Outspoken Oncology

A radiologist tweets a joke about COVID-19 and a cardiologist tweets a serious note on the role of doctors in shaping social policy. Both are met with similarly outraged reactions. Saurabh Jha (@RogueRad), MBBS, MRCS, MS, and John Mandrola (@drjohnm), MD, share with Chadi the immediate aftermath of their tweets and reflect on how social media has become intolerant of diverse opinions. You don't want to miss this unfiltered episode with two of the most prolific physicians on Twitter.

Chadi invites Mary L (Nora) Disis (@DrNDisis), MD, editor-in-chief of Jama Oncology, to learn the ins-and-outs of what it takes to be the lead editor of a highly prestigious oncology journal. She shares what went into her decision to accept the editor-in-chief position and help launch the journal in 2015, what goes into her thought process for rejecting submissions and handling disgruntled authors, management and pain points of “content” and “statistical” peer-reviewers, thoughts on the oversaturation of poorly written COVID-19 papers published in high-impact journals, and plans for the future direction of the journal.

Pamela Kunz (@PamelaKunzMD), MD, director of the gastrointestinal cancers program, Yale University School of Medicine, divulges the subtle microaggressions and power differentials that she and other women experience as they find success in academic medicine, including public undermining of leadership roles and challenges of establishing relationships with pharmaceutical companies for research grants. She explains how she found the courage to speak about these experiences as she was leaving an institution, the fear of retaliation, and her hopes to not only empower other women to speak up, but also to bring further awareness to these issues. Read Dr Kunz's article in Mercury News on the culture of gender discrimination at her previous institution (https://www.mercurynews.com/2020/06/22/stanford-medical-school-professors-say-gender-discrimination-and-harassment-allowed-to-flourish/).

After a 2 month pause, Emily Landon (@emilymicheleL), MD, executive medical director of infection prevention and control, University of Chicago, returns for her eighth appearance on the show to comment on which COVID-19 population statistics should be considered most important for determining societal policy effectiveness, whether asymptomatic people are as likely to spread the virus as symptomatic people, the best types of masks for everyday people, the nuances of schools reopening with remote vs in-person learning, and the vaccine landscape as it currently exists.

Chadi brings on two Lebanese doctors living in Beirut to discuss the tragedy that shook the nation earlier this month. Zakia Dimassi (@ZakiaDimassiMD), MD, MHPE, and Mohamad Ali Cheaito (@MohamadAliChea1), MD, recount their first-hand experiences of the moment the explosion happened, how poorly enforced COVID-19 safety regulations exacerbated the health crisis before the explosion and will likely continue to in the coming days, the hospital environment in the immediate aftermath, and more.

Benjamin Davies (@daviesbj), MD, professor of urology, University of Pittsburgh, shares the facts behind the true devastation that the opioid crisis is inflicting on the US; the blame that pharmaceutical advertising, inappropriate prescribing, and formulation of drugs have on the opioid crisis; the origins and early warning signs of the crisis; and whether there is data to suggest how much the crisis is costing the health care system.

Leah Sera (@leah_sera), PharmD, MA, BCPS, associate professor of pharmacy practice and science, University of Maryland, shares the details and her role as the Program Director of the University's Master's program in Medical Cannabis. She details how cannabis can be used as a medicine to treat conditions such as pain, nausea, and muscle spasms, and she also explains the difficulty in researching cannabis in a clinical setting. View Leah Sera's faculty profile https://faculty.rx.umaryland.edu/lsera/ View the University of Maryland's Master's program in Medical Cannabis https://shadygrove.umd.edu/academics/degree-programs/ms-medical-cannabis-science-and-therapeutics

Chadi sits down with a survivor of ovarian and breast cancer as well as her physician — a key advocate for a survivorship program at Advocate Healthcare System. The trio discuss the fault in the term “survivor” and why many patients reject this label, training that physicians need to better counsel patients on survivorship and everyday life, and the level of psychological and financial support that these patients need at every intersection of their journey.

Jack West (@JackWestMD), MD, City of Hope Comprehensive Cancer Center, and Nathan Pennell (@n8pennell), MD, PhD, Cleveland Clinic, debate the results of the ADAURA trial presented as a plenary session at the 2020 ASCO virtual meeting, especially the extrapolation from DFS to OS, balance of chemotherapy administration in the treatment arms, lumping of varying disease stages in treatment arms, and severity of toxicity issues.

Mikkael Sekeres, MD, MS, director of the leukemia program, Cleveland Clinic, and esteemed author, essayist, and op-ed writer, discusses his latest work “When Blood Breaks Down” and the human interactions with leukemia patients that set the backdrop for discussions in the book. Read Chadi's review of the book at https://thehealthcareblog.com/blog/2020/07/02/when-blood-breaks-down-it-can-break-your-heart/

Arghavan Salles, MD, PhD, scholar in residence, school of medicine, Stanford University, discusses “stereotype threat” and the challenges that women face when training to become surgeons, methods of researching gender inequity and bias in medicine, and bias against foreign medical graduates.

Chadi checks in with Graham Collins, David Steensma, and Vincent Rajkumar to discuss the most prevalent and noteworthy clinical research from the EHA meeting for Hodgkin lymphoma, MDS and AML, multiple myeloma, and DLBCL.

Cristiane Bergerot (@crisbergerot), PhD, health psychologist, City of Hope National Medical Center, discusses when patients should be involved with a psycho-oncologist, whether the psychological state of a patient has an impact on treatment outcomes, pre-diagnosis factors that may put a patient at higher risk of depression, and more.

Anish Koka (@anish_koka), MD, cardiologist in Philadelphia, and Saurabh Jha (@RogueRad), MD, radiologist in Philadelphia, discuss the initial reaction by MedTwitter to the pandemic outbreak, when the community realized it was a serious situation at hand, and the dangers of "politicizing" all aspects of the discussion.

Adam Cifu (@adamcifu), MD, internest in Chicago, and Michel Accad (@michelaccad), MD, cardiologist in San Francisco, debate how much evidence is needed for interventions during COVID-19, whether a short time frame to act calls for less scientific rigor in supporting interventions, and the reliance on RCTs vs other means of information.

Colleen Farrell (@colleenmfarrell), MD, internal medicine resident in NYC, shares the stresses experienced by medical residents treating COVID-19, the physical impact of being on the front lines with extended hours, and a harrowing personal story of the emotional toll of being engrossed in the hospital environment during these times.

Emily Landon, MD, executive medical director of infection prevention and control, University of Chicago, makes her seventh appearance on the show to discuss phased plans to reopen across the country, including how to keep the spread of the virus under control while interacting in indoor settings (eg, barber shops, gyms, airplanes, and restaurants), the importance of furthering contact tracing, and more.

Anita Gruninger, RN and certified case manager, discusses the difficulty of not being with her husband when he receives cancer treatment due to COVID-19, argues that "family" and "visitors" need to have different definitions when it comes to hospital visitation as well as exceptions that should be made for critically ill patients, and more.

Ethan Weiss (@ethanjweiss), MD, associate professor, Cardiovascular Research Institute, University of California at San Francisco, tells his story of volunteering to treat patients in NYC during the COVID-19 outbreak, including expectations of the work he was to do in advance of volunteering, adjusting to a new hospital environment, deciding to chronicle the volunteering experience and subsequent work, and the viral Twitter picture he posted on a crowded plane as he flew home. Dr Weiss' bio can be viewed at https://profiles.ucsf.edu/ethan.weiss

Nilay Shah, PhD, chair of the division of health care policy and research, Mayo Clinic, explains the information and factors that go into the predictive models for the impact of COVID-19; examines the reliability of the Susceptible, Exposed, Infected, and Recovered (SEIR) model for policy decisions; breaks down some of the confounding effects of various input assumptions on the models; and more.

Barron H. Lerner, MD, PhD, a professor of medicine, bioethicist, and 5-time book author at New York University, shares his personal journey of contracting and being treated for COVID-19, thoughts on the usefulness of antibody tests and convalescent-based plasma treatment, ethical considerations of treating patients with experimental therapy, and the balance between patient autonomy and physician paternalism.

Emily Landon, MD, executive medical director of infection prevention and control, University of Chicago, makes her sixth appearance on the show to discuss practical considerations for "ramp-up" testing, what a negative test result really means (or does not mean) and how often to repeat the test, updates on data for remdesivir, and more.

Adam Feuerstein, national biotech columnist, STAT, provides a look into the complexity of reporting on biotech and health care advancements, the shift in STAT's editorial focus to COVID-19 coverage from a science and biotech perspective, and other topics.

Michael Sinha, MD, JD, MPH, research fellow, Harvard-MIT Center for Regulatory Science, dissects the legality of international and domestic travel bans from a health policy perspective, the nuances of state-level authority to enforce a lockdown, the rights of health care workers to refuse reporting to work in the absence of ample and appropriate PPEs, and more.

Seth Trueger, MD, MPH, FACEP, emergency physician at Northwestern University, shares the steps taken in an emergency room setting to prepare for an influx of patients, screening processes for patient admissions, triage steps for patients who arrive at the door, and concerns of misdiagnoses, among other topics.

Emily Landon, MD, executive medical director of infection prevention and control, University of Chicago, returns to discuss crucial considerations for reopening the country, reactions to the way infection control experts have handled new information, and the overreaction to a recent preliminary report from the University of Chicago on a potential treatment option.

Vincent Rajkumar, MD, and Rafael Fonseca, MD, both multiple myeloma specialists at Mayo Clinic, discuss the prospect of opening the country before a vaccine is developed for COVID-19; whether the decisions should be made on a county-, state-, or regional-level; and the critical need for a "TTP" approach: widespread adequate Testing, contact Tracing, and PPEs.

Alison Bateman-House, MPH, PhD, department of population health, NYU Langone Health, returns to discuss the ethics of "expanded access" and "Right To Try" when treating COVID-19, health care workers refusing to report to work if proper PPEs are not available, medical students graduating early to join the frontlines, practicing selective care due to scarce resources, and more.

Nurses from Chicago and California join Chadi to discuss when their institutions began preparing for an influx of COVID-19 patients, conflicting information from their institutions regarding PPE supplies, ease of complying with CDC/WHO guidelines for sanitizing used PPEs, and more.

Emily Landon, MD, executive medical director of infection prevention and control, University of Chicago, returns for her fourth update on COVID-19 testing options and timeliness, whether asymptomatic patients with the disease can transmit it to others, a simple and helpful practice to keep patients needing more oxygen off the ventilators, and more.

Peter Antevy, MD, EMS medical director and founder of Handtevy, describes his bout with COVID-19 as a medical professional, breaks down some of the latest tests being used with rapid turnaround times, projects the coming reality of a national mechanism for instant testing in public places, and more.

Niesha Griffith, RPh, MS, FASHP, interim chief pharmacy officer and executive director at a freestanding cancer center on the West Coast, and Michael Ganio, PharmD, MS, BCPS, FASHP, director of pharmacy practice and quality, American Society of Hospital Pharmacists (ASHP), provide varying perspectives on the potential of drug shortages (eg, pain medications, cancer therapies, and hydroxychloroquine) emerging during the COVID-19 pandemic, as well as how the supply chain functions through the ASHP when a shortage is identified.

Cam Harvey, PhD, professor of finance, Duke University, shares how his June 2019 prediction of a recession in 2020 is being further fueled by COVID-19, compares the pandemic to the likes of the Spanish Flu and SARS in terms of "systemic risk," breaks down the finances of the recently enacted CARES Act, floats the idea of a federal strategic medical equipment reserve, and more.

Emily Landon, MD, executive medical director of infection prevention and control, University of Chicago, returns to share valuable information on COVID-19 testing, ethical dilemmas regarding treatment decisions, proper N95 mask reuse and disposal, potential of durable immunity to the virus, and more.

Stefano Luminari, MD, associate professor of oncology, University of Modena (Italy), provides an update on the COVID-19 situation in Italy, including operational measures undertaken when there was an increase in demand for ICU hospital beds, the country's underestimation of the serious of the disease at the beginning of the outbreak, how hospital staff are protecting themselves from the virus, and more.

Priya Sampathkumar, MD, infectious disease specialist and hospital epidemiologist, Mayo Clinic, breaks down truths and misconceptions of which types of individuals should wear masks in public, proper gown and mask use for health care providers treating and not treating COVID-19, when N95 masks are truly needed and reasons for the potential shortage, and more in this provocative discussion.

Chadi welcomes back Rafael Fonseca, MD, interim executive director, Mayo Clinic Comprehensive Cancer Center, to discuss the steps that large cancer centers should take to protect their patients as well as staff from COVID-19 infection, specific measures that Mayo Clinic has taken for developing in-house testing, and more.

Chadi welcomes back Emily Landon, MD, executive medical director of infection prevention and control, University of Chicago, to provide updates on issues of state-funded COVID-19 testing and laboratory resources, management considerations for immuno-compromised patients in oncology clinics, importance of social distancing and isolation to limit the strain on local health systems, and more.

David Mitchell, president and founder of Patients for Affordable Drugs, discusses the importance of reducing out-of-pocket costs and premiums for patients, the need for an entity to recommend costs for novel therapies to payers, pieces of legislation that address drug patent "abuse" on the part of manufacturers, and more.

Emily Landon, MD, executive medical director of infection prevention and control, University of Chicago, breaks down current exposure risk and mortality rates of COVID-19, preventative steps to avoid exposure, and promising therapies on the horizon.

Rafael Fonseca, MD, and Saurabh Jha, MD, debate the benefits and disadvantages of a third-party vs single payer system, whether Medicare has been a successful program for qualifying patients. and the fairness of judging the health care system based on life expectancy. To read more about our host Chadi Nabhan and access exclusive materials and information about guests, visit journalofclinicalpathways.com/podcasts/outspoken-oncology. Journal of Clinical Pathways is the exclusive producer of the Outspoken Oncology podcast.

Sayeh Nikpay, PhD, MPH, Vanderbilt University School of Medicine, explains the origins of 340B, how safety net clinics as well as large hospitals became participants in the program, and the possibility of getting rid of the program altogether.

Neeraj Agarwal, MD, professor of medicine, University of Utah, discusses management decisions for patients with advanced or metastatic prostate cancer, including weariness in using ADT for many patients with comorbidities and how clinicians are currently weighing existing regimens.

Daniel Goldstein, MD, discusses the ability of interventional pharmacoeconomics to lower drug costs and increase access around the world, as well as the dilemma physicians face for treating patients with a person-centered vs a population health approach.

John Mandrola, MD, cardiac electrophysiologist at Baptist Health (Louisville, KY), explains how all medical evidence is flawed and a critical mistake HCPs can make with overgeneralizing the results of clinical trials.

Stacie Dusetzina, PhD, department of health policy, Vanderbilt University School of Medicine, discusses the "desensitization" of society to cancer prescription drug costs, the role of advancing science in research and development and drug approvals for rare diseases, the H.R.3 bill in front of Congress, and solutions proposed by politicians for inflated Medicare Part D spending, among other topics. To read more about our host Chadi Nabhan and access exclusive materials and information about guests, visit journalofclinicalpathways.com/podcasts/outspoken-oncology. Journal of Clinical Pathways is the exclusive producer of the Outspoken Oncology podcast.

Michael Thompson, MD, PhD, Advocate Aurora Health Care, discusses social determinants of health, eligibility criteria, and other barriers to clinical trial enrollment in the community setting, as well as the importance of real-world evidence in moving the needle for oncology care.

Gilberto Lopes, MD, editor-in-chief of the Journal of Global Oncology and creator of a global oncology program at the University of Miami Sylvester Comprehensive Cancer Center, discusses the intersection of globalization and localization of cancer care and measuring success in a global oncology program, among other topics.

Sumanta (Monty) Kumar Pal, MD, MD, GU medical oncologist at City of Hope, breaks down diagnosing and administering definitive therapy for localized muscle-invasive bladder cancer, postoperative management options for patients with residual disease, optimizing treatment decisions for metastatic disease, and more.

Gary Lyman, MD, MPH, senior lead for quality and policy at the Hutchinson Institute for Cancer Outcomes Research, explains that it may take 8-12 years to prove that biosimilars should be trusted in everyday clinical practice, as well as delves into issues of granting extrapolation.

Andrew Renda, MD, associate vice president of population health at Humana, discusses ways in which Humana designs supplemental benefits for social needs as well as addresses social determinants of health to close clinical gaps in care.