Latest / Get Real with Jim Weiss / Dr. Cliff Hudis on The Optimistic Future of Cancer Treatment

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Dr. Cliff Hudis on The Optimistic Future of Cancer Treatment · Get Real with Jim Weiss

0:00
Speaker 1: Hey everyone, I'm Jim. I got Kate with me here. Hi, Kate.
0:05
Speaker 1: We have an exciting, awesome, i think, ultimately optimistic interview
0:10
Speaker 1: with the head of the American Society of Clinical Oncology
0:16
Speaker 1: otherwise known ABASCO, Cliff Huttis.
0:19
Speaker 2: He's great. We're in the day one of the governments
0:21
Speaker 2: shut down today and I was looking at the transcript
0:24
Speaker 2: before we got on, and he talked about how important
0:29
Speaker 2: government funding is, yes, to advance cancer research, but also
0:33
Speaker 2: to galvanize scientists and to make them feel like they matter.
0:37
Speaker 1: I think it's hard to talk about what the government
0:41
Speaker 1: funding is responsible for us. There's always a lot of
0:43
Speaker 1: controversy with companies. I remember when I was on the
0:47
Speaker 1: corporate side, NIH wanted to take a lot more credit
0:51
Speaker 1: and money for the advances, right, and so there's to
0:56
Speaker 1: be a lot of articles about, well, why are we
0:58
Speaker 1: the American people saying for stuff. The NIH really discovered
1:03
Speaker 1: that the you know, companies took advantage of so it's
1:06
Speaker 1: actually an interesting kind of concept. But I think where
1:11
Speaker 1: companies are great at is the clinical research and the
1:15
Speaker 1: basic science is where you get these breakthroughs. And that's
1:19
Speaker 1: what he's saying. You know what he's saying, is the
1:21
Speaker 1: government funding, you know, clinic as far as clinical trials
1:25
Speaker 1: are concerned, not as critical. That's where the companies come in.
1:30
Speaker 1: And then of course I'm on the foundation of the
1:32
Speaker 1: National Institute's of Health and we work on the public
1:35
Speaker 1: private partnership. I think depending on what dvantage point you're at,
1:39
Speaker 1: I think the simple message is that it won't be
1:43
Speaker 1: as bad. He was optimistic that it won't be as
1:46
Speaker 1: bad as we thought, that there's enough bipartisan support to
1:49
Speaker 1: continue to support it. The person that he thought was
1:52
Speaker 1: going to take over took over today. That was Ann Ouse. Yah, yeah, yeah,
1:56
Speaker 1: that was good, and so he'll be an advocate. And
1:59
Speaker 1: then I sat down with the head of the Cancer
2:01
Speaker 1: Research Institute today and we're all going to their cancer
2:04
Speaker 1: roundtable together. So I guess my view is more optimistic.
2:09
Speaker 1: I think you're going to get more bipartisan support as
2:12
Speaker 1: people are educated about why we need to do this,
2:15
Speaker 1: and someone like Cliff huttis at the vanguard, you know,
2:18
Speaker 1: with ASCO is critical to that and he'll be a champion,
2:22
Speaker 1: you know, and he's well equipped to do that because
2:25
Speaker 1: he's easy to talk to. He puts it in terms
2:28
Speaker 1: of people understand organized and doing a great job with ASCO,
2:33
Speaker 1: and you know, he's certainly earned his space, right He's
2:37
Speaker 1: been treating patients from the beginning, very involved of course
2:41
Speaker 1: in the development of her scepting and other terrific drugs,
2:44
Speaker 1: and you know, a guy who cares about patients, you know,
2:47
Speaker 1: which is what we really want to see more of.
2:52
Speaker 1: But thanks for being with us today. A lot of
2:56
Speaker 1: what we've been doing on the podcast has been talking
2:59
Speaker 1: about empowerment and taking control of your own health. I
3:03
Speaker 1: know that's obviously something ASCO has led the way in
3:08
Speaker 1: over the last few years, so I definitely want to
3:10
Speaker 1: get into that. But before we do that, I remember
3:13
Speaker 1: working with you back in the day on the original
3:16
Speaker 1: startup of Genomic Health, which is now part of Exact Sciences,
3:20
Speaker 1: and of course the launch of herceptin when you were
3:23
Speaker 1: at MSK. Since this episode is going to air in
3:26
Speaker 1: October Breast cancer Awareness month, I just thought we'd start
3:31
Speaker 1: with what's been your why in breast cancer and your
3:34
Speaker 1: overall outlook on the disease, how far we've come, how
3:37
Speaker 1: much more we have to do, and what we can
3:40
Speaker 1: learn from the progress there that can help us with
3:44
Speaker 1: some of the other cancers that have been a little
3:46
Speaker 1: more of calcitrant. I know ASCO represents all cancers, but
3:50
Speaker 1: breast cancer is obviously still in our lives, and a
3:54
Speaker 1: lot of interesting things have happened there, and you've been
3:58
Speaker 1: a big architect of the evolution of that.
4:00
Speaker 3: Thank you.
4:01
Speaker 4: So maybe the right way to think about this is
4:03
Speaker 4: there is my career in breast cancer, and then there
4:06
Speaker 4: is ASCO, and one my career informs the other what
4:11
Speaker 4: I do now. In order to answer your question, I
4:14
Speaker 4: feel like I have to provide a little bit of
4:17
Speaker 4: a review of my own career because a lot of
4:20
Speaker 4: things happened that were just accidents, happy accidents in a way.
4:25
Speaker 4: I went to medical school very young for an American.
4:30
Speaker 4: The point is that I was out of med school
4:33
Speaker 4: at age twenty four, did internal medicine, and then struggle
4:38
Speaker 4: towards the end of internal medicine to figure out what
4:40
Speaker 4: I was really interested in. They thought about cardiology because
4:44
Speaker 4: in a way it's very mechanical, makes a lot of
4:46
Speaker 4: sense to me. Inspiration hit me in the oncology clinic
4:50
Speaker 4: because really, in the very early part of the eighties,
4:53
Speaker 4: you could write on one piece of paper two sides
4:57
Speaker 4: essentially all of the active drugs cancer. That's how limited
5:01
Speaker 4: the field was, and I wanted to take part in
5:06
Speaker 4: what I thought would be a rapidly expanding field. You
5:11
Speaker 4: have to appreciate even by the late seventies we were
5:13
Speaker 4: already talking about so called guided missile therapy, which was
5:17
Speaker 4: antibodies and payloads and the like. We just didn't have
5:20
Speaker 4: them yet. So I got interested in oncology a because
5:24
Speaker 4: of the technology, and then B because I liked it
5:28
Speaker 4: sounds a little funny, but the seriousness of it. I
5:30
Speaker 4: liked helping patients and families confront this feared moment and
5:36
Speaker 4: hopefully getting across from the fear to a place of optimism.
5:41
Speaker 4: And that's true to this day in oncology for all
5:43
Speaker 4: of us, I think. So then I committed to go
5:46
Speaker 4: to Memorials and Kettering for my fellowship training. And this
5:50
Speaker 4: is the happy accident. I started in July nineteen eighty eight,
5:54
Speaker 4: and in the fall of nineteen eighty eight Larry Norton
5:57
Speaker 4: came over from Mount Sinai and at the time time,
6:00
Speaker 4: Memorial for Breast Cancer was a famous surgical program with
6:04
Speaker 4: a little bit of drug development, which is maybe not
6:06
Speaker 4: different in other places, but it wasn't the big program
6:09
Speaker 4: in breast cancer medicine that you came to know, and
6:13
Speaker 4: Larry had obviously remarkable dreams and vision and built out
6:17
Speaker 4: this program pretty quickly, and I was there for this
6:22
Speaker 4: transformative decade in breast cancer. It's sort of hard to believe,
6:26
Speaker 4: but if you go from roughly nineteen eighty eight to
6:28
Speaker 4: nineteen ninety eight, nineteen ninety nine, just over a decade,
6:32
Speaker 4: I think this is the order. But pretty much, Pacla
6:35
Speaker 4: TAXL came to the clinic, GCSF came to the clinic,
6:39
Speaker 4: BRCA was identified and testing began. Her too was identified
6:44
Speaker 4: and treatment began. Oral aromatase inhibitors appeared, and the first
6:49
Speaker 4: conventional but oral chemo darby drug cape SID of being
6:53
Speaker 4: ended the decade. So that was a really exciting decade
6:56
Speaker 4: in breast cancer, and it played out in public health because,
6:59
Speaker 4: of course, the peak incidents of breast cancer death in
7:02
Speaker 4: the United States was about nineteen ninety and it's been
7:05
Speaker 4: a pretty steady and steep decline from there. And that
7:08
Speaker 4: gets me to the question you asked, what can we
7:10
Speaker 4: learn from that? What I always found especially uplifting and
7:14
Speaker 4: exciting about the breast cancer world is it was a community,
7:18
Speaker 4: albeit a big one, a global one, but there was
7:21
Speaker 4: tremendous coordination both within the US Cooperative Group system and beyond,
7:26
Speaker 4: so that the clinical trials were more often than not
7:30
Speaker 4: were coordinated, aligned, and they built in a series of steps,
7:34
Speaker 4: and they developed or tested principles as much as specifics,
7:38
Speaker 4: And I think that's the takeaway lesson that is relevant
7:41
Speaker 4: for today as well. I think across all of oncology,
7:44
Speaker 4: the collaboration and clarity about what the studies are intended
7:49
Speaker 4: to show and what principles were trying to prove, I
7:52
Speaker 4: think is the most useful way forward.
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Speaker 1: What I remember is how you all really did take
7:57
Speaker 1: into consideration seriously the patient point of view. With Susan
8:01
Speaker 1: Love and my high school babysitter Ellen stoveall from NCCS,
8:06
Speaker 1: I felt like they had a seat at your table together.
8:10
Speaker 1: I felt like there's almost no other part of cancer
8:14
Speaker 1: that I've seen. Maybe NHL and folks that do the
8:19
Speaker 1: blood cancer work that I think was very breakthrough too.
8:23
Speaker 1: But is there something to learn from working closely with
8:26
Speaker 1: patients Like I know you said you missed working in
8:29
Speaker 1: the hospital at MSK, working with patients, caregivers, families, I
8:33
Speaker 1: just went through that with my wife, working through that,
8:36
Speaker 1: and if there's anything I can see going forward, looking
8:40
Speaker 1: forward and taking lessons from the gene therapy world, or
8:44
Speaker 1: what I would call the ultra rare disease world. It's
8:48
Speaker 1: often led by people and patients and families and how
8:52
Speaker 1: critical is that. And I do feel asco again you know,
8:55
Speaker 1: has opened up in the time you've been there, a
8:58
Speaker 1: much more open dial with the patient.
9:01
Speaker 3: That's interesting.
9:02
Speaker 4: I always think about it in the grand sweep of history. Frankly,
9:05
Speaker 4: I think it begins with hid. It was Larry Kramer
9:08
Speaker 4: and act Up that really I think lays the path
9:12
Speaker 4: for patient activism, family activism and so forth. And breast
9:16
Speaker 4: cancer followed with the Pink ribbon, both Evelyn Later and
9:19
Speaker 4: the Breast Cancer Search Foundation Susan Coleman, and I think
9:24
Speaker 4: the role of the advocates I think cemented because there
9:29
Speaker 4: were a lot of times where toxicity was an issue,
9:33
Speaker 4: the value of therapy I think could be debated, and
9:37
Speaker 4: being open to the patient voice in a formal way
9:40
Speaker 4: on the research side was just a mirror I think
9:44
Speaker 4: of the kind of dialogue that a sensitive physician should
9:47
Speaker 4: be having with an individual patient about their treatment choices.
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Speaker 1: You don't still see patients, do you?
9:52
Speaker 4: I actually do, although I hasten to point out unpaid,
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Speaker 4: I'm not moonlighting. I still see a very small number
10:00
Speaker 4: of my long term follow up patients when I'm in
10:04
Speaker 4: New York at Memorial on Friday afternoons a few times
10:07
Speaker 4: a month. I enjoy that very much. It means a
10:10
Speaker 4: lot to me to see my patients and connect.
10:12
Speaker 1: Yeah, that's incredible. How has been the CEO of ASCO
10:15
Speaker 1: changed the way you make impact? Then it's not direct
10:18
Speaker 1: to patient, but maybe some other way.
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Speaker 4: First of all, it's a great question, but I actually
10:22
Speaker 4: think it's the inverse of what happened in my career.
10:25
Speaker 4: So I spent the first decade of my career as
10:29
Speaker 4: a pretty conventional drug developer, mentored initially by again Larry Norton,
10:34
Speaker 4: had the opportunity to work on a number of I think,
10:36
Speaker 4: exciting drugs. When I became chief of breast Cancer at Memorial,
10:40
Speaker 4: which was nineteen ninety eight, and I began to then
10:43
Speaker 4: shift to the role of mentor and pushed out those
10:46
Speaker 4: projects to others. I had an opportunity with a collaborator
10:50
Speaker 4: to start to study a broader and more I think
10:54
Speaker 4: fascinating question of causation, and that was why is obesie
11:00
Speaker 4: a rising public health problem associated with an increased risk
11:04
Speaker 4: of so many cancers? What's the underlying biology there? And
11:07
Speaker 4: that got us to some interesting findings. But the relevance
11:11
Speaker 4: to your question is this. I came to see that
11:13
Speaker 4: in the end, this was a public health and public
11:18
Speaker 4: policy question. The reason that we have rising rates of
11:23
Speaker 4: obesity and the West has to do with agricultural policy
11:27
Speaker 4: and a number of big issues that are really managed
11:31
Speaker 4: on Capitol Hill as opposed to in a doctor's office.
11:35
Speaker 4: And I then was developing in my career as a
11:39
Speaker 4: volunteer and leader at ASCO, and I found myself eventually
11:42
Speaker 4: on the Government Relations Committee. And I think by that
11:45
Speaker 4: time of my life, I mean, I'm older than people realized,
11:48
Speaker 4: but by that time my life, approaching fifty, I probably
11:52
Speaker 4: had peak citicism about government. And I'm not commenting on
11:55
Speaker 4: the current environment, but I'll just say at that time
11:59
Speaker 4: we were coming on an era of almost a decade
12:02
Speaker 4: of flat funding at the NIH, and I found that
12:06
Speaker 4: profoundly upsetting because a that meant functionally we were cutting
12:11
Speaker 4: investments because of inflation. And I found myself on Capitol Hill,
12:15
Speaker 4: supported by ASCO, asking representatives and senators and their staff
12:20
Speaker 4: why we had decided to seed scientific leadership to others,
12:25
Speaker 4: why we were cutting our investment, which had been a
12:28
Speaker 4: critical part of the post World War II leadership of
12:30
Speaker 4: America in my opinion. And interestingly, that was around the
12:34
Speaker 4: era when we began to see steady year over year
12:36
Speaker 4: increases culminating at the end of the Obama presidency, obviously
12:40
Speaker 4: with Cures Act, and that was bipartisan. So I began
12:43
Speaker 4: to believe strongly that we could make a difference, and
12:48
Speaker 4: that's why I came to ASCO. It was the opportunity
12:51
Speaker 4: to wield a bigger lever in terms of policy, certainly
12:56
Speaker 4: in terms of appropriations and spending. And that's been a
12:58
Speaker 4: big focus all the time that I've been here.
13:01
Speaker 1: Right, I can't imagine we're not in DejaVu. Right, Whether
13:04
Speaker 1: you comment on what's going on or not, you still
13:06
Speaker 1: have to help.
13:07
Speaker 4: Yeah, well, the pressure has to be kept up. But
13:09
Speaker 4: it's a really interesting point. This is going to air
13:11
Speaker 4: in October. I don't know what the next couple of
13:13
Speaker 4: weeks are going to bring in terms of continuing resolution
13:16
Speaker 4: or shutdown, but I will point out optimistically that despite
13:21
Speaker 4: the rhetoric that we've heard and the specific calls for
13:24
Speaker 4: significant cuts at the NIH and the nci BI, partisan
13:29
Speaker 4: appropriators in the House and in the Senate this summer
13:32
Speaker 4: and fall have called for at least flat funding at
13:36
Speaker 4: the NIH and the nci and in this climate, A,
13:40
Speaker 4: that's a victory. B, it's not the story of cuts
13:43
Speaker 4: that we've all been hearing exactly. And C it's a
13:46
Speaker 4: reminder that there is at least one corner of the
13:50
Speaker 4: legislative world where a rational argument and our unified voice
13:55
Speaker 4: seems to be able to maintain momentum.
13:57
Speaker 1: Yeah, I'm going to have Elias Lahune on to talk
14:00
Speaker 1: about his book related to you know, disease not knowing
14:03
Speaker 1: any politics. I mean, I guess you sign up for
14:06
Speaker 1: that too. I mean, everyone's going to get hit by
14:08
Speaker 1: the bouncing ball, and everybody needs these breakthroughs and advances.
14:14
Speaker 4: Well, the argument for US federal investment in biomedical research
14:20
Speaker 4: science writ large and oncology or cancer specifically is unassailable.
14:26
Speaker 4: It's one of those triple wins. Because we make quality
14:30
Speaker 4: of life better for Americans, we get a eternal investment
14:34
Speaker 4: and ROI that's measurable and real, and we maintain American
14:39
Speaker 4: leadership in the technology arena. There's no argument I can
14:43
Speaker 4: come up with against it.
14:44
Speaker 1: Yeah, I one hundred percent agree. But let me ask
14:47
Speaker 1: the other elephant in the room question. Because we see
14:49
Speaker 1: so much advancement in China around their tech, I mean,
14:55
Speaker 1: is ASCO collaborating with Chinese researchers. It seems to makes
15:00
Speaker 1: sense to me. And they also have an epidemic in
15:03
Speaker 1: breast cancer in their own country. I can't imagine that
15:06
Speaker 1: we can't help them somewhat and vice versa.
15:09
Speaker 4: What do you think, Well, that's a much more complicated question,
15:13
Speaker 4: I'm sure.
15:14
Speaker 1: Yeah.
15:15
Speaker 4: Number one, they do have growing rates of typical solid
15:19
Speaker 4: tumors and cancers associated with Western lifestyle, and they have
15:23
Speaker 4: to come back to an earlier point growing rates of obesity.
15:26
Speaker 4: That's going to be, for sure the world's largest market
15:28
Speaker 4: for clip ones, right right, That's for sure an issue.
15:32
Speaker 4: Number Two, I'll just point out that it is technically
15:37
Speaker 4: challenging for American NGOs to formally be involved in China
15:42
Speaker 4: for a number of reasons if we probably can't touch on,
15:46
Speaker 4: but I will point out that there is a large
15:49
Speaker 4: and growing number of submissions both from abstracts and manuscript's
15:55
Speaker 4: point of view, but also patent development intellectual property from China,
16:00
Speaker 4: and although there's been obviously some concerns about the quality
16:03
Speaker 4: of some of that, at times, I think fundamentally it's
16:07
Speaker 4: just getting stronger and more I would say more worthy
16:12
Speaker 4: as competition with each passing year.
16:14
Speaker 1: Well, I think both countries have the shared goal let's
16:18
Speaker 1: get back to patients, right of helping that epidemic that
16:22
Speaker 1: is occurring. And obviously, no matter what your ideology, you
16:26
Speaker 1: want to keep your population healthy to that extent. So look,
16:31
Speaker 1: I know, ASCO was at the vanguard and the lead,
16:33
Speaker 1: I'm putting patient at the center of their cancer journey.
16:37
Speaker 1: A few years ago when you announced one of the
16:39
Speaker 1: meetings was dedicated to that, and sometimes we end with
16:43
Speaker 1: the patient rather than start with the patient. So how
16:46
Speaker 1: has it gone? And where will it go? How will
16:48
Speaker 1: ask go?
16:49
Speaker 4: Incorporate that That's really an interesting perception because I would
16:53
Speaker 4: have argued that the patient was always at the center
16:57
Speaker 4: and never otherwise. But I do think to your point
17:00
Speaker 4: of view, each year, our president focuses on some area
17:04
Speaker 4: that they deem important. We have a presidential theme and
17:07
Speaker 4: we highlight various aspects of care.
17:10
Speaker 3: So I think that.
17:11
Speaker 4: Probably is what you're referring to. It's a one way trip,
17:16
Speaker 4: and each time we ratchet up I think the quality
17:20
Speaker 4: of something we're doing, we try to have her to backslide.
17:22
Speaker 4: So where has that gone to? Well, there's now more
17:25
Speaker 4: and more patient and patient advocates embedded in more and
17:28
Speaker 4: more aspects of the academic work across ASCO and the
17:35
Speaker 4: policy work. All of that has to reflect the ultimate,
17:39
Speaker 4: if you will, I hate this word, but I'll just
17:41
Speaker 4: say here consumer of the product, which is the patient.
17:44
Speaker 1: Yeah, I mean it's again having gone through it, what
17:48
Speaker 1: I saw work incredibly well between my wife and doctor Vernook,
17:53
Speaker 1: who I think you recommended when we were getting going
17:56
Speaker 1: on her treatment, the partnership they got in the dialogue.
18:00
Speaker 1: I was really impressed by it and how at least
18:04
Speaker 1: her quality of life and her experience with this. Whether
18:08
Speaker 1: you could cure small bottle campser or not, and probably couldn't.
18:11
Speaker 1: We didn't really have all the things one might need,
18:14
Speaker 1: but they work together to come up with ways to
18:19
Speaker 1: I think, take her on the journey, keep that optimism higher,
18:24
Speaker 1: you know, And I was really impressed by that. So
18:27
Speaker 1: I think it was a great lesson and something again
18:30
Speaker 1: I do feel ask go encourage. I've been going to
18:32
Speaker 1: the meetings for twenty thirty years, right, and it has
18:36
Speaker 1: evolved from a more academic focus to a more practical
18:42
Speaker 1: patient focus. I've seen that.
18:44
Speaker 3: All we don't lose.
18:45
Speaker 4: Honestly, I think it's important to maintain scientific standards, and
18:48
Speaker 4: of course you know we're huge supporters of clinical and
18:53
Speaker 4: translational research. We run clinical trials, but all of that
18:57
Speaker 4: infused by the patient and what's best for the patient
19:00
Speaker 4: A I think that that has to always be there,
19:03
Speaker 4: but you can't assume it. You have to do the
19:05
Speaker 4: work to make sure that that happens. The one thing
19:08
Speaker 4: that you reminded me of, and I do think this
19:10
Speaker 4: is an important and broadly optimistic issue. When I was younger,
19:15
Speaker 4: when I went in oncology, the most common question that
19:18
Speaker 4: I would get from high school friends not in medicine
19:22
Speaker 4: and healthcare from relatives was essentially a kind of a
19:26
Speaker 4: sneer and why would you pick oncology? That was the question,
19:30
Speaker 4: because they would look at a decades long career and
19:33
Speaker 4: just with some empathy, wonder like why would you subject
19:37
Speaker 4: yourself to decades of this kind of emotional challenge. And
19:43
Speaker 4: I think that the story you just briefly described is
19:47
Speaker 4: exactly the answer, because it is empowering and uplifting and
19:52
Speaker 4: paradoxically optimistic to take care of people, do the best
19:56
Speaker 4: you can for them, and guide them through this trip.
19:59
Speaker 1: You know.
20:00
Speaker 4: So it always reminded me, among other questions that one
20:03
Speaker 4: has to ask oneself, is this. If nobody stands up
20:06
Speaker 4: to do this, then who's going to be there.
20:08
Speaker 3: It's not like.
20:09
Speaker 4: The disease goes away if you don't have people practicing
20:13
Speaker 4: a zychologists, it's still there exactly right.
20:16
Speaker 1: No, and look that's a big role for asco. Right,
20:19
Speaker 1: you want to continue to encourage that.
20:21
Speaker 4: But that's the point, is that this is a paradoxically
20:24
Speaker 4: optimistic field, in part because there's so much possibility for
20:29
Speaker 4: progress and in part because there's so much actual progress
20:32
Speaker 4: that's being made, notwithstanding there's still too many bad outcomes.
20:36
Speaker 1: Well, I mean again, I guess it's half class full thinking.
20:40
Speaker 1: And you know, my wife's view and sitting with her
20:42
Speaker 1: friends was cancer was a gift wrapped in barbed wire.
20:46
Speaker 1: And she got involved with the dem C Center and
20:48
Speaker 1: went on the board, which again is about holistic cancer care,
20:52
Speaker 1: acupuncture and the shamans and meditation, diet, exercise, the things
20:57
Speaker 1: that I think people feel like you have to get
21:00
Speaker 1: once you get that diagnosis, but you don't, right, I mean,
21:04
Speaker 1: and that is something I think is true. So listen,
21:07
Speaker 1: we need to scale prevention and cancer and as of
21:10
Speaker 1: right now, everything seems designed to treat it. Right, tell
21:14
Speaker 1: us a little bit more about what ASCO's done and
21:16
Speaker 1: we'll be doing to change this. You're not all just
21:20
Speaker 1: about therapies and treatment, right.
21:22
Speaker 4: Well, it's an interesting question. We're all ideally about never
21:27
Speaker 4: having to treat cancer. However, we will always have cancer
21:31
Speaker 4: as long as we have double stranded DNA, multice organisms
21:35
Speaker 4: and long life spans. And this is a touchy topic
21:39
Speaker 4: I think for many people. On the one hand, there
21:42
Speaker 4: are modifiable risk factors for cancer, and we are passionate
21:47
Speaker 4: about intervening there.
21:49
Speaker 3: Should people smoke?
21:50
Speaker 1: No?
21:51
Speaker 4: Obviously, obesity is the most prevalent now modifiable risk factor
21:57
Speaker 4: for cancer, although that can rate at which it quiss.
22:01
Speaker 4: Cancer does not approximate what combustible tobacco does obviously.
22:05
Speaker 1: Right, it's not as direct. Take the GLP ones and
22:08
Speaker 1: we'll reduce our cancer risks, right or is that possible.
22:12
Speaker 4: Now, it'll reduce your risk. But the point is, you know,
22:15
Speaker 4: I would always make this point. If you saw a
22:18
Speaker 4: fifty five year old three packa day cigarette smoker who
22:23
Speaker 4: developed non small cell lung cancer, you could be pretty
22:27
Speaker 4: confident about why that happened to them. On the other hand,
22:30
Speaker 4: if you see a fifty five year old obese person
22:33
Speaker 4: who happens to have a colon cancer, you can't have
22:37
Speaker 4: confidence that they're colon cancers from that because there's a
22:39
Speaker 4: lot of colon cancer anyway, the relative risk isn't quite
22:42
Speaker 4: as big. And by the way, this is an important
22:45
Speaker 4: issue from a patient point of view, because all of
22:48
Speaker 4: this sense of control ends up possibly being a pretty
22:52
Speaker 4: heavy burden for patients who can then feel or be
22:55
Speaker 4: made to feel responsible.
22:57
Speaker 3: And so what I'm.
22:58
Speaker 4: Really saying here is vaccinate HPV hepatitis B you will
23:04
Speaker 4: prevent a large number of cancers. Avoid combustible tobacco. Alcohol
23:10
Speaker 4: is the other one, although it's a steady linear relationship,
23:13
Speaker 4: and we as a society have certainly not made any
23:16
Speaker 4: decision that we're willing to forego the other perceived or
23:21
Speaker 4: not real benefits of alcohol in exchange for risk reduction.
23:26
Speaker 4: But to come back to your question. As experts in cancer,
23:29
Speaker 4: our members are often called upon to both opine on
23:33
Speaker 4: this and help make and formulate policy. But it's also
23:38
Speaker 4: worth pointing out, by and large, our members are seeing
23:41
Speaker 4: people after the diagnose. That's where their professional livelihoods are.
23:46
Speaker 4: Certains operate when they have cancer. The radiation collogists treats
23:50
Speaker 4: the cancer they see, the medical and collegist gives drugs,
23:53
Speaker 4: and so we're basically or collectively in a place where
23:57
Speaker 4: we would be happy if there was less demand for
23:59
Speaker 4: our services.
24:00
Speaker 1: No doubt. But doesn't it make the job easier if
24:04
Speaker 1: you've been diagnosed earlier, right.
24:05
Speaker 4: So let's just focus on that for a second. So
24:08
Speaker 4: there the interesting thing is, first of all, for the
24:12
Speaker 4: most common solid tumors in the West, the single most
24:17
Speaker 4: important risk factor is age. So as you have a
24:20
Speaker 4: higher quality of life, few are competing causes of mortality
24:25
Speaker 4: greater longevity, you will see more prostate cancer, colon cancer,
24:30
Speaker 4: breast cancer, and so on. That doesn't have anything to
24:34
Speaker 4: do with the fact that there's always going to be
24:36
Speaker 4: young people or old people that smoke and drink and
24:39
Speaker 4: don't get cancer. We're just talking averages, right, But it
24:43
Speaker 4: makes the point that I started with, which is that
24:45
Speaker 4: cancer is kind of part of the human condition, whether
24:49
Speaker 4: we want to acknowledge that or not. And so the
24:53
Speaker 4: question in terms of prevention is different than the question
24:57
Speaker 4: in terms of screening. The prevention side is can we
25:00
Speaker 4: we're still delay avoid some of those cancers? On the
25:04
Speaker 4: screening side, you're absolutely right, of course, but there are
25:07
Speaker 4: challenges we have right now a limited number of cancers
25:10
Speaker 4: where we have evidence based screen proverbs, and we need more.
25:14
Speaker 4: We're all optimistic that the molecular revolution that we're living
25:18
Speaker 4: through right now is going to soon yield that we're
25:21
Speaker 4: not quite over the finish line.
25:22
Speaker 1: Well, so let's stay there. If AI and personalized medicine
25:26
Speaker 1: are improving diagnosis and risk prediction, why are doctors still
25:30
Speaker 1: relying on traditional tests like mimmography and cat scanning when
25:35
Speaker 1: there are new, less invasive tools to use. I mean
25:37
Speaker 1: there are, and are we not quite ready for those?
25:41
Speaker 1: I mean, I look at things like pernuvo, and we
25:45
Speaker 1: can go on and on, and then there's the grail
25:47
Speaker 1: and garden tests and blood tests, and I think there's
25:51
Speaker 1: a range of reliability here, so we know that.
25:55
Speaker 4: I think you're actually diving into an extraordinarily nuanced and
25:59
Speaker 4: complicated area of science. When it comes to public health
26:03
Speaker 4: and screening tests for cancer. The gold standard may not
26:08
Speaker 4: be what people think it is. Historically, the gold standard
26:11
Speaker 4: was do you make the population healthier? Because the idea
26:15
Speaker 4: is that you're doing these tests as screens, not diagnostics,
26:20
Speaker 4: in people who have no symptoms, no complaints, no suspicion,
26:25
Speaker 4: and so when you do that, there is for sure
26:28
Speaker 4: some risk of downside harm. You will find false positives,
26:32
Speaker 4: you will subject people to interventions, you will cause some damage,
26:35
Speaker 4: and in order to justify them, you have to ultimately show,
26:40
Speaker 4: as we have with colonoscopy, mammography, lung cancer screening, cervix
26:46
Speaker 4: cancer screening, even and prostate that you improve quality of
26:51
Speaker 4: life or mortality. What you said is we have these
26:54
Speaker 4: newer tests, and some people wouldn't accept that statement just yet.
26:59
Speaker 4: What they would say is that we are promising the
27:02
Speaker 4: technologies that have not yet met the rigorous standards that
27:07
Speaker 4: establish the older imaging modalities. It's a question about what's
27:12
Speaker 4: adequate evidence, and you know, can you substitute them because
27:16
Speaker 4: they performed just as well and you don't need to
27:18
Speaker 4: do a big population based on it. There's lots of
27:21
Speaker 4: ways that I think we can get over that hurdle.
27:23
Speaker 4: And what I was saying just a moment ago is
27:25
Speaker 4: we're really close right now. And I'm bullish on this personally,
27:28
Speaker 4: for it's not quite there yet.
27:29
Speaker 1: Yeah. No, that's great to hear, because I do think
27:33
Speaker 1: new technologies, coupled with genomic information, we can now harvests.
27:38
Speaker 1: Do you think with that we're going to see more
27:41
Speaker 1: warp speed like development and cancer treatments or is that
27:44
Speaker 1: too much to hope for that fast?
27:46
Speaker 4: I actually think that we could, but that would require
27:49
Speaker 4: the warp speed part of it would require a whole
27:52
Speaker 4: of government coordinated effort.
27:53
Speaker 1: So fine, So taking all the politics out of it,
27:56
Speaker 1: how are you feeling about where we are on institutional
27:59
Speaker 1: you know where and institutionalized research is going in the
28:02
Speaker 1: fate of the overall war on cancer given new policies
28:06
Speaker 1: and rhetoric and Washington right now, which to your point,
28:09
Speaker 1: I think what we hear isn't really always what is
28:13
Speaker 1: happening and how even people really believe and feel. So
28:19
Speaker 1: can we believe everything we read about it?
28:21
Speaker 4: I've heard some I think well respected cancer centered directors
28:25
Speaker 4: and others responding to anxieties from staff and others point
28:31
Speaker 4: out that in this environment right now, we can't be
28:34
Speaker 4: reacting to each and every utterance. Instead, we have to
28:38
Speaker 4: wait for the facts to play out, and I think
28:41
Speaker 4: as we do that we can be obviously much more
28:44
Speaker 4: effective in our response and not waste time and effort
28:48
Speaker 4: on things that might not turn out to be the
28:50
Speaker 4: way we think. So, for example, I think are likely
28:55
Speaker 4: to have a new NCI director by the time you
28:57
Speaker 4: heir this podcast. Certainly there are rumors out there, we'll
29:00
Speaker 4: see it's been a while. I think that will be really.
29:03
Speaker 3: Important for our community.
29:06
Speaker 4: I think that the fact again that at least barring
29:10
Speaker 4: a government shutdown and whatever else is going to play
29:12
Speaker 4: out between now and when this airs, the fact that
29:15
Speaker 4: there are proposals for at least flat funding. It's less
29:18
Speaker 4: than we need because with inflation and the increased opportunities
29:22
Speaker 4: of broadening science, we should be investing more, not flat funding.
29:26
Speaker 4: But in this environment, if we can maintain flat funding
29:29
Speaker 4: before growing again, that would have to be taken as
29:32
Speaker 4: a minor victory right now. Where I think there's a
29:34
Speaker 4: little bit of a challenge is a question of prioritization
29:38
Speaker 4: of the spend where's it actually going to go.
29:40
Speaker 1: Well, I'm curious because we looked into this for my
29:42
Speaker 1: wife and I've had Leonard Lee, who's doing a lot
29:46
Speaker 1: of the work in the UK on their cancer vaccine program.
29:50
Speaker 1: I was curious, are the policy decisions slowing research for
29:54
Speaker 1: vaccines in clinical trials or will we see that? And
29:58
Speaker 1: is it the right word? I always ask the question,
30:00
Speaker 1: is vaccine the right word to talk about these immuno
30:04
Speaker 1: therapies that could be breakthrough?
30:07
Speaker 4: Well, I think vaccine is one technology under the broad
30:11
Speaker 4: array of munotherapies right and it is confusing, I think,
30:15
Speaker 4: especially for people that may not be in the field, because,
30:18
Speaker 4: as I suggested some moments ago, we have two really
30:23
Speaker 4: important vaccines for cancer right now, hepatitis B and HPV.
30:29
Speaker 4: But they are not cancer vaccines per se. They are
30:33
Speaker 4: conventional anti viral vaccines. But the viruses that they protect
30:37
Speaker 4: you against are the cause of these malignancies. So it
30:41
Speaker 4: can get pretty confusing I think for people not in
30:45
Speaker 4: the field. When people go about cancer vaccines, they're typically
30:49
Speaker 4: talking about taking advantage of some distinct epitope on a
30:55
Speaker 4: cancer cell, some target that distinguishes that cancer from the
31:00
Speaker 4: native normal tissue around it and utilizing the immune system
31:05
Speaker 4: that way. And the reason I'm oversimplifying, but one of
31:09
Speaker 4: the reasons that this has been such a long and
31:11
Speaker 4: challenging journey is that, of course the DNA in our
31:15
Speaker 4: cancer is obviously, in most cases some version of the
31:20
Speaker 4: DNA we were born with. It's not like a real
31:22
Speaker 4: foreign invader in terms of easily distinguishable targets, and you
31:26
Speaker 4: can have a good bit of overlap. I mean, by
31:28
Speaker 4: the way, just as a simple analogy to think about you,
31:32
Speaker 4: you reference Chastoosmab at the beginning of our discussion. Her too,
31:35
Speaker 4: is present on many cells of the body. What distinguished
31:40
Speaker 4: her to positive breast cancer wasn't the absence or presence
31:43
Speaker 4: of the receptor, It was the amount of the receptor.
31:46
Speaker 4: Related to that, some toxicities of the drug were because
31:50
Speaker 4: of the receptors present on normal, healthy tissues. This has
31:53
Speaker 4: been the reason that I think vaccine as treatment for
31:56
Speaker 4: cancer has been so challenging, and of course in our era,
32:00
Speaker 4: the development of the checkpoint inhibitors as an initial first
32:03
Speaker 4: step highlighted the fact that by manipulating the immune system
32:07
Speaker 4: we could make real progress. So I think this remains
32:10
Speaker 4: tremendous enthusiasm for vaccines and for immunotherapies more broadly and
32:17
Speaker 4: maybe ever more personalized and customized, if you will, immunotherapies
32:21
Speaker 4: like t cars and so on. But to come full circle,
32:26
Speaker 4: and I have said a lot, this is really an
32:28
Speaker 4: expensive proposition here, and this is going to take coordinated, steady, reliable,
32:35
Speaker 4: year over year endsceence not just by the federal government
32:38
Speaker 4: but also by the private sector, and commitment by the
32:40
Speaker 4: academic community. It's a three part effort.
32:43
Speaker 1: Well, I mean, so you said we're less funded than
32:47
Speaker 1: we need to be, and that's always true. Well, that's true.
32:50
Speaker 1: What's the negative impact that's having? So people just understand
32:54
Speaker 1: why we have to fight for it.
32:56
Speaker 4: Yeah, So, first of all, we always have to fight
32:58
Speaker 4: for it. Is if you think about my own career,
33:00
Speaker 4: I came here because we were fighting for it. The
33:02
Speaker 4: second thing is, I do think it's having a negative impact.
33:06
Speaker 4: And I'll divide it into two obvious places. Number One,
33:09
Speaker 4: there are institutions and specific research efforts that either because
33:14
Speaker 4: of what they study or as an unfortunate innocent bystander effect,
33:19
Speaker 4: have been compromised. Those investigators are hurting. Number Two, there
33:24
Speaker 4: are investigators who have not yet felt a direct impact,
33:28
Speaker 4: but are living in a state of anxiety and fear
33:31
Speaker 4: about what lies ahead. And I think this is a
33:34
Speaker 4: pretty big thing, you know, thinking about your podcast and
33:37
Speaker 4: the audience. People that commit years and decades of their
33:41
Speaker 4: lives to research need, if nothing else, to know that
33:46
Speaker 4: society has their back. And this moment of rhetoric and
33:51
Speaker 4: turmoil I think raises questions about society's commitment and people
33:56
Speaker 4: will not be able therefore to stick it out and
34:00
Speaker 4: academia in their research projects if they don't feel like
34:04
Speaker 4: a year after year they're going to get the support
34:06
Speaker 4: they need.
34:07
Speaker 1: Or does that help to happen state by state? You know,
34:10
Speaker 1: I guess that's always the argument, right, federal government is
34:14
Speaker 1: handing over more to the I mean, if you really
34:16
Speaker 1: look at what's happening, and it sounds like they're not
34:19
Speaker 1: as negative about the space as maybe things appear to
34:23
Speaker 1: be written. There was that New York Times article about
34:26
Speaker 1: the war on cancer and.
34:27
Speaker 4: Right, and that institution is suffering. That's right, There is
34:31
Speaker 4: something to recognize. The largest single funder biomedical research on
34:35
Speaker 4: earth is a federal government. States are not going to
34:38
Speaker 4: make that up. Philanthropies can make that up. There are
34:41
Speaker 4: more zeros in what the federal government has in its
34:43
Speaker 4: budget than any entity has. And honestly, it's a collective
34:47
Speaker 4: expression of both our optimism and our desire to build
34:51
Speaker 4: a better society.
34:53
Speaker 1: Right and I guess having a new NCI director can
34:56
Speaker 1: only help.
34:57
Speaker 3: I'm very optimistic about that.
34:59
Speaker 1: Yes, right, good, I'm glad to hear that. I wouldn't
35:02
Speaker 1: want to leave. I know there is anxiety because I
35:05
Speaker 1: know people in those labs, and I work with so
35:07
Speaker 1: many of the third party groups working toward this to
35:11
Speaker 1: fill avoid of really education, do you think it's also
35:14
Speaker 1: a matter of do you think everybody understands the consequences
35:19
Speaker 1: and even some of these complexities the same easy stuff.
35:22
Speaker 4: Well, there's some interesting trade offs because if you survey
35:26
Speaker 4: the American public across the generations, there is huge support
35:33
Speaker 4: for biomedical research. In fact, it's one of the most bipartisan, unifying,
35:37
Speaker 4: consistent findings. Support for federal investment in research. Cancer research,
35:42
Speaker 4: but also all of medicine is ballparking the eighty ninety
35:46
Speaker 4: plus percent. There are very few issues that garner this
35:49
Speaker 4: level of support. The challenge, if I may, is, it's
35:53
Speaker 4: not clear how many people make their ballot box decisions
35:57
Speaker 4: based upon this. That's the issues. So the education, I
36:02
Speaker 4: feel like we've done a pretty decent job. People really
36:05
Speaker 4: do want if you ask them, yes or no, they
36:08
Speaker 4: want federal investment in cancer research.
36:11
Speaker 1: Yeah. No, it seems like I know brainer you know,
36:15
Speaker 1: and there's lots of other research that gets done, but
36:17
Speaker 1: cancer research can be informative for many diseases, right, I mean,
36:21
Speaker 1: because I feel like there's that link between the immunotherapy
36:26
Speaker 1: you know, you know, immunological diseases and cancer and allergy. Right,
36:31
Speaker 1: I'm involved with the food allergy group, and you know
36:34
Speaker 1: there seems to be a through line in and around.
36:37
Speaker 4: Well, some signs ends up translating, or you learn things
36:40
Speaker 4: from one area and applied to another. That's right, And
36:43
Speaker 4: it's a simple example. But you know, we alluded to
36:45
Speaker 4: this before. The widespread use of CLIP one inhibitors to
36:49
Speaker 4: reduce the acute challenges of obesity, for sure, will reduce
36:53
Speaker 4: the risk of certain sol timbers too.
36:55
Speaker 1: Well, that's incredible. So it's certainly been concerning because the
36:59
Speaker 1: numbers see to be in some reports going down. You
37:02
Speaker 1: mentioned breast cancer.
37:04
Speaker 4: Mortality down to be prebled.
37:07
Speaker 1: Okay, so but now we're hearing more about the rising
37:09
Speaker 1: incidents and prevalence of cancer, and especially in younger people,
37:12
Speaker 1: which I think I would qualify my wife in her
37:15
Speaker 1: fifties as being younger, but it's much younger than that.
37:18
Speaker 1: It's twenties, thirties, forties. Is this happening because diagnosis got
37:23
Speaker 1: better or something else is going on.
37:26
Speaker 4: I don't have a simple answer. I think it's multifactorial.
37:30
Speaker 4: And what I mean is, I think for the diseases,
37:32
Speaker 4: and it's not all of them where these increases are
37:35
Speaker 4: being observed. I think that's real. It's hard to believe
37:39
Speaker 4: that it would just be awareness, because in the case
37:43
Speaker 4: of colon cancer, for example, or breast cancer, if we
37:46
Speaker 4: weren't aware, you would still find those cancers just a
37:50
Speaker 4: little bit later and more advanced. So the fact that
37:53
Speaker 4: we're finding more cancers at specific age groups in a
37:56
Speaker 4: few of these cases does suggest that there's something wrong
38:00
Speaker 4: speculating about the rising body mass index or specific components
38:04
Speaker 4: of the diet or whatever else. And the truth is,
38:07
Speaker 4: we could speculate about a lot, but we really don't
38:09
Speaker 4: have any good evidence that we can point to.
38:11
Speaker 3: To any right.
38:12
Speaker 1: I mean, you know, people talk about plastics and all
38:15
Speaker 1: the other things.
38:16
Speaker 4: I'll give you just a counterpoint to people need to
38:19
Speaker 4: keep in mind, which is, if you think about the
38:21
Speaker 4: long sweep of human history, when was infant mortality lower
38:26
Speaker 4: and when was overall lifespan longer than right now?
38:30
Speaker 1: Not right exactly, which brings like you said, the probably
38:35
Speaker 1: the longer we live, the more chance we're going to
38:37
Speaker 1: develop these.
38:38
Speaker 4: But to be fair, that doesn't get at the rising
38:40
Speaker 4: incidents of some cancers and young people. So I think
38:44
Speaker 4: we have to look at that really carefully.
38:46
Speaker 1: Okay. So what I say though, is to my audience,
38:49
Speaker 1: listen to this because you two can get hit by
38:52
Speaker 1: this bouncing ball sooner, which is why you have to
38:54
Speaker 1: fight and maybe vote for this part of the equation.
38:58
Speaker 1: We need more, right, and that's what you and I
39:01
Speaker 1: are working toward the CEO round table for cancer. What
39:03
Speaker 1: do you think the most urgent needs and priorities to
39:07
Speaker 1: make this more chronic disease and reduce diagnosis and death.
39:12
Speaker 1: Do you think translational research is more important than the
39:15
Speaker 1: clinical research phase that you all focus on? I mean,
39:18
Speaker 1: where do you think the money needs to go most urgently?
39:21
Speaker 4: That's a version of which of your kids is your
39:23
Speaker 4: favorite one?
39:24
Speaker 1: Right? You got it? Both can be true. I always
39:28
Speaker 1: use that one too, so you can give me two
39:30
Speaker 1: answers that are true.
39:31
Speaker 4: Yeah, yeah, I mean, I just think it's a continuum
39:34
Speaker 4: if you think about it. We will have dry periods
39:37
Speaker 4: where people invest a ton of time and effort into
39:41
Speaker 4: basic research, discovery science, try to get the translation and fail, fail, fail,
39:47
Speaker 4: and then something happens. In some ways, the whole story
39:50
Speaker 4: of the mr Anda vaccines for COVID are that there
39:55
Speaker 4: were decades of research before, and in fact a lot
39:58
Speaker 4: of it looking for a cancer application, so that when
40:01
Speaker 4: we pivoted to try to make the original code vaccines
40:04
Speaker 4: with mRNA, the technology was all there and developed. It
40:06
Speaker 4: had been targeted for something else. It didn't work so
40:09
Speaker 4: well yet in the other area, and that was a
40:12
Speaker 4: long effort, but look at the payoff we got short
40:16
Speaker 4: term with operation warp speed. So I think it's all important.
40:20
Speaker 4: Is the answer to that? I have to give.
40:22
Speaker 1: What worries you about the future cancer, whether it's mutations
40:26
Speaker 1: or resistance or rising rates, and contrast what makes you
40:29
Speaker 1: hopeful right now?
40:31
Speaker 4: Well, I'll answer the second part first. What makes me
40:34
Speaker 4: hopeful is that we've just never had the array of
40:39
Speaker 4: tools and the depth of understanding we have today, and
40:44
Speaker 4: some decades in the future we will look back at
40:46
Speaker 4: this and think it was remarkably crude. So I am
40:48
Speaker 4: very optimistic about our ability to suss all this out.
40:53
Speaker 4: It's worth interjecting here there wasn't even a specialty called
40:57
Speaker 4: medical oncology until nineteen seventy two. For oh wow, yeah,
41:02
Speaker 4: this is a new area of human endeavor. There were
41:06
Speaker 4: cancer docs, but there was not a board in medical
41:09
Speaker 4: oncology until, in fact, my predecessors at ASCO went to
41:13
Speaker 4: the ABIM and petitioned for the creation of a subspecialty
41:17
Speaker 4: of internal medicine. But the idea that it came in
41:22
Speaker 4: the early part of my life. The creation of this
41:25
Speaker 4: specialty is just a reminder of how young we are
41:28
Speaker 4: in this effort and how much ground we've covered already
41:32
Speaker 4: with our relatively accrued tools. What worries made is that
41:36
Speaker 4: we will not make an adequate investment to take full
41:40
Speaker 4: advantage of the burgeoning opportunities. And I want to point
41:45
Speaker 4: something out here we haven't touched on. We almost got
41:48
Speaker 4: to it. With our increased understanding of the biology of
41:53
Speaker 4: many common cancers, we are slowly converting them into collections
41:58
Speaker 4: of rare diseases, and by definition, that's going to take
42:02
Speaker 4: even more resources, both in terms of the quality of diagnostics,
42:07
Speaker 4: the precision of treatment recommendations, and the development of the
42:11
Speaker 4: right drugs for those relatively small subsets of patients. When
42:15
Speaker 4: I trained, non small cell lung cancer was essentially one disease,
42:19
Speaker 4: of course, and now.
42:20
Speaker 3: It's a number.
42:21
Speaker 4: And this idea of rare diseases for everybody, I think
42:26
Speaker 4: is it's a challenge that we're going to confront more
42:28
Speaker 4: and more.
42:29
Speaker 1: Thank you for bringing it up, because I absolutely see it,
42:32
Speaker 1: experience and understand it, particularly with my wife's very rare
42:35
Speaker 1: cancer and that situation and where the money needs to
42:39
Speaker 1: go and the investment, So that further complicates what we're
42:42
Speaker 1: talking about. But look, the next and last couple of
42:45
Speaker 1: questions are all about you and getting a little more personal.
42:49
Speaker 1: So two questions I ask every guest again, You're going
42:52
Speaker 1: to a desert island, and this is it. What's the
42:56
Speaker 1: album you're going to bring along with you? If you've
42:58
Speaker 1: only had one you could bring.
43:00
Speaker 3: It's easy for me.
43:00
Speaker 4: It's always it's the single best rock and roll album
43:03
Speaker 4: ever made, which is Exile on Main Street by the
43:05
Speaker 4: Rolling Stones.
43:06
Speaker 1: Awesome.
43:07
Speaker 4: Yeah, if you're a music fan and you actually take
43:11
Speaker 4: the time to listen carefully to Exile and Main Street,
43:14
Speaker 4: the pulling in of the Delta Blues, the melding with
43:18
Speaker 4: English pop in a hidden way, and the way they
43:21
Speaker 4: recorded that in the South of France during a really
43:24
Speaker 4: challenging time in their existence. The music is remarkable for
43:30
Speaker 4: a rock and roll album. It's just and it's ageless
43:34
Speaker 4: in its way because it's roots.
43:36
Speaker 3: Are actually going back to the nineteenth century.
43:39
Speaker 1: I love how definitive you are.
43:40
Speaker 4: You didn't even blink, so I have little anecdotes for you.
43:43
Speaker 4: One time I went into an Italian restaurant on East
43:46
Speaker 4: sixty second Street in New York City on Saturday night
43:49
Speaker 4: at six o'clock. My wife insisted that we go drop
43:52
Speaker 4: some paperwork off in her office on Saturday night.
43:54
Speaker 3: Because she's compulsive. So we go there.
43:56
Speaker 4: We walk in the restaurant and there are a few
43:58
Speaker 4: people at the bar because it's a summer Saturday night
44:01
Speaker 4: and it's a narrow New York restaurant. We live right
44:04
Speaker 4: near there, and they want to seat us in the
44:07
Speaker 4: front where all these other people, and I see the
44:09
Speaker 4: back is quiet, and can't we sit in the back
44:12
Speaker 4: they look at us for a couple of moments and
44:14
Speaker 4: then they say okay. And as we walk to the back,
44:16
Speaker 4: there are three guys in suits with earpieces and one
44:20
Speaker 4: couple on a bankhead on the left, and they seat
44:23
Speaker 4: us on the right. It's a narrow like a rowhouse
44:25
Speaker 4: in New York City, right, and I don't take much notice.
44:29
Speaker 4: And then as I'm sitting there with my back to
44:32
Speaker 4: the room, my wife's on the bankhead, I hear the
44:35
Speaker 4: distinctive sound of Mick Jagger and he was sitting there
44:38
Speaker 4: with his girlfriend, the ballerina, six o'clock on Saturday night
44:42
Speaker 4: in New York City, having dinner, and they were trying
44:44
Speaker 4: to decide when we walked in if we could be
44:46
Speaker 4: trusted to sit back there and not bother them.
44:49
Speaker 1: For some of us getting away and having real time off,
44:53
Speaker 1: it's important. What would be your dream vacation.
44:56
Speaker 4: I take my dream vacation every single year. I'm lucky,
44:59
Speaker 4: so number one, I spend a few weeks on a
45:02
Speaker 4: very nice island in the Caribbean in the middle of
45:05
Speaker 4: the winter with my wife, and we rent the same
45:08
Speaker 4: house and we did the same things. And it's like
45:12
Speaker 4: I can't remember one year to the next. But it's
45:14
Speaker 4: a complete disconnect and we get to live a little
45:19
Speaker 4: like we're in another country for a few weeks.
45:21
Speaker 1: Yeah. Good, All right, so you're really chilling out.
45:24
Speaker 4: I'm exercising, of course, right reading, and I'm spending time
45:29
Speaker 4: with whichever part of my family I can convince to
45:32
Speaker 4: come with me when mom and dad are paying exactly.
45:36
Speaker 1: That sounds quite dreamy to me.
45:38
Speaker 3: So it's actually wonderful.
45:40
Speaker 1: Then.
45:41
Speaker 4: The other is, in the last few years, my wife
45:43
Speaker 4: and I've had the good fortune to finally, i mean
45:45
Speaker 4: late in life, have a summer house, well New Yorkers
45:48
Speaker 4: say country house, and so I get myself there and
45:51
Speaker 4: I have been mini vacation most weekends.
45:54
Speaker 1: That's great. Anyway, this was great. Thanks so much for
45:57
Speaker 1: talking to us today. Again. Look forward to you in
46:00
Speaker 1: a few weeks. And I assume you're going to make
46:02
Speaker 1: that roundtable meeting.
46:03
Speaker 4: I'm actually on the hill that day to tell you
46:05
Speaker 4: the truth.
46:06
Speaker 1: So oh, all right, Well you've got important work today.
46:09
Speaker 1: All right. Well, I'm glad you're out there doing it.
46:12
Speaker 1: Keep doing it. Thanks for all you're doing, and we'll
46:15
Speaker 1: see you soon.
46:16
Speaker 3: Thanks for inviting me on. It was really a pleasure
46:18
Speaker 3: to talk to you and an honor.
46:20
Speaker 1: Yeah, same here and it went so fast, easy and well,
46:24
Speaker 1: all right, doc, I'll let you go.
46:26
Speaker 3: Thank your care.
46:29
Speaker 1: Hey everyone, thanks for joining me on the Get Real podcast.
46:33
Speaker 1: You know, I hope you feel a little healthier hanging
46:35
Speaker 1: out with me. You know it's going to be a
46:37
Speaker 1: lot of fun. Passing this along to others. Please subscribe below,
46:42
Speaker 1: Please share. I'm excited not just to talk about healthcare,
46:46
Speaker 1: but a lot of other fun topics. It's about making
46:50
Speaker 1: healthy talk about healthcare. It's not a lecture. This is
46:53
Speaker 1: supposed to be fun. And look forward to spending more
46:56
Speaker 1: time with you in the future.