Today Prostates,

Tomorrow the World!

Bostwick Laboratories performs more prostate biopsies than any other lab -- anywhere. Such disciplined focus could well revolutionize the $35 billion-a-year medical lab business.

Dr. David Bostwick tells a story about a 55-year-old pathology colleague whose blood analysis showed a slowly rising serum PSA count, a possible indicator of prostate cancer. The man had a biopsy taken, and sent it to the lab. He couldn’t sleep that night, or the next, for worry that he had cancer. As if the waiting weren't agonizing enough, the tests came back inconclusive. Most of the slides looked benign, but one showed a small “focus”, the size of a pin, that looked ambiguous. In desperation, he sent the slide to Bostwick, one of the leading prostate cancer pathologists in the world.

Bostwick determined that the biopsy was benign. His colleague, who’d gone without sleep by then for three days, was immeasurably relieved. “It was the uncertainty,” Bostwick says. “Knowing you’ve got cancer, and being able to deal with it, is easier in some ways than not knowing.”

One of the failings of the contemporary health care system is the extended turn-around time in lab results that can take anywhere from two days and two weeks. “The uncertainty is torture,” Bostwick says. And there’s no good reason for it.

That was Bostwick's primary motivation for founding Bostwick Laboratories, which has expanded over four years into the world’s fastest-growing, most efficient – and, quite possibly, most accurate – prostate biopsy laboratory in the world. “It’s quite remarkable, really,” says Bostwick. “We see more prostate biopsies than anyone else in the world – right here in this building in Richmond, Virginia.”

With unremitting focus on quality and speed, David Bostwick has attained the quickest turn-around times in the business. Physicians from California to Florida can get faster results by packing up their biopsies and shipping them halfway across the country to Bostwick’s facility in Richmond  than by running them to the lab across town. From the moment that the UPS truck arrives every morning, the staff surges into motion processing the biopsies: tagging them, prepping them, slicing them, placing them on slides, and moving them upstairs to the lab’s 13 physicians to inspect.

Bostwick Laboratories also addresses a hidden scandal of the laboratory industry: inaccurate findings. For prostate biopsies, the number of false positives (a diagnosis that says there is cancer when there really isn’t) runs about 1.5 percent. There are no hard numbers on false negatives (failing to spot the cancer), but Bostwick guesstimates the rate to be about three percent. "Every error is a personal tragedy, resulting either in unneeded treatment or delayed treatment for a disease that is easily curable if caught early. Many of those errors are preventable," he says. “I estimate that I’ve diagnosed 125,000 prostate cancers over the years. To the best of my knowledge, I’ve never gotten one wrong.”

Bostwick wrote the book on prostate pathology-- literally. He was the senior author of The American Cancer Society’s Complete Guide to Prostate Cancer, the definite resource on the subject. While he makes a point of saying that he isn’t any “better” than other physicians, he does insist that and his team are more focused than anyone else. Other labs perform biopsies for 24 different organs, from the heart to the brain, from skin to the liver. Bostwick Laboratories limits itself to the organs associated with urology: the prostate, kidney, the bladder and the testes--and 95 percent of that business is concentrated on the prostate. “As a consequence of doing it over and over,” he says, “we know everything there is to know about prostate pathology.”

That’s not just self-promotion. “Dr. Bostwick is one of the most respected prostate pathologists in the world,” says Pierre Desy, CEO of DiagnoCure, developer of a genetic prostate cancer test that Bostwick has been the first in the world to adopt. “He’s very intense, very passionate. … Whenever he feels he can bring the field forward, he’s very much behind it.”

Bostwick and his fellow specialists keep current with the latest literature on the prostate. Indeed, most of them have been published extensively on their own research. Bostwick, for one, gives speeches all over the world. (Granting an interview to Richmond Bio Synthesis was his last appointment one day before catching a flight to Tokyo.) In sum, there may be more prostate-pathology brainpower on the top floor of the Bostwick Building in Innsbrook than in any other single location in the world. If any of the Richmond pathologists has difficulty interpreting a biopsy, he or she can readily consult with another world-renowned expert right down the hall.

Hyper-focused medicine is the wave of the future. With a 35-person sales force calling on urologists all around the country, Bostwick Labs is rapidly gaining market share in its narrow slice of the medical marketplace. After four years, annual revenues are running in the eight digits. Operations are so efficient that the company generates significantly higher profit margins than conventional laboratories, which gives it the capital to expand. The company has opened satellite offices in Orlando, Fla., and London, England, and it has plans for more.

The U.S. health care system, by contrast, is incredibly inefficient. A typical hospital has 55 different lines of business under one roof. Some critical care functions logically belong together, but there is no justification for delivering many medical services out of a central facility. In the long run, Bostwick contends, big chunks of the health care industry need to be unbundled from hospitals and delivered by specialized firms that concentrate on doing one thing very well. Such organizations would train nurses, purchase specialized equipment, develop unique business processes, and employ physicians possessing specialized bodies of medical knowledge.

In other words, efficient health care companies would look a lot like Bostwick Laboratories does today. In the laboratory sector, if competitors don’t reorganize themselves voluntarily by moving to Bostwick-style specialization, they may find that the marketplace reorganizes them involuntarily. The global laboratory industry is a $35 billion-a-year business, and it’s growing at the rate of 10 percent per year. Growing exponentially faster, Bostwick Laboratories is gaining market share. Not only is David Bostwick expanding his prostate labs internationally, he’s considering applying his business model to other organs, particularly to the gastro-intestinal system, and he’s seriously thinking of taking the company public.

If Bostwick can prove his model works outside the narrow specialty of prostate biopsies, the entire lab business is up for grabs. Today prostates, tomorrow the world.

Bostwick first hit upon the idea for a specialized prostate pathology lab back in 1985. As a doctor at the University of Chicago Hospitals, he observed how long people were waiting for their biopsy results, and he wondered why the process couldn’t be reorganized so that pathologists could review the biopsy slides “as fast as humanly possible.” His colleagues thought it was a “cute idea,” he recalls, but they weren’t interested. It was impractical, they declared. Existing processes were scheduled around their schedules, their convenience. And that’s the way it had always been.

But Bostwick wouldn’t let the idea go. He moved on to the University of Maryland, earning an MBA at Loyola College in his spare time, and then to the Mayo Clinic, where he was a full professor. Then in 1999, he gave up his job at one of the most prestigious medical institutions in the country to put his dream into effect. Drawing upon his personal savings plus funds from friends and family, Bostwick launched his “next-generation” laboratory.

His move to Virginia was something of a fluke. He wound up in Richmond because it was there that he found a urology practice willing to engage him part-time while he got his business off the ground. By 2001, he reached the point where he could go out entirely on his own. Four years later, his company had grown to 170 employees and moved into a new office – the former Cavalier Telephone building in Innsbrook – that seems cavernously empty now but has the space to accommodate anticipated growth.

On a personal level, Bostwick is driven by the relentless pursuit of medical excellence. He displays little interest in the traditional trappings of wealth and power: His personal car is a practical Ford model, his office is equipped with furniture from OfficeMax. There are two key pieces of equipment on his desk – a PC and a microscope. Bostwick remains, first and foremost, a doctor. He personally reviews about 4,000 biopsies per year, which averages out to roughly 16 per working day. To accommodate his medical workload while gallivanting around the globe, he invested recently in state-of-the-art telemedicine capabilities that allow him to review digital biopsy images from afar.

Bostwick is a fanatic about quality. He provides free biopsy kits to his physician-clients, complete with standardized specimen jars, requisition forms, labels and cardboard boxes. To ensure that biopsies don’t get mixed up – an all-too-common error elsewhere – the company maintains a thorough paper trail. Although he strives to create an employee-friendly environment, Bostwick is uncompromising about certain procedures. Working on more than one batch at a time is literally a firing offense. So is placing a biopsy in a drawer – if it’s out of sight, the doctor explains, it can get mixed up.

The lab has developed strict procedures for preparing the biopsy tissue for the microscope slides. Technicians slice the tissue into 12 delicate ribbons for mounting. Most labs take only three. Then technicians apply three types of stains that highlight the existence of certain proteins associated with the presence of cancer. “It those proteins are present,” Bostwick says, “it greatly increases the likelihood of there being cancer. You’ve got to do it right the first time, every time.”

With his dedicated focus on urology, Bostwick invests in specialized equipment that general labs would find hard to justify. He’s also quick to adopt the latest medical technology. For a year and a half, he’s offered a new genetic test for prostate cancer – UPM3, or urine prostate marker 3 – that’s better than any other test on the market. It hasn’t been cleared by the Food and Drug Administration for widespread use, but as a fully accredited and licensed lab, Bostwick has permission to offer the test through physicians who order it. Says the doctor: “That’s our goal – to stay on the cutting edge of medicine and technology.”

“He’s ready to put his reputation behind that test,” marvels Desy with DiagnoCure, the company that developed the test. “He’s not only the first to use the test, he is, for the moment, the only one!”

To most people, looking at and thinking twenty-four/seven about a part of the body normally associated with rectal exams might eventually lose its allure. But the medicine and business both are endlessly fascinating to Bostwick. With the revolution in genomics and proteomics on the one hand, and the opportunity to reinvent the health care sector, things never get dull. “I don’t get tired of it,” he says. “It’s what I am.”

For Bostwick, however, the true bottom line is the potential to do tremendous good. One in six men is diagnosed with prostate cancer over the course of his lifetime. “If we catch it early, we can cure it,” the doctor explains. The trick is catching it early, when the signs are subtle and hard to read. That’s something he and his colleagues have proven they can do.

On Bostwick’s desk sits a wooden plaque, given him by his employees, with a quip that sums up his life’s work. It reads, “The prostate stops here."

-- March 31, 2005