American pharmaceutical company
On today's episode, meet Rita Ribeiro. Rita is a bi-lingual leader with broad multi-cultural and health equity experience. She is currently the Product Director, Lung at The Janssen Pharmaceutical Companies of Johnson & Johnson (JNJ). Before joining JNJ, Rita held multiple roles in Sales and marketing at Boehringer Ingelheim Pharmaceuticals, Abbott Diagnostics and Bristol Myers Squibb company. Rita has a bachelor's degree in Management from Pace University, a Master's in Business Administration in Marketing Management from Pace Lubin School of Business and a Strategic Marketing Certificate from Columbia University in New York. She holds leadership roles with community not-for profit organizations including president of the board of directors of the United Way of greater Mercer County, the first Latina to hold the position. Her non-profit work is focused on community health, economic development, and gender parity.
You won't want to miss the PA Conference for Women. It's in person October 6th and online October 7th. If you want to be inspired, uplifted, nurtured both personally and professionally there's no better place to be. As part of our special series spotlighting Women Leaders sponsored by the PA Conference for Women - I speak to from Bristol Myers Squibb's Catherine Owen, Senior Vice President and General Manager, U.S. Commercialization and a working mom with two teen girls and Ester Banque, Senior Vice President and General Manager of Hematology and the mother of twin daughtersNot all of us can be at the very top of the corporate ladder and maybe you wouldn't want to be - but we all can apply the lessons Owen and Banque learned on their way to the top, and maybe you'll be inspired to push the envelope in your own lives and careers. www.paconferenceforwomen.org.
Kalpa is the Founder and CEO of Knekxt Group, LLC a consulting firm with a mission to create an equitable world. Today she speaks about being a sexual abuse survivor and how that led to her mission and activism in bringing others like her together. She is a product management leader with a track record of building trust and consistently delivering innovative experiences while leading diverse and inclusive teams. She has 15 years of experience in diverse domains of product, marketing, analytics and fraud risk management for new customer acquisition and deepening existing customer relationships for B2C and B2B businesses. She currently serves as Principal Advisor to Liminal, a boutique strategy advisory firm serving digital identity, fintech, and cybersecurity clients, and the private equity and venture capital community. Prior to her entrepreneurial pursuits, she worked at companies such as Early Warning Services/Zelle, American Express, General Electric and Bristol-Myers Squibb. Connect with Kalpa: https://www.linkedin.com/in/kalpashreegupta/ https://firstname.lastname@example.org https:/knekxt.com FOLLOW ME: YouTube: https://www.youtube.com/ChristineWong Instagram: https://www.instagram.com/christine.innovates Linkedin: https://www.linkedin.com/in/christineywong Facebook: https://www.fb.me/ChristineWongFB Website: https://christineywong.me/ --- This episode is sponsored by · Anchor: The easiest way to make a podcast. https://anchor.fm/app Support this podcast: https://anchor.fm/christinewong/support
Paul D. Ashley is a seasoned procurement executive with over 20 years of Industry Experience. Paul is currently Director Strategic Engagement within the Global Procurement group at Bristol- Myers Squibb. In his role, Paul is responsible for strategic advising on global category strategies, performance management, professional development, communications and Market Intelligence. Diversity and Inclusion has been a passion of Paul throughout his career. At BMS he is on the Leadership Team of BOLD (Black Organization for Leadership Development), the People and Business Resource Group (PBRG) where he helped to develop their strategic business plan as well as leads BOLD's Patient Advocacy Initiative. He is also active in the LGBTA People and Business Resource Group. Paul serves as co-chair of the Diversity and Inclusion Council for the Global Business Operations function at BMS. His role as a procurement professional and passion for diversity coalesce with his work advocating for small and diverse businesses within the supply chain of large companies such as BMS. Because of his leadership in this area, he was named to the Board of Directors of the National LGBT Chamber of Commerce (NGLCC), a national advocacy and policy organization, where he recently served as chair of its strategic planning committee. Prior to joining BMS, Paul has held various roles in Procurement and Supply Chain management with both IBM and Pfizer. Paul also served as the Chief Procurement officer at Howard University, where he led several transformation initiatives that increased organization performance and compliance. Giving back to the community has always been important to Paul. In 2015 he started and facilitated sponsorship of community outreach events as part of BMS engagement at supplier diversity conferences. The objective is to connect with diverse patient communities and/or top diverse talent representing the next generation of corporate professionals and entrepreneurs, as well as providing an additional opportunity to engage and highlight diverse suppliers. For this work, Paul was named a 2017 Corporate Buyer of the Year and was recognized for leading the Corporate Initiative of the Year from the National Business Inclusion Consortium at its 2019 Best of the Best Awards. Paul holds a Bachelor of Science in Industrial Engineering from Northwestern University, and well as a Master of Science in Industrial and Operations Engineering from The University.
With over three decades of managing operations ‘in-the-trenches,' running a successful business, and speaking, Wayne's view of ‘operational excellence' is radically different. Wayne has learned ‘operational excellence' is not a destination, but an ongoing journey, in pursuit of a company's strategic objectives. Sometimes called, ‘The Doctor of Operations,' Wayne is known for his skill in diagnosing ailing operations, prescribing a course of action, and serving as mentor during implementation. Wayne's blend of real-world examples, a conversational approach, and transparency, connects Wayne with his clients and audiences in an authentic, engaging, and ‘truly unique' way. Wayne has managed an $18 million expense budget, a $5 million capital budget, and led over 100 employees as facility manager for the Mead Johnson Nutritional Division of Bristol Myers Squibb, in Evansville, Indiana. Wayne is the founder and current CEO of a 20+-year-old facility management company. Wayne's efforts at Mead Johnson resulted in an annual average reduction of 7% in the division's facility costs over a three-year period. When you get Wayne, you get a driven, focused, and results oriented individual as demonstrated by his personal achievement of losing 230 pounds in 11 months using ‘diet and exercise. #waynewashington #growcompanyprofits #tsc #gogetit Social Media Links Youtube Channel youtube.com/c/ChipBakerTheSuccessChronicles LinkedIn http://linkedin.com/in/chipbakerthesuccesschronicles Facebook- Profile https://www.facebook.com/tscchipbaker Facebook- Page facebook.com/chipbakertsc Instagram https://www.instagram.com/chipbakertsc/ Twitter twitter.com/chipbaker19 TikTok tiktok.com/@chipbakertsc Linktree https://linktr.ee/ChipBakerTSC Online Store http://chip-baker-the-success-chronicles.square.site/ Chip Baker- The Success Chronicles Podcast https://anchor.fm/chip-baker
Gastrointestinal cancer experts Dr. Aparna Parikh and Dr. Kristin Ciombor discuss the treatment implications of the phase 3 PARADIGM trial and other advances in colorectal cancer with guest host and ASCO Daily News Associate Editor, Dr. Shaalan Beg. TRANSCRIPT Dr. Shaalan Beg: Hello, and welcome to the ASCO Daily News Podcast. I'm Dr. Shaalan Beg, your guest host of the ASCO Daily News Podcast today. I'm an adjunct associate professor at UT Southwestern's Simmons Comprehensive Center and vice president of Oncology at Science 37. I'm delighted to welcome Dr. Aparna Parikh, and Dr. Kristen Ciombor to the podcast today. Dr. Parikh is an assistant professor of Medicine at Harvard University and a GI medical oncologist at the Mass General Hospital Cancer Center. Dr. Ciombor is an associate professor of Medicine and GI medical oncologist at the Vanderbilt University Medical Center. Today, we'll be discussing exciting new approaches using EGFR inhibitors as frontline therapy in colorectal cancer, and promising advances with immune therapy in the treatment of rectal cancer. Our full disclosures are available in the show notes, and disclosures of all guests on the podcast can be found in our transcripts at: asco.org/podcasts. Dr. Parikh, and Dr. Ciombor, it's great to have you on the podcast today. Dr. Aparna Parikh: Thanks so much. Dr. Kristen Ciombor: Thanks so much for having us. Dr. Shaalan Beg: We've seen some exciting advances in GI oncology this year. Let's start with colorectal cancer. Dr. Parikh, there have been many trials looking to compare EGFR and VEGF inhibitors in colorectal cancer. We've heard about the IDEA studies, the FIRE trials, and CALGB 80405. At the 2022 ASCO Annual Meeting, we heard the results of the PARADIGM trial. Have we finally answered the question of when to use EGFR inhibitors as frontline therapy for colorectal cancer? Dr. Aparna Parikh: Thanks so much, Dr. Beg, for this great question. It has been a really exciting year for colorectal cancer across the board. So, the anti-EGFR story is really interesting and has evolved. And maybe just for a little bit of background, we know that colorectal cancer originating from both the right and left side of the colon differ. So, they differ embryologically, and epidemiologically; there are different genetic and molecular aspects to right and left sides of colon cancers. And we have learned over time that in the era of targeted therapy, the primary tumor location has been found to play a very important role, not only in the prognosis of patients but to predict treatment response. We know that patients that have left-sided colon cancers-- and when we think about left-sided colon cancers, we think about cancers that originate from the splenic flexure and descending colon, sigmoid colon, rectosigmoid junction, and sometimes include the rectum in this as well. The rectals have slightly different molecular features than distal colons. And we know that these left-sided patients, overall, have better survival benefits than patients that have right-sided CRC. And that includes again, cecum, ascending colon, hepatic flexure, and transverse colon. So, we know that that had prognostic implications, but what about the predictive implications? And with ASCO, we saw some really exciting data with the PARADIGM study, as Dr. Beg highlighted. We have seen many examples in the past showing the predictive power of anti-EGFR therapy, and anti-EGFR therapy showing a detriment for patients on the right side of the colon. But all these results historically have been obtained by retrospective analysis. So, retrospective analysis of the pivotal CALGB 80405 study, which is the first-line biologic trial. FIRE-3, which is a similar study, but done out of Europe, and KRYSTAL. So all these studies show the same finding but were all obtained basically by retrospective analysis. And what we saw with PARADIGM this year, which is exciting to see, is that this was the first prospective trial to test the superiority of an anti-EGFR inhibitor panitumumab versus bevacizumab in combination with standard doublet first-line chemotherapy for patients that were RAS-wild type. I guess I forgot to mention that again, anti-EGFR therapies are only eligible for patients that are RAS-wild type. We know that RAS-mutant patients and RAS, KRAS HRAS patients don't respond to anti-EGFR therapy. So, the study was looking at RAS-wild type patients, and again, asking the question “was panitumumab better than bevacizumab in combination with chemotherapy for these RAS-wild type patients and for left-sided tumors?” It was a multicenter trial done in Japan-- and I always commend the Japanese on their work and their designs and ability to do these studies that ask really important questions. And, overall survival was the primary endpoint of the study in patients with left-sided tumors, but they also did a full set analysis including patients that didn't have left-sided tumors. They had 823 randomized patients. Many patients, a handful did not receive per-protocol treatment, and some were excluded for other reasons relating to inclusion criteria. And they had 400 patients that ultimately received panitumumab and 402 patients that received bevacizumab in the full set analysis. And of those patients, there were 312 and 292 respectively had left-sided tumors. And although the PFS was comparable between the treatment group, we saw that panitumumab in the left-sided patients actually did improve the OS in both patient populations. But when you looked at the left-sided tumors, the difference was 37.9 versus 34.3 months meeting statistical significance. So, this was an exciting study because it confirmed prospectively what we have seen time and time again, and really behooves us to do early biomarker testing and know RAS status early for these patients with right-sided tumors, as they do derive benefit from anti-EGFR. Maybe I'll just pause there and open it up for more questions or comments from Dr. Ciombor as well. Dr. Kristen Ciombor: Yeah, Dr. Parikh, I thought these data were encouraging. And as you mentioned, the first prospective data that we have in this setting now that we know this primary tumor sidedness matters. Just on a practical note, what do you do in practice? Do you give a lot of anti-EGFR in the first-line? I find that the toxicity can be challenging sometimes and patients may not want to do that. So, it leaves us in a quandary sometimes. Dr. Aparna Parikh: Yeah. So, what's interesting and I don't think we have this data clearly answered yet is, I had, especially for kind of a fit patient-- with the previous data that we've seen with TRIBE and others showing a survival benefit with triplet chemotherapy for first-line therapy, my inclination had actually been to prefer triplet-- and we know that triplet and anti-EGFR toxicity-wise is really, really tough to manage, and really no benefit there that we've seen with OS or PFS, even though you maybe do get a little bit of a better response rate with that. And so where I have sort of struggled is triplet versus just doing first-line doublet plus anti-EGFR. You know, we are not having a discussion about triplet today, but we also saw some data at ASCO showing that perhaps the benefit of the triplet, with the triplet study, is not as much as we had hoped it would've been too. So, it's a good question. I do tend to prefer triplet, I guess, overall, for the healthy, good performance status patient. And then, if not, then doublet. And we, unfortunately, don't have kind of rapid EGFR testing, we're pushing for that. In practice, I think having RAS/RAF status up front would be entirely helpful. It's lumped into our pan-tumor profiling, comprehensive genomic panels. We get microsatellite instability (MSI) status, which I know we'll talk about here next right away. But I think another reason that oftentimes we don't add it right away, is because we don't have the RAS status right away. So, you just start with a doublet and you may end up sneaking it on later. And then, I'd love to, maybe in another podcast, where we can discuss second-line anti-EGFR therapies and what people do in practice for those right-sided patients should they never get anti-EGFR and later-lines of therapy too. And I would argue, perhaps not, because we do see some patients that do benefit, but it can be challenging sometimes with a fresh new patient to make these decisions. But at least, feel encouraged that we're doing the right thing by adding anti-EGFR therapy if they can tolerate it for the left-sided RAS-wild type patient. How about you? What do you do? Dr. Kristen Ciombor: Yeah. Largely, it's a great question. And I don't love giving anti-EGFR therapy. We have an additional issue where I am geographically in that we don't ever give cetuximab because of the high rates of an infusion reaction. So, we pretty much stick to panitumumab and are glad to have that option. But I have started to talk to patients about toxicity and I'm really upfront with the survival data. And it's interesting how people choose differently in terms of what's important to them. And whereas a few extra months in the overall survival may be overshadowed by the toxicity that they have to go through to accomplish that. So, it's good to have many options though, and that's the important thing, and I think the takeaway, as well. Dr. Shaalan Beg: So, kind of brings it back to the fundamentals of practicing medicine, right? Bringing our patients and giving them the options that are most available to them. But I'm going to ask both of you one by one: So, if we have our patient with left-sided colorectal cancer, known as KRAS RAS-wild type, do you recommend EGFR therapy and VEGF therapy and allow the patients to decide, or do you feel that we decide if their profile is such that we should continue with VEGF therapy instead? Dr. Ciombor, do you want to go first? Dr. Kristen Ciombor: Yeah, I think both are good options. I don't only do bevacizumab in the first-line by any means because we do have that survival data. It mostly comes down to a discussion with the patient in terms of toxicities and survival and how well those balance out. Dr. Aparna Parikh: Yeah, very similar. I think we have also gotten a little bit more adept at managing toxicity. I'm pretty aggressive about prophylaxis with even doxy and topicals for managing the rash. And so, for some of my younger patients who are wanting to be "aggressive" and want the exposure to anti-EGFR early but are still very mindful of how it's impacting their day-to-day semblance of self, especially for the younger patients, try to be very proactive about side effect management. And then, of course, we have the patients that have the electrolyte wasting and things too that sometimes if it's bad, we are stuck with infusions frequently and you may end up dropping for those patients. But I think the rash at least I feel like for most patients we can manage if you're aggressive about it too. And I think we have gotten better at that than we were many years ago. Dr. Kristen Ciombor: Never thought we'd be dermatologists, did we? In training, that was definitely not a path I was good at. Dr. Shaalan Beg: Dermato-Oncology, rapidly growing field. So, Dr. Ciombor, the rectal cancer space has evolved very rapidly in recent years, especially when we hear about total neoadjuvant therapy, short-course radiation, watch-and-wait, for those with complete clinical responses. So at ASCO this year, we heard results on immune therapy and rectal cancer. Can you summarize where we are with immune therapy and rectal cancer? Dr. Kristen Ciombor: So, yes. We heard a lot this year at ASCO; both at ASCO GI and ASCO, from the Memorial group and Dr. Cercek's group. And this has been a really exciting advance that we're starting to see and potentially paradigm-shifting data. So, we know-- as you mentioned, that our treatment of rectal cancer, specifically, locally advanced rectal cancer has changed a lot in the last few years with a shift to more Total Neoadjuvant Therapy. And what the Memorial data showed was that for the patients who have microsatellite instability or mismatch repair deficiency, which admittedly, is a small group, but certainly ones that we see in clinic, those patients, on their trial were treated with six months of dostarlimab as neoadjuvant therapy prior to any other treatment; before radiation, surgery, et cetera, and no chemotherapy. And what they found was that actually, six months of dostarlimab in the first 14 evaluable patients actually induced a 100% clinical complete response rate. So, it's really unheard of in most of our trials to see 100%. And I think that caught everyone's attention for sure. I think we have to keep in mind who these patients were and are because they are currently being followed. So, for instance, these were patients that had pretty bulky node-positive disease, almost all these patients did. These were not really early-stage tumors. We did see that 100% were BRAF-wild type, so it does tell us maybe this is not completely the population that we're all seeing when we do see microsatellite instability since we see a lot of sporadic tumors with BRAF mutations. But on the whole, I mean, these were all MSI-high patients and treated with dostarlimab; the six months, that was the total amount of treatment that they received, though a few patients achieved that clinical complete response earlier at about three months, at the three-month reassessment. And what the clinical complete response rate was, was looking both radiographically, as well as endoscopically, and not seeing any sign of residual tumor. I think the important thing here is that median follow-up is still pretty short. There are a few patients who are approaching now two years past that dostarlimab therapy and have not had tumor recurrence, but overall, the median follow-up is still quite short. So, I think we do need to continue to follow these patients. We don't have overall survival data yet either. I think we still have a lot to learn, but this is a very encouraging start and certainly, something that could be really treatment-changing for these patients, which again, as Dr. Parikh was saying, we need this molecular profiling early to make treatment decisions right off the bat, not even only for metastatic now, but even for these locally-advanced rectal cancer patients. Because if you think about it, we've all taken care of patients who have to go through chemoradiation, and chemo, and surgery, and have a lot of morbidity from those treatments so that even if you cure them, they're left with a lot of toxicity. So, if we could avoid some of that, even potentially, surgery, that would be wonderful. But I do caution that this is not the standard of care yet. This is only based on 14 patients with short follow-ups at the current time. But the trial is ongoing, and there are other trials open in this space for patients who don't live in New York or can't get to New York. And for instance, ECOG-ACRIN study 2201 is treating these same patients with nivo and ipi, as opposed to dostarlimab. And that trial is open in about 80 sites now across the US. So hopefully, geographically near all of these patients. Dr. Shaalan Beg: I think a lot of us and a lot of our listeners, that Monday after the results were announced on ASCO had our phone lines and our patient secure messaging lines blowing up. Dr. Kristen Ciombor: We should have warned our nurses and our treatment teams that they would be fielding these questions, yes. On one hand, it's wonderful that our data and the science is getting out to patients. But I think we also have to be really careful as to what is reaching them because many of them didn't realize it was for this subset of patient populations. But great that they're asking those questions and wondering-- being advocates for themselves too. Dr. Shaalan Beg: You use the term clinical complete response. Can you talk about how we determine someone has a complete clinical response and what their follow-up looks like? Dr. Kristen Ciombor: Yeah. In the context of this study, it was actually, as I mentioned, it was both radiographic complete response, as well as endoscopic. So that's one thing that is a little bit tricky when you think about surveillance of these patients. So, it requires a lot, both in frequent surveillance, MRIs, FLEX SIGs often, digital rectal exams, sometimes doing PET scans or CTs, and patients who-- not only on this kind of study but also in non-operative management; watch-and-wait - really have to commit to very close, very frequent follow-up because if the cancer recurs, we don't want to miss that and lose our chance to cure them. So I think that's a little bit different everywhere, how that watch-and-wait approach really manifests, but I think we're learning how to do that, and working in a multidisciplinary group to make sure that patients get the surveillance that they need. Dr. Aparna Parikh: Yeah. I totally agree. If we offer, for the MSI-high patients, if we ultimately end up offering neoadjuvant immunotherapy-- and actually, I'm looking forward to your study, Dr. Ciombor, too, I think the monotherapy versus doublet, too, is going to come up for these patients. But I had a patient just a week or two ago that was starting on this approach with neoadjuvant immunotherapy, but for now, as a group, if we're proceeding down that and they do get a clinical complete response, we're deciding to forego even the radiation and surgery. We're following what they did in the OPRA study, which was pretty aggressive surveillance on the backend, both with direct visualization and MRIs, and you're seeing these patients every three months or so. Dr. Shaalan Beg: Well, thank you Dr. Ciombor and Dr. Parikh for sharing some valuable insights with us on the podcast today. Dr. Aparna Parikh: Thanks so much for having us. It was a lot of fun. Dr. Kristen Ciombor: Thanks for having us on. Dr. Shaalan Beg: And thank you to our listeners for your time today. If you value the insights that you hear on the ASCO Daily News podcast, please take a moment to rate, review and subscribe, wherever you get your podcasts. Disclaimer: The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. Guest statements on the podcast do not express the opinions of ASCO. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement. Follow today's speakers: Dr. Kristen Ciombor @KristenCiombor Dr. Aparna Parikh @aparna1024 Dr. Shaalan Beg @ShaalanBeg Listen to additional episodes on advances in GI oncology: Novel Therapies in GI Oncology at ASCO22 ASCO22: Key Posters on Advances in GI Oncology Follow ASCO on social media: @ASCO on Twitter ASCO on Facebook ASCO on LinkedIn Disclosures: Dr. Shaalan Beg: Employment: Science 37 Consulting or Advisory Role: Ipsen, Array BioPharma, AstraZeneca/MedImmune, Cancer Commons, Legend Biotech, Foundation Medicine Research Funding (Inst.): Bristol-Myers Squibb, AstraZeneca/MedImmune, Merck Serono, Five Prime Therapeutics, MedImmune, Genentech, Immunesensor, Tolero Pharmaceuticals Dr. Kristen Ciombor: Consulting or Advisory Role: Merck, Pfizer, Lilly, Seagen, Replimune, Personalis Research Funding (Inst.): Pfizer, Boston Biomedical, MedImmune, Onyx, Bayer, Boehringer Ingelheim, Bristol-Myers Squibb, Merck, Novartis, Incyte, Amgen, Sanofi Recipient, Bristol-Myers Squibb, Array BioPharma, Incyte, Daiichi Sankyo, Nucana, Abbvie, Merck, Pfizer/Calithera, Genentech, Seagen Travel, Accommodations, Expenses Company: Array Dr. Aparna Parikh: Stock and Ownership Interests: C2i genomics Consulting or Advisory Role: Eli Lilly, Natera, Checkmate Pharmaceuticals, Pfizer, Roche/Genentech, Inivata, Biofidelity, Guardant Health Research Funding(Inst.): PMV Pharma, Plexxikon, Bristol-Myers Squibb, Genentech, Guardant Health, Array, Eli Lilly, Novartis Pharmaceuticals UK Ltd., PureTech, Mirati Therapeutics, Daiichi Sankyo
Quelle(s) définition(s) de la Polyarthrite Rhumatoïde difficile à traiter ? Comment se présente la Polyarthrite Rhumatoïde difficile à traiter ? Quel impact a-t-elle dans la pratique en rhumatologie ? Comment adapter les interventions thérapeutiques en fonction des différents types de diagnostics ? Quel conseil donner aux auditeurs ? Le Pr Jérôme Avouac, rhumatologue au sein du service de Rhumatologie de l'Hôpital Cochin à Paris, et chercheur INSERM à l'Hôpital Cochin, répond à vos questions. Invité : Pr Jérôme Avouac – Hôpital Cochin – Paris https://www.cochin-poa.com/les-services/rhumatologie/ Le Pr Avouac déclare des liens d'intérêts avec les laboratoires Pfizer, Bristol Myers Squibb, UCB, Roche, Nordic, Novartis, Sanofi, Boehringer, Abbvie, Chugai, Galapagos, Biogen, Fresenius Kabi, Sandoz. L'équipe : Comité scientifique : Pr Jérémie Sellam, Pr Thao Pham, Dr Catherine Beauvais, Dr Véronique Gaud-Listrat, Dr Céline Vidal, Dr Sophie Hecquet Animation : Pyramidale Communication Production : Pyramidale Communication Soutien institutionnel : Pfizer Crédits : Pyramidale Communication, Sonacom
Did you know PsA and fibromyalgia can coexist? Knowing whether it's fibromyalgia, PsA or both can impact your treatment options. Listen as rheumatologist Dr. Evan Siegel from Arthritis and Rheumatism Associates in Rockville, MD, discusses symptoms, similarities, differences and treatment options. This Psound Bytes episode is provided with support from AbbVie, Amgen, Bristol Myers Squibb, Janssen, Lilly and Pfizer.
Die Börsen sind gut gelaunt und wollen Rendite, Elon Musk ist schlecht gelaunt und will kein Twitter. Außerdem hat Bristol-Myers Squibb einen Blockbuster ohne Label und MicroStrategy kauft Krypto ohne Strategie. Wasserstoff ist die Zukunft. Und bei SFC Energy (WKN: 756857) ist diese Zukunft sogar profitabel. Biotech-Profiteur mit 26er KGV und massivem Insiderhandel? Medpace (WKN: A2APTV) macht's möglich. Diesen Podcast der Podstars GmbH (Noah Leidinger) vom 13.09.2022, 3:00 Uhr stellt Dir die Trade Republic Bank GmbH zur Verfügung. Die Trade Republic Bank GmbH wird von der Bundesanstalt für Finanzaufsicht beaufsichtigt.
Join us on Be Brave at Work as we speak with Brenda Bence. Brenda knows top talent. Ranked by both Thinkers50 and Global Gurus as one of the world's top executive coaches, Brenda is passionate about two things – branding and leadership – and how the two work together. As a member of the “Billion Dollar Coaches Club,” she has coached dozens of C-Suite executives from many of the world's largest corporations. With an MBA from Harvard Business School, Brenda made a name for herself when building mega brands for Fortune 100 companies like Procter & Gamble and Bristol-Myers Squibb, where she was a senior executive responsible for billion dollar businesses across four continents and 50 countries. Links of Interest LinkedIn Twitter Facebook Website The Forgotten Choice - Shift Your Inner Mindset, Shape Your Outer World A special thank you to our sponsor, Cabot Risk Strategies. For more information, please visit them at CabotRisk.com Please click the button to subscribe so you don't miss any episodes and leave a review if your favorite podcast app has that ability. Thank you! More information about Ed, visit Excellius.com © 2022 Ed Evarts
Description: Co-hosts Ryan Piansky and Holly Knotowicz talk with guest Nicole Arva, MD, PhD, about genetics and eosinophilic colitis. Dr. Arva is a pediatric pathologist at Ann & Robert H. Lurie Children's Hospital of Chicago. She is also an Associate Professor in the Department of Pathology at Northwestern University Feinberg School of Medicine. She has been a part of more than 50 publications, many of which explore eosinophilic diseases, and recently co-authored a manuscript entitled “Genetics of Eosinophilic Colitis Revealed.” In this episode, Holly and Ryan discuss with Dr. Arva her recent and upcoming research. They cover the purposes of molecular testing and a new molecular study that concludes that EoC is a unique disease, with specific genetic characteristics that set it apart from other EGIDs, Crohn's disease, and IBD. Dr. Arva explains how that uniqueness was discovered, and what it means for therapeutic options for EoC. Listen in to learn about this innovative research. Disclaimer: The information provided in this podcast is designed to support, not replace the relationship that exists between listeners and their healthcare providers. Opinions, information, and recommendations shared in this podcast are not a substitute for medical advice. Decisions related to medical care should be made with your healthcare provider. Opinions and views of guests and co-hosts are their own. Key Takeaways: [1:44] Holly shares the topic of this episode, genetics and eosinophilic colitis (EoC), and introduces today's guest, Dr. Nicole Arva. [1:51] Dr. Nicole Arva is a Pediatric Pathologist at Ann & Robert H. Lurie Children's Hospital of Chicago and an Associate Professor in the Department of Pathology at Northwestern University Feinberg School of Medicine. [2:37] Dr. Arva wanted to understand the mechanisms of diseases to be able to treat them more efficiently. She tells of her professional journey after medical school, studying cancer and leukemia cell lines. She continued her medical training in pathology, specializing in pediatric pathology. [3:15] Dr. Arva's work involves assessing laboratory slides from pediatric tissue samples to establish a diagnosis. [4:05] Dr. Arva explains molecular testing. An increasing number of diseases are found to have genetic abnormalities. Molecular testing can help lead to an accurate diagnosis. Dr. Arva describes getting a tumor diagnosis from molecular testing showing specific chromosomal translocations in correlation with microscopic examination. [5:23] By performing molecular testing, we can discover gene alterations that can help guide the development of new therapies. Molecular testing can uncover genes that can be targeted. [5:51] Genetic analysis can also provide insight into how a disease develops and shed light on the pathways that are involved. [6:35] Dr. Arva describes EoC. EoC affects the large bowel. Eosinophils cause inflammation in the colon. Patients usually have abdominal pain, diarrhea, which can be bloody, and fluid in the abdominal cavity. Patients can become malnourished. They may develop a bowel obstruction or perforation. [7:25] Studies have been performed on Eosinophilic Gastrointestinal Disorders (EGIDs) and Inflammatory Bowel Disease (IBD). But EoC is a poorly understood condition. When Dr. Arva and her colleagues started their study, they didn't know whether EoC should be considered to be within the spectrum of EGIDs or as an IBD. [8:03] The research team was looking to determine where EoC belongs because that would affect the way patients would be treated. Although EoC is similar to other EGIDs because eosinophils drive the inflammation,, EoC has a lower incidence than EGIDs, more severe symptoms, and co-morbidities. [8:38] EoC is similar to IBDs in that it is an inflammation of the large bowel, but a different type of cell is predominantly involved in IBD (neutrophil) with some eosinophils present. [9:38] The diagnosis of EoC is challenging. Other, more common conditions can cause colonic eosinophilic inflammation. When pathologists encounter eosinophilia in the large bowel, they have to think of other medical conditions that can cause that. A diagnosis of EoC is established only after other causes of gastrointestinal eosinophilia have been ruled out. [10:14] IBD, intestinal parasites, autoimmune or connective tissue disorders, and vasculitis can all mimic EoC. Certain medicines can induce eosinophilia. Eosinophils are normally found in the large bowel. [10:51] Pathologists have to establish eosinophil count values for each segment of the large bowel to best evaluate colonic biopsy; everybody needs to follow the standards when diagnosing EoC. [11:42] Patients suspected to have EoC may undergo lab testing, imaging, and colonoscopy to reach a diagnosis. The findings may vary, depending on which section of the bowel wall is infiltrated by eosinophils. [13:02] A biopsy may reveal an increased number of eosinophils. All these test results have to be combined to reach a diagnosis of EoC. [13:27] The focus of the study was performing molecular testing that was very helpful in diagnosing EoC. They found that nearly 1,000 genes were differentially expressed in EoC compared to normal participants or Crohn's disease subjects. [14:30] They found differences in gene expression between EoC and other types of EGIDs, such as eosinophilic esophagitis or gastritis. [15:02] The main chemotactic factor in EoC seems to be CCL11 (Eotaxin-1). CCL11 is a molecule that attracts eosinophils in the tissue. In eosinophilic esophagitis or gastritis, the main chemotactic factor appears to be CCL26 (Eotaxin-3). All these findings support the idea that EoC is a distinct entity, which is different from other EGIDs and IBD. [15:37] EoC seems to be driven by a mechanism that does not involve an allergic inflammation. The therapeutic strategy may be much different now that we have a better understanding of EoC. [16:23] Eosinophilic esophagitis has been shown to run in families and it would be beneficial to test family members with a blood test, allergy testing, or endoscopy if they develop symptoms. As eosinophilic colitis has a different epigenetic mechanism, it is not clear that the same testing is needed for EoC patients or family members. [17:26] Besides endoscopies and colonoscopies, blood tests looking for high IgE levels, allergy testing, and CT can be useful in testing for various eosinophilic disorders. [21:07] Dr. Arva explains how many eosinophils are seen in a high-power field of a slide from a colon biopsy to diagnose EoC. They established a normal count of eosinophils for the segment of the colon and the abnormal count would be twice the normal count. [22:20] Now that a different pathogenic mechanism has been discovered for EoC than for EGIDs and IBD, new treatments can be explored or developed. We are just beginning the research. CLC protein (galectin-10) is upregulated in EoC and may be a target for treatment development. Antibodies may be effective for relieving EoC inflammation. [23:34] It is challenging to treat EoC because the newly-discovered pathogenic mechanism shows that EoC is unlikely to be allergic in nature, making elimination diets and steroid treatments ineffective. New therapies will be required. [24:05] All EGIDs can have a significant impact on quality of life. People with EoC can develop serious complications, such as dehydration, malnutrition, intestinal strictures, and bowel obstruction. [25:04] Dr. Arva considers the difficulties pathologists face in analyzing eosinophilic diseases. There are few patients with EoC. Dr. Arva describes additional challenges. [26:25] Dr. Arva looks ahead. Most of her research goes in the direction of pediatric gastroenterology. She is working with a clinical colleague, Dr. Josh Weschler, to analyze the role of mast cells in EGIDs. They are finding that eosinophils are not the only offenders in EGIDs and are looking to establish a cohort of EGID patients to study. [27:43] Holly thanks Dr. Arva for taking the time to talk with us today. [27:51] Dr. Arva says we are just at the beginning of understanding the etiology of EoC. This study had a small sample size and the results will have to be validated with larger cohorts of patients. The analyses were performed on whole biopsies that contained all types of cells. Future studies using single-cell preparations will be important. [28:55] Ryan invites listeners to look at apfed.org/eoc to learn more about EoC. Ryan also encourages you to connect with the APFED online community at apfed.org/connections. [29:25] Dr. Arva thanks Ryan and Holly for having her on the podcast. She is grateful for the opportunity to research EGIDs and benefit patients suffering from these conditions. Mentioned in This Episode: American Partnership for Eosinophilic Disorders (APFED) APFED on YouTube, Twitter, Facebook, Pinterest, Instagram Nicole Arva, MD, PhD Ann & Robert H. Lurie Children's Hospital of Chicago® Department of Pathology at Northwestern University “Genetics of Eosinophilic Colitis Revealed” Apfed.org/eoc APFED Eos Connections Online Community Real Talk: Eosinophilic Diseases Podcast APFED Podcast Episode Featuring Holly Knotowicz Tetsuo Shoda Joshua B Wechsler This episode is brought to you thanks to the support of our Education Partners Abbott, Bristol Myers Squibb, GlaxoSmithKline, Mead Johnson Nutrition, Sanofi, and Regeneron. Tweetables: “I have always wanted to better understand the mechanisms of diseases because I considered that if we know how an illness occurs, we can treat that entity more efficiently.” — Dr. Nicole Arva “As testing increases, more and more diseases are found to have recurrent genetic abnormalities. … Molecular testing can help the pathologist to render the correct diagnosis.” — Dr. Nicole Arva “There are similarities and dissimilarities between EoC and other EGIDs and IBD.” — Dr. Nicole Arva “Findings support the idea that EoC … seems to be driven by a mechanism that does not involve an allergic inflammation.” — Dr. Nicole Arva
Robert and Kay Lee talk about how they make it work working together and how it can happen for other married couples, Robert shares the devasting loss early on in his first marriage and Kay Lee talks about her super power of making friends in the line at Starbucks."You can't achieve what you don't define."Robert and Kay Lee Fukui are the co-founders of i61, inc., a business consulting company. They assist married entrepreneurs create better work/life balance by structuring the business to scale while giving precious time back to the owner to invest into their marriage.Robert received his marketing degree from San Jose State University and experienced 25 successful years in sales/marketing with companies such as Coca-Cola, Novartis Pharmaceutical and Bristol-Myers Squibb. He played instrumental roles in the launch of six major brands, directly responsible for over $150 million in revenue and a recipient of national sales and leadership awards.His business acumen allows him to help family businesses build a more profitable, efficient and sustainable company.Kay Lee Fukui earned her business degree from the University of La Verne. She worked in the banking industry for many years and in her family business as operations manager for over 10 years before meeting the love of her life, Robert. She understands the highs and lows of running a family business and the sacrifices the owners make; often at the expense of marriage and family. Her passion is to see marriages flourish in the midst of building a profitable business and to help the entrepreneur couple understand that you don't have to sacrifice the marriage and family for the business.Together, they have developed an innovative consulting program, Power Couples by DesignTM, which equips the married entrepreneur to build a Thriving Marriage AND Prosperous Business.https://www.powercouplesbydesign.com/https://www.marriageandbusinesspodcast.com/https://www.linkedin.com/in/robertfukui/https://www.facebook.com/powercouplesbydesignhttps://www.instagram.com/powercouplesbydesign/Enjoying the podcast? Please tell your friends, give us a shoutout and a follow on social media, and take a moment to leave us a review at https://lovethepodcast.com/talkingtocoolpeople.Find the show at all of the cool spots below.WebsiteFacebookInstagramIf something from this or any episode has sparked your interest and you'd like to connect about it, please email us at email@example.com. We love hearing from our listeners!If you are interested in being a guest on the show, please visit jasonfrazell.com/podcasts.
Dr. Christina Rahm is a medical, clinical and research scientist, entrepreneur, author, Chief Science Officer for ROOT Wellness, and Chair of the International Science Nutrition Society from Brentwood, TN. Her resume includes working for pharmaceutical giants such as Johnson & Johnson, UCB, Bristol Myers Squibb, and Pfizer and she has created multiple provisional patents, proprietary formulas, and trade secrets. Dr. Rahm's journey with Lyme disease and chronic illness began when she suffered multiple bites from a “bed of seed ticks” at the age of 19. Within two weeks, she became chronically ill causing her to suffer memory loss, headaches, fever, fainting, and to feel “generally sick all over”. Driven by a desire to help the patient community avoid the physical, emotional, and spiritual trauma caused by chronic illness, Dr. Rahm managed her own disease symptoms while earning undergraduate and graduate degrees (BA, MS, Ph.D and Ed.D) and post graduate certificates from Ivy League Harvard University and Cornell University. In her adult life, Dr. Rahm has survived multiple bouts of cancer that she believes were stimulated by Lyme disease. If you would like to learn more about how Lyme disease has inspired professional, spiritual, emotional, and instinctive discoveries that have granted Dr. Christina Rahm the opportunity to help patients in more than 80 countries, then tune in now!
TRC Editor, Dr. Lori Dickerson, PharmD, FCCP talks with Joseph Saseen, PharmD, FCCP, FNLA, Associate Dean for Clinical Affairs, Professor, Department of Clinical Pharmacy and Professor, Department of Family Medicine from the Skaggs School of Pharmacy and Pharmaceutical Sciences at the University of Colorado Anschutz Medical Campus about managing statin intolerance. Listen in as they discuss how to evaluate statin-associated muscle pain...and review strategies to help patients take a statin successfully. You'll also hear practical advice from panelists on TRC's Editorial Advisory Board:Andrea Darby Stewart, MD, Associate Director, Family Medicine Residency at Honor HealthAnthony A. Donato, Jr., MD, MHPE, Associate Program Director, Internal Medicine from the Reading Health System, and Professor of Medicine at the Sidney Kimmel Medical College at Thomas Jefferson UniversitySteven E. Nissen, MD, MACC, the Chief Academic Officer at the Heart and Vascular Institute and the Lewis and Patricia Dickey Chair in Cardiovascular Medicine Professor of Medicine at the Cleveland Clinic Lerner School of Medicine at Case Western Reserve UniversityJoseph Scherger, MD, MPH, Family Physician, Primary Care 365, Eisenhower HealthCraig D. Williams, PharmD, FNLA, BCPS, Clinical Professor, Department of Pharmacy Practice at the Oregon Health and Science UniversityFor the purposes of disclosure, Dr. Steven Nissen reports a relevant financial relationship with AbbVie, Amgen, AstraZeneca, Bristol-Myers Squibb, Eli Lilly, Esperion, Medtronic, Novartis, Pfizer, Silence Therapeutics (grants/research support).The other speakers have nothing to disclose. All relevant financial relationships have been mitigated.Pharmacist's Letter offers CE credit for this podcast. Log in to your Pharmacist's Letter account and look for the title of this podcast in the list of available CE courses.If you're not yet a Pharmacist's Letter subscriber, find out more about our product offerings at trchealthcare.com. Follow or subscribe, rate, and review this show in your favorite podcast app. You can also reach out to provide feedback or make suggestions by emailing us at ContactUs@trchealthcare.com.
In this week's episode we dig into the microbiome with world renowned expert Dr. Ghannoum. We chat about what the microbiome is, and that is not JUST bacteria. How the microbiome not just in your gut, the health implications of these colonies, what disrupts them and what feeds them. No one has done more research of the microbiome that Dr G., and he continues to research more everyday.Dr G is the Co-Founder and Chief Scientific Officer, BiohmHealthReceived an MSc in Medicinal Chemistry and his PhD in Microbial Physiology from the University of Technology in Loughborough, England, and an MBA from the Weatherhead School of Management at Case Western Reserve University, Cleveland, OH. A tenured Professor and Director of the Integrated Microbiome Core and Center for Medical Mycology, and Case Western Reserve University and University Hospitals Cleveland Medical Center. Published > 450 peer reviewed publication and 6 scientific books, and was on the top 1% of cited Scientists Worldwide Established a multidisciplinary Center of Excellence that combines basic and translational research that spans test tube to the bedside capabilities. He pioneered studies on the fungal communities residing in and on our body and coined the term ‘Mycobiome”. Awarded the Rhoda Benham Award from the MMSA, and the Freedom to Discover Award from Bristol-Myers Squibb for his outstanding and meritorious contributions to the fields of medical mycology and microbial biofilms. Fellow of the Infectious Disease Society of America (IDSA), past President of the Medical Mycological Society of the Americas (MMSA). Fellow of the American Academy of Microbiology (FAAM), and the European Society of Clinical Microbiology and Infectious Diseases (FESCMID).An entrepreneur-scientist who has launched a number of companies focused on the treatment of biofilm infections, as well as microbial dysbiosis.
Treating clinicians rely on pathology to help diagnose and stage their patient which fundamentally determines the treatment management plan. Therefore, it is incredibly important to get it right in the first place. In this engaging podcast aimed at GPs, our multidisciplinary experts discuss: Why can it be challenging to get the pathology right? What clinical information is important to include on the pathology request form? How is the pathology report structured? How is the specimen processed? What biopsy is key to maximising the diagnostic and prognostic interpretation of the pathology? Are partial biopsies ever appropriate? What implications does the type of biopsy have for subsequent surgery? When does a GP need to refer their patient? The discussion is concluded with two case studies to summarise key learnings. This podcast is suitable for GPs, Dermatologists, Surgeons, Oncologists, Pathologists and other healthcare professionals. SPEAKERS Dr Adrian Quek - Skin Cancer GP, Melanoma Institute Australia and The Chatswood Skin Cancer Clinic Dr Alison Potter - Pathologist, Melanoma Institute Australia and Royal Prince Alfred Hospital Dr Nigel Maher - McMurtrie Cancer Pathology Fellow, Melanoma Institute Australia A/Prof Alexander van Akkooi - Associate Professor in Melanoma Surgical Oncology, Melanoma Institute Australia and Royal Prince Alfred Hospital, The University of Sydney Dr Niamh-Anna O'Sullivan - Specialist Dermatologist, Melanoma Institute Australia HOST Danielle Fischer - Education Program Manager, Melanoma Institute Australia Please note that this podcast was accurate at the time of recording (June 2022) but may not reflect the rapidly evolving treatment landscape and approvals in Australia. For more practice-changing education, visit our Melanoma Education Portal. MIA's Education Program is proudly supported through unrestricted educational grants from: MSD, Bristol Myers Squibb, Novartis and HEINE.
Investors worried whether aggressive rate hikes by the Federal Reserve would drive the economy into recession. But energy stocks rose 1.5% in response to a higher oil price. Technology shares eased in response to higher interest rates. Shares in Apple fell by 1.4% and Microsoft lost 1.1%. Shares in Bristol Myers Squibb slid 6.2% after its drug candidate for preventing ischemia strokes missed the main goal in a mid-stage trial. At the close of trade, the Dow Jones index was lower by 184 points or 0.6% after being down 311 points earlier in the session. The S&P 500 index fell by 0.7% and the Nasdaq index lost 124 points or 1.0%. Commonwealth Securities Limited ABN 60 067 254 399 AFLS 238814 (CommSec) is a wholly but non-guaranteed subsidiary of Commonwealth Bank of Australia ABN 48 12 12 124 AFSL: 234945 (the Bank) and a Market Participant of the ASX Limited and Cboe Australia Pty Limited, a Clearing Participant of ASX Clear Pty Limited and a Settlement Participant of ASX Settlement Pty Limited. Any advice contained in this broadcast is general advice only. As the information in this broadcast has not been prepared with reference to your objectives, financial or taxation situation or needs, you should, before acting on it, consider its appropriateness to your circumstances and seek appropriate professional advice. CommSec, the Bank, and their related entities do not accept any liability arising out of or in relation to reliance on the information in this broadcast. We believe that the information in this broadcast is correct as at the time of its compilation, but no warranty is made as to its accuracy, reliability or completeness. This report is under copyright to CommSec and the Bank and may not be used without their prior consent.
Joe Dustin is Vice President of Product Strategy and General Manager for eCOA and Decentralized trials at Medable. He is responsible for the go-to-market strategy around Medable's solutions and is working to define what decentralized trials will become with the professionals who are living it every day. For 20 years, Joe has been in the Clinical Trials Industry at the intersection of Technology, Innovation and Science. He has held a number of roles in IT, Project Management, Solution Consulting, Product Development and Sales at tech companies like Medidata and CRF Health, and most recently was the Head of Clinical Innovation and Change Management at Bristol Myers Squibb. In this episode we discuss decentralized clinical trials (duh), the financial implications for sites, the disconnect between sponsor, vendor and site, the value proposition of site technology, and so much more.
Le méthotrexate est-il un facteur de risques de pneumopathies interstitielles diffuses ? Comment dépister les patients atteints de polyarthrite rhumatoïde ayant un risque de développer une pneumopathie interstitielle diffuse ? Quelle est la relation entre activité de la maladie rhumatoïde et survenue d'une pneumopathie interstitielle diffuse ? Où en est la recherche sur les pneumopathies interstitielles diffuses ? Le Pr Philippe Dieudé, chef du service de Rhumatologie de l'Hôpital Bichat - Claude-Bernard à Paris, répond à vos questions. Invité : Pr Philippe DIEUDE – Hôpital Bichat - Claude-Bernard https://www.aphp.fr/service/service-18-011 Le Pr Dieudé déclare les liens d'intérêt suivants : orateur ou formation pour les laboratoires Bristol Myers Squibb, Boehringer Ingelheim, Novartis, Pfizer, Roche, Chugai, Lilly, Abbvie, Janssen, MEDAC, UCB - consulting pour les laboratoires Bristol Myers Squibb, Boehringer Ingelheim, Pfizer, Roche, Chugai, Lilly - travaux de recherche pour les laboratoires Bristol Myers Squibb, Pfizer. L'équipe : Comité scientifique : Pr Jérémie Sellam, Pr Thao Pham, Dr Catherine Beauvais, Dr Sophie Hecquet, Dr Céline Vidal Animation : Pyramidale Communication Production : Pyramidale Communication Soutien institutionnel : Pfizer Crédits : Pyramidale Communication, Sonacom
Lakshi Aldredge, board-certified Dermatology Nurse Practitioner with the VA Portland Health Care System, answers questions from around the world about skin and scalp psoriasis such as the best soap and moisturizers, over-the-counter sunscreen, hair care products to avoid, what to look for in shampoos and conditioners, and more. This Psound Bytes episode is provided with support from CeraVe, AbbVie, Amgen, Bristol Myers Squibb, Janssen and Lilly.
Ex-pharma senior scientist and medical whistleblower Mike Donio joins me for an insightful and disturbing show centred around the highly dubious “science” underpinning the HIV-AIDS myth. He details how he came through the education system and into the pharmaceutical industry with the best of intentions, hoping to do good science to make the world a better place. However he soon began finding reasons to question what he had been told about “viruses”, how they were supposedly worked with, “proved,” and how they were identified as so-called disease-causing agents. It turned out that nothing about HIV was as it initially seemed. Eventually, Mike realised the realm of corporately controlled Science wasn't going to let him make a positive difference in the world, and was ultimately terminated from his job for refusing to take the experimental DNA-altering covax. Special Guest: Mike Donio.
Members taking specialty drugs represent about 2% of any given employer's population but often consume as much as 30% of an employer's total cost of care. As Pramod John, PhD, in EP353 has said, this isn't just small companies we're talking about here. Some of the largest employers in the US are dropping big bucks on specialty drugs, and they are obviously overpaying and don't need to. No employer or plan really need pay any more than the pharmacy's acquisition price plus a reasonable professional fee. But so many employers pay way more than that. Let's just keep in mind that specialty pharmacy spend extends beyond just pharmacy spend. Medical claims for pharma drugs that are infused, for example, can be more than 50% of an employer or plan's specialty pharmacy spend. What I'm talking about now is buy and bill–type stuff where a hospital or physician practice bills for an infused pharmaceutical product under a patient's medical benefit. Listen to EP370 with Autumn Yongchu and Erik Davis about how some hospitals, for example, are managing to charge employers 6x the cost of specialty meds to infuse them and also EP365 with Scott Haas about PBM shenanigans. So, currently, specialty pharmacy spend is big; but it's grown bigger every single year. Every year, employers and the government/taxpayers alike spend more and more on these really expensive drugs. As you can see, there are billions and billions of dollars on the specialty pharmacy table here. Also, as you certainly know if you've listened to the recent series of specialty pharmacy shows that we've done lately, it's kind of a war out there. There are multiple healthcare industry stakeholders trying to capture all of the money. If you can get your hands on a specialty pharmacy patient and manage their care—or, probably more pointedly, manage to bill for their care—it can be incredibly profitable. This show kind of wraps up some loose ends for me. In this healthcare podcast, I'm speaking with Mike Baldzicki, who is chief brand officer over at AscellaHealth. A majority of Mike's background is in specialty pharmacy infusion, capabilities with an array of different healthcare companies. So, he is a great guy to wrap up some of these loose ends with. On the show today, we discuss how many/the percentage of self-funded employers who have taken their specialty pharmacy business from the “Big Three” or “Big Five” PBMs, how many of them have actively started steering their members and managing their benefit carefully. I talk with Mike about what these employers are doing and how they are doing it. From there, the conversation, of course, naturally flows into preventing hospitals from rapaciously buying and billing, which then segues into a discussion about hospital strategy … because if you can't do your buy-and-bill thing for a whole bunch of your patients, then it makes sense for you to do two things strategically: (1) stand up your own specialty pharmacy and/or (2) set up your own network of infusion centers. Mike and I talk about this. We also discuss how much trying to get a specialty pharmacy drug sucks for most patients, which I deeply investigated in EP337 with Olivia Webb. Also in this episode, you can hear me contend that maybe if Pharma and payers enter into outcomes-based contracts, maybe patients would be better served. It's kind of the pharmacy version of the whole “let's pay for value, not volume” thing. I ask Mike how many pharma outcomes-based contracts are out there in the wild, for reals. All of this and more … but you gotta listen to the podcast. Oh, by the way, acronym alert: SPP stands for specialty pharmacy provider. You can learn more at ascellahealth.com. Michael J. Baldzicki, CRCM, is chief brand officer (CBO) at AscellaHealth. As CBO, Mike supports the AscellaHealth Family of Companies comprehensive business strategy to increase brand awareness, boost perceived value, and improve lines of services in the marketplace. He is responsible for oversight of their Family of Companies based on sales and marketing to finance, client services, and specialty pharmacy strategies throughout the organization that drive strategic business initiatives. Within his roles, he enhances the success of the strategic projects and applies business development, contract negotiations, network advancement, and marketing and outreach strategies that cultivate opportunities for AscellaHealth and their Family of Companies. With more than 24 years of experience, Mike held roles in senior executive management within the specialty pharmacy supply group, pharmaceutical and biotech industry of managed markets, group purchasing organizations, specialty wholesale, and integrated delivery networks. He assumed roles within the pharmaceutical organization such as Bristol Myers Squibb, Enzon BioTech, Novo Nordisk, Baxter BioScience, as well as roles within the distribution channel of AmerisourceBergen specialty groups, BioMatrix Specialty and Infusion Rx, Diplomat/BioRx Specialty Pharmacy, CareCentrix Medical Infusion, Asembia GPO, Axelacare Infusion, to other manufacturer and specialty pharmacy home infusion companies. Mike is active in the biotech community and is council advisor of the Council of Strategic Healthcare Advisors (CSHA), an advisor/faculty member of the Academy of Managed Care Pharmacy (AMCP) for Specialty Pharmacy Advisory Group & Biosimilars Partnership Forum, NCPDP Specialty Pharmacy Stakeholder Action Group, Self-insured Institute of America (SIIA) advisor, National Alliance of Healthcare Purchaser Coalitions, and was 2014 Editorial Board Member for Specialty Pharmacy Times. Mike holds a bachelor's degree in business management and a Certificate in Clinical Research Compliance and Management (CRCM). He has completed programs in leadership development at Harvard University, Brooks Group, Miller Heiman Account Management, and MD Anderson Center Cancer Courses. 04:27 Is it a conflict of incentives to worry about the cost of million-dollar pharmaceuticals? 06:24 “Really, does it make sense to carve up my specialty pharmacy benefit … away from my typical PBM model?” 06:48 What's the trend line with moving away from the big PBMs? 07:20 Specialty pharmacy episodes.07:53 How does a small PBM contract with Pharma? 08:34 EP365 with Scott Haas.10:15 EP337 with Olivia Webb.11:32 “We're still lacking the overall insight to data.” 12:15 “When you have insight and good data, then you can start really driving the plan language and cover requirements.” 13:07 “It is a frustrating game because … the large PBMs that have traditionally managed an employer's spend … doesn't give them the data that's needed.” 13:48 What's going on with outcomes-based contracts? 14:16 What's the importance of aligning reimbursement around value instead of volume? 14:57 “The issue is, how real is the data?” 19:24 EP370 with Erik Davis and Autumn Yongchu.20:36 Are hospital-based specialty pharmacies teaming up with big PBMs? 22:01 “It's market ownership.” 29:17 EP369 with Keith Hartman, RPh.30:43 “These are real scenarios that are happening in the self-insured planned sponsor market.” 30:59 “Employers really should start recognizing organizations that take more of an integrated and thoughtful approach.” You can learn more at ascellahealth.com. Mike Baldzicki of @AscellaHealth discusses #specialtypharma, #PBM, #hospitals, #employers, and #pharma on our #healthcarepodcast. #healthcare #podcast Is it a conflict of incentives to worry about the cost of million-dollar pharmaceuticals? Mike Baldzicki of @AscellaHealth discusses #specialtypharma, #PBM, #hospitals, #employers, and #pharma on our #healthcarepodcast. #healthcare #podcast “Really, does it make sense to carve up my specialty pharmacy benefit … away from my typical PBM model?” Mike Baldzicki of @AscellaHealth discusses #specialtypharma, #PBM, #hospitals, #employers, and #pharma on our #healthcarepodcast. #healthcare #podcast What's the trend line with moving away from the big PBMs? Mike Baldzicki of @AscellaHealth discusses #specialtypharma, #PBM, #hospitals, #employers, and #pharma on our #healthcarepodcast. #healthcare #podcast How does a small PBM contract with Pharma? Mike Baldzicki of @AscellaHealth discusses #specialtypharma, #PBM, #hospitals, #employers, and #pharma on our #healthcarepodcast. #healthcare #podcast “We're still lacking the overall insight to data.” Mike Baldzicki of @AscellaHealth discusses #specialtypharma, #PBM, #hospitals, #employers, and #pharma on our #healthcarepodcast. #healthcare #podcast “When you have insight and good data, then you can start really driving the plan language and cover requirements.” Mike Baldzicki of @AscellaHealth discusses #specialtypharma, #PBM, #hospitals, #employers, and #pharma on our #healthcarepodcast. #healthcare #podcast “It is a frustrating game because … the large PBMs that have traditionally managed an employer's spend … doesn't give them the data that's needed.” Mike Baldzicki of @AscellaHealth discusses #specialtypharma, #PBM, #hospitals, #employers, and #pharma on our #healthcarepodcast. #healthcare #podcast What's going on with outcomes-based contracts? Mike Baldzicki of @AscellaHealth discusses #specialtypharma, #PBM, #hospitals, #employers, and #pharma on our #healthcarepodcast. #healthcare #podcast What's the importance of aligning reimbursement around value instead of volume? Mike Baldzicki of @AscellaHealth discusses #specialtypharma, #PBM, #hospitals, #employers, and #pharma on our #healthcarepodcast. #healthcare #podcast “The issue is, how real is the data?” Mike Baldzicki of @AscellaHealth discusses #specialtypharma, #PBM, #hospitals, #employers, and #pharma on our #healthcarepodcast. #healthcare #podcast Are hospital-based specialty pharmacies teaming up with big PBMs? Mike Baldzicki of @AscellaHealth discusses #specialtypharma, #PBM, #hospitals, #employers, and #pharma on our #healthcarepodcast. #healthcare #podcast “It's market ownership.” Mike Baldzicki of @AscellaHealth discusses #specialtypharma, #PBM, #hospitals, #employers, and #pharma on our #healthcarepodcast. #healthcare #podcast “These are real scenarios that are happening in the self-insured planned sponsor market.” Mike Baldzicki of @AscellaHealth discusses #specialtypharma, #PBM, #hospitals, #employers, and #pharma on our #healthcarepodcast. #healthcare #podcast “Employers really should start recognizing organizations that take more of an integrated and thoughtful approach.” Mike Baldzicki of @AscellaHealth discusses #specialtypharma, #PBM, #hospitals, #employers, and #pharma on our #healthcarepodcast. #healthcare #podcast Recent past interviews: Click a guest's name for their latest RHV episode! Lisa Bari, Betsy Seals (EP375), Dave Chase, Cora Opsahl (EP373), Cora Opsahl (EP372), Dr Mark Fendrick (Encore! EP308), Erik Davis and Autumn Yongchu (EP371), Erik Davis and Autumn Yongchu (EP370), Keith Hartman, Dr Aaron Mitchell (Encore! EP282), Stacey Richter (INBW34), Ashleigh Gunter, Doug Hetherington, Dr Kevin Schulman, Scott Haas, David Muhlestein, David Scheinker, Ali Ucar, Dr Carly Eckert, Jeb Dunkelberger (EP360), Dan O'Neill, Dr Wayne Jenkins, Liliana Petrova, Ge Bai, Nikhil Krishnan, Shawn Rhodes, Pramod John (EP353), Pramod John (EP352)
Professor Piotr Rutkowski, of the Maria-Sklodowska-Curie National Research Institute, discusses how Poland is managing the influx of 5 million Ukrainian refugees since the war began and tells host Dr. John Sweetenham, of the UT Southwestern Harold C. Simmons Comprehensive Cancer Center, about the future health needs of Ukrainian refugees with cancer. TRANSCRIPT Dr. John Sweetenham: Hello. I'm Dr. John Sweetenham, the associate director for Clinical Affairs at UT Southwestern's Harold C. Simmons Comprehensive Cancer Center and host of the ASCO Daily News podcast. My guest today is Professor Piotr Rutkowski, who leads the department of Soft Tissue and Bone Sarcoma and Melanoma at the Maria Sklodowska-Curie National Research Institute of Oncology in Warsaw, Poland. Prof. Rutkowski is also the deputy director for the National Oncological Strategy and Clinical Trials, and serves as president of the Polish Oncological Society. Prof. Rutkowski spoke with us earlier this year as millions of people were fleeing the war in Ukraine, and he described the really remarkable response from both the Polish government and his institution to this crisis. He's back on the podcast today to tell us about cancer care for Ukrainian refugees 5 months into the conflict, and how health systems are coping with the influx of millions of refugees. He will also share his insights on the kind of support that will be needed long-term to care for these patients in the future. Our full disclosures are available in the show notes and disclosures relating to all guests on the podcast can be found on our transcripts at asco.org/podcasts. Professor Rutkowski, thank you for being on the podcast today. It's been about 4 months since we last spoke. How are you doing? Dr. Piotr Rutkowski: I'm very privileged that we can speak again. I'm talking probably on behalf of many Polish physicians and citizens involved with this dramatic situation of war in Ukraine and helping our patients and citizens from Ukraine. And I feel okay, but of course, the situation is still dramatic, and we don't know what will happen during the next months. What we can tell, first, is what has been changed for these last 4 months, it is the number. So as of now, almost 5 million people from Ukraine crossed the border between Ukraine and Poland. And we can estimate that about 3 million refugees stay temporary or maybe even permanently in our country. This is a completely new situation because it means that it's about 10% of our citizens now. And what didn't change but still the cancer care for Ukrainian patients is the extension of regular cancer care within our national oncology network and our national health fund with this Polish insurance system. And this is the same for patients in Poland. And so all refugees from Ukraine are entitled to receive the same care as citizens of Poland. Still, this extraordinary legislation, which was adopted by the Polish parliament, covers all the refugees of war, social security, and health insurance. And we have a better situation because all comprehensive cancer centers or major cancer centers organize the help with a hotline, not only on the level of the whole country but also on the center level in the Ukrainian language. And the majority of these centers have staff speaking the Ukrainian language. Moreover, what I can say as a president of Polish Oncological Society, recently, with the help of an educational grant, we bought electronic translators for major oncological cancer centers. So they can help in the situation, like in the emergency situation, when we have access to live talk. So they can be used in that situation. And in my opinion, it is very, very helpful. So this is the current situation. And of course, I will present further the structure of oncological patients from Ukraine in Poland now and what's been done. Dr. John Sweetenham: Thank you. It's really quite extraordinary to grasp that your patient population almost overnight increased by 10%. That's just quite extraordinary. What aspects of the cancer care would you say are working well at the moment and what are your greatest remaining challenges with this population as of now? Dr. Piotr Rutkowski: First, with this challenge for the pediatric cancer population, and about 1,000 children with cancer were evacuated from Ukraine. They were transported to the Ukrainian hub near Lviv in western Ukraine and thereafter to Polish hub. And with help of many nongovernmental organizations (NGOs) and many organizations, many hospitals from Europe but also U.S. and Canada, many institutions helped within this operation to transfer after triage the pediatric, so children with cancer, to Polish, German, and U.S. physicians. So more than 1,000 children were transferred to these different hospitals around the world—so Europe, the USA, and Canada. But of course, when we look at specific other issues with Ukraine refugees with cancer, first we have a very extraordinary situation and demography because the majority are women with children and only a very small percentage of males, mostly in older age. So when we looked at the cost of hospital admission of patients from Ukraine until May, the signs and symptoms were not in abnormal laboratory tests, or not otherwise classified. So generally, [these were] different conditions, mostly internal conditions. The second one was obstetric gynecology, so pregnancy, childbirth, etc. And the third in the rank were neoplastic diseases. I looked also carefully how it looks on the level of our institution because Maria Sklodowska-Curie National Research Institution is the largest oncological center in Poland. And we have the central part in Warsaw, but also we have 2 branches in Poland. So when we looked at the populations, all together, we had about 1,000 visits with new patients in our institutions. And number 1 was breast cancer. And second were gastrointestinal, and thereafter gynecology. And the fourth in the rank was melanoma and also soft tissue tumors or cancers probably related to the younger population. But melanoma was also relatively frequent. But number 1 was breast and reconstructive in all our branches. And of course, the distribution of patients is also different. In the whole of Poland, the largest numbers are in our region because probably because Warsaw is the largest city in Poland. So they have a lot of relatives or colleagues. So about 20% of patients from Ukraine are concentrated in our region, but more than 10% are also near Katowice or Gliwice. So it's Silesia and also near Krakow. So this central and southeastern part of Poland have the majority of Ukrainian patients now. However, of course, some of the patients were also transferred to other parts of Poland. But as I said, in some of the departments, more than 10% of patients are now from Ukraine, especially in breast cancer units and also gynecological units. When I look in the department which I'm chairing, department of soft tissue, bone sarcoma, and melanoma, we have mostly patients from Ukraine involved in the treatment of advanced melanoma, some with earlier stages, and some patients with sarcoma, especially if they were contacted by physicians from Ukraine specifically for this type of disease. But generally, the state of disease is a little bit more advanced. So, many of these patients are receiving neoadjuvant therapy in breast cancer or they are going directly to treatment of stage IV disease with modern drugs like immunotherapy or targeted therapy for melanoma. This is also the real situation. One of my points I want to mention is, if the access to the cancer care, regular cancer care probably is good for patients, but the problem with communication exists, and still I think that patients or citizens from Ukraine do not participate too much in prevention programs because the participation in mammography, cytology for cervical cancer and other screening programs are at very low levels. So, of course, it's a new situation for these people. But still, probably it will be one of the points for which we have to undertake some strategies. Because we do not know how to get information on if they will be staying longer in our country what we can anticipate for next months and even years. So this can be problematic because it means that we'll have more and more advanced stages of disease. Dr. John Sweetenham: It's very interesting, and of course not surprising, that you have this very skewed demographic of predominantly female patients. I wonder whether you have any insights into whether the—maybe resistance to screening is the wrong word—but the reluctance to be screened? Is that do you think, a reflection of screening services in Ukraine? Or do you think it relates more to the current stresses and priorities that these patients face? Dr. Piotr Rutkowski: I think whether it's first for our colleagues from Ukraine, it's a new situation, and they still are not in a normal life. So I agree that first, of course, the participation in the screening programs in Ukraine is on the lower level, but still, maybe the people do not consider staying here, staying at home, of course, and staying in their own country. So they are a little bit in between of normal life and living as refugees only. So they did not start all normal activities. And of course, the information about the screening programs, about the normally functioning health care, it's also probably a little bit more difficult for them because they may not understand all the details of our health care. So I think that it is one of the points which we have to think about for new strategical enterprises in the coming months. So as I mentioned, for normal access to health care, I do not foresee now that it's problematic. Of course, it can be problematic if we'll have a shortage of our people. But still, we can manage this on a regular level. But as I mentioned, when I talked to our colleagues from the department of prevention, the percentage of the people who are coming for screening programs is very low as compared to the total number of refugees. Dr. John Sweetenham: You mentioned that the future for many of the Ukrainian refugees is uncertain at the moment. Now that the heaviest fighting appears to be concentrated on the east of the country, are you seeing any signs that Ukrainian patients will be able to go home for their treatments at any point in the near future? Dr. Piotr Rutkowski: Yes, I think so. Some of the refugees even started to come back home to Western Ukraine, especially when they felt that it was a little bit safer. But as we know, still the situation on the front and the plans of the Russian invaders are not predictable. So we cannot say how even we can behave in this situation. So, for example, in my hospital, we have psychologists from Ukraine who first escaped from Donbas to Kharkiv. And when Kharkiv started to be shelled by bombs, they escaped to Poland. So it's sometimes really dramatic fates for these people. So, of course, the movements between the border are relatively high because some of the people are trying to come back because they feel more comfortable in their homeland, in the country where they can all speak one language, but others they feel they've started to adapt to in living in Poland and we have more and more patients who are accompanied by people speaking Polish. So they started to try to live more normally in our country. I also noticed that we have some patients from Ukraine in the clinical trials. Of course, we also adapted the informed consent and some information sheets into the Ukrainian language. So Ukrainian patients interested in taking part in clinical trials are also included based on normal inclusion criteria. This is also important that we can propose this to patients from Ukraine because if they want to stay longer so they can get extra treatment within the frame of clinical trials. What is also interesting with our National Science Center is that it started to support researchers who are fleeing from war. And they prepared the special funding scheme for researchers from Ukraine to encourage the grant winners to employ researchers from Ukraine on ongoing projects. So there are many specific actions to adapt the citizens of Ukraine in Poland, and of course allow them to undertake normal work. We also allowed for specific temporary work in health care for physicians and nurses. And as it was announced recently by the Polish Minister of Health, more than 2,000 physicians from Ukraine decided to work in the Polish health system. So this is what we can do now. And probably we can do follow-up in half a year again. We'll see what will happen. Dr. John Sweetenham: I thank your responsiveness and that view of government. So this situation has been really remarkable and also remarkably quick. And as you've already pointed out, these patients are going to have needs for many months and many years to come. And you've touched on some of those, specifically the needs around cancer screening. Do you have any other insights into what you think the most pressing future needs for these refugees will be? And then what support your health system, which is presumably already overstretched, what additional support will it need to cope with the ongoing demands and needs of this population? Dr. Piotr Rutkowski: We really appreciate the help from the international community with material for our Ukrainian patients. Probably the next step will be a specific maybe European Union (EU) fund for a health care system which is affected now by numbers of patients from Ukraine, because, of course, we are doing this with our internal Polish funds. But I don't know how it would affect the next year with regular health service in Poland. So this is one of the points. The second point, of course, which we are always afraid of is the situation with the staff shortage for regular health care because Poland, generally in our part of Europe, we can see the shortage of nurses and educated oncological physicians. This is what we included in our national oncological strategy. However, we didn't anticipate it would have such an extraordinary situation which we have to face now. So these points can be one of the problems which can be raised next month. Dr. John Sweetenham: And so you you've indicated the potential support from the EU and other international agencies. I wonder if we could take that question a little bit further to the international oncology community, including organizations like ASCO, the European Cancer Organization (ECO), the American Cancer Society, and others, who've been collaborating to support Ukrainian patients and the oncology community in Poland and in the region. How do you think the international oncology community can continue to respond and help in the coming months and years? Dr. Piotr Rutkowski: It seems that it's a very continuous effort. So we have regular meetings between the national representatives, ECO, as you mentioned, ASCO, and also some NGOs to discuss the hottest problems with the situation in Europe and also how we can find solutions. Colleagues from Ukraine are also asking us about these specific issues like access to radiation therapy and the possibility to transfer the patients because the equipment is not working perfectly in the whole of Ukraine. This effort is very, very important. I feel that it will be a very excellent platform for next month, maybe for next year. I think that it's extraordinary because it was organized very fast, and it was not temporary, but it seems that it will be continuous for a long time. As I mentioned in this platform, we can exchange some materials, and some information very quickly and in an efficient way. I would like to thank you, ASCO, and ECO for the organization of this platform. Dr. John Sweetenham: Well, Professor Rutkowski, I want to thank you again for taking the time to join us for a follow-up discussion regarding the situation in your country with respect to Ukraine, and express, once again, our respect and admiration for the way that you and your colleagues and your country have responded to the crisis. It's been a real pleasure having you on the podcast today. So thank you for joining. Dr. Piotr Rutkowski: Thank you very much. Goodbye. Dr. John Sweetenham: And thank you to our listeners for your time today. If you're enjoying the content on the ASCO Daily News podcast, please take a moment to rate and review us wherever you get your podcasts. Disclosures: Dr. John Sweetenham: Consulting or Advisory Role: EMA Wellness Dr. Piotr Rutkowski: Honoraria: Bristol-Myers Squibb, MSD, Novartis, Roche, Pfizer, Pierre Fabre, Sanofi, and Merck Consulting or Advisory Role: Novartis, Blueprint Medicines, Bristol-Myers Squibb, Pierre Fabre, MSD, Amgen Speakers' Bureau: Pfizer, Novartis, Pierre Fabre Research Funding (institution): Novartis, Roche, Bristol-Myers Squibb Travel, Accommodations, Expenses: Orphan Europe, Pierre Fabre Disclaimer: The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. Guest statements on the podcast do not express the opinions of ASCO. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement.
Curious about the Mediterranean Diet and impact on psoriatic disease? Dr. Adam Ford, UC Davis Health, Dept. of Dermatology and registered dietitian, Danielle Baham, Supportive Oncology & Survivorship, UC Davis Comprehensive Cancer Ctr, discuss evidence supporting use, and how changes lead to improved therapy response and reduce risk of related health conditions. This Psound Bytes episode is provided with support from AbbVie, Amgen, CeraVe, Bristol Myers Squibb, Janssen and Lilly.
Since the summer of Black Lives Matter in 2020, institutions all over the U.S. have been exploring their pasts. In order to understand how they may have contributed to or helped perpetuate systemic racism. Universities, private businesses, and non-profits have all been working to try to understand what it means to be Anti-Racist. The American Statistical Association launched an Anti-Racism Task Force to explore this very thing, and that's the focus of this episode of Stats+Stories with guests Dr. Adrian Coles and Dr. David Marker. Dr. Coles is an Associate Director of Biostatistics at Bristol Myers Squibb. He is a collaborative researcher who specializes in the design and implementation of clinical trials and the interpretation of clinical trial data to facilitate the assessment of benefit/risk for promising pharmaceutical innovations. He is also a subject matter expert in diversity, equity, and inclusion and chairs the American Statistical Association's Committee on Minorities in Statistics as well as the organization's Antiracism Taskforce. Dr. Marker is a senior statistician who recently retired after 37+ years at Westat. He is continuing to consult on topics of personal interest. He has worked on studies in the fields of public health, environmental pollution, homelessness, voting rights, and many others. He recently served as co-chair of the American Statistical Association's Anti-Racism Task Force. Dr. Marker is an internationally recognized consultant in total quality management, having advised the Swedish, Norwegian, Finnish, South African, Dutch, and Danish Governments on improving the quality of their data collection activities. He has also appeared as an expert witness before Federal, state, and local governments and on voting rights and language-minority rights before Federal, State, and Provincial courts. Dr. Marker is a Fellow of the ASA and American Academy for the Advancement of Science (AAAS), and an Elected member of the International Statistical Institute. He will receive a Founders Award from the ASA at this summer's Joint Statistical Meetings.
Hear cardiologist Dr. Nehal Mehta, Chief, Section of Inflammation and Cardiometabolic Diseases at the NIH in Bethesda, MD provide an update on the role "adipokines" play in the development of inflammatory diseases such as psoriasis, along with tips on reducing your inflammatory risk. This Psound Bytes episode is provided with support from AbbVie, Amgen, CeraVe, Bristol Myers Squibb, Janssen and Lilly.
Es hora de hablar sobre medicina, y no cualquiera, en concreto la hematología, que es el estudio de la sangre y sus derivados, lo cual implica hemofilias, anemias y cánceres líquidos, como leucemias y linfomas. Pero, para hablar sobre ello tenemos que empezar por el principio: ¿qué es la sangre?, ¿dónde se produce?, ¿qué son los grupos sanguíneos?...Para hablar sobre ello tenemos con nosotros a Armando Vicente Mena Durán, que es Doctor en Medicina por la Universidad de Valencia, médico especialista en Hematología y Hemoterapia, y médico especialista en Cirugía Cardiovascular. Desarrolló su tesis doctoral en Síndromes mielodisplásicos gracias a las becas FIS-Fulbright en el Sanford Burnham Medical Discovery Institute, en La Jolla California, y en el Hospital La Fe de Valencia gracias a la beca nacional de la Fundación Carreras. Es Máster en Trasplante Hematopoyético y ha sido profesor asistente del departamento de Medicina de la Universidad Católica de Valencia. Ha formado parte del Departamento de investigación clínica de la compañía farmacéutica Bristol-Myers-Squibb y actualmente es médico adjunto y responsable del Área de Hospitalización del Servicio de Hematología y Hemoterapia del Consorcio Hospital General Universitario de Valencia.
Miguel Salazar es expresidente y director general de Boehringer Ingelheim para México, América Central y el Caribe para medicamentos recetados y productos veterinarios. Es un ejecutivo multinacional con experiencia en el desarrollo de panoramas estratégicos para productos de Farmacia Humana, Salud Animal y Bienes de Consumo para las industrias farmacéutica y alimentaria. Trabajó en corporaciones como McDonald's, Bristol Myers Squibb y Boehringer Ingelheim. Ha trabajado en la industria farmacéutica desde 1988 en Alemania y México y tuvo supervisión regional para los EE. UU., Canadá y el Caribe. Fue responsable global del Departamento Corporativo de Preparación para el Lanzamiento en Boehringer Ingelheim. Es consejero de varias empresas farmacéuticas. Ha dado clases en el TEC, ITAM, y en otras instituciones mexicanas y europeas. Es Mentor Endeavor en donde es considerado entre los 100 mejores mentores de Endeavor México. En esta entrevista hablamos de: ✨ ¿Cómo prepararte para ser director general de una empresa multinacional? ✨ ¿Cómo generar cultura dentro de las empresas? ✨ ¿Por qué es importante trabajar en diferentes áreas y no durar más de 10 años en un mismo rol? ✨ ¿Por qué sí recomienda terminar la universidad? Más de Miguel… Hace Business Scouting, actúa como asesor de CANIFARMA y participa en proyectos de desarrollo de personal de algunas empresas. Obtuvo su bachillerato en la Universidad Anáhuac del Sur, obtuvo su maestría en negocios en el Instituto Tecnológico de Estudios Superiores Monterrey CCM y participó en programas ejecutivos en Kellogg School of Management en Northwestern University e INSEAD en Fontainebleau, Francia. Casado, padre de 1 hijo y 3 hijas, practica deportes de equipo a nivel preuniversitario como voleibol y fútbol, disfruta el pádel y ama el esquí alpino. SI TE GUSTA ESTE PODCAST, CALIFÍCANOS CON 5 ESTRELLAS AQUÍ: https://open.spotify.com/show/2O952j0tyXgDCW5APgYpzN?si=7b6edd78b5aa46cb ► SÍGUENOS EN: ◄ ☘️ YouTube: https://www.youtube.com/channel/UCt2r8LeKpms_rf2zw_jYO-Q ☘️ Instagram: https://www.instagram.com/mentores_con_maite/ ☘️ Facebook: https://www.facebook.com/mentoresconmaite ☘️Spotify: https://open.spotify.com/show/2O952j0tyXgDCW5APgYpzN?si=HgB3vsMVRWSZYdk1ge5AAQ ☘️iTunes: https://podcasts.apple.com/mx/podcast/mentores/id1524837156 Contacto: firstname.lastname@example.org ➖➖➖➖➖➖➖➖➖➖➖➖➖➖➖➖➖➖➖➖➖➖ ► SÍGUELO EN: ◄ ☘️ LinkedIn: https://www.linkedin.com/in/miguel-alberto-salazar-hernandez-9118578a/ ☘️ Twitter: @msalazarh66 ➖➖➖➖➖➖➖➖➖➖➖➖➖➖➖➖➖➖➖➖➖➖ Este SET es patrocinado por mi empresa Yes to Value, una empresa que se dedica a dar “Performance mentoring” (mentoría en desempeño) a través de programas de inteligencia emocional, cultivar hábitos, aprender a vivir incómodos, mindfulness y despertar inteligencias. El enfoque está en generar excelencia y satisfacción dentro de las empresas y en la vida de las personas de manera simple y eficaz. Si eres dueño de negocio o colaboras en alguna empresa contáctame si quieres que llevemos estos programas, serán impactantes, benéficos y ayudará a generar un ambiente laboral en el que es inspirador trabajar y crecer. Escríbeme a: email@example.com ➖➖➖➖➖➖➖➖➖➖➖➖➖➖➖➖➖➖➖➖➖➖ Maite Valverde de Loyola:
In this episode of Money Tales, our guest is Jeff Savlov. Jeff started working at an early age in his family business, a growing commercial printing operation. His first role was to peel off strips of silver in the film that was otherwise garbage so they could sell the silver for cash. Jeff learned firsthand the challenges that come with working for your dad. As Jeff shared with us, his dad took out the business frustrations on Jeff because it was safe. Jeff, after all, was family. They ultimately hired a therapist to help address the challenging family dynamics. This experience inspired Jeff's ultimate career decision.Jeff is founder of Blum & Savlov, LLP - Family Business & Wealth Consulting and works with family businesses, high net-worth families, family offices and their advisors with a focus on balancing family dynamics with ownership and management of shared assets across generations. Jeff's specialty is working with families that want their wealth to serve current and future generations in healthy and productive ways and he loves coaching parents on raising children in a family business/wealth context to harness potential and avoid common, painful pitfalls. He speaks in the U.S. and internationally, has been quoted in the NY Times, Family Business Magazine, and authors a popular blog - “The Family Business Minute.”Jeff brings more than 25 years of unique experience in sales and marketing, business ownership, entrepreneurial endeavors and family dynamics training, along with a common sense style, to his consulting work with families. By integrating his diverse business background, extensive academic work and family dynamics/psychological training with his experience working in his family's commercial printing business, Jeff helps enterprising families to balance family dynamics and business so both will thrive for many generations.Having participated in his family's business, Jeff understands first-hand the challenges of balancing the interplay between family and business and the devastation that can befall an otherwise healthy business when this balance is not proactively managed. In the business Jeff's family owned, a consultant was brought in to work with the family, facilitated a successful reorganization of the business and helped rebuild family relationships. This is one of the primary experiences which motivated Jeff's career in family business/family wealth consulting.Jeff holds a Master of Social Work degree from Rutgers University with specializations in group dynamics and family systems theory and has a post-graduate certification from the Institute for Psychoanalysis and Psychotherapy of New Jersey (now the Center for Psychoanalysis and Psychotherapy of NJ) where he is a member of the faculty. He earned an Advanced Certificate in Family Business Advising and Fellow status from the Family Firm Institute (FFI), Boston, MA. In addition, he has consulted with Fortune 500 companies such as Bristol-Myers Squibb, Johnson & Johnson and Schering Plough. He also devotes a portion of his time to performance enhancement with corporate executives and elite high school athletes.Through membership in the Family Firm Institute, an international organization comprised of family business and family wealth advisors, consultants, educators and researchers, and the Purposeful Planning Institute, Jeff has access to the latest trends, developments, best practices and research in family business and family wealth consulting. Jeff is the founder of the Princeton Family Business Consultants Group - an interdisciplinary group of professionals serving enterprising families across the U.S. and convening to develop best practices.Jeff lives in New Jersey with his wife and two children. He coaches youth sports and makes time for his lifelong passion – ice hockey. Jeff approaches his life and work with creativity and a sense of humor.Learn more about Money Tale$ > Subscribe to the podcast
CardioNerds (Amit Goyal), Dr. Colin Blumenthal (CardioNerds Academy House Faculty Leader and FIT at the University of Pennsylvania), and Dr. Anjali Wagle (CardioNerds Ambassador and FIT at Johns Hopkins University), discuss the baseline assessment of stroke and bleeding risk in patients with atrial fibrillation (AF) with Dr. Elaine Hylek. Dr. Hylek is a professor of medicine at the Boston University School of Medicine and is the Director of the Thrombosis and Anticoagulation Service at Boston Medical Center. Stroke is a potentially devastating and preventable complication of AF. Understanding the balance between stroke and bleeding risk is crucial in determining who should be on anticoagulation. Join us to discuss this topic! In the next episode of the series, we will discuss situational risk assessment in the context of peri-cardioversion, peri-procedural status, triggered atrial fibrillation, and more. Audio editing by CardioNerds Academy Intern, Pace Wetstein. This CardioNerds Atrial Fibrillation series is a multi-institutional collaboration made possible by contributions of stellar fellow leads and expert faculty from several programs, led by series co-chairs, Dr. Kelly Arps and Dr. Colin Blumenthal. This series is supported by an educational grant from the Bristol Myers Squibb and Pfizer Alliance. All CardioNerds content is planned, produced, and reviewed solely by CardioNerds. We have collaborated with VCU Health to provide CME. Claim free CME here! Disclosures: None Pearls • Notes • References • Guest Profiles • Production Team CardioNerds Atrial Fibrillation PageCardioNerds Episode PageCardioNerds AcademyCardionerds Healy Honor Roll CardioNerds Journal ClubSubscribe to The Heartbeat Newsletter!Check out CardioNerds SWAG!Become a CardioNerds Patron! Pearls and Quotes - Atrial Fibrillation: Assessment of Stroke & Bleeding Risk The CHA2DS2-VASc should be used to determine stroke risk in all patients. It was updated from the CHADS2 score to better separate patients into high and low risk and a score of 0 has a very low risk of a stroke.Understanding a given model's derivation is key to application for any risk model. Understanding who was and was not included when a risk score was derived helps determine how to clinically use it. For example, mechanical valves, hypertrophic cardiomyopathy, cardiac amyloidosis, and moderate to severe MS were all excluded or poorly represented and should receive AC in AF regardless of CV.The HAS-BLED score should be used to identify modifiable risk factors for bleeding and address them. It is less useful to determine when we should stop AC. Factors that go into the score are dynamic and the intention was to alert the provider of potentially modifiable factors that could be addressed to lower bleeding risk (such as better BP control).Fear the clot. Patients should be on AC unless there is a serious contraindication as embolic strokes can be devastating with a high mortality (~24% mortality at 30 days)“What am I saying by not writing the prescription... I am saying that it's OK to have an ischemic stroke.” Survey data shows that patients are willing to experience 3.5 GI bleeds on average before 1 stroke, so favoring AC is often a patient centered approach Notes - Atrial Fibrillation: Assessment of Stroke & Bleeding Risk Notes drafted by Dr. Anjali Wagle 1. Why do strokes happen in atrial fibrillation? Why is reducing stroke risk so important? Atrial fibrillation is associated with a significantly increased risk of stroke. The mortality of strokes related to AF have been estimated to be around 25% at 30 days in early studies which included either persistent or permanent AF, though of note, these studied were biased towards larger strokes since the diagnosis was based on physical exam and not high resolution imaging. AF promotes thrombogenesis through Virchow's triad which includes:
In this episode, Jonathon Andell and I discuss his involvement with Motorola when Six Sigma was first introduced. Jonathon was a young engineer at Motorola at that time and shares some great memories about his learnings early on. We also discuss how Lean and Six Sigma has shaped his problem solving approach over the years and he shares his biggest factors impacting effectiveness of lean transformations. What You'll Learn: Jonathon's experience with Six Sigma at Motorola early on. Lean and Six Sigma's impact on his approach to solving problems. If you could counsel your earlier self in LSS, what advice would you give? What do you consider the biggest factors impacting the effectiveness of Lean transformations? About the Guest: Jonathon Andell is an accomplished operational excellence leader and an exceptional instructor, coach, and mentor in all aspects of lean-six sigma and continuous improvement. Jonathan is a master black belt with a track record of millions of dollars of bottom-line impact across many organizations in multiple industries. He has served as an operational excellence practitioner across many organizations such as Motorola, Boeing, Verizon, Blue Cross and Blue Shield, Bristol Myers Squibb, and now Vistra. Connect with Jonathon Here: https://www.linkedin.com/in/jonathon-andell/ --- Support this podcast: https://anchor.fm/leansolutions/support
El año pasado en España se diagnosticaron más de 7 000 casos de cáncer renal, un tipo de cáncer cuya incidencia parece estar aumentando. Los expertos creen que una razón de este crecimiento podría estar en que cada vez se utilizan más pruebas con técnicas de imagen, como la tomografía computarizada, lo que hace que muchos de estos cánceres se descubran accidentalmente. Pese a todo, el cáncer de riñón puede considerarse una enfermedad silenciosa. Poco se habla de ella en los medios en comparación con otros cánceres, como el de mama, pulmón o colón, así que en general no sabemos identificar sus síntomas o los factores de riesgo específicos de esta enfermedad.Hoy charlamos con una oncóloga, la doctora Begoña Valderrama, para aprender y concienciarnos sobre esta patología, dentro de la campaña de Viva Voz, en colaboración con Bristol Myers Squibb.
Leadership and branding are two words that don't typically appear in the same sentence.We think of branding as something that's applied to products to give them an identity or greater consumer appeal.Leadership tends to conjure images of building team spirit or guiding a company through tough times or towards greater success.But what if to be more successful senior executives need to combine the principles of both branding and leadership?Today I'm speaking with Brenda Bence, whose has deep experience in both branding and leadership.Brenda spent 20 years working in six countries in Europe and Asia leading billion dollar consumer brands for Procter & Gamble and Bristol-Myers Squibb.Since then, she's coached over a thousand leaders from around the world and is recognized by Thinkers50 as a World Leader in Coaching.Brenda believes that every great leader has their own personal brand. In this podcast she talks about1. What a ‘personal brand' is and why it plays a critical role for leadership success.2. How to get started identifying and building our leadership brand.3. Errors that leaders might not realise they make that undermine their brand image.USEFUL LINKSConnect with Brenda Bence on LinkedIn: https://www.linkedin.com/in/brendabence/Brenda Bence's books: https://brendabence.com/books-products/Brenda Bence's website: www.BrendaBence.comBrenda Bence on YouTube: https://www.youtube.com/c/BrendaBenceLearn about the Current Situation Sourcing: https://thecurrentsituation.netA Seat at The Table website: https://seat.fm
Listen as dermatologist Dr. Laura Ferris, Professor of Dermatology at the University of Pittsburgh, joins us to talk about the primary types of skin cancer, how it compares to psoriasis, risk factors (including those associated with medications), diagnosis, treatments, and steps to protect your skin while in the sun. Psound Bytes is supported by unrestricted educational grants from AbbVie, Amgen, Bristol Myers Squibb and Janssen.
Hong Tang is the co-founder and Chief Medical Officer of OnQuality Pharmaceuticals, a targeted cancer supportive care (TCSC) pharmaceutical company dedicated to the development of treatments to address specific side effects of cancer therapies- to improve the quality of life and outcomes for patients fighting cancer. Prior to founding OnQuality, she worked as a Physician-Scientist in numerous medical affairs and leadership roles at the NIH, Bristol-Myers Squibb, Astellas Pharma, Dendreon, and Juno Therapeutics. She studied medicine at Guangzhou University and studied pharmacology at the University of Texas-San Antonio. In this episode, we discuss OnQuality's clinical pipeline of TCSC drugs, the field of medical affairs, the inspiration we draw to pursue science and medicine, and the role of clinical conferences.Hosted by Joe Varriale.
For more details, visit the #DrGPCR Podcast Episode #80 page https://www.drgpcr.com/episode-80-with-andrew-tobin/ ------------------------------------------- About Dr. Andrew Tobin Andrew Tobin studied Biochemistry at Queen Mary College, the University of London obtaining first-class honors before studying for a D.Phil at the University of Oxford. Following a post-doctoral period at Bristol Myers Squibb in Princeton USA, Andrew returned to the UK to establish his own laboratory at the University of Leicester. Funded through three consecutive Wellcome Trust Senior Research Fellowships Andrew established a reputation in the field of receptor signaling. Now at the University of Glasgow, his primary research interests are focused on the rational design of novel drugs to treat the three global health challenges of dementia, asthma, and malaria. In this Andrew runs a research laboratory of around 15 staff supported by basic research grants investigating aspects of disease biology and the action of drugs in the context of disease. The vehicle by which Andrew is translating fundamental findings to commercial products is Keltic Pharma Therapeutics Ltd, a biotechnology company co-founded by Andrew with series A funding from the European Union. Andrew is also the Director of the Advanced Research Centre (ARC) a collaborative initiative at the University of Glasgow underpinned by a £118M new build that will house over 550 researchers designed to drive interdisciplinary research. Dr. Andrew Tobin on the web University of Glasgow ResearchGate Google Scholar Twitter Dr. GPCR Ecosystem ------------------------------------------- Become a #DrGPCR Ecosystem Member ------------------------------------------- Imagine a world in which the vast majority of us are healthy. The #DrGPCR Ecosystem is all about dynamic interactions between us who are working towards exploiting the druggability of #GPCR's. We aspire to provide opportunities to connect, share, form trusting partnerships, grow, and thrive together. To build our #GPCR Ecosystem, we created various enabling outlets. Individuals Organizations ------------------------------------------- Are you a #GPCR professional? Subscribe to #DrGPCR Monthly Newsletter Listen and subscribe to #DrGPCR Podcasts Listen and watch GPCR focused scientific talks at #VirtualCafe
“My White Coat Doesn't Fit” by Narjust Florez (Duma): a medical oncologist shares her story about exclusion, depression and finding her way in oncology as a Latina in medicine and oncology. TRANSCRIPT Narrator: My White Coat Doesn't Fit, by Narjust Duma, MD (10.1200/JCO.21.02601) There I was, crying once again all the way from the hospital's parking lot to my apartment, into the shower, and while trying to fall asleep. This had become the norm during my internal medicine residency. For years, I tried hard every day to be someone else in order to fit in. It started with off-hand comments like “Look at her red shoes,” “You are so colorful,” and “You are so Latina.” These later escalated to being interrupted during presentations with comments about my accent, being told that my medical school training in my home country was inferior to my US colleagues, and being assigned all Spanish-speaking patients because “They are your people.” Some of those comments and interactions were unintentionally harmful but led to feelings of isolation, and over time, I began to feel like an outsider. I came to the United States with the dream of becoming a physician investigator, leaving behind family, friends, and everything I knew. Over time, I felt pigeonholed into a constricting stereotype due to my ethnicity and accent. Back home, I was one of many, but in this new setting, I was one of a few, and in many instances, I was the only Latina in the room. I was raised by divorced physician parents in Venezuela; my childhood years were often spent in the clinic waiting for my mother to see that one last patient or outside the operating room waiting for my father to take me home. The hospital felt like my second home, growing up snacking on Graham crackers and drinking the infamous hospital's 1% orange juice. “She was raised in a hospital,” my mother used to say. Sadly, that feeling of being at home in the hospital changed during medical training as I felt isolated and like I did not belong, making me question my dream and the decision to come to the United States. I remember calling my family and crying as I asked “Why did I leave?” “Why didn't you stop me from coming here?” and seeking permission to return home. I felt like I was disappointing them as I was no longer the vivid, confident young woman who left her home country to pursue a bright future. I remember one colleague, Valerie (pseudonym), from Connecticut. Valerie attended medical school in the United States, did not have an accent, and was familiar with the American health care system. She understood how the senior resident-intern relationship functioned, a hierarchy that continually confused me. Over the following weeks, I took a closer look at how my colleagues and other hospital staff interacted with Valerie. I noticed that people did not comment about her clothing or personality. She was “normal” and fit in. I remember my senior resident asking me, “Narjust, why can't you be more like Valerie?” Ashamed, I mumbled that I would try and then ran to the bathroom to cry alone. That interaction was a turning point for me; I got the message. I needed to change; I needed to stop being who I was to be accepted. As the years passed, I kept key pieces of my personality hidden, hoping I could earn the respect of my colleagues. I refrained from sharing my personal stories as they were different from those around me. I grew up in a developing country with a struggling economy and an even more challenging political situation. It was clear that we simply did not share similar experiences. When I sought help from my senior residents and attending physicians, my feelings were often minimized or invalidated. I was told that “residency is tough” and that I should “man up.” A few even suggested that I mold my personality to fit the box of what a resident physician was supposed to be. I slowly realized that my clothing changed from reds and pinks to greys and blacks because it was “more professional”; my outward appearance faded, as did my once bright sense of humor and affability. All these issues led to depression and an overwhelming sense of not belonging. A few months later, I was on antidepressants, but the crying in the shower continued. Rotation by rotation, I looked for a specialty that would help me feel like I belonged, and I found that in oncology. My mentor embraced my research ideas; my ethnic background or accent did not matter; we had the same goal, improving the care of our patients with cancer. I got to travel to national and international conferences, presented my research findings, and received a few awards along the way. From the outside, it looked like I was thriving; my mentor often called me a “Rising Star,” but in reality, I was still deeply depressed and trying to fit in every day. My career successes led me to believe that not being myself was the right thing to do. I felt isolated; I was trying to be someone I was not. A year later, I matched at my top choice oncology fellowship program; the program had the balance I was looking for between clinical care and research. This meant that I needed to move to the Midwest, further away from family, and to an area of the country with less racial and ethnic diversity. After 2 years on antidepressants and the 10 extra pounds that came with it, my white coat did not fit. My white coat felt like a costume that I would put on every day to fulfill the dream of being a doctor. I would often wake up in the middle of the night exhausted and depressed. I had all the responsibilities of a hematology/ oncology trainee and the additional full-time job of trying to fit in every day; I was using all my energy trying to be someone I was not. Regardless of my fears, I felt in my element when talking to patients and interacting with my cofellows. Despite having a different skin color and accent, I felt accepted by my patients with cancer. I remember when one of my patients requested to see me while in the emergency room because “Dr Duma just gets me.” She had been evaluated by the head of the department and attending physicians, but for her, I washer doctor. Tears of happiness accompanied my bus ride to see her; at that moment, I knew I was an oncologist, and oncology was the place I belonged. The next day, I realized that it was time to be myself: Narjust from Venezuela, a Latina oncologist who was her true self. I searched the bottom of my closet for the last piece of colorful clothing I had saved, a yellow dress. I put on that brightly colored dress for the first time in 5 years and finally felt comfortable being my authentic self; the yellow dress represented freedom and embraced the culture and colors I grew up seeing in my hometown. I finally understood that I brought something special to the table: my unique understanding of the challenges faced by Latinx patients and trainees, my advocacy skills, and my persistence to endure the academic grindstone. Psychotherapy was also an essential part of my recovery; I learned that happiness lived within me as a whole person—hiding my accent, cultural background, and past experiences was also hiding the light and joy inside me. Along the way, I found colleagues who faced the same challenges and validated that my experiences resulted from an environment that excludes the difference and values homogeneity. This route to self-discovery helped me find my calling to support others in situations similar to mine.3 I learned how to incorporate and celebrate my ethnicity in the world of academic oncology by teaching others the power of cultural humility, diversity, equity, and inclusion. Together with newfound friends and colleagues, I cofounded the #LatinasinMedicine Twitter community for those who face similar burdens during their training and careers. The #LatinasinMedicine community was created to share our stories, embrace our culture, and amplify other Latinas in medicine—to create connections that alleviate the sense of isolation that many of us have experienced and serve as role models to the next generation of Latinas in medicine. To help drive systemic change, I founded the Duma Laboratory, a research group that focuses on cancer health disparities and discrimination in medical education. Through research, the Duma Laboratory has shown that my experiences are not unique but rather an everyday reality for many international medical graduates and other under-represented groups in medicine. The Duma Laboratory has become a safe environment for many trainees; we seek to change how mentorship works for under-represented groups in oncology, with the hope that the isolation I felt during my training is not something that future physicians will ever have to endure. After years of depression and self-discovery, my white coat now fits. However, this is not your regular white coat; it has touches of color to embrace my heritage and the ancestors who paved the way for me to be here today. The face of medicine and oncology is changing around the world; young women of color are standing up to demonstrate the strength of our experiences and fuel the change that medical education needs. For all minority medical students, residents, fellows, and junior faculty, we belong in medicine even during those moments when our identity is tested. Through my journey, I learned that we can and must challenge the status quo. I hope to inspire others to join me in this path of advocating for diversity, equity, and inclusion because the time for change is now. I was finally free the moment I realized I could not be anyone else but myself, a proud Latina in medicine and oncology. Dr. Lidia Schapira: Welcome to JCO's Cancer Stories: The Art of Oncology, brought to you by the ASCO Podcast Network, which offers a range of educational and scientific content and enriching insight into the world of cancer care. You can find all of the shows including this one at podcast.asco.org. I'm your host, Lidia Shapira, Associate Editor for Art of Oncology and Professor of Medicine at Stanford. And with me today is Dr. Narjust Duma, Associate Director of the Cancer Care Equity Program and Medical Thoracic Oncologist at Dana Farber and an Assistant Professor at Harvard Medical School. We'll be discussing her Art of Oncology article, ‘My White Coat Doesn't Fit.' Our guest has a consulting or advisory role with AstraZeneca, Pfizer, NeoGenomics Laboratories, Janssen, Bristol Myers Squibb, Medarax, Merck, and Mirati. Our guest has also participated in a speaker's bureau for MJH Life Sciences. Narjust, welcome to our podcast. Dr. Narjust Duma: Thank you for the invitation and for letting us share our story. Dr. Lidia Schapira: It's lovely to have you. So, let's start with a bit of background. Your essay has so many powerful themes, the story of an immigrant in the US, the story of resilience, the story of aggression and bullying as a recipient of such during training, of overcoming this and finding not only meaning, but really being an advocate for a more inclusive and fair culture in the workplace. So, let's untangle all of these and start with your family. I was interested in reading that you're named after your two grandmothers, Narcisa and Justa. And this is how your parents, both physicians, Colombian and Dominican, gave you your name, and then you were raised in Venezuela. So, tell us a little bit about your family and the values that were passed on in your family. Dr. Narjust Duma: Thank you for asking. Having my two grandmothers names is something that my mother put a lot of effort into. She was a surgery resident with very limited time to decide to do that. And I don't have a middle name, which is quite unique in Latin America, most people in Latin America have one or two middle names. So, my mother did that to assure that I will use her piece of art, which is my first name. But little does she know that my grandmothers were going to be such an important part of my life, not only because they're in my name, but also because I am who I am thanks to them. So, the first part of my name, Narcisa was my grandma who raised me and she gave me the superpower of reading and disconnecting. So, I'm able to read no matter where I am and how loud it can be and disconnect with the world. So, it is often that my assistants need to knock on my door two or three times so, I don't like being scared because I'm able to travel away. That was also very unique because you will find me in the basketball games from high school or other activities with a book because I was able to block that noise. But it also makes very uncomfortable situations for my friends that find it embarrassing that I will pull a book in the basketball game. And as I grow, thanks to the influence of my grandmothers, I always have these, how can I say, mixed situation, in which they were very old school grandmothers with old school habits and values, and how I'm able to modify that. My grandma told me that you can be a feminist, but you still take care of your house. You can still, you know, cook. And that taught me that you don't have to pick a side, there is no one stereotype for one or another. Because as my mother being a single mother and a surgeon, my parents divorced early on, told me, ‘Yes, I can be the doctor but I can also be the person that has more than a career that's able to have hobbies.' I love cooking, and when I'm stressed, I cook. So, I had a grant deadline a few weeks ago and I cooked so much that there was food for days. So, having the names of my grandmothers is very important because I have their values, but I have modified them to the current times. Dr. Lidia Schapira: Let me ask a little bit about reading. I often ask the guests of this podcast who have written and therefore I know enjoy reading and writing, what their favorite books are or what is currently on their night table. But I'm going to ask you a second question and that is what languages do you read in? Dr. Narjust Duma: I prefer to read in Spanish. I found that books in Spanish, even if it's a book that originated in English, have these romantic characteristics. And I often tell my editors, ‘Just take into account that I think in Spanish, and write in English'. Because I grew up with Gabrielle Garcia Marquez, and when he describes a street, that's a page of the little things that he describes. So, that's how I write and that's how I read in a very romantic, elaborate way. The aspects of realistic imagism, which is my favorite genre in literature, and there are so many Latin American and South American writers that I don't think that I am going to run out. And when I run out, I reread the same books. I have read all of Gabrielle Garcia Marquez's books twice, and Borges, too. It's the type of stories that allows you to submerge yourself and you imagine yourself wearing those Victorian dresses in the heat of a Colombian street, as you try to understand if, you know, Love in the Time of Cholera, if they were more in love with being in love or what it was happening in the story. And that just gives me happiness on a Sunday morning. Dr. Lidia Schapira: That's beautiful. I must confess that reading Borges is not easy. So, I totally admire the fact that you have managed to read all of his work. And I think that you're absolutely right, that magical realism is a genre that is incredibly fresh, and perhaps for the work that we do in oncology, it's a wonderful antidote in a way to some of the realities, the very harsh realities that we deal with on a daily basis. So, let me ask you a little bit about growing up in Venezuela in the 80s, 90s, early aughts. That must have been difficult. Tell us a little bit about that, and your choice of attending medical school. Dr. Narjust Duma: So, growing up in Venezuela, with a Colombian mother, it was quite a unique perspective because she was very attached to her Colombian roots. So, a lot of the things that happened in the house were very Colombian, but I was in Venezuela. So, it was a unique characteristic of being from a country but your family is not from there. So, my parents are not from Venezuela, my grandparents either, and I'm Venezuelan because I was born and raised there. So, that brought a unique perspective, right? The music that I played in my house was Colombian music, not Venezuelan music. So, my family migrated from Colombia to Venezuela due to the challenges in the early 80s with violence and the Medellin, due to the drug cartels. So, we moved to Venezuela for a better future. And growing up in the first years, Venezuela was in a very good position. Oil was at the highest prices. Economically, the country was doing well. I remember, in my early years, the dollar and the bolivar had the same price. But then little by little I saw how my country deteriorated, and it was very heartbreaking. From a place where the shells were full of food to a place now when there is no food, and you go to the supermarket, and many of them are close. And now you're only limited to buying certain things. And you used to use your federal ID that has an electronic tracking on how much you can buy because of socialism. So, you're only allowed to buy two kilograms of rice per month, for example, you're only allowed to buy this number of plantains. So, every time I go home, because Venezuela is always going to be my home, it doesn't matter where I am., I see how my country has lost pieces by pieces, which is quite very hard because I had a very good childhood. I had a unique childhood because I was raised in hospitals. But I had a childhood in which I will play with my friends across the street. We were not worried about being kidnapped. We were not worried about being robbed. That's one thing that children in Venezuela cannot do right now. Children of doctors – there's a higher risk of being kidnapped as a kid right now if your father is a doctor or your mother. So, my childhood wasn't like that. When I teach my students or talk to my mentees, I'm often selling my country, and saying that's not what it used to be. That's not where I grew up. But every year I saw how it no longer is where I grew up. That place doesn't exist, and sometimes, Lidia, I feel like my imagination may have to fill it out with more good things. But I think it was a good childhood. It's just that nobody in Venezuela is experiencing what I experienced as a kid. Dr. Lidia Schapira: So, both parents were doctors and you chose to study medicine, was this just right out of high school? Dr. Narjust Duma: Even before high school, I found myself very connected to patients. So, since I turned 15, my father would give his secretary a month of vacation because that's the month that we fill in. So, I was the secretary for a month every summer since I was 15 until I was 20. That early exposure allowed me to like get to know these patients and they know I was the daughter, but I was also the secretary. So, I really cherished that. Growing up in my household, we're a house of service. So, our love language is acts of service. That's how pretty much my grandmas and my parents were. So, in order to be a physician, that's the ultimate act of service. I have wanted to be a doctor since I was 11. I think my mother face horrible gender harassment and sexual harassment as a female in the surgery in the early 80s, that she tried to push me away from medicine. Early on, when I was 11, or 12, being an oil engineer in Venezuela was the career that everybody should have, right? Like, people were going to the Emirates and moving to different parts of the world and were doing wonderful. So, my mother, based on her experience in the 80s, was pushing me away from it. She's like, ‘You can do other things.' My father always stayed in the back and said, ‘You can do what you want.' This is how our parents' experiences affect our future. If I wouldn't be this stubborn, I would probably be an oil engineer today, and I wouldn't be talking to you. Dr. Lidia Schapira: So, you went to medical school, and then after you graduated, what did you decide to do? Because when I look at what we know about the history there is I think you graduated in '09, and then the story that you write about sort of begins in '16 when you come to New Jersey to do training in the US, but what happened between '09 and '16? Dr. Narjust Duma: I started residency in 2013. '16 was my fellowship. So, going to medical school was one of the hardest decisions I made because right in 2003 and 2004 was a coup in Venezuela where part of the opposition took over the country for three days, and then the President of the time came back and the country really significantly destabilized after that coup. Most schools were closed. Entire private industries were closed for a month. And I think for some people, it's hard to understand what happened. Everything closed for a month, McDonald's was closed for a month. There was no Coke because a Coke company was not producing. Everything was closed. The country was just paralyzed. So, my mother and I, and my family, my father, took into account that we didn't know when medical school would resume in Venezuela. We didn't know if the schools would ever open again. I decided to apply for a scholarship and I left Venezuela at the age of 17 to go to the Dominican Republic for medical school. Very early on, I noticed that I was going to be a foreigner wherever I go because I left home. And since then, I think I became very resilient because I was 17 and I needed to move forward. So, that is what happened in 2004. I left everything I knew. I left for the Dominican. I do have family in the Dominican, but it was very hard because even if you speak the same language, the cultures are very different. And then I went to medical school in the Dominican and when I was in the Dominican Republic, I realized I really wanted to do science and be an advocate and focus on vulnerable populations with cancer. So, then I made the decision to come to the United States, I did a year of a research fellowship at Fred Hutchinson, and then I went to residency in 2013. Dr. Lidia Schapira: I see. And that's when you went to New Jersey, far away from home. And as you tell the story, the experience was awful, in part because of the unkindness and aggression, not only microaggression but outright bullying that you experienced. In reading the essay, my impression was that the bullying was mostly on two accounts. One was gender. The other was the fact that you were different. In this particular case, it was the ethnicity as a Latin or Hispanic woman. Tell us a little bit about that so we can understand that. Dr. Narjust Duma: I think what happened is that perfect example of intersectionality because we are now the result of one experience, we're the result of multiple identities. So many woman have faced gender inequalities in medicine, but when you are from a marginalized group, those inequalities multiply. I have an accent and clearly a different skin color. I grew up in a family in which you were encouraged to be your true self. My grandmothers and my mother said, ‘You never want to be the quiet woman in the corner because the quiet woman never generates change.' That's what they said, and I bet there are some who do. But that intersection of my identities was very challenging because I was seen as inferior just for being a woman and then you multiply being one of the few Latinas you are seen like you are less just because you are - it doesn't matter how many degrees or papers or grants you had done and all, I was the most productive research resident in my residency for two years in a row - but I would still be judged by my identity and not what I have produced, or what I do on my patients' experiences, which were great – the feedback from my patients. It's just because I was the different one. Dr. Lidia Schapira: When I hear your story about your origins, it seems to me that you came from a very capable loving family, and they basically told you to go conquer the world, and you did. And then you arrive and you're a productive successful resident, and yet, you are marginalized, as you say. People are really aggressive. Now that you've had some years that have passed, if you think back, what advice would you give that young Narjust? Dr. Narjust Duma: My number one advice, would be that, I will tell myself is that I belong, in many instances, I feel like I didn't belong. It makes me question all the decisions to that day because when you're doing a presentation, and I still remember like today, and you're interrupted by someone, just for them to make a comment about your accent, it really brings everything down to your core, like, 'Is my presentation not accurate? Is the information not all right? And why am I here? Why did I left everything I love to be treated like this?' Dr. Lidia Schapira: Of course. So, from New Jersey, you write in your essay that you really discover your passion for cancer research, and you land in a fellowship with a mentor who is encouraging, and things begin to change for you. Can you tell us a little bit about that phase of your training in your life where you slowly begin to find your voice in the state, that also where you crash, where you find yourself so vulnerable that things really fall apart? Dr. Narjust Duma: So, when I was a resident, I didn't know exactly - I was interested in oncology, but I wasn't sure if it was for me. So, Dr. Martin Gutierrez at Rutgers in Hackensack is the person who I cold emailed and said, ‘I'm interested in studying gastric cancer in Hispanic patients because I think that patients in the clinic are so young.' He, without knowing me or having any idea, he trusted me. We still meet. He still follows up with me. He encouraged me. I think him being a Latino made the experience better, too, because I didn't have to explain my experience to him. I didn't have to explain that. He understood because he went through the same things. And he's like, ‘I got you. Let's follow what you want to do.' He embraced who I was, and how I put who I was into my research. And thanks to Dr. Gutierrez, I'm at the Mayo Clinic as an international medical grad. So, finding a place in which my ideas were embraced was very important to allow me to stay in medicine because, Lidia, I can tell you several times, I decided to leave. I was very committed to finding something else to do or just being a researcher and leaving clinical medicine behind. So, when I went to Mayo, I still followed with that mentor, but I already knew what I wanted to do. I wanted to do cancer health disparities. I wanted to do inclusion and diversity. And that allowed me to develop the career I have now and is having that pathway because I, with my strong personality and everything else, faced this discrimination, and I can imagine for other trainees that may still be facing that or will face that in the future. So, I use the negative aspects to find my calling and do many things I have done after that. Dr. Lidia Schapira: Speaks to your strengths and your determination. Let's talk a little bit about the people who may also feel different but whose differences may not be so apparent. How do you now as an emerging leader, and as a mentor, make sure that you create an inclusive and safe environment for your younger colleagues and your mentees? Dr. Narjust Duma: One of the things that resulted was the founding of the Duma Lab, which is a research group that focuses on cancer, health disparities, social justice as a general, and inclusion in medical education. So, one of the things that I practice every day is cultural humility. I continue to read and remember the principles. I have them as the background on my computer at work. The number one principle in lifelong learning is that we learn from everyone and that we don't know everything and other people's cultures, and subculture, we learn their culture is rich. So, in every meeting, I remind the team of the principles of cultural humility when somebody is joining the lab. I have one-on-one meetings, and I provide information and videos about cultural humility because the lab has been created as an environment that's safe. We have a WhatsApp group that is now kind of famous - it's called The Daily Serotonin. The majority of the members of the lab are part of marginalized groups, not only by gender but race, religion, sexual and gender orientation. So, we created this group to share good and bads, and we provide support. So, a few weeks ago, a patient made reference to one of their lab member's body, the patient was being examined and that was quite inappropriate. The member debriefed with the group and we all provided insights on how she had responded, and how she should respond in the future. That's not only learning from the person that brought the scenario but anybody else feels empowered to stop those microaggressions and stop those inappropriate behaviors that woman particularly face during clinical care. So, cultural humility, and having this WhatsApp group that provides a place where, first, I remind everybody that's confidential, and a place in which anything is shared has been very successful to create inclusivity in the group. Dr. Lidia Schapira: You have such energy and I'm amazed by all of the things that you can do and how you have used social connection as a way of bringing people up. So, can you give our listeners perhaps some tips for how you view creating a flatter culture, one with fewer hierarchies that makes it safer for learners and for those who are practicing oncology? What are three quick things that all of us can do in our work starting this afternoon? Dr. Narjust Duma: The concept is that we all can be allies. And being an ally doesn't take a lot of time or money because people think that being an ally is a full-time job, it is not. So, the first one tip will be to bring people with you. Your success is not only yours. It's a success of your mentees. It's a success of your colleagues. So, don't see your success as my badge on my shoulder. It's the badge that goes on everyone. So, bring people in, leave the door open, not only bring them but leave the door open because when you do it helps the next generation. Two, little things make a difference. I'm going to give you three phrases that I use all the time. When you think somebody has been marginalized in a meeting, bring them up, it takes no time. For example, 'Chenoa, what do you think we can do next?' You're bringing that person to the table. Two, you can advocate for other women and minorities when they're easily interrupted in a meeting. This takes no time. ‘I'm sorry you interrupted Dr. Duma. Dr. Duma?' So, that helps. The third thing is very important. You can connect people. So, one of the things is that I don't have every skill, so I advocate for my mentees and I serve as a connector. I have a mentee that is into bioinformatics. Lidia, that's above my head. I don't understand any of that. So, I was able to connect that person to people that do bioinformatics. And follow up. My last thing is to follow up with your people because they need you. Dr. Lidia Schapira: Well, I'm very glad that you're not an oil engineer in the Emirates. I'm sure your family is incredibly proud. I hope that you're happy where you are. We started a little bit about where you started, I'd like to end with your idea of where you imagine yourself 10 years from now? Dr. Narjust Duma: That is a question I don't have an answer prepared for. I guess my career development plans I think I want to be in a place where I look back and I can see that the careers of my mentees being successful. And I think that we measure my success based not on myself, I would measure my success in 10 years based on where my mentees are. And medical education is a more inclusive place. That will be the two things I want to see in 10 years. In the personal aspect, I don't know if we have art, don't know if we have those grants as long as my mentees are i