Latest / The iAlign Podcast with Flint Mitchell / #9 - Asking Questions Like Lives Depend on Them With MD/PhD Student Noah Earland

Transcript

#9 - Asking Questions Like Lives Depend on Them With MD/PhD Student Noah Earland · The iAlign Podcast with Flint Mitchell

• 0:09
  SPEAKER_01: What's up, y'all?
• 0:10
  SPEAKER_01: Welcome to Seeking Authenticity.
• 0:12
  SPEAKER_01: My name is Flint Mitchell, and I get absolutely psyched by having conversations with authentic people that I admire about the things they value.
• 0:21
  SPEAKER_01: Their stories and perspectives don't just make me smile, laugh, and think.
• 0:25
  SPEAKER_01: They inspire me to wake up earlier, listen better, focus, and work harder, and help make me a better version of myself.
• 0:32
  SPEAKER_01: And it's my hope that sharing these conversations through this podcast might do the same thing for you.
• 0:38
  SPEAKER_01: In this episode, I'll be talking with Noah Erland, a friend of mine from college.
• 0:42
  SPEAKER_01: He's currently pursuing his MD PhD and training to become a medical scientist.
• 0:47
  SPEAKER_01: We met while living in the same freshman dorm and created that bond you really only get from an experience like that.
• 0:53
  SPEAKER_01: Noah has always stuck out in my head, not because he's a foot taller than everyone else, but because he's got this big, joyful smile, and a laugh that makes you want to laugh yourself.
• 1:03
  SPEAKER_01: I always knew he was pursuing medicine, but not until senior year did I realize the extent of his work ethic and drive.
• 1:09
  SPEAKER_01: Through a variety of research internships and jobs, he found from an early age the excitement that comes from asking good questions.
• 1:16
  SPEAKER_01: Now, in his training, it's more relevant than ever, as the big questions he's starting to ask don't only deal with lab science, but also with how to do ethical research in a clinical study, dealing with real patients suffering from real diseases.
• 1:29
  SPEAKER_01: We cover interesting topics like the interaction between researchers and clinical physicians, palliative care, the politics of academic research, the struggle to create trust between the medical system and historically underserved communities, and the true joy of curiosity found from asking the right question.
• 1:46
  SPEAKER_01: Noah is an energetic, well-spoken, and passionate person.
• 1:50
  SPEAKER_01: I had so much fun listening to him, and I know you will too.
• 1:53
  SPEAKER_01: Enjoy.
• 1:58
  SPEAKER_00: Then we're now in the age of, you know, cancer genomics, so you can look at specific genomic markers, and then you can look at what the clinical research says.
• 2:06
  SPEAKER_00: How long is this person gonna live?
• 2:09
  SPEAKER_00: That's the mentality you're gonna need to give to your career for the rest of your career.
• 2:13
  SPEAKER_00: It's always gonna be all in.
• 2:16
  SPEAKER_00: Curiosity allows you to open up almost an economy of thought.
• 2:22
  SPEAKER_00: When you get to the top of the game in your field, it's about asking the good questions.
• 2:28
  SPEAKER_00: You can agitate, you can demonstrate, you can do all those sorts of things in the street, but at the end of the day, there's going to be a table where they write down the actionable items.
• 2:38
  SPEAKER_00: And the only way to change that list is to have a seat at the table.
• 2:47
  SPEAKER_01: Thanks for doing this with me, my man.
• 2:49
  SPEAKER_01: I really appreciate it.
• 2:50
  SPEAKER_01: No problem.
• 2:51
  SPEAKER_01: I was pretty fascinated by the idea of an MD PhD at the end of uh when we were graduating college, and then for a couple of years afterwards.
• 3:00
  SPEAKER_01: So that interest always makes conversations with people who in them or who have done them that much more fun for me.
• 3:08
  SPEAKER_01: And I'm sure you hear this all the time, but it's a pretty incredible testament to your level of patience and work ethic to undertake or commit to such a long and tedious program, right?
• 3:21
  SPEAKER_01: Something I really respect.
• 3:22
  SPEAKER_01: For people who don't know, I mean, an MD PhD is generally about eight years if I'm not understood misunderstood.
• 3:31
  SPEAKER_01: Oh yeah, yeah, yeah.
• 3:32
  SPEAKER_00: Yeah.
• 3:32
  SPEAKER_01: If you're lucky, you can do it in seven.
• 3:34
  SPEAKER_01: Right.
• 3:34
  SPEAKER_01: And if you're unlucky, as PhDs sometimes are, I can go even bit longer, right?
• 3:40
  SPEAKER_00: Oh yeah, yeah.
• 3:41
  SPEAKER_00: That's uh yeah, yeah, that's it's definitely possible.
• 3:44
  SPEAKER_00: I mean, it's not it's definitely not like an un an uncommon sort of thing for you to end up with a five-year PhD, depending on what you're doing the PhD in.
• 3:54
  SPEAKER_00: Right.
• 3:55
  SPEAKER_00: Exactly.
• 3:55
  SPEAKER_01: Yeah.
• 3:56
  SPEAKER_01: And yeah, I know.
• 3:58
  SPEAKER_01: And and then it's also fun for me to see, well, it's fun for me to see that side of you, at least from you know, LinkedIn and social media.
• 4:04
  SPEAKER_01: We haven't talked in a while.
• 4:06
  SPEAKER_01: But especially because in my head, you know, is freshman year, you and the you in the dorms, which is this lanky dude down the hallway always cracking jokes and laughing with a big smile plastered across your face.
• 4:22
  SPEAKER_01: Um, and so it's all up with things that were plastered.
• 4:27
  SPEAKER_01: So it's it's it's exciting for me to see kind of that mix of qualities, right?
• 4:32
  SPEAKER_01: This patience and hard work with also this laid back, fun, fun dude, you know, especially in a doctor, a future doctor, a future medical researcher, or whatever you're aimed at doing.
• 4:44
  SPEAKER_01: Um, and when I was looking through your LinkedIn, I was really impressed with the sheer quantity of research labs that you had worked in by the time they graduated.
• 4:58
  SPEAKER_01: I mean, is honestly, I don't know anyone who has I mean, intern, most of it seemed like cell bio or biochemistry stuff, but Philadelphia College of Medicine, NIH, UT Southwestern, SMU, then there was one in your post book.
• 5:15
  SPEAKER_01: Oh, yeah.
• 5:16
  SPEAKER_01: NIH, yeah, yeah.
• 5:18
  SPEAKER_01: Yeah.
• 5:18
  SPEAKER_01: And I was wondering if you could tell me if any of them stick out in your mind as your favorite lab experience before your MD PhD.
• 5:27
  SPEAKER_00: Yeah, yeah, definitely.
• 5:29
  SPEAKER_00: Uh, so I'd say I can kind of tell that almost in in three acts.
• 5:35
  SPEAKER_00: And so I guess to give uh a foreword as to why I was in so many different labs, so that was a very specific kind of setup uh that I was lucky enough to get involved in.
• 5:51
  SPEAKER_00: Uh, I was in this very unique biomedical camp that sort of recruited people like me to some degree right out of like middle school.
• 6:02
  SPEAKER_00: Really?
• 6:02
  SPEAKER_00: And yeah, yeah, yeah.
• 6:04
  SPEAKER_00: So that's how I was able to.
• 6:06
  SPEAKER_00: So right when I started my freshman year of high school, that summer was when I had completed one of my first quote-unquote biomedical like research sort of internships for six weeks.
• 6:21
  SPEAKER_00: I like learned how to run a Western blot and was helping out on this lab group uh at the Philadelphia College of Osteopathic Medicine.
• 6:29
  SPEAKER_00: And we were studying osteoarthritis and this small peptide inhibitor of this enzyme that was driving a process that they thought was important in the development of osteoarthritis.
• 6:40
  SPEAKER_00: So that was like the eye-opening, you know.
• 6:42
  SPEAKER_00: You want to talk about a moment of like your eyes being opened to and you don't look at the world in the same way after.
• 6:50
  SPEAKER_00: I'd say it was that experience.
• 6:51
  SPEAKER_00: That was my first experience.
• 6:53
  SPEAKER_00: And it was just because it was so new.
• 6:55
  SPEAKER_00: Yeah, yeah.
• 6:56
  SPEAKER_00: It was new and it would like took place over the summer, which is normally when at least studies show, you know, like children lose, you know, I don't I don't know exactly how much, but like a certain percentage of all the work you put in during the year, you know, and you take the three months off, it's almost like an atrophy of thinking, which isn't necessarily a bad thing, but sure it's like you start the next year off not where you really were the year previously, but actually like a few months before that.
• 7:27
  SPEAKER_00: Whereas for me, it was like, you know, during the summer, I would ramp up instead of kind of leveling off and going down.
• 7:34
  SPEAKER_00: Yeah.
• 7:34
  SPEAKER_00: And uh my cousin also was in that very same program.
• 7:38
  SPEAKER_00: So I, you know, in the beginning we were talking about, oh, like we're we're very unique in that we were both, you know, like going through this path, but arguably we were put on this path at a very young and impressionable age.
• 7:50
  SPEAKER_00: And so that's why it's not so surprising that we both were able to successfully get into these programs.
• 7:59
  SPEAKER_00: Uh but then I would say my SMU lab experience, so the reason I I really enjoyed that was because in comparison to these brief kind of summer 10 week, 12-week, I mean, uh for anyone that's done research, you know, for long term, they know that you know, 12 weeks seems like a lot the first time you do 12 weeks, but then when you do like a year, you realize 12 weeks, I mean, you could be hung up on a technical difficulty for four weeks, waiting on you know, materials or troubleshooting advice from uh you know a biotech uh materials producer or who's ever making your assay.
• 8:43
  SPEAKER_00: So it's like 12 weeks can get chomped up very quickly with very little to show for it.
• 8:48
  SPEAKER_01: Yeah, as I I had a I had a I a boss who coined it pretty well, and he said, biology research is all about waiting for ice to melt.
• 9:04
  SPEAKER_01: You know, there's so much waiting involved.
• 9:06
  SPEAKER_01: Yeah, 12 weeks is not a lot of time.
• 9:08
  SPEAKER_00: That's yeah, that's exactly how so I would say the SMU experience, you know, in the lab of uh Dr.
• 9:14
  SPEAKER_00: William Orr, who was, you know, you know, prestigious in and of himself.
• 9:18
  SPEAKER_00: Like he was a Harvard, you know, he did his postdoc and I believe his PhD at Harvard in aging.
• 9:26
  SPEAKER_00: And so that's where I got you know this more extended experience.
• 9:30
  SPEAKER_00: And unlike, you know, some of those other places that I worked at, the NIH and uh Philadelphia College of Osteopathic Medicine and several others, uh, you know, when we were in the SMU lab, it was there was like more of this gritty kind of less high-tech bread and butter sort of science that I had to learn and get used to.
• 9:52
  SPEAKER_00: You know, at the NIH, you get the bio rad gels that run every time and it's it runs perfect lines, perfect, like perfect antibodies, whereas it's like at the SMU labs, you know, budget's a little different.
• 10:07
  SPEAKER_00: You're pouring your own gel.
• 10:08
  SPEAKER_00: If you mix up, you know, like it's gotta be 4% or 2%.
• 10:13
  SPEAKER_00: Like if you mix up the measurement even by a little bit, then it's not 4% or 2%, and then you pour it.
• 10:19
  SPEAKER_00: If you don't pour it, it doesn't solidify correctly.
• 10:22
  SPEAKER_00: So I think SMU was challenging in the sense that it was like, you know, you can't you can't blame the tools at a certain point.
• 10:30
  SPEAKER_00: I mean, it's like the athletes say it all the time, you know, like you can't always be blaming the rim or your shoes or the court or the net.
• 10:38
  SPEAKER_00: Like you just gotta be able to perform.
• 10:40
  SPEAKER_00: And so I think at SEU, that was the first time I had to perform under, you know, not not the prestigious or best circumstance.
• 10:49
  SPEAKER_00: Yeah, not other ideal.
• 10:50
  SPEAKER_00: Yeah, exactly.
• 10:51
  SPEAKER_00: So I I'm I enjoyed that experience out of out of SMU because it really kind of brought like the grittiness of research.
• 10:58
  SPEAKER_00: And then objectively, my favorite experience was at uh the NIH.
• 11:04
  SPEAKER_00: I mean, it's it's hard to beat.
• 11:06
  SPEAKER_00: It's it's even outside of the research I was doing.
• 11:09
  SPEAKER_00: The research I was doing wasn't even exactly what I wanted to do, but I got publications out of it.
• 11:14
  SPEAKER_00: I had a cool mentor, I learned a lot about a field I knew nothing about, really.
• 11:18
  SPEAKER_00: But it's like you're on you know the campus, and it's like the mecca of research and science.
• 11:25
  SPEAKER_00: Massive buildings, all of them all devoted to some ultra-specific part of biomedical learning, you know, or biomedical development, and they'll bring in speakers from across the country, all the most prestigious speakers, Nobel Prize laureates, uh, you know, and it's you can just go to any of that.
• 11:44
  SPEAKER_00: And it's it's this feeling that anything is possible.
• 11:46
  SPEAKER_00: Like if if the world's gonna be solved, medically speaking, it's gonna be solved in these halls.
• 11:53
  SPEAKER_00: And it's that that was the feeling.
• 11:56
  SPEAKER_01: That yeah, that's wild.
• 11:58
  SPEAKER_01: So is it it was even just the environment was what made it so remarkable.
• 12:04
  SPEAKER_01: Really?
• 12:04
  SPEAKER_00: Oh, yeah.
• 12:05
  SPEAKER_00: Yeah.
• 12:06
  SPEAKER_00: And you know, it's I mean, it's a hierarchy.
• 12:08
  SPEAKER_00: Like there is, you know, you had the bosses and you had the postdocs and people coming from Europe, you know, people that have been physicians for five, ten years, but they just want to get beyond, you know, the simple medicine they've been practicing, get a pulse on like, you know, the brand new genetics or genomics or uh you know, transcriptomics, like every omics possible, every way of analyzing a problem possible, you know, the newest, the best, the brightest, the most expensive.
• 12:36
  SPEAKER_00: It's being done here in the States.
• 12:38
  SPEAKER_00: And so that was incredible.
• 12:40
  SPEAKER_00: And then there's 2,000 other people exactly like you.
• 12:44
  SPEAKER_00: Undergrads just came out of college, really, you know, wanted to do some.
• 12:48
  SPEAKER_00: Oh, yeah, yeah.
• 12:49
  SPEAKER_00: They have 2,000 undergrad or post back, what they call them postbacks.
• 12:54
  SPEAKER_00: Right, right.
• 12:55
  SPEAKER_00: You know, at any one time, around 2,000 of them, and especially over the summer, because that's when people who are still in college, they'll come and do summer internships.
• 13:04
  SPEAKER_00: And so it's great, you know, you work the day job, and then you go out, have a night on the town with your friends from the lab, and then you wake up the next day and you get it done all over again.
• 13:13
  SPEAKER_00: Living the dreams.
• 13:14
  SPEAKER_01: And so all these guys, all these undergrads or postbacks, because postbacks are all trying to do medical school, right?
• 13:20
  SPEAKER_01: Or are they are any of them graduate school?
• 13:23
  SPEAKER_00: I'd say I'd say at the NIH it's probably a split.
• 13:26
  SPEAKER_00: I'd say it's maybe 50-50, but I I don't have any official numbers to back that up.
• 13:31
  SPEAKER_00: That was just my cohort.
• 13:32
  SPEAKER_00: But it's yeah, people are either doing this because they want to get their skills up to go to grad school, or they want to get their publications up and get into med school.
• 13:40
  SPEAKER_00: And then, of course, there was this uh segment of us right down the middle that you know, we want the whole enchilada, the end of the PhD.
• 13:48
  SPEAKER_01: Absolutely.
• 13:49
  SPEAKER_01: Was there um when you're in this really inspiring environment, are there any memories that stick out or stories where you kind of sat there and were like, whoa, this place is crazy?
• 14:01
  SPEAKER_00: Uh yeah, I mean, I would say, you know, just because he's like a big face nail in the news, uh, Fauci, you know, he was so I worked at NIAD, uh National Institute of Biology and Infectious Diseases.
• 14:15
  SPEAKER_00: Yeah.
• 14:16
  SPEAKER_00: So, you know, when Fauci would come in and he would give, you know, updates on what his lab group was doing, which at the time, you know, everyone was interested in pandemic flu.
• 14:26
  SPEAKER_00: And they were all interested in a universal flu vaccine.
• 14:29
  SPEAKER_00: That was, you know, that was the most likely culprit of the next pandemic.
• 14:33
  SPEAKER_00: And that was where, you know, vaccine research, you know, was at least at the at the highest point, where the uh you know, a lot of the more prestigious labs at NIAD, they were looking at vaccine research uh breakthroughs in order to have a universal flu vaccine.
• 14:52
  SPEAKER_00: And so it was kind of like, you know, uh, he would come in and talk, and you know, the whole entire institute would fill up those seats and and building 10 and hold on to every single word he had.
• 15:04
  SPEAKER_00: And I mean, yeah, it was, you know, you hear someone of that height talk about, you know, their science, the science they've done in the past.
• 15:13
  SPEAKER_00: Uh so yeah, I'd say that's you know, that was the I I knew him as that guy, and now, you know, it's he's kind of seen as the the last bright light in DC, able to guide us through a quote unquote historical event.
• 15:29
  SPEAKER_01: Yeah, no, it's that's a really interesting memory, especially now, obviously reflecting on it in the current state of the world and his importance.
• 15:38
  SPEAKER_01: That's pretty that's pretty awesome.
• 15:41
  SPEAKER_01: Yeah, yeah.
• 15:43
  SPEAKER_01: So on this subject of you know, there being like a split between some people going to graduate school and some people doing medical school.
• 15:50
  SPEAKER_01: I was wondering, it sounds like your interest was research first because of how you know the internships you were doing early on.
• 15:58
  SPEAKER_01: When did medicine come into the picture?
• 16:01
  SPEAKER_00: So, yeah, I mean, I'd say I was always well, I don't even want to say it like that because you know, if I were to say this on a personal statement, you'd get tattooed saying stuff like since third grade, I've always wanted to treat patients.
• 16:14
  SPEAKER_00: That's how they that's that's the first thing they do.
• 16:17
  SPEAKER_00: They run a control F for the always statement in the opening line.
• 16:21
  SPEAKER_00: They throw those personal statements out.
• 16:23
  SPEAKER_00: But I I do my my core interest, it was almost like I was interested in research as a result of this program that I was in, as a result of all these internships.
• 16:34
  SPEAKER_00: But a lot of the people I worked for were dual degree scientists themselves.
• 16:41
  SPEAKER_00: So, you know, at UT Southwestern, I worked an internship there before starting uh freshman year at SMU.
• 16:49
  SPEAKER_00: And of course, I got that position through my summer camp.
• 16:52
  SPEAKER_00: Like I use the term summer camp very lightly.
• 16:54
  SPEAKER_00: It was really a collection of side door entrances into prestigious research institutions.
• 17:02
  SPEAKER_00: You know, the program was validated, so it was kind of like you get into this program and you bypass the application process, you know, in a lot of these institutions.
• 17:14
  SPEAKER_00: And so when I was I when I worked at UT Southwestern, I worked under an MD PhD.
• 17:19
  SPEAKER_00: Uh in high school, I worked under a DO PhD, and the DO degree is equivalent to an MD.
• 17:25
  SPEAKER_00: Uh and then during my Gap year after college, I worked for an MD MPH, but he had a basic science lab.
• 17:33
  SPEAKER_00: And so the whole, it was like from the beginning, I saw medicine, not necessarily from the perspective of, you know, the guy you see once a year for your physical.
• 17:44
  SPEAKER_00: I mean, that guy is very important.
• 17:46
  SPEAKER_00: All of our data suggests investing in primary care is how you make lasting change on the population at whole.
• 17:52
  SPEAKER_00: Interesting.
• 17:53
  SPEAKER_00: But all of my perspective on medicine was always like, okay, you have this patient population, and they have these struggles with treatment or with outcomes or what have you, and there's all these open questions.
• 18:06
  SPEAKER_00: Well, what about you, the person that's treating the patient?
• 18:11
  SPEAKER_00: You can also be part of the person, part of the group, you know, coming up with the next line of treatments that will that will benefit your patient.
• 18:21
  SPEAKER_00: And then you, if you're the one that does it, you can open up the clinical trial, you know, the phase one, phase two, and you can get that treatment to your patients, you know, right there.
• 18:32
  SPEAKER_00: They're at the front doorstep of the next medical achievement.
• 18:37
  SPEAKER_00: So for me, I've never really seen a division between the research side of medicine and the clinical side of medicine.
• 18:47
  SPEAKER_00: And that's that really made the MD PhD a very natural decision for me.
• 18:51
  SPEAKER_00: And I mean SMU as a pre-health advising uh the pre-health pre-health advising committee, it was maybe me and one other person were seriously considering MD PhD out of our entire class.
• 19:03
  SPEAKER_00: Because I'd say most people wanted to do MD or MDMTH or MDMBA, which were all great dual degree tracks.
• 19:12
  SPEAKER_00: Uh and so I remember them specifically telling me, uh, Noah, maybe you shouldn't apply only MD PhD.
• 19:20
  SPEAKER_00: And I've I'd heard that before in the past.
• 19:22
  SPEAKER_00: I mean, you look at the numbers, all you do is look at the numbers, they have higher, you know, acceptance or higher step one scores, more publications, a lot of them take gap years, you know, it's all around, it's a it's a tougher pool to fight it.
• 19:34
  SPEAKER_00: So they're saying, well, we just want you to successfully get into med school.
• 19:38
  SPEAKER_00: And you know, if you go with that formula, maybe it is like, yeah, you should apply some schools only MD.
• 19:45
  SPEAKER_00: But every MD PhD I had talked to, you know, people with the degree told me they were told the same thing, but they believe that part of the reason they got to where they were was this all in mentality.
• 19:58
  SPEAKER_00: And they were like, look, do you want to be an MD student or you want to be an MD PhD student?
• 20:03
  SPEAKER_00: If you want to be, if you don't know, then maybe you apply one or the other.
• 20:06
  SPEAKER_00: And I would say if you don't know at this point in the game, probably just go MD, see if you like the research, convert later.
• 20:13
  SPEAKER_00: But if you want to do MD PhD, you gotta be all in for it because that's that's the mentality you're gonna need to give to your career for the rest of your career.
• 20:20
  SPEAKER_00: It's always gonna be all in.
• 20:22
  SPEAKER_00: Residency, you gotta learn clinical medicine, but you also gotta keep your finger on the pulse for research and then fellowship, and then when you have your job, you're gonna have clinical responsibilities, but then you're gonna have to make publications and advancements in the lab.
• 20:37
  SPEAKER_00: It's gonna take an all-in mentality, so you might as well start now.
• 20:41
  SPEAKER_00: And I'm like, that makes sense.
• 20:42
  SPEAKER_00: I'm all in.
• 20:43
  SPEAKER_00: So I that's what I did.
• 20:44
  SPEAKER_00: I only applied MV PhD.
• 20:47
  SPEAKER_01: Right.
• 20:48
  SPEAKER_01: But why were you so all in?
• 20:51
  SPEAKER_01: Was it it was just this ability to see the potential to bring research to the front lines?
• 20:57
  SPEAKER_00: Yeah, yeah.
• 20:58
  SPEAKER_00: I I mean, as much as I like the idea of clinical medicine, uh, what a lot of people tell me, you know, my mentor's now at Wash U, you know, they like clinical medicine, but they're like the parts of it that get exhausting are when, I mean, particularly when you're talking with cancer patient populations, is for a lot of them, you know, the treatments we have, they they run out of steam.
• 21:22
  SPEAKER_00: They run out of steam quickly.
• 21:24
  SPEAKER_00: And you're doing these treatments, you know, patient after patient after patient.
• 21:30
  SPEAKER_00: And without looking at almost anything in the patient's personal records, you can just look at in a lot of cancers, clinical grade, clinical stage, and then we're now in the age of you know cancer genomics, so you can look at specific genomic markers, and then you can look at what the clinical research says how long is this person gonna live?
• 21:50
  SPEAKER_00: And it's a dissatisfying feeling to just know with within a relatively high level of certainty how uh you.
• 22:00
  SPEAKER_00: Know certain patients are gonna fare depending on their cancer, depending on the genotype and the stage and all these other objective things that have nothing to do with the individual person.
• 22:09
  SPEAKER_00: And so they say that part of the job that gets exhausting and the research becomes that light at the end of the tunnel because you know the the data doesn't take into account what new breakthroughs you could make.
• 22:22
  SPEAKER_00: And in cancer, in the last five, ten years, I mean, the the breakthroughs have been coming in day by day.
• 22:30
  SPEAKER_00: It's it's almost hard to keep up with treatment outcomes with so many new immunotherapeutics and targeted uh treatment therapies.
• 22:40
  SPEAKER_00: At the end of the day, that came from clinicians that were, you know, clinicians and researchers and research clinicians that said, enough's enough.
• 22:47
  SPEAKER_00: You know, we're tired of the six-month, the eight-month prognosis.
• 22:51
  SPEAKER_00: We want to see one year.
• 22:52
  SPEAKER_00: And then when you get to one year, you're you're okay, we're not satisfied with that.
• 22:56
  SPEAKER_00: We want to see two years and three years.
• 22:58
  SPEAKER_00: And in in most cancer, most people that are oncologists, the the big point you want to get to is five-year survival.
• 23:08
  SPEAKER_00: Five year survival is as good as cure, you know, in the world of cancer.
• 23:12
  SPEAKER_00: And so that's that's really where you want to push your patient to.
• 23:14
  SPEAKER_00: Let's get them to the five-year survival and let's make sure that every patient diagnosed with this condition has a reasonably high chance of making it to that to that five year.
• 23:25
  SPEAKER_00: So I think for me, without even having done really much clinical medicine, I I've heard those sorts of frustrations.
• 23:33
  SPEAKER_00: And then from the research oncologists, they say, like, oh man, if I was if I was only doing, you know, just the clinical treatment, for you know, prescribing the different chemotherapy or immunotherapy, radiation regimens, what have you, just doing the surgery, uh, I mean, after a while it would maybe get me down.
• 23:53
  SPEAKER_00: But when you're doing the research, you feel like, okay, every day I'm contributing to pushing survivors, not just survivorship, but also, you know, like health, health, uh health years, like how you know, we don't want the treatment to completely destroy the person.
• 24:10
  SPEAKER_00: Uh and so, yeah, there's a lot of those.
• 24:13
  SPEAKER_00: And I I think everyone that practices oncology in an academic uh institution is involved in research in some way, like they're trying new drugs or I mean it's across the board sort of a research research-driven field, especially right now.
• 24:28
  SPEAKER_01: It sounds like no, and I totally see what you're saying on all that.
• 24:32
  SPEAKER_01: I I like your perspective on uh I I've never heard I don't know much about cancer treatment, but I like your perspective on how each each stage is just about pushing it a little bit further, right?
• 24:44
  SPEAKER_01: It's just about it's so tangible, right?
• 24:48
  SPEAKER_01: Everyone, everyone knows of a of a cancer survivor or someone who succumbed to it, but the idea of on average they live to eight months.
• 24:59
  SPEAKER_01: You know, a couple years, we want them to live twice as long.
• 25:02
  SPEAKER_01: That's a really yeah cool thing.
• 25:03
  SPEAKER_01: And what it sounds like to me is the reason you maybe find it so impactful or so important in your head is that it's kind of like you're trying to provide a little bit of hope.
• 25:14
  SPEAKER_00: Yeah, yeah.
• 25:16
  SPEAKER_00: Yeah, I would I'd say that's that's the that's the most succinct way to do it.
• 25:20
  SPEAKER_00: But not just, you know, not just we're we're hoping for the best, you know.
• 25:23
  SPEAKER_00: It's I don't because there's a lot of that in medicine.
• 25:26
  SPEAKER_00: It's a lot of you know med managing, you know, the person where they are.
• 25:30
  SPEAKER_00: You don't want to drop the stuff oh well 60% of people in your position aren't gonna be alive three months like that's that's bad medicine, and that doesn't help at the end of the day.
• 25:41
  SPEAKER_00: But you there is this need, everyone in medicine, there's this need to like say we are doing everything we can and we think we're gonna be able to get a good outcome, not just to be able to say that, but to actually truly mean it, you know.
• 25:57
  SPEAKER_00: That uh that's that's a driver throughout medicine and and sure.
• 26:01
  SPEAKER_00: Research, that's the way to get there.
• 26:04
  SPEAKER_01: Yeah.
• 26:04
  SPEAKER_01: What then obviously every you know pros come with cons, right?
• 26:11
  SPEAKER_01: So what then are the cons that you see, the things that might get you down with research and not doing as much clinical?
• 26:18
  SPEAKER_00: Yeah, uh, so I mean research, so there's there's a lot of ways to answer that.
• 26:23
  SPEAKER_00: Uh so the first way I think to answer that is to to kind of end where I left off, the other side of the whole hope pushing survivorship forward paradigm.
• 26:34
  SPEAKER_00: And this is kind of a side I didn't really see until taking a class on death and dying at the end of my first year of med school.
• 26:43
  SPEAKER_00: Uh and the reason it intersects specifically with oncology is you know, there's a growing resurgence in the world of medicine to make palliative care a more tangible option.
• 26:57
  SPEAKER_00: And so you tend to see this a lot with oncology.
• 27:01
  SPEAKER_00: And specifically the people, you know, that were running the course talked, I talked to them at the end, and they were like, you know, some of the toughest decisions and conversations we have are with these oncologists that have the next new immunotherapy line, and they're, you know, they're they're telling their patients exactly what they believe that this could really do it when really maybe it would be better for the patient to, you know, be put on palliative care, be put on, you know, the comfort treatment, and you know, subcumb in a way that allows their dignity to be maintained.
• 27:38
  SPEAKER_01: Could you briefly explain palliative care?
• 27:40
  SPEAKER_00: Sure thing.
• 27:41
  SPEAKER_00: Yeah.
• 27:42
  SPEAKER_00: So palliative care is in a lot of ways, it's a way of focusing on the comfort of the patient rather than just on survivorship.
• 27:57
  unknown: Yeah.
• 27:57
  SPEAKER_00: And in a in a lot of ways, you can actually extend survivorship just by making the person more comfortable.
• 28:04
  SPEAKER_00: And so people that you because now I believe it's it's becoming, it's not quite a specialty, but you can kind of get a palliative care fellowship, or I I don't know what the degree the official uh sort of designation is for it now, but it uh it tends to be more of this focus on like, okay, normally you only want to give so much of a painkiller like morphine because there's all these sorts of side effects, and especially digestively, uh just binding, you know, the opioid receptors in the gut, for instance, will slow uh colon transit time.
• 28:45
  SPEAKER_00: So in translation, that means you tend to get people very constipated when you when you do that.
• 28:51
  SPEAKER_00: But the idea is that it's like we're going to balance between, you know, we don't want to knock the person unconscious entirely, but we want them comfortable and calm so that they can spend the last couple weeks or months with their family members, you know, able to reminisce and able to relish in a life they lived, instead of you're in the hospital and now, you know, we're pumping you with these drugs, they may knock out your immune system, they may make you vulnerable to other infections, it's very isolating, you're not around your family members, you don't get a good night's sleep, and we're doing all this just to say, well, you lived two months longer, and you know, that's significant, and you know, this is the landmark study, I'm gonna get a publication.
• 29:36
  SPEAKER_00: Like that's uh, you know, that's a that those those external motivators outside of just the quote unquote, we want to help people, they do affect your decision.
• 29:46
  SPEAKER_00: And so that's one of the things you have to balance in research is when to call it, you know, not even quits, but when to say, like, okay, let me let this person go in the way that we all will go eventually.
• 30:02
  SPEAKER_00: Uh so that that's something I've become way more aware of because they specifically said oncologists have are notorious, and they always have been throughout all of oncology medicine.
• 30:13
  SPEAKER_00: They've always been the ones trying to push, you know, a little bit more on the survivorship, sometimes at the cost of meaningful months or weeks lived, you know, by the patient.
• 30:28
  SPEAKER_01: Super interesting.
• 30:29
  SPEAKER_01: I mean, I did research for a little while, but it was all you know, physics or chemistry.
• 30:35
  SPEAKER_01: There's no interaction with a human patient.
• 30:37
  SPEAKER_01: And so it's super fascinating to hear that perspective of of the balance between acquiring scientific data that could help your career or your studies or what your research is, and the fact of the matter that your research is dealing with people who are in difficult times.
• 30:57
  unknown: Yeah.
• 30:59
  SPEAKER_00: And you are biased by your own research.
• 31:01
  SPEAKER_00: Like that's that's the one issue behind combining the clinician with the researcher.
• 31:06
  SPEAKER_00: Because if the researcher is just doing the research stuff and the clinician is with the patient, then the clinician can advocate on the part of the patient, the researcher can advocate on the part of the researcher and all of the research, and then together they can mutually determine what's best for the patient.
• 31:22
  SPEAKER_00: But if you are both of those people, and it's usually not just you, you're gonna have clinical colleagues that are purely clinical, you're gonna have research colleagues that are purely research.
• 31:31
  SPEAKER_00: Right.
• 31:31
  SPEAKER_00: But if you tip the scale of balance towards towards one side in that dynamic, you have to think, well, who are you really trying to help?
• 31:42
  SPEAKER_00: Like, is this helping the patient in a meaningful way, or is this just shifting that that you know, that time scale towards the six months?
• 31:53
  SPEAKER_00: And so now you have seven patients that lived six months with metastatic stage four breast cancer, and it's a landmark discovery, and you're gonna get all the awards and alkalades and publications, but then that's at a certain point, are you just prolonging you know, the suffering of six more people?
• 32:13
  SPEAKER_00: Like, would they be better off dying two months earlier?
• 32:16
  SPEAKER_00: Because as I understand it, can't speak from experience, but metastatic cancer is quite horrible to live through, even if you are receiving quote unquote treatment or you're seeing mild tumor response or aggression, you know, it's it's it's a burden staying alive.
• 32:34
  SPEAKER_00: And some people honestly probably rather would not at that point.
• 32:39
  SPEAKER_00: They would rather be made comfortable, be made available to their friends and family to to kind of take the victory lap on life uh that that everyone really deserves.
• 32:51
  SPEAKER_01: Yeah, no, that's fascinating.
• 32:53
  SPEAKER_01: And I'm sure it probably in your eyes, as you're studying this stuff and starting to get into it, knowing that that is kind of a part of your future, right?
• 33:05
  SPEAKER_01: Yeah, is it probably sounds like you know you're taking on some pretty wild responsibility.
• 33:13
  SPEAKER_00: Yeah, yeah, you definitely, you definitely can.
• 33:17
  SPEAKER_00: So, I mean, I I guess initially at the beginning of this uh question, I said there were two parts to you know my concern of research.
• 33:24
  SPEAKER_00: So one, that's that that kind of ethical side of this is a person, this isn't just a mouse model that we're trying to boost, you know, the tumor regression on.
• 33:33
  SPEAKER_00: So that's one part.
• 33:35
  SPEAKER_00: The the and probably the more important of the two parts, but the second side is that, and it pains me to say it because I'm not even like high enough in it, really, research to have this opinion, but it's an open secret that research, you know, there's politics around it.
• 33:52
  SPEAKER_00: And as, you know, as much as scientists would like to believe that science, you know, it's the pure, it's the last pure meritocracy, it's the last one where the best ideas truly you come to the top, and it's it really, it's no, there is a political nature to academic medicine, there's a political nature to getting things like grants.
• 34:13
  SPEAKER_00: You can get to the point in your career where even though the grant review process is anonymous, even though publication reviews are anonymous, you know, there are professors at Washu, at Penn, at Yale, at Stanford, at UCSF.
• 34:29
  SPEAKER_00: You could go on at every major institution that can get on the phone with the editor of Nature, with the editor of Cell, with the editor of Science or Lancet or JCI and say, hey, I got some good stuff coming in the pipeline.
• 34:44
  SPEAKER_00: Let me just give you a little sketch of what we got coming through.
• 34:47
  SPEAKER_00: The preliminaries look good.
• 34:49
  SPEAKER_00: And when they submit whatever work they're doing, regardless of actual scientific authenticity, it will get published, it will get funded, it will get greased through the system.
• 35:01
  SPEAKER_00: And before you get to that point, you are to some degree at a disadvantage.
• 35:06
  SPEAKER_00: The young investigator who is yet to have their landmark paper, they're fighting a harder uphill battle than the person who's already gotten it.
• 35:16
  SPEAKER_00: And they might publish in one of the big three journals every year or every six, eight months.
• 35:22
  SPEAKER_02: Yeah.
• 35:22
  SPEAKER_00: And sounds frustrating.
• 35:25
  SPEAKER_00: Yeah, that's it's really frustrating for uh for new researchers.
• 35:29
  SPEAKER_00: But you know, when you're the one working with that big name, it's it's a it's a double-edged sword, it's a double-edged sword.
• 35:35
  SPEAKER_00: You know, when you got that big name on your paper, you kind of have this calm.
• 35:38
  SPEAKER_00: You're like, oh, he knows the editor.
• 35:40
  SPEAKER_00: This is gonna get through, it's gonna have my name on it, this is gonna boost my career.
• 35:44
  SPEAKER_00: I need this win.
• 35:46
  SPEAKER_00: But then it also, you know, it's I I don't know if you're aware of this, but uh a while back, a couple years ago, there is this study that showed like a third of the pay of the findings in either nature cells, one of the two big journals, couldn't be replicated.
• 36:03
  SPEAKER_00: You know, they they redid these quote unquote landmarked studies using all the information in the paper, and they did not find the same thing.
• 36:14
  SPEAKER_01: And that's outrageous.
• 36:15
  SPEAKER_01: I mean, so I actually knew about that in a different context.
• 36:19
  SPEAKER_01: I know we're kind of going, I think they call it the reproducibility crisis.
• 36:23
  SPEAKER_01: Yeah, but I actually had no clue that that was in also in clinical science or clinical medicine.
• 36:32
  SPEAKER_00: Yeah, I I mean it's not as much in it's it's harder to fake patient outcomes, you know, in clinical medicine.
• 36:40
  SPEAKER_00: But even still in these in these translational publications where it's like we have the patient cohort, we found in the patient cohort, and then we did the basic science stuff, and the basic science on the paper, it looks like it's one-to-one.
• 36:52
  SPEAKER_00: We're seeing patient, we're seeing mouse, we're seeing cell line, and then you try and reproduce those mouse and cell line, you know, experiments, you don't quite see the response.
• 37:02
  SPEAKER_00: So then the question is, okay, well, what are we seeing in patients?
• 37:05
  SPEAKER_00: Is this signal?
• 37:06
  SPEAKER_00: Is this just a very nice picture painted in the stars, or are we actually tracking something?
• 37:11
  SPEAKER_01: Yeah.
• 37:12
  SPEAKER_01: So how does in your mind now seeing this for the first time?
• 37:17
  SPEAKER_01: It sounds like these are kind of new issues for you, maybe over the past couple of years that you've started seeing.
• 37:22
  SPEAKER_01: What have you started to what kind of mindset have you started to take to kind of go about them?
• 37:29
  SPEAKER_01: Like what has become more important for you as far as scientific research?
• 37:33
  SPEAKER_01: Does that make sense?
• 37:34
  SPEAKER_00: Yeah, yeah, yeah.
• 37:35
  SPEAKER_00: I can kind of see what you're saying.
• 37:36
  SPEAKER_00: So I mean, I know on a on a I've also seen people that are addressing, you know, how to solve this.
• 37:43
  SPEAKER_00: So one of the ways that they're going about it is there's like now reservoirs of sort of like, because it used to be like you just wouldn't publish the parts of your research that didn't support your overall theory.
• 37:56
  SPEAKER_00: Like the failed experiments that you would do and they didn't work, it's like, okay, we're just gonna leave that out of the transcript.
• 38:01
  SPEAKER_00: We're gonna go with all the stuff that did work.
• 38:03
  SPEAKER_00: And then that just sits in your drawer.
• 38:04
  SPEAKER_00: And then another lab group comes up with the same idea and they're like, oh, well, why did this lab group look at X, Y, and Z?
• 38:10
  SPEAKER_00: And then they waste money doing it.
• 38:12
  SPEAKER_00: And they're like, okay, it doesn't work.
• 38:13
  SPEAKER_00: Then they keep it in their drawer.
• 38:14
  SPEAKER_00: And so the idea is taking these kind of null studies and putting them online.
• 38:20
  SPEAKER_00: Uh, there's a very specific database that I'm blanking on right now, but they're starting to build these sort of null studies, databases, so that you don't waste grant funding that might come from the federal government or a private, you know, charity organization so that there is not so much waste.
• 38:38
  SPEAKER_00: So that's one of the good things I'm seeing.
• 38:40
  SPEAKER_00: One of the other things is now they are kind of demanding you submit all the raw files, you know, all the all the Excel files, all the R files, all the raw data is now being submitted with uh the original data that you're presenting in the paper, so that we do see everything.
• 39:01
  SPEAKER_00: We see everything that worked, everything that didn't work.
• 39:04
  SPEAKER_00: And I mean, just that, you know, just at a personal level, you just always want to be skeptical of your own work.
• 39:09
  SPEAKER_00: Like that's the best way to prevent making any misleading statements is to, you know, don't be totally convinced by your own work.
• 39:18
  SPEAKER_00: Yeah, you should be your own worst critic.
• 39:20
  SPEAKER_00: And that's an easy thing to say, but when you you're trying to get a grant or you're trying to get a publication, that's that's really when it becomes a harder thing to stick to.
• 39:30
  SPEAKER_00: So I'd say just me personally becoming a more skeptical person, both about researchers that I believe, you know, researchers that I look up to.
• 39:39
  SPEAKER_00: Anyone can make a mistake, anyone can overstretch the truth.
• 39:44
  SPEAKER_00: So just holding everyone, holding everyone honest is is really the best way.
• 39:49
  SPEAKER_00: Be skeptical of yourself, be skeptical of everyone else.
• 39:52
  SPEAKER_01: And it's hard to be I no, it's it's I it's a mindset that I've kind of it's a very objective mindset, uh, you know, analytical.
• 40:02
  SPEAKER_01: But it's also, I mean, that comes with difficulties, right?
• 40:05
  SPEAKER_01: Because you see, I mean, not it comes with a variety of difficulties.
• 40:10
  SPEAKER_01: One side of them is just when you see the world in an extremely skeptical way, it's tough to question everything.
• 40:19
  SPEAKER_01: Yeah, yeah, yeah.
• 40:21
  SPEAKER_01: It's a hard world to live in, and I fully empathize with this.
• 40:24
  SPEAKER_01: It's a hard world to live in when you don't believe what anyone else says.
• 40:31
  SPEAKER_01: I mean, to an extent, right?
• 40:33
  SPEAKER_01: Yeah, but on the other, and then uh another issue with it is and this is a it is it's a positive as far as maybe research goes, is when you are skeptical, you tend to produce better results because you actually find out what the underlying reasons are.
• 40:49
  SPEAKER_01: You don't glance over things.
• 40:51
  SPEAKER_00: Um but how like so one of the ways to do this practically also is to do less of what uh this really brilliant guy that I want to do a lab research with this summer calls descriptive science.
• 41:06
  SPEAKER_00: And so descriptive science might be you do some cool CRISPR screen, or you you look at like a big genetic database and you find gene Y correlated with gene X or outcome X or whatever, and then you look at the mouse model and the correlations there again, and by the end of the experiment, you just have a whole lot of correlations.
• 41:28
  SPEAKER_00: You know, statistically, these things keep occurring together.
• 41:32
  SPEAKER_00: And so that's really what's called descriptive research.
• 41:35
  SPEAKER_00: But when you're actually gonna prove something's happening, you know, you want to start doing these knockout, knock-in experiments where it's like, okay, we knock it, we knock gene X out, and then we measure outcome Y, and we don't see the response we were expecting to see.
• 41:49
  SPEAKER_00: And then in that knockout, you then knock back in the gene and compare that to wild type.
• 41:55
  SPEAKER_00: And so it's like you do these kinds of on-off, you do these series of experiments.
• 42:00
  SPEAKER_00: And then you don't just look at it in the cell line, then you reproduce that whole setup in the mouse model.
• 42:05
  SPEAKER_00: And you know, you're looking at protein expression, so that's RNA.
• 42:10
  SPEAKER_00: This is a little cell biology, so I don't want to get too deep into that.
• 42:13
  SPEAKER_00: But it's like you're looking at one level of readout in the RNA.
• 42:16
  SPEAKER_00: Then you look at another level of readout, maybe in the DNA.
• 42:20
  SPEAKER_00: And then you want to, if it's something secretable that you can measure in a serum, okay, well, we want to pull it out of the serum and see it in the cells.
• 42:27
  SPEAKER_00: And so it's like at every step along the way, you're cutting something out and making sure you're not seeing signal, and then putting it back in and making sure you're seeing the signal equivalent to the original organism or setup that that the signal was produced from.
• 42:43
  SPEAKER_00: And so it's like by doing these really in-depth interrogations of the relationship between gene X and gene Y, that's where you can kind of keep the skepticism alive, and by the end of it, you can really say, well, okay, across organisms, across, you know, mediums, across uh levels of output, RNA, DNA, protein, we are seeing a consistent signal that is statistically significant, and we are now reasonably confident that that this is a major pathway or a drumble target.
• 43:22
  SPEAKER_00: So I'd say that's like a very just sort of, you know, put it in practice to an abstract theory.
• 43:29
  SPEAKER_01: Absolutely.
• 43:30
  SPEAKER_01: And I guess something that is really interesting for me, because I think this is it's I I understand that there's a very uh uh detail-oriented way of proving things.
• 43:41
  SPEAKER_01: Uh it's not that you should necessarily question everything, especially when people do good science.
• 43:46
  SPEAKER_01: But then this idea of skepticism and and of and of questioning things that are valid, how do you take that out?
• 43:56
  SPEAKER_01: How do you separate that from your research?
• 44:00
  SPEAKER_01: And your your own personal world?
• 44:02
  SPEAKER_01: Or do you find that you just become more special with people and right?
• 44:07
  SPEAKER_00: Yeah, no.
• 44:08
  SPEAKER_00: You know, you do end up becoming kind of a dick if you if you just have this.
• 44:14
  SPEAKER_00: I've found it even in my own life, you know, like I was always a funny guy.
• 44:17
  SPEAKER_00: I still think I'm a funny guy, but I I can't help the feeling that, you know, I'm becoming into one of those sort of like, you know, like smart asses, like, oh, you know it all.
• 44:27
  SPEAKER_00: I'm just so skeptical, huh?
• 44:29
  SPEAKER_00: Everything just makes sense to you.
• 44:32
  SPEAKER_00: You know, that that will, you know, from a very social perspective outside of the world of research, because you're gonna have a life outside of your research life.
• 44:40
  SPEAKER_00: Even if your wife is a scientist, you know, you talk to it to your kids or whatever, like you're gonna have to talk to the common person.
• 44:48
  SPEAKER_00: And there's this very real threat of sounding like someone that talks down to people.
• 44:55
  SPEAKER_00: And sometimes I can feel myself talking down to people, and I don't stop myself because you just feel like, well, how like how dare you have like a belief system like that, or you don't trust the science or any other sorts of belittling thoughts.
• 45:10
  SPEAKER_00: And yeah, you you there's a really high threat.
• 45:13
  SPEAKER_00: You know, that's the third thing I'm worried about in research.
• 45:15
  SPEAKER_00: I don't want to be that guy that's just like a dick.
• 45:17
  SPEAKER_00: Like, you don't even want him at the party, like you don't even want him at the gathering because he's just gonna get like you're having hot dogs and hamburgers, and he's telling you how the nitro groups can get ethylated by the grill, and it's it contributes to colon cancer and fail studies.
• 45:37
  SPEAKER_00: Like, no one wants that guy there.
• 45:39
  SPEAKER_00: I don't even want that guy there.
• 45:40
  SPEAKER_00: But it's like there's this very real threat of becoming that guy, you know.
• 45:45
  SPEAKER_00: You and it's the real the really great scientists aren't like that.
• 45:49
  SPEAKER_00: They have all the science and facts and truth, if that's what truth, that's one way of looking at truth, you know, whatever many ways of looking at it, but they have it all, and yet they just aren't like that.
• 46:03
  SPEAKER_00: They're e they're they're still curious, but they're not belittling.
• 46:08
  SPEAKER_00: And I think that's what separates the mature scientist from you know the younger scientist who's trying to climb that academic ladder and be a member of that that cast of the you know the so-called enlightened group.
• 46:21
  SPEAKER_00: You know, the you're you're always trying to prove it, and for some reason the way to prove it is by like, you know, gotcha, you know, getting people on leaves.
• 46:30
  SPEAKER_00: No, I gotcha.
• 46:31
  SPEAKER_00: No, that's it.
• 46:33
  SPEAKER_01: No, it's it's super interesting, and it's it's super relevant because a lot of people maybe take on that skeptical mindset for good reasons, and then it invades into their personal life, and like you're saying, they kind of become dicks.
• 46:48
  SPEAKER_01: I know I I've I've totally have I I probably still do that, and I it's something I I see, but you know, I guess the question is where do you draw that line where you it's not necessarily about accepting face value, but like where's the line where you stop asking questions to people in things not related to your research?
• 47:13
  SPEAKER_00: Yeah, yeah.
• 47:15
  SPEAKER_00: I mean, for me, like I'll I'll try and ask as many questions as I I like to gauge the person's excitement, you know.
• 47:22
  SPEAKER_00: If I just if I'm asking questions and you're just getting more and more offended that, like, why am I asking this?
• 47:28
  SPEAKER_00: Or these are simple level questions, that's usually what I'm like, all right, maybe we we nip this one in the butt, maybe I'll do a Google search on it later, some other whatever, get a different perspective.
• 47:37
  SPEAKER_00: But if the person's you know excited, like it's like when I I would talk to people at SMU about just stocks, you know.
• 47:43
  SPEAKER_00: For me, stocks, they're one-dimensional.
• 47:45
  SPEAKER_00: You buy them, you sell them.
• 47:46
  SPEAKER_00: Some people are better at it, but people just dive into like the theory of just cash.
• 47:52
  SPEAKER_00: And I'm like, I didn't even really know it was that deep.
• 47:55
  SPEAKER_00: And so I'll keep asking well, what about this?
• 47:57
  SPEAKER_00: Well, well, then how do you predict it under this?
• 48:00
  SPEAKER_00: And and well, what what other objective measures are you using?
• 48:03
  SPEAKER_00: And you know, it's like if they're engaged and they're exciting, I I mean, I I I love getting excited and engaged with what I know a lot about, and so it sounds like I can keep that vibe, I'll keep asking.
• 48:15
  SPEAKER_01: It sounds more than it's maybe, and I I I don't know exactly how to word this, but it's less actually about being skeptical, it's more about being curious, right?
• 48:27
  SPEAKER_01: It's finding things that excite you or excite other people.
• 48:30
  SPEAKER_00: Yeah.
• 48:32
  SPEAKER_00: Yeah, I think I think skepticism is a healthy thing to have both in the world and specifically in your field and in a field like science.
• 48:39
  SPEAKER_00: But I think more than that, curiosity allows you to open up almost an economy of thought.
• 48:47
  SPEAKER_00: So then we're like exchanging, like we started this conversation talking about you know the need for specialists and how you know the specialist is critical.
• 48:56
  SPEAKER_00: The specialist just knows more because they've been doing more.
• 48:58
  SPEAKER_00: And so when you get two specialists together, and everyone's a specialist in something, they might not even know it, but then you can exchange this information, and it's it really is almost like an economic exchange, uh, but it's one where you feel like you're not losing and they're not losing, like it's an actual win-win.
• 49:20
  SPEAKER_00: We're exchanging two pieces of information that are based on our specialties.
• 49:26
  SPEAKER_00: And me, so I don't know that much, I'm I'm gonna be a little skeptical, but more than that, I'm gonna be curious.
• 49:34
  SPEAKER_00: And so if I can give you that curiosity and you feed on it that energy, and then you give me back, you know, what what is the real deal?
• 49:43
  SPEAKER_00: What's behind the news?
• 49:44
  SPEAKER_00: I feel like that's really what people want nowadays.
• 49:47
  SPEAKER_00: They want the story behind the New York Times or the Wall Street Journal, sort of made for the masses generalization.
• 49:55
  SPEAKER_00: But we don't all want to read the Economic Times or Cell or, you know, like some sort of abstract theologian or or uh philosopher.
• 50:08
  SPEAKER_00: I think it is good for us to step out of our boundary, but we can't read it all.
• 50:11
  SPEAKER_00: We can't do it all.
• 50:12
  SPEAKER_00: So that's why we have other specialists to kind of you know give us their take on it.
• 50:18
  SPEAKER_00: And so I think yeah, it's it's it's more of a curiosity thing.
• 50:22
  SPEAKER_01: Why is I mean, no, and I I see I totally agree with that sentiment, and I think it's this kind of general idea that people want it's and it's kind of BS to just say the truth, but they want to see something authentic, you know?
• 50:40
  SPEAKER_01: And it sounds to me like your form, one of your forms of being an authentic person is this you know, this sense of curiosity.
• 50:49
  SPEAKER_01: Do you know why do you why does it make you so maybe proud to be like a curious person?
• 50:56
  SPEAKER_00: Uh yeah, I don't even know if I'd say I'm proud about it.
• 51:01
  SPEAKER_00: I've never attached that sort of emotion to it, but I do just, you know, I I I it's maybe from like uh a childhood growing up, like I was one of those dinosaur kids, like with dinosaurs, there's these things.
• 51:15
  SPEAKER_00: Like, I feel like when I was growing up, I felt like people weren't talking enough about it.
• 51:18
  SPEAKER_00: I'm like, okay, this is maybe millions of years ago, but this this is pretty important that these things are here.
• 51:23
  SPEAKER_00: And so it was like learning about them, and you know, you go through the whole history timeline and all that.
• 51:30
  SPEAKER_00: But I I also feel like like people in general, that's that's what makes us where we are today.
• 51:37
  SPEAKER_00: We're sitting in our houses talking via Skype through iPhone technology.
• 51:44
  SPEAKER_00: You know, why aren't we in in the in the in the environment with the rest of the you know the natural living kingdom?
• 51:52
  SPEAKER_00: Yeah, and it's because our ancestors were curious, they wanted to know more about stuff, you know, eating, reproducing, and staying alive didn't quite cut it.
• 52:01
  SPEAKER_00: There was more time left in the day when you weren't being killed or starved.
• 52:06
  SPEAKER_00: And it's it's just kind of like, well, how do you fill that time?
• 52:11
  SPEAKER_00: Boredom is what sets in, and to overcome that bored, like in between fighting for your life or anything else, some of our ancestors were just bored, and they then that led them to curiosity, and that curiosity has shaped us forever.
• 52:28
  SPEAKER_00: We've, you know, in a lot of ways escaped the natural order of natural selection, of environmental pressure, you know, we still have those things, but we don't have to wait for a third of the population to die, and then the survivors, you know, come up with some mutation that'll yeah, like we can just think about something for long enough and then initiate change and say, Yeah, I think that's just the way I look at people in general.
• 52:55
  SPEAKER_00: Like we're all curious about something.
• 52:57
  SPEAKER_00: You know, I know people that say they're not curious, they are, they just don't know how to phrase it.
• 53:02
  SPEAKER_01: Right.
• 53:03
  SPEAKER_01: No, and I I I can see then from this your perspective, why maybe proud isn't the right word.
• 53:10
  SPEAKER_01: But it does, I mean, you clearly are very passionate about this idea.
• 53:14
  SPEAKER_01: And it I would say maybe the better word would be it, it brings you like a sense of like a reward, like a sense of fulfillment when you ask the right question, you know.
• 53:23
  SPEAKER_01: There's an excitement to it.
• 53:26
  SPEAKER_00: Yeah.
• 53:27
  SPEAKER_00: No, I mean that's that's uh that's that's that's like the tagline for PhD.
• 53:32
  SPEAKER_00: They're like, don't go for the sexy new uh uh procedure, or or you know, there's there's always gonna be new procedures and new methods.
• 53:43
  SPEAKER_00: It's it's really when you get to the top of the game in your field, it's about asking the good questions.
• 53:49
  SPEAKER_00: And so I think even now, that's what gives me the most joy uh at this part of my training because I have I've only done a couple internships.
• 53:58
  SPEAKER_00: I have not quite transitioned into grad school yet.
• 54:00
  SPEAKER_00: That happens later this summer.
• 54:02
  SPEAKER_00: But at our at our uh like weekly meetings, well, back when we had in-person weekly meetings for dinner, and it's like you listen to this guy, he talks about his research, he gets kind of in depth, and then you might see something, and you're starting to phrase the question halfway through the talk, and then you ask the question, and then the presenter will actually say, Well, hmm, that's a very good question.
• 54:26
  SPEAKER_00: You should look into that, and that's when you kind of feel like you're like, Wow, that's that was a good question.
• 54:31
  SPEAKER_00: How cool is that feeling?
• 54:33
  SPEAKER_01: Oh my gosh, how cool is that feeling?
• 54:37
  SPEAKER_00: Oh, it's the best.
• 54:38
  SPEAKER_00: It's I mean, you feel it, you don't want to smile because once again, then you're shifting towards the dick, you know.
• 54:46
  SPEAKER_00: No, no, you're just so excited.
• 54:48
  SPEAKER_00: No, it's it's great.
• 54:49
  SPEAKER_00: It's it, I do like love it.
• 54:51
  SPEAKER_00: And I mean, I've even like heard other MSDPs like ask, like, well, you know, how do you like what goes into asking a good question?
• 55:00
  SPEAKER_00: And I'm like, I I mean, normally it's just something I want to know.
• 55:03
  SPEAKER_00: I saw their data, and there's just this one thing missing out, and maybe they're working on it, and that's that's the other funny part.
• 55:12
  SPEAKER_00: Sometimes you ask the question.
• 55:14
  SPEAKER_00: I've seen lots of other older MSGPs ask this because it's like as you get older, they just ask better qualities of questions that come from years of experience.
• 55:23
  SPEAKER_00: And I'm like excited to like, oh, I can't wait till I'm asking those questions.
• 55:27
  SPEAKER_00: I didn't even think of that.
• 55:28
  SPEAKER_00: Yeah, and then the presenter will be like, Well, I'm glad you asked that question.
• 55:32
  SPEAKER_00: We just did that experiment last week.
• 55:34
  SPEAKER_00: Let me show you the next slide.
• 55:36
  SPEAKER_00: Yeah, sometimes they have it, but other times they're like, I only looked at one outcome, but it actually does seem to be that that that very thing you have to question about is in fact what's going on.
• 55:48
  SPEAKER_00: And it's like you're predicting, you know, it's you're seeing the results and the outcome before they even come.
• 55:54
  SPEAKER_00: That's that's I mean, that's there's nothing that beats that.
• 55:57
  SPEAKER_00: Seeing the future, you know, that's the soothsayer, the fortune, the fortune teller.
• 56:03
  SPEAKER_01: No, I mean it it ties into what we were talking about maybe 30 minutes ago, which is the point of research, maybe not the point, but one of the results of medical research is that it provides hope.
• 56:17
  SPEAKER_01: And it's like one of a very tangible reason why people might do it is that you feel like you're providing like at least the potential for a new cure or a new procedure that could help.
• 56:28
  SPEAKER_01: And yeah, and I love then that being followed up with, well, what does that actually feel like?
• 56:34
  SPEAKER_01: And the feeling of providing that is like that excitement you get by asking the right question where everyone else kind of pauses for a moment and thinks, you know, especially as a young person, I I've had that feeling a couple times before where I asked something and then the room kind of got quiet, and they're like, And you know, I'm like fist bumping under the table.
• 56:56
  SPEAKER_00: I know the feeling.
• 56:57
  SPEAKER_00: No, yeah.
• 56:58
  SPEAKER_00: You asked the right question, everyone looks around like, look at this guy asking tough questions.
• 57:05
  SPEAKER_01: I love that.
• 57:06
  SPEAKER_01: I absolutely love that.
• 57:09
  SPEAKER_01: Oh my gosh.
• 57:11
  SPEAKER_01: Yeah.
• 57:12
  SPEAKER_01: No, especially because it it it's not just the quality of the question.
• 57:21
  SPEAKER_01: I guess it's kind of also a uh talks to like the amount of work you were willing to put in to understand it, you know.
• 57:31
  SPEAKER_01: Because in order to ask questions, you have to really know what's going on.
• 57:36
  SPEAKER_00: Oh yeah, yeah.
• 57:39
  SPEAKER_00: I mean, it's it's almost like a like a detective story.
• 57:41
  SPEAKER_00: Like, I don't know if you saw the movie with Will Smith, iRobot.
• 57:46
  SPEAKER_00: Yeah, of course.
• 57:47
  SPEAKER_00: Hilarious movie, you know, very good, very early 2000s sci-fi.
• 57:52
  SPEAKER_00: But I just remember where Will Smith's character, uh Detector Spooner, he's like interacting with a hologram of the dead guy whose murder he's trying to solve.
• 58:04
  SPEAKER_00: And he just keeps saying, like, I am a limited responding, you know, recording.
• 58:11
  SPEAKER_00: You have to ask the right questions in order to get the response.
• 58:14
  SPEAKER_00: And then at one point, midway through the movie, he asks something about like, you know, the robots or like why, like, why the robots are acting this way now.
• 58:23
  SPEAKER_00: And then the hologram says, like, that detective spooner is the right question.
• 58:29
  SPEAKER_00: And so it's kind of like you do feel like in research, you're just throwing stuff against the wall, and the hologram is just telling you, like, I only have limited responses.
• 58:38
  SPEAKER_00: You have to ask the right questions, and then eventually you do ask the right question that is, you know, the breadcrumb that leads you to solving the mystery.
• 58:50
  SPEAKER_00: You know, you're as a researcher, you're like a Sherlock Holmes kind of guy.
• 58:53
  SPEAKER_00: You're looking at a crime scene, which is the disease, and then there's these breadcrumbs that are leading you towards something more, and you just gotta you gotta put it all together.
• 59:02
  SPEAKER_00: You gotta you gotta solve the crime.
• 59:04
  SPEAKER_01: That's fascinating.
• 59:05
  SPEAKER_01: No, I it's a it's a really good analogy.
• 59:08
  SPEAKER_01: Um, it's it's a really wonderful analogy, and it's a funny story to use as an analogy.
• 59:18
  SPEAKER_01: Oh who knew Will Smith would teach us so much?
• 59:22
  SPEAKER_00: Oh, yeah.
• 59:22
  SPEAKER_00: Will Smith, man, he taught me a lot.
• 59:24
  SPEAKER_00: So fresh prints, uh I robot, I am legend.
• 59:30
  SPEAKER_01: I guess, and I I don't want to take too much of your time, but kind of one thing I'm really interested in.
• 59:38
  SPEAKER_01: I mean, I really enjoyed this conversation.
• 59:41
  SPEAKER_01: It's been fun hearing how you kind of got into science and then how the nitty-gritty aspect of like the SMU lab and the longer commitments gave you kind of a better perspective of the the work necessary, but also the put the possibility, right?
• 59:58
  SPEAKER_01: Of what the things that are possible from doing research.
• 1:00:01
  SPEAKER_01: And then how you've kind of taken this all in mentality, which is obvious because you've jumped into a huge ass program.
• 1:00:11
  SPEAKER_01: Um but it's been really interesting to hear about kind of the the reason why maybe you're doing some of this, which is this curiosity and this desire to ask the right questions in order to provide like a better future for patients, a better future for the doctors who are doing these procedures, right?
• 1:00:34
  SPEAKER_01: And I guess one thing I'd be interested in is who or what do you feel the responsibility to ask those questions for or to do that work for?
• 1:00:45
  SPEAKER_00: Yeah.
• 1:00:46
  SPEAKER_00: So I mean, uh there's, you know, like a lot of your questions, a lot of ways to answer that.
• 1:00:52
  SPEAKER_00: Uh, for one, you know, what we're seeing nowadays with the demonstrations in the streets, a lot of it is, you know, sparked by the George Floyd, like that's the tangible trigger, but there's this underlying set of conditions that much like a disease in in a living person, uh, there's underlying sets of genetic, of behavioral, of you know, certain insults you introduce to the body, the physiology, the tissues, the genes themselves that prime a person to undergo a disease process.
• 1:01:30
  SPEAKER_00: The disease isn't just a thing, it's the emergent result of lots of things that have gone wrong.
• 1:01:38
  SPEAKER_00: And so I think one of the things that have gone wrong, maybe in this country, is the relationship with you know African Americans, minorities, with medicine.
• 1:01:48
  SPEAKER_00: And so there is definitely on the part of all the other, you know, members of underrepresented ethnic groups, especially the African Americans at WashU and other MD PhD programs, uh, just the people that I met on the interview trail, I've stayed in touch with them.
• 1:02:05
  SPEAKER_00: There is this sort of idea that it's like, you know, when we had more women, for instance, enter medicine, we started seeing more research addressing sexual differences to in presentations of disease and treatments of disease.
• 1:02:24
  SPEAKER_00: And you are actually now to some degree starting to see better treatment outcomes because the archetypal, you know, medit like most of the disease described in medicine described in men.
• 1:02:38
  SPEAKER_00: And outside of obigeine specific, you know, issues that you just can't describe in men, and so you you have to describe in women, uh the the a lot of it was sort of biased, and that was leading to worse outcomes.
• 1:02:53
  SPEAKER_00: And so the same happens when it comes to ethnicity and race.
• 1:02:58
  SPEAKER_00: And so I do think it is important for me to ask questions that will impact members of my own community, because most of medicine in America has been done for a predominantly white population, even if early experiments actually would have used everyone from prisoners who may have been African-American slaves, obviously African-American, or just people who are, you know, poor.
• 1:03:31
  SPEAKER_00: I mean, we saw that all the time at the NIH.
• 1:03:33
  SPEAKER_00: There is like a limit to like how much money you could offer max to participate in certain studies because you don't want it to become this thing where we're paying you to use your body as a physiological experiment.
• 1:03:49
  SPEAKER_00: You know, that's that's also sort of uh uh uh an issue.
• 1:03:53
  SPEAKER_00: And so, you know, I do really want to eventually focus on you know what the the questions that will ultimately impact people that will look like me.
• 1:04:06
  SPEAKER_00: You know, you want to focus on the questions for everybody, you know, I want to treat all patients, but definitely acutely looking at the drivers of cancer, of inflammation, uh, both in society but also within us, specifically as an ethnic group, uh that result in our different outcomes in cancer.
• 1:04:28
  SPEAKER_00: And you know, you you don't have to have too much imagination to believe that across the board a lot of outcomes in cancer are much worse than African Americans.
• 1:04:38
  SPEAKER_00: That's true for breast cancer, that's true for uh endometrial cancer.
• 1:04:43
  SPEAKER_00: Oh, yeah, yeah.
• 1:04:44
  SPEAKER_00: I mean that's and that that that's a whole nother dynamic with infectious disease.
• 1:04:48
  SPEAKER_00: But so yeah, same story.
• 1:04:51
  SPEAKER_01: And I love that perspective, especially because in my head, it probably sounds like being an African American in this really cool place that ties into what we were talking about before, which is you need to ask the right questions.
• 1:05:10
  SPEAKER_01: And so with your background, you may be able to ask better questions that could help out other African Americans, right?
• 1:05:19
  SPEAKER_00: Yeah, yeah.
• 1:05:21
  SPEAKER_00: In theory, that is that definitely, or you know, ask them in a way that includes that aspect, you know, that treats that as an actionable, not an actionable variable in the sense that you can change it, but treats it as something unique and with its own, you know, assigned risk and to mitigate those risks or treat those specific parts uh more specifically in order to boost you know the outcomes.
• 1:05:49
  SPEAKER_01: Yeah.
• 1:05:49
  SPEAKER_01: Yeah.
• 1:05:50
  SPEAKER_01: And if if even just you know being in the conversation where, you know, someone, a group of people ask a set of questions, and then you're here going.
• 1:06:00
  SPEAKER_01: I think you left someone out, right?
• 1:06:02
  SPEAKER_00: Yeah, yeah, yeah, yeah.
• 1:06:03
  SPEAKER_00: No, that's that's I mean, that's kind of the dynamic that uh there's this guy named Will Ross at WashU.
• 1:06:08
  SPEAKER_00: He's a prominent African-American nephrologist, he's one of our deans, superstar.
• 1:06:13
  SPEAKER_00: Everyone knows him on campus, highly published guy, both in terms of basic science and then later in life, more public health initiatives.
• 1:06:21
  SPEAKER_00: Uh, but it's kind of this idea that I heard from him and several others in the past is having a seat at the table.
• 1:06:27
  SPEAKER_00: You know, there's just certain tables that exist in America and every society that will make the decisions that matter.
• 1:06:34
  SPEAKER_00: You know, you can agitate, you can demonstrate, you can do all those sorts of things in the street, but at the end of the day, there's gonna be a table where they write down the actionable items.
• 1:06:45
  SPEAKER_00: Yeah.
• 1:06:45
  SPEAKER_00: And the only way to change that list is to have a seat at the table, even if they don't take your suggestions, which many times they won't or they don't for a variety of reasons, just being there.
• 1:07:00
  SPEAKER_00: So it's like, okay, well, the next list I'm gonna get one of my suggestions on.
• 1:07:04
  SPEAKER_00: It's it's having a seat at that table is very, very important.
• 1:07:10
  SPEAKER_00: And then also being able to communicate that back to the patient because there are a lot of minorities in general that have a skeptical, you know, we talk about this idea of skepticism, it works in reverse.
• 1:07:23
  SPEAKER_00: There are people that have been, you know, functionally screwed over by the American healthcare system and ignored.
• 1:07:31
  SPEAKER_00: And so there's this sort of like, well, what are they in center?
• 1:07:34
  SPEAKER_00: Well, why really should they believe what you're saying outside of maybe they aren't well read on the PubMed literature health, but they know that their mother, when they went in for breast cancer or for something, you know, didn't receive good treatment and may or may not have died as a result of that.
• 1:07:52
  SPEAKER_00: What incentive, like, why would they believe it would be any different now?
• 1:07:56
  SPEAKER_00: Just because we've moved forward in time, yeah, maybe we haven't, maybe we have.
• 1:08:00
  SPEAKER_00: Uh so being able to, you know, it's almost going in reverse and sort of not challenging the skepticism because the skepticism is valid, honestly, at the end of the day, but being able to say, you know, like I am of the group as well.
• 1:08:19
  SPEAKER_00: I've seen the table, I've tried to, you know, add some items to the list, changes of this that mattered, and I am advocating for you because, you know, I'm treating you because I am you.
• 1:08:32
  SPEAKER_00: And then when I'm in your position, if I'm ever in your position, those that I help get here will then be treating me.
• 1:08:39
  SPEAKER_00: So it's kind of like, you know, this chain of this chain of support, not even really a chain of command, but it's like a chain of support.
• 1:08:46
  SPEAKER_00: Like I I personally have your back, even though you may not think American medicine as a whole has your back.
• 1:08:56
  SPEAKER_00: That's it's really important to kind of emphasize that.
• 1:08:59
  SPEAKER_01: No, it's it's create like the creation, maybe a recreation of trust or the establishment of trust, even.
• 1:09:06
  SPEAKER_01: Yeah.
• 1:09:06
  SPEAKER_01: Um, that's really powerful.
• 1:09:08
  SPEAKER_01: It sounds like that is a heavy responsibility to take on.
• 1:09:19
  SPEAKER_00: Yeah, yeah, I'd say, you know, it's just kind of added to the list.
• 1:09:23
  SPEAKER_00: Like medicine in general, you know, you're you're pretty responsible.
• 1:09:27
  SPEAKER_00: You mix it up, you mix up the drug-drug interactions, you mix up the patient name, you know, it's it's it's the profession is responsibility.
• 1:09:36
  SPEAKER_00: You're not ready for responsibility.
• 1:09:38
  SPEAKER_00: You are uh you're in the wrong, you're on the wrong job.
• 1:09:42
  SPEAKER_00: But I I do no, it is very true that you know it's a it's an added level of responsibility, and it's one that, like everything else, you gotta be all in for it.
• 1:09:52
  SPEAKER_00: That's the only way to be able to balance all this.
• 1:09:54
  SPEAKER_00: You can't blame the rim ladies.
• 1:09:56
  SPEAKER_00: Yeah, yeah, you can't blame the rim, you know.
• 1:09:57
  SPEAKER_00: And the rim is actually sometimes set up against you, but you know, when you lose, the patient loses.
• 1:10:04
  SPEAKER_00: So it's it's not just about you subjectively losing, it's it's you gotta have a win at all cost mentality.
• 1:10:11
  SPEAKER_00: You know, if the rim's off, if the gym slanted, well your patients lose.
• 1:10:16
  SPEAKER_00: So you gotta find a way to shoot in the slanted gym in a bent rim.
• 1:10:21
  SPEAKER_00: Figure it out.
• 1:10:22
  SPEAKER_00: You know, you're smart.
• 1:10:23
  SPEAKER_00: Get a team, get on it.
• 1:10:33
  SPEAKER_01: I want to thank Noah for that energizing conversation.
• 1:10:37
  SPEAKER_01: His adventure of becoming a medical scientist is such a privilege to witness and hear about.
• 1:10:41
  SPEAKER_01: He has a great take on personal responsibility and commitment, with the all-in mentality that once you go for something, it's on you to roll with the twists and turns.
• 1:10:50
  SPEAKER_01: As he puts it, you can't blame the rim.
• 1:10:53
  SPEAKER_01: I love that because it shows both awareness of the reality of a situation and optimism that something can be done to change it.
• 1:11:00
  SPEAKER_01: Likewise, I really connect with his enjoyment of being curious.
• 1:11:04
  SPEAKER_01: I believe that the ability to balance emotion and empathy with objectivity is difficult.
• 1:11:09
  SPEAKER_01: But Noah shows that learning to walk that line opens up the biggest opportunities to create positive change.
• 1:11:16
  SPEAKER_01: Not only that, but asking the right questions and doing the hard work necessary to answer them leads directly to the production of hope.
• 1:11:23
  SPEAKER_01: It teaches me that by asking the tough but worthy questions, I might find the best ways to navigate life and help others.
• 1:11:31
  SPEAKER_01: And maybe it does the same thing for you too.
• 1:11:34
  SPEAKER_01: Thanks for listening.
• 1:11:40
  SPEAKER_01: If you liked this episode of Seeking Authenticity, that's freaking awesome.
• 1:11:45
  SPEAKER_01: All I want to ask of you, the listener, in return for the time and effort I put into making it, is that you take a deep breath.
• 1:11:52
  SPEAKER_01: I mean really breathe.
• 1:11:54
  SPEAKER_01: Breathe so that it stretches out your shoulders and your back and your chest and pushes out your stomach.
• 1:12:00
  SPEAKER_01: No more of these shallow, bullshit breaths.
• 1:12:02
  SPEAKER_01: They're barely keeping you alive, my friend.
• 1:12:04
  SPEAKER_01: And after you exhale, go out and soak up today.
• 1:12:08
  SPEAKER_01: Because in the end, your actions and the way they interact with the world and the people around you right now are all you have in this life.
• 1:12:16
  SPEAKER_01: So be authentic with them.
• 1:12:18
  SPEAKER_01: Peace.