – a case that aimed to prevent severe restrictions on laboratory-developed tests – I also questioned why, among 20,000 pathologists, I was the one chosen.
Not every committee or board I’ve served on has had such a far-reaching impact, but many have. Each experience has enriched my career, broadened my perspective, and deepened my understanding of the field.
What are the biggest challenges facing clinical pathologists today, and how should they be addressed?
Pathologists who limit their work to laboratory management and occasional clinical input are no longer positioned for success. Today's clinical pathologists need to take an active role in delivering rapid, accurate diagnoses across all areas of medicine using AI. The future of our field lies in embracing diagnostic innovation and leading its integration into everyday medical practice.
Looking ahead, what innovations or developments in laboratory medicine excite you the most?
Without a doubt, the rise of AI and its rapid development is the most remarkable advancement I’ve witnessed in more than 40 years of medicine.
And finally, would you recommend laboratory medicine as a future career to pathology residents?
I would recommend laboratory medicine, clinical pathology, or any diagnostic discipline to anyone who wants to be at the center of the detective work behind uncovering why patients are ill. I believe the role of pathologists can evolve into one of the most important in clinical medicine.
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