Okay, so first discussion question here, what factors have had the greatest impact on your practice in the last five years, and how have they impacted your practice? If anyone wants to jump in and go for it. I think I can start off by saying in the last five years, the most important thing is probably the pandemic. So that has certainly changed how GI practices have been affected. So right from how we, well, a lot of patients got delayed in terms of getting their screening colonoscopy. So that's something which is very noticeable and we're seeing sort of later stages and sort of the aftermaths because of the pandemic. We still have patients who are either experiencing sort of the post-viral phase and having some GI symptoms related to it, so that's a little bit different. And then how things are practiced, you know, more virtual visits have also become a part of our care, which was not a usual routine, I would say, before. So that the uptake in the medical community, as well as amongst our patients, has been tremendous. So I think a lot has changed, you know, pre-pandemic, post-pandemic. I would also add in, yeah, definitely the pandemic is the biggest factor. We kind of touched on this a little bit previously, but as someone who most of my time has spent on colon cancer screening and prevention, definitely the single biggest thing that's had the biggest impact is lowering the screening age from 50 to 45. So it was definitely necessary to do. We've clearly demonstrated that it does save lives. However, that's a huge cohort of people that need screening. And so there have definitely been some growing pains with having enough capacity to do procedures on everyone else that needs, everyone that really needs it. And so now we're seeing, I mean, I know this is probably a regular thing for everyone, but I mean, we see patients in their 20s, 30s coming down with colon cancer. And even if it does make sense from a risk benefit standpoint to start screening people earlier in certain parts of the country, certainly in Chicago, we do not have the capacity to screen folks younger than 45 at this time. So that's something that we're going to have to kind of keep adapting. We're starting to kind of integrate some more non-invasive screening methods as well, too. Things like Hologuard, potentially this blood-based screening test that just got approved, even though it's not ideal. Anyone else has any thoughts? So next question here, how do you see the role of industry as it relates to your practice? We kind of talked about this one already, so we'll save that. This is a good one. So if you could give one piece of advice to the audience on how to work with you and your colleagues, what would it be? I can take this one. Just because I work at a—I'm at Stroger, which is a county hospital, so amongst the big IBD centers like your Chicago, Northwestern, we often have our reps and our people who are from the industry reaching out to bigger centers to offer newer things that may be coming out. I think there is—I think because of the more outreach and community initiatives that are happening and the change in even the models of how the clinical trials are run with their pragmatic approach, there is role of industry interacting at more community level, because not only can they provide support in terms of access for certain medications—I deal with a lot of biologic and biologic access—I heavily rely on industry to support my patients who are underserved for the biologic access. But that being said, even in the endoscopy world, there are centers which are far—which are sort of not really affiliated with bigger centers or not research centers, but are kind of doing some of the cutting-edge things or change in guidelines, practices, and things could be introduced to them as well. So I'd say this is one area that could be explored a lot by the industry to reach out and see what they might need. I think Bianca said something similar earlier, but I would also say, I guess, just to stay engaged. So if you reach out to us once, want to set up a meeting, to be honest, a lot of the times it might slip our mind, we might forget. And so just being present and available and checking in is helpful. You know, I mean, obviously there's a balance. You don't want to badger people, but, you know, if you meet someone and you kind of, you know, vaguely talk about, okay, let's discuss this, and then it kind of gets lost, just reach out again and say, hey, do you think you'd have any—have a chance to talk about this? And a lot of times, honestly, we're so busy, we just forgot. But actually your resources may actually be helpful. So just staying available and then also being available when we do have questions is really helpful. Definitely with my patient population, as well as Kajuli's, just getting—being able to figure out how to get the right drug for the patient is unfortunately a large part of what I do. So your resources on that—in that area are extremely helpful. Okay. I mostly meet device-related reps, so I think the best piece of advice is, especially if you're newer to the company, nobody's expecting you to know everything, but it's really important that you know your devices and your products really well, how to troubleshoot, and kind of keep your finger on the pulse of the other doctors that you're working with, what sort of issues have they run into, any, you know, creative uses. And I think being interested in that sort of thing really—that can really help add and provide value to the endoscopies that you're working with. Okay. So maybe you can do— Yeah, that's probably the question that I'm on. So where do you think the practice of gastroenterology will be in 10 years is a broad question. If robots have not taken over endoscopy world? I mean, I think in 10 years, AI is going to play a very important role. That's just, you know, how the nature of it is going to be. I don't know if it's going to replace us in endoscopy, probably not in 10 years, but in general, even in clinic visits to our medical records and AI endoscopy, we were talking about, you know, GI Genius and other AI sort of assistance. I think that's going to be the major boom and what I think will change our practices in a lot of ways. Yeah, I would agree. I think AI is already changing my practice and I think it'll be incorporated even more. I was an AI skeptic, but the past few months using the technology, it's been helpful. Yeah, no, I just want to say that it's not going to replace us as such gastroenterologists, but it'll be a good co-pilot system and that's what we are actually trying to achieve. The goal is that in the office-based practice, if we can get at least an hour or two saved every day for the physicians and the staff, so we can spend more time doing, you know, what we used to do, talk to the patients and also do some teaching and other things. Whereas in the inpatient side, some of these newer computer-aided imaging technologies coming out will help us in developing better detection techniques and also diagnosing some of these lesions pretty quickly. I think that's what it is. It's not going to replace that much, but yeah, that's what we are hoping for as a co-pilot. But one thing that I have to, I know there's a lot of hype on this, but there is going to be a ceiling, or at least in the next 10 years, it's going to come in this research, because I'm facing it. It's a computational power. So, I mean, everyone talks about AI, but you know, when you do all these training things, you need a lot of computing power, a lot. You have no idea. It's beyond terabytes. So, that's a big limitation that we are facing now. We are using cloud-based services, et cetera, but that, unless there is an also parallel improvements in the computer science, so where, you know, you have heard of CPU, GPU, you know, and now with the NVIDIA, you know, coming up with all these newer graphic processing units, this is beyond that level. So, quantum computing will come, but that, I don't know where it will be in the 10 years. So, we will hit a ceiling. We are not going to go beyond certain level of achievements in this area, though. But it will be good as a co-pilot. After that, if you ask me, then we'll see. We'll see when the computational power improves our capability of testing. So, yeah, maybe we can come up with a robotic AI-driven device to do procedures. I think I'm the least scope-heavy panelist here. I hope that in 10 years, you know, one of my areas of research is an active area of research at Cedars-Sinai is precision medicine. So, irritable bowel syndrome, I know you spoke about a lot, is sort of a bucket term that we use, and there was a really nice paper that was recently published called Taking the BS Out of IBS. A lot of patients, unfortunately, like was alluded to previously, who are diagnosed with IBS have something else going on. So, I think and I hope that in the next 10 years, patients who are diagnosed with IBS, but who have persistent, severe, and debilitating symptoms will actually have more targeted therapies. You know, we know now that a lot of patients who are diagnosed have underlying mast cell activation syndromes, small fiber neuropathies, things that have targeted treatment more than just treating symptoms. So, I think that in the next 10 years, we'll be able to better identify those patients without every patient having to undergo a million-dollar workup and have targeted therapies for some of these patients that are put in a really vague bucket. I specialize in IBS, yet I still really despise the term. We just say, if you have pain and change in bowel frequency, you know, you have IBS, but that describes Crohn's disease. It describes, you know, pancreatic exocrine insufficiency. It describes a lot of things, and where to stop the workup is, you know, it's, I think, does a disservice to say, well, you're young and healthy. You're not old and anemic, so let's stop here. So, I'm really hopeful that in the next 10 years, that will change for a lot of patients, and that's a lot of the patients that I see in my clinic and that we see in our practice. Patients fly from all over the world, actually, to see us because we kind of look a little bit further than the Rome criteria. I totally agree with that. Yeah, that would be my hope is where we're going because we, unfortunately, are still kind of going at it with a shotgun approach and kind of hoping we hit something, and if not, we fall back on that symptomatic treatment. And, yeah, it's not great. It doesn't feel great to be in the gray area when, you know, there's other possibilities where you could be getting patients to feel better, so I totally agree. I think this is along those same lines, but I'm hoping we get a little bit more detail and light shed on sort of microbiome research because this has a role in sort of IBS, but also in other disease processes, you know, IBD, certain cancers of the digestive system. So right now we get information, oh, if there's something wrong with your microbiome, for whatever reason, that's not good, but we can't really, we don't have clinically translatable information to tell patients. We can attribute it to this culprit or those, or we can't even tell them that, let alone have to tell them we have no treatment options because we don't know which or who or what. I totally agree. So that's the first time the microbiome has come up today. And, yeah, I was thinking that in the back of my mind as well, too. Okay, well, great. So actually our program is supposed to be wrapping up really in just about 10 minutes, so I know I kept holding everyone back from questions, but does anyone have any thoughts or questions about any of the topics that our presenters brought up today or just in general? I don't know if this works. Oh, I have a question. You know, it seems to be a common theme that we're all feeling like we're doing two people's jobs, three people's jobs, so there's only so many of you and so many of us in industry. What's like your favorite style of learning, new products, devices, or about medicine, outside of a rep being physically there to, you know, help with troubleshooting or whatever it might be? I think outside of a rep coming to our center and showing us things, probably at conferences, so DDW, ACG, I don't think I attend that many hands-on sessions because they're usually focused on teaching the fellows, but I think that would be a good place to, especially if something really new were coming up, then oftentimes they have oral, you know, plenary sessions where they have a platform to really showcase. For the exhibition itself, like there are so many presentations happening in the exhibition which, believe it or not, people do target and go to, especially if they're newer therapies or things that I don't know of or of that nature, people do go stop and kind of hear, so those are interesting and there's always new ways to learn. I think outside of what's been mentioned already, just sort of keeping in contact with my colleagues or people I've met at conferences. So say, for example, today there's about 20-something of you and you all come from different companies and maybe in different departments. If you've met anybody that you click with, stay in touch and just check in with each other, say what's new with you, or I do that with people I've trained with, I do that with people I've met at courses or conferences, and it's a more low-key way of learning. Even people that are not in the same specialty as me, because, I mean, I obviously don't have the depth of IBD knowledge or motility knowledge with these two ladies to the right of me, and I don't know as much about AI. And if there's no other questions, I think we can wrap up for the day. But thank you so much, everyone, for your attention and your participation. I hope that this was helpful for you.

COVID-19 impact

colon cancer screening

virtual consultations

AI in gastroenterology

precision medicine