“If anyone can draw on the power, where do we put the meter?”J....

“If anyone can draw on the power, where do we put the meter?”

J. Pierpont Morgan

My friends,

Tiresias mentioned in his most recent epistle the potential for reformulation of the whole field of anatomical pathology and especially the expansions, networking and thus potential remuneration. Initially, when the Optiscan’s confocal laser endomicroscopy (CLE) was developed, the vision would have been to have in vivo digital histopathology to enable, in surgery, in theatre, cancer pathology to enable accurate real time diagnosis and margin detection. That has been the main use which Carl Zeiss has been and is working on, in the brain tumour field. This will, Tiresias believes, replace frozen section biopsy, that 120-year-old technology developed at the Mayo Clinic. Carl Zeiss chose to apply it to neurosurgery, a field in great need, stuck in a “do-loop” which has shown no improvement in outcome for the patient in sixty years. This is perhaps the most difficult of fields, and given the Teutonic behemoth’s bureaucratic snail-paced methods, it is unsurprising that it has taken so long and is just now coming into wider clinical use. All the developments here are of course applicable to other fields of surgery. The next most obvious application, where marginal detection is vital, is breast surgery. Other low hanging fruit is in gastroenterology, then in cancer screening where frozen section biopsies, monitoring biopsies, and cytology is now used. This requires installation of Optiscan’s CLE installation in cancer operating theatres, endoscopy suites, colposcopy clinics and such. However, a number of developments have now overtaken these, “modest” aims. The first was the development in molecular biology and genomics of cancer and the attachment of fluorescent marker to a PARP1 inhibitor which enables in-vivo, real-time digital immunohistochemistry, a major advance which as yet, is largely missed, except perhaps at the Mayo Clinic, who have actually been the developers and leaders in the PARP and PARP inhibitors. This of course is just the tip of the iceberg of a new and potentially burgeoning field. The next development, which is still only in its infancy, is machine-learning/AI. Carl Zeiss have been doing some development in glioblastoma, but Carl Zeiss is not a clinical institution, and do not have the clinical or pathological resources to develop this in anything like the scope that is needed. The real game changer has been the partnering with Mayo Clinic, which has an enormous bank of over 25,000,000 histopathological specimens, the clinical knowhow and skills, the human and financial resources and most importantly a very long and unique history of bring new technology into the field. The other development is the networking of these technological developments allowing instant access of any optical biopsy or subcellular imaging to be viewed anywhere in the world. This is instant reporting, using AI and if need be expert pathologists from anywhere in the world, of optical biopsies, and obviate in the need in many situations for actual cutting out biopsies, with all its flaws, all its difficulties, all its delays and very big expenses. As Tiresias has alluded, we are witnessing the “Kodak-digital photography” Amazon moment in pathology. So, how can this profit us.

That is what J. Pierpont Morgan asked Nikola Tesla. Where does Optiscan place its “meter” collect on its new paradigm. The original plan, to provide the equipment and charge a suitable price, is far too limited. First, Australia is not really a manufacturer. Although companies like Cochlear and ResMed do some manufacturing in Australia, much of their manufacturing is in fact overseas. Although he has dreamt of Optiscan developing a hi-tech Med-Tech manufacturing in Australia, Tiresias now believes that the manufacturing will actually occur overseas, Asia, or in “Med-Tech Silicon Valley”, in Minnesota. In this transfer, Tiresias considers that an offer from a major firm from either Asia or the US might be too hard to refuse and Optiscan like so many other Australian medical developments would be taken overseas. This would mean missing out on what will become the real action, the remuneration from a “metered” online pathology service. You see my friends, where the action will be is in real-time AI-driven of pathology with instantaneous AI-enabled reporting of optical biopsies networked around the world facilitating rapid diagnosis and treatment. This is where Tiresias sees the revolutionary change and where the really massive remuneration will come from. This is what will enable robotic-surgery, and this is what will transform cancer and other forms of surgery. What are the methods that Optiscan can receive the appropriate remuneration. “Where “to place the metre”? How best to “Clip-the Ticket” is the question? It is important to think on this even if, as Tiresias believes, Optiscan will have been largely or fully taken over. It is important in the pricing and valuation of our company, now. Will it be subscription? Will it be charge per click? Will it be some other way. Tiresias sees that his alma mater, the Mayo Clinic, sees this too, and is positioning itself to be the centre or one of the centres to provide the world’s pathology and corner the whole market, in the way of Amazons the Apples, and even Cochlear have done in their fields. Now Tiresias is not a marketing guru, but he sees rivers of gold streaming through the optical fibre lines around the world. This is why Tiresias thinks long before this we the long-term shareholders may well be given the offer which our company may find hard to refuse.

POST SCRIPTUM: My friends, Tiresias is going on one of his Astronomy sojourns, far from light polluted sky, to view the skies. He will be taking his telescope and although the only planets that are visible at the moment with this telescope are Mercury just at sunset, and hopefully Venus just immediately after sunset, and the moon will be a Crescent waning, but available for detailed study, the nebulae and the star clusters, which interest him, and hopefully not too many clouds, he can enjoy the star gazing and the inspiration.

In A fortnight