"Adapt or Become Irrelevant": Puerto Rico Lab CEO and Natera Pathologist Tell Journal of Clinical Pathology Readers to Become Diagnostic Architects

Who is making the argument

De Socarraz leads CorePlus, a clinical and anatomic pathology laboratory in Carolina, Puerto Rico, and is listed on the paper as its CEO. Lennerz carries two affiliations: the Pathology Innovation Collaborative Community, a program housed at the Medical Device Innovation Consortium in Arlington, Virginia, and Natera in Austin, Texas, where he is employed and where the paper's correspondence is addressed. His declared prior employer is BostonGene and he advises Ibex. Both authors state they contributed equally. Two of the seven scenarios the essay examines, AI triage and germline testing, are markets in which Ibex and Natera respectively sell products, a context the competing-interests statement supplies without comment.

Eight failure patterns, from commoditization to eroded accountability

The abstract describes the method as mapping seven scenarios to find "critical inflection points and opportunities for conceptual transformation," drawing on peer-reviewed literature, policy analysis, institutional data and qualitative insight. The authors say the same patterns surfaced across all seven, and their list is long: well-intended initiatives with unintended consequences, commoditization, unsustainable economic models, efficiency gains left unused, misaligned infrastructure, missed clinical opportunity, regulatory rigidity and erosion of diagnostic accountability. In their words, the patterns "signal not only operational gaps but a cognitive crisis. A failure by pathologists to position themselves as more than an interpretative service."

As a response, the authors prescribe a change of role. Pathologists, the abstract says, "must assume the role of diagnostic architects, synthesising multimodal data into structured, clinically actionable insights and engaging more directly with physicians, those organising clinical trials and patients as partners in precision medicine." The competencies the authors attach to the role are diagnostic synthesis, systems thinking, digital fluency and what they call "strategic presence in value-based care," which they offer as "a mindset guide for both personal growth and anchoring the discipline's next transformational step."

Behind BMJ's $64 paywall

BMJ Group is selling the article at $64 and it has no PubMed Central deposit, so the scenario-by-scenario detail, any institutional data the authors cite and the specific recommendations under each inflection point could not be read for this report. What appears above comes from the abstract, the author footnotes and the PubMed record. The abstract names the scenarios but gives no figures for PD-L1 test volumes, NGS reimbursement rates or AI triage performance, and attaches no precedent to any of the seven. Readers who want to test the argument against the evidence the authors assembled will need the full text.

Why This Matters to the APO|APE Reader

The Journal of Clinical Pathology has published this under the Association of Clinical Pathologists' banner with a handling editor, Vikram Deshpande, rather than as an unreviewed commentary, which gives a polemic written by two industry-affiliated pathologists the standing of a peer-reviewed paper in the specialty's own literature. Its seven scenarios overlap almost exactly with the topics pathology departments are currently being asked to fund or defend, and the "diagnostic architect" label is the kind of phrase that travels into strategic plans and job descriptions before the supporting evidence does. Only the paywalled text can show whether the essay's institutional data bear the weight of its title.