Latest / CareTalk: Healthcare. Unfiltered. / Can AI Help Us Finally Beat Cancer? w/ Dr. Sanjay Juneja, TheOncDoc

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Can AI Help Us Finally Beat Cancer? w/ Dr. Sanjay Juneja, TheOncDoc · CareTalk: Healthcare. Unfiltered.

• 0:07
  John: Welcome to Care Talk America's home for incisive debate about healthcare, business, and politics.
• 0:12
  John: Today we have Dr. Sanjay Juneja, the onc doc to fill us in on where we are on this amazing journey we have to turning oncology from a, a devastating death sentence to a manageable disease.
• 0:27
  John: Welcome, Sanjay.
• 0:29
  Dr. Sanjay Juneja: Thank you so much for having me and, and discussing this topic that I know kind of sits in the back of many of our minds, but, but you know, lots of reasons for optimism in my opinion.
• 0:39
  John: So, Sanjay, maybe talk a little bit about your journey to become a doctor.
• 0:43
  John: What drew you to oncology and, and how you got to the position where you are really one of the, the most public authorities translating, uh, the impossible into something that's manageable.
• 0:57
  Dr. Sanjay Juneja: Yeah.
• 0:57
  Dr. Sanjay Juneja: So, you know, it's funny you ask because it, it's a story that really I saw that you have a, a doctor philosophy, and when I was growing up, I really wanted to be a science teacher, a middle school science teacher.
• 1:09
  Dr. Sanjay Juneja: And, and I loved, I loved the concept that you could be taught something.
• 1:14
  Dr. Sanjay Juneja: That you just all of a sudden, quote unquote, see, right?
• 1:16
  Dr. Sanjay Juneja: Like, you know, even the turning speeds around, around the street, like is based on the friction of your wheels.
• 1:22
  Dr. Sanjay Juneja: And when you appreciate all of these things, you appreciate life more.
• 1:25
  Dr. Sanjay Juneja: But I got into a car accident in high school and I lost my eyesight.
• 1:30
  Dr. Sanjay Juneja: I was legally blind, uh, for, for more than a couple of weeks and.
• 1:35
  Dr. Sanjay Juneja: After my eyesight had come back, many were like, well, weren't you just so scared you'd never get it back?
• 1:39
  Dr. Sanjay Juneja: And, and worried.
• 1:41
  Dr. Sanjay Juneja: And I was like, you know, I wasn't, and at first I was, you know, proud, like, oh, I wasn't worried.
• 1:45
  Dr. Sanjay Juneja: And then I really dissected, like, how come I wasn't worried?
• 1:47
  Dr. Sanjay Juneja: I was 17, I was an athlete.
• 1:49
  Dr. Sanjay Juneja: Um, and it was because.
• 1:51
  Dr. Sanjay Juneja: The way my doctor, at the time, Dr.
• 1:51
  Dr. Sanjay Juneja: Grier, my ophthalmologist, really broke down every step of the process.
• 1:58
  Dr. Sanjay Juneja: Like, this is what your trauma did, this is what it did.
• 2:01
  Dr. Sanjay Juneja: I had no medical background at this point.
• 2:03
  Dr. Sanjay Juneja: You know, this is, this is where the pressure that we're monitoring lies and it's pushing on this blood vessel, and that's your nutrient supply to your eye, et cetera, et cetera.
• 2:11
  Dr. Sanjay Juneja: So we, we celebrated mini victories all the time.
• 2:14
  Dr. Sanjay Juneja: Like when my pressure was coming down from 38, you know, in one eye to, to the teens, et cetera.
• 2:20
  Dr. Sanjay Juneja: I knew what that meant, and I realized it was this kind of, uh, serial, uh, breakdown of these different parts and processes that then gets you to the finish line.
• 2:30
  Dr. Sanjay Juneja: It's, that was manageable, more manageable to take a bite at a time, you know?
• 2:34
  Dr. Sanjay Juneja: And, and so that kind of got me into this whole idea of, well, if education could be so powerful and, and placate, uh, a scary process.
• 2:43
  Dr. Sanjay Juneja: You know, where else is that kind of potentially or arguably more necessary than something as terrifying as cancer and hard to understand as cancer.
• 2:50
  Dr. Sanjay Juneja: And so that's where, uh, that journey came and the decision to go to medical school to be an oncologist.
• 2:57
  John: And why oncology?
• 2:58
  John: I mean, it's a very hard category of medicine.
• 3:02
  John: I mean, you could become a pediatrician, kids get better.
• 3:04
  John: You could be an orthopedic surgeon and you just fix things and move on.
• 3:08
  John: Yeah, like what, what drew you to this?
• 3:11
  John: This hard and bedeviling mystery of cancer.
• 3:15
  Dr. Sanjay Juneja: I think the biggest part of it is just how, you know, heterogeneous as one would call it, or, or in other, in other words, just how different all of the cases can be.
• 3:25
  Dr. Sanjay Juneja: I mean, when I learned that you can have the same cancer, the same stage, and have such different outcomes and experiences, uh, that intrigued me.
• 3:33
  Dr. Sanjay Juneja: I love problem solving.
• 3:34
  Dr. Sanjay Juneja: My dad's a, an engineer and, and did you know Six Sigma kind of quality?
• 3:39
  Dr. Sanjay Juneja: Improvement number stuff, and I'm like, surely that can be applied to something that otherwise has a lot of variability.
• 3:45
  Dr. Sanjay Juneja: Uh, so that was one and two was just to bring what I experienced from as a patient that the power that a physician can potentially have on dictating what kind of experience someone has with cancer.
• 4:00
  Dr. Sanjay Juneja: So.
• 4:00
  Dr. Sanjay Juneja: You know, I went into it thinking I can't change the fact that a diagnosis comes, but I can certainly change or influence how that diagnosis is, is received and what that cancer journey looks like.
• 4:11
  Dr. Sanjay Juneja: Both for the family member, or both for the patient and their family.
• 4:15
  Dr. Sanjay Juneja: Right.
• 4:16
  Dr. Sanjay Juneja: So if you don't know something, it's very scary.
• 4:18
  Dr. Sanjay Juneja: It's very scary to navigate a room in the dark and then you turn the lights on and nothing really changes and your fear goes away other than the fact that you're, you know what's ahead.
• 4:26
  Dr. Sanjay Juneja: And so that same concept I think can be.
• 4:28
  Dr. Sanjay Juneja: Applied to, you know, a cancer battle.
• 4:31
  Dr. Sanjay Juneja: It's like, is, is let's break down this stuff.
• 4:33
  Dr. Sanjay Juneja: And, and the more you know, I believe the less intimidating something can be.
• 4:38
  Dr. Sanjay Juneja: Uh, and there's been data that shows, you know, mentality and belief and hope and all of these things actually influence outcomes.
• 4:45
  Dr. Sanjay Juneja: So I think it's just imperative that we focus on the freebies, which are things like that education and, and decreasing, uh, you know, the fear components of it.
• 4:54
  John: So cancer's gonna affect, I think some, I think this current statistic are about one out of every four or five men, one outta two or three women across a lifetime.
• 5:03
  John: And as we, as our, our population ages and, and we extend life, um, as we've done in the last 50 years, cancer's going to emerge more and more frequently in our population.
• 5:16
  John: It's the second largest killer after, after, after cardiac, uh, in the United States.
• 5:22
  John: W 50 years ago, cancer, a cancer diagnosis considered a death sentence.
• 5:27
  John: People talk about it now as a manageable disease.
• 5:31
  John: Are we gonna cure cancer in our lifetime?
• 5:33
  John: What's the prospect for us to turn this toxic diagnosis into a manageable, a manageable condition?
• 5:41
  Dr. Sanjay Juneja: Yeah, it's a great question.
• 5:43
  Dr. Sanjay Juneja: And you know, the cure word is one that I guess, you know, is a little bit of semantics.
• 5:48
  Dr. Sanjay Juneja: But I will tell you like, you know.
• 5:51
  Dr. Sanjay Juneja: Certainly we don't feel shy about using that term.
• 5:54
  Dr. Sanjay Juneja: There are diseases or types of cancers that we, by all accounts consider curable even in a stage four setting.
• 6:01
  Dr. Sanjay Juneja: So, you know, I fight a lot of misinformation on, on social media, and one of 'em is like, oh, stage four means it's.
• 6:07
  Dr. Sanjay Juneja: Absolutely not incurable, but, but that's not the case.
• 6:10
  Dr. Sanjay Juneja: And we have seen some just phenomenal, uh, responses and, and control and, you know, technically cures when it comes to things like melanoma, uh, and even potentially renal cell.
• 6:21
  Dr. Sanjay Juneja: These two tumors are, are very, uh.
• 6:24
  Dr. Sanjay Juneja: The immune system works very well on 'em.
• 6:26
  Dr. Sanjay Juneja: So when immune therapy came out, you went from melanoma, which was devastating.
• 6:29
  Dr. Sanjay Juneja: If it was stage four and scary, two people are 9, 10, 11 years out where the stage four is in multiple organs, vital organs, and no disease.
• 6:37
  Dr. Sanjay Juneja: So, you know, amazing.
• 6:39
  Dr. Sanjay Juneja: We're doing it in certain tumor types.
• 6:40
  Dr. Sanjay Juneja: Absolutely.
• 6:41
  Dr. Sanjay Juneja: I think blood cancers, uh, is a very exciting concept too, with something called CAR T therapy, where basically you just take the color shirt, I'm wearing a blue shirt that's, you know, ribbed and, and take a marker or feature of the cancer, attach it to your immune s you know, immune cell, re-put it into your body.
• 6:58
  Dr. Sanjay Juneja: And then it knows exactly what it's looking for and can, and can kill everything that's wearing that, that, that color or that flag.
• 7:05
  Dr. Sanjay Juneja: So these kind of concepts make us excited about certainly many cancers.
• 7:10
  Dr. Sanjay Juneja: And then also on the other side, you know, in general, cancer is.
• 7:14
  Dr. Sanjay Juneja: Is a population in your body of cells that just went rogue.
• 7:17
  Dr. Sanjay Juneja: So it's just one, it starts in just one little village, right?
• 7:20
  Dr. Sanjay Juneja: And then over time, if given time, then it can grow and, and get new features and evolve to wanna spread now and wanna recruit blood vessels so it, it gets fed that things that needs like creatine and protein, you know, for, for Jim bro, so to speak.
• 7:35
  Dr. Sanjay Juneja: So it can do all of this, but if you can take that colony out, out the gates.
• 7:39
  Dr. Sanjay Juneja: Now you've potentially cured it.
• 7:40
  Dr. Sanjay Juneja: Right?
• 7:40
  Dr. Sanjay Juneja: And that's, that's generally how we talk about staging.
• 7:43
  Dr. Sanjay Juneja: So where I get excited too is the imaging potential and the blood tests and everything that we're looking at, if we can find it in a stage one setting.
• 7:51
  Dr. Sanjay Juneja: Now you don't have to do some billion dollar drug to be able to cure a disease, but just finding it early.
• 7:57
  Dr. Sanjay Juneja: Can kind of spare you this evolution or challenge that otherwise will be throughout your body.
• 8:02
  Dr. Sanjay Juneja: So there's multiple angles where people are getting excited, both on the therapy side, the diagnostic side, and then of course, you know, this whole AI and technology piece is gonna really, I think, um, just catalyze how quickly we see we are controlling some of the more stubborn disease processes.
• 8:20
  John: There's a real debate around imaging right now where the folks who are pushing imaging and early stage tests and, you know, extending beyond the typical panel of tests for folks, you know, whether it's a, with a longevity lens or a preventive healthcare lens.
• 8:38
  John: What's your view on the explosion in the extension of testing beyond the typical panels that you'd get in your annual physical?
• 8:48
  Dr. Sanjay Juneja: Yeah, I think, uh, you know, when it comes to imaging and cancer screening, I think it's kind of a pendulum.
• 8:54
  Dr. Sanjay Juneja: Maybe it's swung quite a bit in the other direction as far as, you know, full body MRIs at some certain sequence.
• 9:02
  Dr. Sanjay Juneja: I, I'm, I'm always a doctor at heart, so we, we need the medical evidence that, that, at least if somebody is paying for it, say like tax dollars or something, you need medical statistical evidence that doing something at a certain frequency.
• 9:15
  Dr. Sanjay Juneja: In a certain way, we'll actually change the outcomes compared to how we're doing things currently.
• 9:20
  Dr. Sanjay Juneja: So there's no doubt about that when it comes to lab testing, uh, and some of these more expanded panels, I am a little more in favor of those.
• 9:30
  Dr. Sanjay Juneja: Four and two, develop our understanding.
• 9:33
  Dr. Sanjay Juneja: So the way that people are,
• 9:35
  John: just to be specific, you know, like Google came out with a grail test that, that then spun out and there's a, it's, it's very probabilistic about your, the possibility that you, that you will develop certain cancers and, you know, it is both intriguing intellectually and sort of scary at a personal level.
• 9:55
  John: That's, I think, currently the, the, the most interesting.
• 10:00
  John: Thing that really isn't conventional, but is a, is, is is run through a conventional blood test.
• 10:06
  John: What do you think of that?
• 10:08
  Dr. Sanjay Juneja: Yeah, so, uh, I'll speak on M says in general, which is this whole concept, exactly what you're saying.
• 10:13
  Dr. Sanjay Juneja: Can you take a blood test and get a multi cancer detection panel?
• 10:17
  Dr. Sanjay Juneja: And I think the easiest way to understand it is if you've ever, you know, if you have a parent, a grandparent, and you go to the doctor and they say.
• 10:24
  Dr. Sanjay Juneja: They see a skin lesion and they say, this thing can turn into cancer and therefore they burn it.
• 10:29
  Dr. Sanjay Juneja: That the, that evolution, that kind of pre-cancer state or with pap smears, women get pap smears to look at cells and see that they look quote unquote sketchy, for lack of a better term.
• 10:40
  Dr. Sanjay Juneja: That same concept is very much applicable to the other cells in your body, not surprisingly so.
• 10:47
  Dr. Sanjay Juneja: That's where I get excited because a lot of the times other than a few cancers, you get a little bit of a lead time where something does look quote unquote sketchy and that can clue you in to potentially know that there's something awry in a certain population or village, as I mentioned earlier, that could evolve into a cancer or potentially is an early cancer.
• 11:06
  Dr. Sanjay Juneja: So I think there's certainly, um, um.
• 11:10
  Dr. Sanjay Juneja: Hope surrounding that.
• 11:12
  Dr. Sanjay Juneja: I think it's gonna take then what's called a multimodal approach.
• 11:15
  Dr. Sanjay Juneja: Like, okay, you know, it's circulating in your blood, you know, it's somewhere, but then what is the imaging gonna look like to, to localize it or to find it?
• 11:23
  Dr. Sanjay Juneja: I, I think that is where the answer still needs to be had, because, you know.
• 11:28
  Dr. Sanjay Juneja: What they're basically testing for is the hair or dust.
• 11:31
  Dr. Sanjay Juneja: You know, dust in a house is about, uh, you know, a large percentage of your old skin cells and hair cells, so you know that somebody was there.
• 11:39
  Dr. Sanjay Juneja: Right.
• 11:39
  Dr. Sanjay Juneja: That's exactly what these tests are doing.
• 11:41
  Dr. Sanjay Juneja: They're looking at properties that like, oh, this is, you know, if hair and dust is human, uh, then this is cancer.
• 11:47
  Dr. Sanjay Juneja: Like, but then you still have to localize it.
• 11:48
  Dr. Sanjay Juneja: So I think we have a little way to go there.
• 11:50
  John: But you're hopeful, you're saying put the, the, the full body MRIs, maybe, maybe hit the pause button on that till the data is there.
• 11:59
  John: But on the, on the, on the, on the blood tests that are still developing and, and we're getting better every day, pay, pay a bit of more attention.
• 12:07
  John: There is kind of what you're, what you're, if you were to grade them separately.
• 12:11
  Dr. Sanjay Juneja: Yes.
• 12:11
  Dr. Sanjay Juneja: I think, I think the concept of lead time and having aberrant or, or quote unquote screwed up tissues, uh, and little, uh, flares that signify that is a, a very real thing because that's how it, it aligns with our understanding of the tumor of evolution process.
• 12:29
  John: So in cancer, you've been a big advocate of patient empowerment infor in, in information and engagement.
• 12:40
  John: Why?
• 12:41
  John: How, what kind of an impact can that have for, uh, if, uh, my wife had breast cancer?
• 12:47
  John: Thankfully she is, is cured.
• 12:49
  John: As far as we at, at this, at this, at this point.
• 12:53
  John: Um, we're very lucky.
• 12:55
  John: We've got a lot of access to healthcare, but there, there, there for the average person who doesn't necessarily, doesn't no background in healthcare, why is, what's the responsibility of the patient, the patient family, once you get a cancer diagnosis and how do you, how do you.
• 13:10
  John: Execute on that.
• 13:12
  Dr. Sanjay Juneja: Yeah.
• 13:12
  Dr. Sanjay Juneja: I mean it's, it's an unfortunate reality, but a real one, and that's that there is.
• 13:19
  Dr. Sanjay Juneja: A disparity, or at least it is not congruent, the kind of care or quote unquote elite or guideline, you know, top, top level care, uh, is not distributed equally from, you know, throughout the United States.
• 13:32
  Dr. Sanjay Juneja: And I don't, I do not believe in my heart, you know, heart that it's with intention.
• 13:36
  Dr. Sanjay Juneja: It's just more of a resource issue and a labor issue.
• 13:39
  Dr. Sanjay Juneja: We know there's a severe deficiency of oncologists, of, of healthcare staff.
• 13:44
  Dr. Sanjay Juneja: You hear about it all the time and.
• 13:46
  Dr. Sanjay Juneja: There's an over of taking care of patients because of how common cancer is becoming, as you had mentioned at the beginning of this podcast.
• 13:54
  Dr. Sanjay Juneja: So what that means is.
• 13:58
  Dr. Sanjay Juneja: All of this, this, you know, amazing scientific discovery we're, we're learning.
• 14:03
  Dr. Sanjay Juneja: And the guideline updates, and the therapy updates.
• 14:05
  Dr. Sanjay Juneja: And the diagnostic updates and all of this, all this stuff that's coming out quickly and multiple tumor types.
• 14:11
  Dr. Sanjay Juneja: I wanted to reach the same places that I grew up, which is, and still live today, Baton Rouge, Louisiana.
• 14:16
  Dr. Sanjay Juneja: Right?
• 14:16
  Dr. Sanjay Juneja: And I'm a person of color, but we know that, that certain demographics, depending on where they live, the color of their skin, don't get the same.
• 14:26
  Dr. Sanjay Juneja: Uh, care either to the time of diagnosis
• 14:29
  John: reliably, don't get that access to care.
• 14:32
  Dr. Sanjay Juneja: Correct?
• 14:33
  Dr. Sanjay Juneja: Correct.
• 14:34
  Dr. Sanjay Juneja: And I think, I think the only solution until someone, you know, proposes one is like, well, then let's make it collaborative and co informed so that we can, I, again, I don't think it's, it's malice on anyone's part to not deliver that.
• 14:46
  Dr. Sanjay Juneja: I just, there are gaps that exist.
• 14:48
  Dr. Sanjay Juneja: That's a fact.
• 14:49
  Dr. Sanjay Juneja: So I am kind of obsessed with this concept of.
• 14:52
  Dr. Sanjay Juneja: Why not participate?
• 14:53
  Dr. Sanjay Juneja: Like if you have the time and it's your family member, uh, or yourself, you know, they're, the accessibility to information is, is easier and more seamless than ever, especially with these frontier large language models like, you know, chat, pt, et cetera, which take their own caution, don't get me wrong.
• 15:10
  Dr. Sanjay Juneja: But information is accessible, so I think it's a bandaid of a solution until hopefully technology.
• 15:16
  Dr. Sanjay Juneja: Uh, and the system can find a way to distribute the most elite kind of care that you would otherwise have to travel for or be fortunate to live in the area of, uh, to anyone that has a cancer diagnosis.
• 15:29
  Dr. Sanjay Juneja: 'cause it's just not going anywhere.
• 15:30
  John: So you get a cancer diagnosis, what should a what's what, what are items of one, two, and three for a patient?
• 15:36
  Dr. Sanjay Juneja: Number one, you really have to know, like you must know what kind of cancer it is.
• 15:41
  Dr. Sanjay Juneja: The flip side is also true, like don't, don't, you know, be scared if you heard X, Y, Z, uh, if it's not your cancer, like specifically your histopathologic diagnosis, meaning like non-small cell lung cancer adenocarcinoma.
• 15:54
  Dr. Sanjay Juneja: Like that is a characterization that is far different than.
• 15:57
  Dr. Sanjay Juneja: Small cell lung cancers, right?
• 15:58
  Dr. Sanjay Juneja: So you have to know the kind of cancer.
• 16:00
  Dr. Sanjay Juneja: Number two, the management totally depends on the stage.
• 16:04
  Dr. Sanjay Juneja: So stage one is managed very differently than stage three and stage four, that those are the two most important things.
• 16:09
  Dr. Sanjay Juneja: And the third thing, and this is my opinion, is, is you have to have a precision workup.
• 16:15
  Dr. Sanjay Juneja: And that means outside of just throwing it on a slide and looking at the histopathology, almost every cancer type.
• 16:22
  Dr. Sanjay Juneja: The guidelines recommend getting what's called the molecular, uh, pattern of this cancer.
• 16:26
  Dr. Sanjay Juneja: So these are features at a deep birth level that we were not able to know, you know, decades ago.
• 16:32
  Dr. Sanjay Juneja: Drugs are designed for these prognosis, uh, is determined by these.
• 16:36
  Dr. Sanjay Juneja: Um, so those are the three things you definitely wanna know.
• 16:38
  Dr. Sanjay Juneja: Tumor type the stage and have I gotten, you know, molecular next generation sequencing NGS testing, um, for my cancer?
• 16:47
  John: And that cost of sequencing goes down by the day.
• 16:50
  John: Mm-hmm.
• 16:51
  John: And most, and almo, and it's almost always covered by insurance, just to Correct.
• 16:55
  John: Just to reinforce the, the, the, the to-dos for the, for the patients.
• 17:00
  John: So you, you touched on this earlier, but I wanted to return back to it.
• 17:04
  John: Uh, Dr. Sanjay.
• 17:07
  John: What's the impact of hope in terms of the arc of, of, uh, of care and recovery?
• 17:14
  John: Like you, you know, we, we, we, we tend to think of our, the ultimate sense of victimhood is when you get a, a potentially, you know, deadly diagnosis and the world feels like it's crashing in around you.
• 17:27
  John: What's if, if we could cultivate a sense of hope and courage in that moment, what's the impact of that in terms of the patient's, the pa, the arc of the patient's outcomes?
• 17:37
  Dr. Sanjay Juneja: Yeah, and you know, I just think this is so interesting.
• 17:40
  Dr. Sanjay Juneja: There are multiple pieces of literature and data that show mood, emotion, hope, belief, um.
• 17:50
  Dr. Sanjay Juneja: Impact your survival with stage four cancer.
• 17:54
  Dr. Sanjay Juneja: Um, and then you could break it down and get nerdy and talk about, you know, what, what stress hormones do to the body and the immune system, et cetera.
• 18:01
  Dr. Sanjay Juneja: It, it makes sense, but
• 18:02
  John: just stay on but stay on that one point.
• 18:04
  Dr. Sanjay Juneja: Yeah,
• 18:05
  John: we have that, that is a very empowering point.
• 18:08
  Dr. Sanjay Juneja: It's amazing.
• 18:09
  Dr. Sanjay Juneja: It's another freebie as we talked about.
• 18:10
  Dr. Sanjay Juneja: It's it truly.
• 18:12
  Dr. Sanjay Juneja: Matters.
• 18:12
  Dr. Sanjay Juneja: It truly influences outcomes.
• 18:14
  Dr. Sanjay Juneja: And that's why, you know, I, I wrote a book recently like it is called, um, uh, we Need to Talk About Cancer.
• 18:20
  Dr. Sanjay Juneja: It's like, I just think that understanding something, if you can have any degree of comfort or hope, and if you're listening to this, please understand, like one cancer is never somebody's fault.
• 18:30
  Dr. Sanjay Juneja: It just destroys my soul when I see that suggested on, on social media.
• 18:35
  Dr. Sanjay Juneja: But two, that we live in a time where anything is truly potentially possible.
• 18:40
  Dr. Sanjay Juneja: So.
• 18:41
  Dr. Sanjay Juneja: I couldn't say that even when I started my training.
• 18:43
  Dr. Sanjay Juneja: Right.
• 18:44
  Dr. Sanjay Juneja: 10 years ago.
• 18:44
  Dr. Sanjay Juneja: So, um, those two things alone, that hope matters.
• 18:48
  Dr. Sanjay Juneja: And if you're a loved one of someone with cancer, you want to bring that kind of confidence.
• 18:53
  Dr. Sanjay Juneja: And I will tell you.
• 18:54
  Dr. Sanjay Juneja: If nothing else at the end of the day, like, you know, and this may be a secret, but, but we all have a finite time in this world.
• 19:00
  Dr. Sanjay Juneja: Like we all have a unknown date.
• 19:02
  Dr. Sanjay Juneja: I even tell my young kids that, I'm like, you know, it's kind of freaky, but there's a day that's not our birthday, but our death date.
• 19:07
  Dr. Sanjay Juneja: And I just want to remind them that, that everything is finite and so.
• 19:12
  John: I might, I might wanna work with you on motivating your children, but yeah, keep going.
• 19:16
  Dr. Sanjay Juneja: But, but the point is like, you know, you have a finite amount of experience and you have some control over dictating what that experience looks like, whether it's a cancer diagnosis or an autoimmune disease, or other debilitating processes.
• 19:28
  Dr. Sanjay Juneja: At the end of the day, if there's any wiggle room, uh, or any, you know, kind of toggle of up and down, you know, you wanna be in a position that's, that's most, you know.
• 19:39
  Dr. Sanjay Juneja: Comfortable as possible, and I think, I think a lot of that has to do with just understanding a disease process and being hopeful, and you have reason for it today.
• 19:47
  John: You know, I think you, you, you hit on a really powerful point that any, that 10 years ago we didn't know that any, everything was, was, was, was, was potentially curable or manageable, depending on how you want to use those words in cancer.
• 20:01
  John: And now we do, and we get more hopeful things from diagnosis to diet, to, to drugs, to, to, to tools every day where they keep getting better every day.
• 20:13
  John: I guess as you think about, you know, cancer isn't one thing, it's many things, even within the, the different organs that cancer will, will take hold As you, as you've touched on, what's gonna help us accelerate and catalyze our ability to cure more cancers.
• 20:31
  Dr. Sanjay Juneja: This is why I actually, you know, regrettably don't do as much social media as I used to, and it's because I, I fully believe that with this concept of artificial intelligence and, and pattern recognition, we will be able to greatly.
• 20:47
  Dr. Sanjay Juneja: Accelerate the way we understand things now.
• 20:50
  Dr. Sanjay Juneja: The thing that the aha moment for me was I just can't believe that you can go to Chachi Bt, or Claude, or whatever your frontier alum of choice is.
• 20:59
  Dr. Sanjay Juneja: And I can't believe that it understands what we're saying just by understanding the pattern of the words and it knows what to say.
• 21:05
  Dr. Sanjay Juneja: Just by understanding the pattern of what word comes next, that's literally how it can be such a linguistic.
• 21:11
  Dr. Sanjay Juneja: Um, um, you know, like
• 21:14
  John: Bengali.
• 21:15
  John: Uh,
• 21:15
  Dr. Sanjay Juneja: there you go.
• 21:16
  Dr. Sanjay Juneja: Perfect.
• 21:16
  Dr. Sanjay Juneja: I couldn't think of a word big enough.
• 21:18
  Dr. Sanjay Juneja: So when you think of something like that, that it could, it could understand context and connotation and, and sentiment and all of these things that decorative speakers are able to do with language.
• 21:28
  Dr. Sanjay Juneja: It can do the same thing when it comes to, uh, understanding a disease process.
• 21:33
  Dr. Sanjay Juneja: So all of these variables, all the things that makes the cancer unique, that makes the individual unique, that makes the therapy toxic or not toxic or effective, or not effective.
• 21:41
  Dr. Sanjay Juneja: You have to dump all of this stuff to get the juice from, from the squeeze.
• 21:46
  Dr. Sanjay Juneja: And that, you know, is a very, for lack of a better term, unsexy word called data and data.
• 21:51
  Dr. Sanjay Juneja: When we talk about data, we don't mean social security numbers and, and all this sensitive in information, uh, in, in a financial capacity.
• 21:58
  Dr. Sanjay Juneja: It's still sensitive.
• 21:59
  Dr. Sanjay Juneja: But if we can take all of the aggregate of, of tragedy that is from unfavorable outcomes of cancer, the only way we get better, which I get these questions all the time on social.
• 22:10
  Dr. Sanjay Juneja: Yeah, the whole thing's a farce, you know, uh, how come we haven't done better and it's been around for decades?
• 22:15
  Dr. Sanjay Juneja: You can't do better unless you can look at the past, right?
• 22:17
  Dr. Sanjay Juneja: That's why ways and Google Maps can predict so beautifully.
• 22:21
  Dr. Sanjay Juneja: And consider the time of day, you know, that you're traveling, what day of the week it needs all of that information, what time the school gets out.
• 22:28
  Dr. Sanjay Juneja: It's gonna consider all of those to tell you how long it takes to get somewhere.
• 22:31
  Dr. Sanjay Juneja: We need that in cancer and we're finally able to do that because of, of, you know, again, technical terms called interoperability issues.
• 22:39
  Dr. Sanjay Juneja: We couldn't, we couldn't talk to the data, we couldn't access the data.
• 22:42
  Dr. Sanjay Juneja: We couldn't be able to, you know, harmonize it to be able to.
• 22:45
  Dr. Sanjay Juneja: Put it into
• 22:45
  John: things.
• 22:46
  John: Just to be clear, there's a lot of battles right now going on between Epic and interoperability, and I think this administration actually is uniquely aggressive in reinforcing.
• 22:56
  John: Access to data, but to your point, that data, that, that deep data layer is how we can create models that then can test how precise we can be in diagnosis and cures.
• 23:08
  John: And it's, it's a hugely important initiative to your point.
• 23:12
  John: It's nerdy and complex and bureaucratic, but it's absolutely essential to feed the models.
• 23:17
  John: And, and I just a, a slight adjustment to your point.
• 23:20
  John: Yes.
• 23:21
  John: They're predictive word machines and attention is all you need the Google, but there is a massive amount of RHLF or human engagement in the reinforcement learning of these models, and so.
• 23:34
  John: Thousands of people are, are, are engaged in making sure the models can then tune and learn from the reinforcement with humans as well as these monstrously powerful machines.
• 23:45
  John: But they all require more and more precise data, and I think it's a brilliant call out for how we can accelerate.
• 23:54
  John: Cancer care.
• 23:55
  John: So if, if, uh, if I wanted to as a, you know, 'cause you're, you're the, you're, you're the doc here.
• 24:02
  John: Advice for people who don't have cancer, who wanna avoid it, what can people do in their daily lives to avoid or reduce cancer risk?
• 24:11
  Dr. Sanjay Juneja: Look, there's no question and I sometimes I, I, I'm joking, but wish it wasn't the case.
• 24:17
  Dr. Sanjay Juneja: Only 'cause I don't do enough of it.
• 24:18
  Dr. Sanjay Juneja: But exercise and mobility are unquestionably, unquestionably decreases your cancer risk.
• 24:25
  Dr. Sanjay Juneja: There was a study that showed a. Only a couple years ago now that even six minutes of strenuous exercise to where that heart rate goes up and you're panting six minutes a day can go upwards of 25 to 30, you know, 5% reduction in your lifetime risk of cancer.
• 24:41
  Dr. Sanjay Juneja: Uh, and there's many massive, massive, that's a, a
• 24:44
  John: massive reduction.
• 24:45
  Dr. Sanjay Juneja: Yes.
• 24:46
  Dr. Sanjay Juneja: And, and you know, a lot of the question I get on, on social is, well, how come rates are going up and is it this, you can, you can theorize all the time.
• 24:53
  Dr. Sanjay Juneja: There's just no question about the physical activity level.
• 24:57
  Dr. Sanjay Juneja: And you know, arguably.
• 24:58
  Dr. Sanjay Juneja: Uh, maybe a, a more physically inert state that we are as, as human beings.
• 25:04
  Dr. Sanjay Juneja: So that's, that's number one.
• 25:05
  Dr. Sanjay Juneja: That is, that is not unquestionable.
• 25:07
  Dr. Sanjay Juneja: Number two, again, like, you know, for better or for worse, but there's no question that alcohol increases your chance of, of, of cancers to any degree.
• 25:16
  Dr. Sanjay Juneja: Uh, like unfor, you know, unfortunately to some, because before it was like, oh, it was three or four and that's okay.
• 25:22
  Dr. Sanjay Juneja: Acceptable in a week, you know, et cetera.
• 25:23
  Dr. Sanjay Juneja: But alcohol.
• 25:25
  Dr. Sanjay Juneja: Potentially injures this, the mutational kind of landscape of, of certain colonies on multiple cancer types.
• 25:32
  Dr. Sanjay Juneja: And then, uh, a third one, you know.
• 25:36
  Dr. Sanjay Juneja: Obesity.
• 25:37
  Dr. Sanjay Juneja: Like, like I, I just wish there were better answers, but this is where the science shows the most correlation or these couple of things, um, can also, it does increase your chance, especially like of breast cancer, et cetera, uh, which is very challenging, you know, to tackle all of these.
• 25:52
  Dr. Sanjay Juneja: But, but again, it, it's how we started this.
• 25:54
  Dr. Sanjay Juneja: Just take a bite at a time.
• 25:56
  Dr. Sanjay Juneja: If you're taking one bite.
• 25:58
  Dr. Sanjay Juneja: You are, you are effectively decreasing your chance, overall chance of, of cancer.
• 26:02
  Dr. Sanjay Juneja: And I think that's, you always, you know, I tell patients all the time, we do the best we can and it applies to my life and I'm sure yours.
• 26:08
  Dr. Sanjay Juneja: Uh, and so those are some measures that people can take and then just eat a diverse diet, bunch of greens, bunch of vitamin C, a bunch of fruits.
• 26:15
  Dr. Sanjay Juneja: You know, if you believe in microbiome and gut health and all of those things, you need to diversify.
• 26:20
  Dr. Sanjay Juneja: The kind of intake you have and not just, you know, have a chicken nugget diet.
• 26:23
  Dr. Sanjay Juneja: Like my kids keep bringing up my kids, but like I tell them, I'm like, do you want autoimmune disease?
• 26:27
  Dr. Sanjay Juneja: Do you want inflammation?
• 26:28
  Dr. Sanjay Juneja: And you know, cancer risk, like you gotta eat the green stuff and the orange stuff and the purple stuff.
• 26:33
  Dr. Sanjay Juneja: Uh, you know, for multiple reasons.
• 26:36
  John: Well, I, I think you've given us a lot to, to think about and feel hopeful about for patients, um, for people and for policy.
• 26:43
  John: Dr. Sanjay, so thanks for joining Care Talk.
• 26:47
  John: Um, oh, it was an honor.
• 26:48
  John: We appreciate you, really appreciate you having if for and for all of you out there in listener world, if you liked what you heard or you didn't, we'd love you to subscribe to care, talk on your favorite service.