Podcasts about lilly foundation

Have you adopted scripts around the terms feminine and masculine? Today we unpack Chapter 8 of Richard's book, Eager to Love, entitled "Lightness of Heart and Firmness of Foot: The integration of Feminine and Masculine", and we ask for our listener's grace as we imperfectly grapple with a subject inherently challenging to define. The conversation delves into the integration of masculine and feminine energies within the context of spirituality, particularly through the lens of the Franciscan tradition. Richard and our hosts explore how cultural influences shape our definitions, how terms like masculine and feminine can easily be confused for gender, and the revolutionary approach of Francis of Assisi in breaking free from traditional norms. We're then joined by two incredible voices in the world of liberation psychology and contemplative spirituality, Jennifer Abe and Douglas Christie, who share their personal journeys and insights, emphasizing the interconnectedness of life and the need for openness to mystery and transformation. Jennifer Shimako Abe earned her PhD in clinical psychology from UCLA and has been on the faculty of the Department of Psychological Science at Loyola Marymount University since 1994. Her experience in Central and South America drew her to the work of Jesuit priest and social psychologist, Fr. Ignacio Martin-Baró, SJ and the field he founded, liberation psychology. The principles of liberation psychology have guided her research in different areas, including how the practice of cultural humility relates to institutional and social transformation, and how culturally rooted, community-defined evidence practices are critical for addressing mental health disparities across diverse communities. In 2024, she helped lead a commission on Student Spiritual Growth and Mental Health: Toward a Hope-Filled Future for Jesuit institutions in North America. Jennifer is currently the interim director for the Marymount Institute for Faith, Culture, and the Arts at LMU, leading efforts to strengthen the legacy of the women religious and the Marymount educational tradition at her institution. Across different leadership roles, Jennifer has been committed to working at the intersections of culture, spirituality, and justice in the context of Ignatian values and the Jesuit educational mission.  Douglas E. Christie is Professor Emeritus in the Theological Studies Department at Loyola Marymount University in Los Angeles. He is the author of The Word in The Desert: Scripture and the Quest for Holiness in Early Christian Monasticism (Oxford, 1993), The Blue Sapphire of the Mind: Note for a Contemplative Ecology (Oxford, 2012), and The Insurmountable Darkness of Love: Mysticism, Loss and the Common Life (Oxford, 2022). He has been awarded fellowships from the Luce Foundation, the Lilly Foundation and the National Endowment for the Humanities. From 2013-2015 he served as Co-director of the Casa de la Mateada study abroad program in Córdoba, Argentina, a program rooted in the Jesuit vision of education for solidarity. He lives with his family in Los Angeles and is currently working on a book about the desert as spiritual landscape.   Hosted by CAC Staff: Mike Petrow, and Paul Swanson Resources: A PDF of the transcript for this episode can be found here. Grab a copy of Eager to Love here. To learn more about the work of Jennifer Abe, visit here. For more by Douglas Christie, visit the following: Wasting Time Conscientiously, What is Contemplation

In this episode, Fr Lorenzo Lebrija chats with the Rev Tricia Lyons about the Mutual Ministry initiative at Virginia Theological seminary. A grant initiative and multi-year process designed to leverage the strengths and address the challenges of a residential, denominational seminary to meet the urgent need for clergy and lay leaders trained as ministry developers in local, culturally specific contexts by shifting from the model where professional clergy are the sole minister that others gather around. https://vts.edu/resource/mutual-ministry/ Patricia “Tricia” Lyons is a Senior Lecturer in Practical Theology at Virginia Seminary, teaching theology and evangelism. She works with the VTS Lifelong Learning team and serves as the Senior Advisor to the Dean for Evangelism Initiatives. Tricia was a lay chaplain and teacher of religion in Episcopal Schools for 20 years before being ordained a priest and then serving urban parishes in Washington, DC, and eventually serving as Canon for Evangelism in the Diocese of Washington. Tricia also serves as a non-stipendiary priest at the Church of Saint Clement in Alexandria, VA. Tricia is a member of the Presiding Bishop's Strategic Cabinet on Evangelism and one of the original writers of the “Way of Love” church-wide curriculum. She is an honors graduate from Harvard College, the Harvard Divinity School and received her doctorate from the Virginia Theological Seminary. Tricia also currently directs a 1-million-dollar grant from the Lilly Foundation, Inc., to study models of mutual ministry across the country. She is the author of five books on faith formation, “The Soul of Adolescence,” “Teaching Faith with Harry Potter,” “What is Evangelism?” “The Evangelist's Breviary,” “Thirty Days: A Devotional” and the upcoming devotional “From Rome to Home: A 30-Day Devotional for those traveling from Roman Catholicism to the Episcopal Church.” 

How does Ministry Focus support the Lord's work through financially supporting church workers? The Rev. Ken Krueger, President and Chair of Ministry Focus, joins Andy and Sarah to talk about Ministry Focus's impact over the last year, how this has made a difference for church workers through the year, and the very exciting new opportunity for Ministry Focus through a grant from the Lilly Foundation. Learn more and find the Church Worker Grant application at ministryfocus.org. As you grab your morning coffee (and pastry, let's be honest), join hosts Andy Bates and Sarah Gulseth as they bring you stories of the intersection of Lutheran life and a secular world. Catch real-life stories of mercy work of the LCMS and partners, updates from missionaries across the ocean, and practical talk about how to live boldly Lutheran. Have a topic you'd like to hear about on The Coffee Hour? Contact us at: listener@kfuo.org.

I've just returned from my sabbatical - a nearly four-month break from work that was facilitated by the amazing people, clergy, and staff of Church of the Redeemer, and graciously funded by the Lilly Foundation - who awarded Church of the Redeemer with a Clergy Renewal Grant which enabled me to travel both by myself and with my family. The primary purpose of this sabbatical was simply to rest, which I'm glad to say happened. When I wasn't just resting, I was going places that connected me to conversion experiences and food - and the places where conversion and food meet. So, what better place for me to take my family than Italy? It's famous for its food, it's rife with religious sites, and it was the location of my accidental conversion all those years ago. We spent a little less than a month in Italy, traveling all throughout the northern half of the country, and finishing our time there in Cinque Terre - the little patch of land on the hillside I keep talking about. I wanted to walk the trails of Cinque Terre again like I did all those years ago, and I wanted to take my family with me. I knew doing this would inevitably draw comparisons to the first time. How could it not? And while I was quick to tell anyone listening that I had no expectations of another conversion experience, I could not help but wonder if just maybe I'd be knocked down and picked back up as thoroughly as I once had been. Want to support our podcast? Give Here

“Remember those three minutes for the rest of your life.” In this episode, Al White, Advisor for Corporate Responsibility and VP of The Lilly Foundation at Eli Lilly and Company, joins Derrin Slack for a conversation about breaking the cycle of crime and making the most of every opportunity. Al's father was a well-known drug dealer in Delaware, and his grandfather was murdered as a result of his involvement with organized crime. When Al was arrested before his senior year of high school, it seemed he would follow the pattern. As he shares his story, you'll hear how he was given a second chance, and what he did next to take full advantage of it. Additional Resources: Connect with Derrin  Check out the original episodes  More on PeopleForward Network Follow PeopleForward Network on LinkedIn

Dr. David Wang is a licensed psychologist and associate professor of psychology and pastoral counseling at the Rosemead School of Psychology, at Biola University. He is the editor of the Journal of Psychology and Theology and serves on the editorial board for Spirituality in Clinical Practice (an APA journal). He also leads research funded by the John Templeton Foundation and the Lilly Foundation investigating the spiritual and character/virtue development of seminary students. Dr. Wang teaches and speaks internationally, maintains a small clinical practice in Fullerton, CA and is the pastor of spiritual formation at One Life City Church

There was time during the early 70's when the field of oncology began to take hold where the singular focus was to extend the patient's life. In this ASCO Education podcast, our guest was one of the first to challenge that notion and rethink methods that focused the patient's QUALITY of life. Dr. Patricia Ganz joins us to describe her transition from cardiology to oncology (6:00), the moment she went beyond treating the disease and began thinking about treating the WHOLE patient (10:06) and the joy of the increasing numbers of patients who survive cancer (21:47).  Speaker Disclosures Dr. David Johnson: Consulting or Advisory Role – Merck, Pfizer, Aileron Therapeutics, Boston University Dr. Patrick Loehrer: Research Funding – Novartis, Lilly Foundation, Taiho Pharmaceutical Dr. Patricia Ganz: Leadership - Intrinsic LifeSciences  Stock and Other Ownership Interests - xenon pharma,  Intrinsic LifeSciences, Silarus Therapeutics, Disc Medicine, Teva,  Novartis, Merck. Johnson & Johnson, Pfizer, GlaxoSmithKline, Abbott Laboratories Consulting or Advisory Role - Global Blood Therapeutics, GSK, Ionis, akebia, Rockwell Medical Technologies, Disc Medicine, InformedDNA, Blue Note Therapeutics, Grail Patents, Royalties, Other Intellectual Property - related to iron metabolism and the anemia of chronic disease, Up-to-Date royalties for section editor on survivorship Resources If you liked this episode, please follow the show. To explore other educational content, including courses, visit education.asco.org. Contact us at education@asco.org. TRANSCRIPT  Disclosures for this podcast are listed on the podcast page.   Pat Loehrer: Welcome to Oncology, Etc., an ASCO Education Podcast. I'm Pat Loehrer, Director of Global Oncology and Health Equity at Indiana University.  Dave Johnson: And I'm Dave Johnson, a Medical Oncologist at the University of Texas Southwestern in Dallas. If you're a regular listener to our podcast, welcome back. If you're new to Oncology, Etc., the purpose of the podcast is to introduce listeners to interesting and inspirational people and topics in and outside the world of oncology. Pat Loehrer: The field of oncology is relatively new. The first person treated with chemotherapy was in the 1940s. Medical oncology was just recognized as a specialty during the 1970s. And while cancer was considered by most people to be a death sentence, a steady growth of researchers sought to find cures. And they did for many cancers. But sometimes these treatments came at a cost. Our next guest challenged the notion that the singular focus of oncology is to extend the patient's duration of life. She asked whether an oncologist should also focus on addressing the patient's quality of life.  Dave Johnson: The doctor asking that question went to UCLA Medical School, initially planning to study cardiology. However, a chance encounter with a young, dynamic oncologist who had started a clinical cancer ward sparked her interest in the nascent field of oncology. She witnessed advances in cancer treatment that seemingly took it from that inevitable death sentence to a potentially curable disease. She also recognized early on that when it came to cancer, a doctor must take care of the whole patient and not just the disease.  From that point forward, our guest has had a storied career and an incredible impact on the world of cancer care. When initially offered a position at the West LA VA Medical Center, she saw it as an opportunity to advance the field of palliative care for patients with cancer. This proved to be one of her first opportunities to develop a program that incorporated a focus on quality of life into the management of cancer. Her work also focused on mental, dietary, physical, and emotional services to the long-term survivors of cancer.  That career path has led to many accomplishments and numerous accolades for our guest. She is a founding member of the National Coalition for Cancer Survivorship, served as the 2004 Co-chair of ASCO's Survivorship Task Force, and currently directs UCLA's Cancer Survivorship Center of Excellence, funded in part from a grant from Livestrong. Our guest is Dr. Patricia Ganz. Dr. Patricia Ganz: It's great to be with both of you today. Dave Johnson: We always like to ask our guests a little about their background, where they grew up, a little about their family. Dr. Patricia Ganz: Yes. I grew up in the city of Beverly Hills where my parents moved when I was about five years old because of the educational system. Unlike parts of the East Coast, we didn't have very many private schools in Los Angeles, and so public education was very good in California at that time. So I had a good launch and had a wonderful opportunity that many people didn't have at that time to grow up in a comfortable setting. Dave Johnson: Tell us about your mom. I understand she was a businesswoman, correct? Dr. Patricia Ganz: Yes, actually, my parents got married when my mom was 19 and my dad was 21. He was in medical school at the University of Michigan. His father and mother weren't too happy with him getting married before he could support a wife. But she worked in a family business in the wholesale produce business in Detroit. One of six children, she was very involved with her family in the business. And they were married, and then World War II started, my father was a physician in the military, so she worked in the family business during the war. After finally having children and growing up and being in Beverly Hills, she sat back and was a homemaker, but she was always a bit restless and was always looking for something to do. So wound up several years later, when I was in my early teens, starting a business with one of my uncles, an automobile parts business. They ultimately sold it out to a big company that bought it out.  Pat Loehrer: Where did your father serve in World War II? Dr. Patricia Ganz: He was actually D-Day Plus 21. He was in Wales during the war. They had to be stationed and moved down into the south before he was deployed. I have my parents' correspondence and letters from the war. He liberated some of the camps. Actually, as I have learned about the trauma of cancer and post-traumatic stress that happens in so many people, our military veterans, most recently, I think he had post-traumatic stress. He didn't talk very much about it, but I think liberating the camps, being overseas during that time, as it was for that silent generation, was very profound in terms of their activities.   He wound up practicing medicine, and Los Angeles had a practice in industrial medicine, and it was a comfortable life. He would work early in the morning till maybe three or four in the afternoon and then go to the gym, there were moonlighting physicians who worked in the practice. But I kind of saw an easy kind of medicine, and he was always very encouraging and wanted me to go into medicine -- that I could be an ophthalmologist or a radiologist, good job for a woman. But I didn't really see the tough life of some of the internists and other people who were really working more 24/7, taking care of patients in the way medicine used to be practiced. Dave Johnson: Yeah. So you were interested in, early in your career, in cardiology. Could you tell us about that, and then a little bit more about the transition to oncology?  Dr. Patricia Ganz: I went away to college, I went to Harvard Radcliffe and I came home during the summers. And was interested in doing something during the summer so I actually in a pediatric cardiology research laboratory as a volunteer at UCLA for a couple of summers between my freshman and sophomore year then my sophomore and junior year. And then I actually got a California Heart Association Fellowship between my junior and senior year in college.  And this pediatric cardiology lab was very interesting. They were starting to give ketamine, it had an identification number, it wasn't called ketamine. But they were giving it to children in the cardiac cath lab and then were very worried about whether it would interfere with measuring the pressures in the heart. So we had intact dogs that had catheters implanted in the heart, and the drug would be given to the animals and we would then measure their pressures in the heart.  That cardiology experience in 1970, the summer between my first and second year of medical school, the Swan-Ganz catheter was being tested. I worked at Cedars that summer and was watching them do the various studies to show the value of the catheter. And so by the time I was kind of finishing up medical school, I'd already invested all this time as an undergraduate. And then a little bit when I was in medical school and I kind of understood the physiology of the heart, very exciting. So that's kind of where I was headed until we started my internship. And I don't know if any of you remembered Marty Cline, but he was the oncologist who moved from UCSF to Los Angeles to start our hem-onc division. And very exciting, a wonderful bedside teacher.   And so all of a sudden, I've never been exposed to oncology and this was very interesting. But at the same time, I was rotating through the CCU, and in came two full-arrest patients, one of whom was a campus cop who was very obese, had arrested at his desk in the police station. And we didn't have emergency vehicles to help people get on campus at that time. This was 1973 or 1974, something like that. And he came in full arrest, vegetable. And then another man had been going out of his apartment to walk his dog and go downstairs, and then all of a sudden his wife saw him out on the street being resuscitated by people. And he came in also in full arrest.   So those two experiences, having to deal with those patients, not being able to kind of comfort the families, to do anything about it. As well as taking care of patients in my old clinic who had very bad vascular disease. One man, extremely depressed with claudication and angina, all of a sudden made me feel, “Well, you know what? I'm not sure I really want to be a cardiologist. I'm not sure I like the acute arrest that I had to deal with and the families. And also, the fact that people were depressed and you couldn't really talk to them about how serious their disease was.” Whereas I had patients with advanced cancer who came in, who had equally difficult prognoses, but because of the way people understood cancer, you could really talk about the problems that they would be facing and the end-of-life concerns that they would have.  So it was all of those things together that made me say, “Hmm.” And then also, Pat, you'll appreciate this, being from Indiana, we were giving phase II platinum to advanced testicular cancer patients, and it was miraculous. And so I thought, “Oh my gosh, in my lifetime, maybe cancer is going to be cured! Heart disease, well, that's not going to happen.” So that was really the turning point.   Pat Loehrer: When many of us started, we were just hoping that we could get patients to live a little bit longer and improve the response rate. But you took a different tack. You really looked at treating the whole patient, not just the disease. That was really a novel approach at the time. What influenced you to take that step forward? Dr. Patricia Ganz: Well, it was actually my starting– it was thought to be in a hospice ward. It would turn out it was a Sepulveda VA, not the West LA VA, but in any case, we have two VAs that are affiliated with UCLA. And it was an intermediate care ward, and there was an idea that we would in fact put our cancer patients there who had to have inpatient chemotherapy so they wouldn't be in the acute setting as well as patients who needed to travel for radiation. Actually, the West LA VA had a hospice demonstration project. This is 1978. It's really the beginning of the hospice movement in England, then in Canada, Balfour Mount at Montreal and McGill was doing this. And so I was very much influenced by, number one, most of our patients didn't live very long. And if you were at a VA Hospital, as I was at that time, you were treating patients with advanced lung cancer, advanced colon cancer, advanced prostate cancer, other GI malignancies, and lung cancer, of course. So it was really the rare patient who you would treat for curative intent.  In fact, small cell lung cancer was so exciting to be treating in a particularly limited small cell. Again, I had a lot of people who survived. We gave them chemo, radiation, whole brain radiation, etc. So that was exciting. This was before cisplatin and others were used in the treatment of lung cancer. But really, as I began to develop this ward, which I kind of thought, “Well, why should we wait just to give all the goodies to somebody in the last few weeks of life here? I'm treating some patients for cure, they're getting radiation. Some of them are getting radiation and chemo for palliation.” But it was a mixed cancer ward. And it was wonderful because I had a team that would make rounds with me every week: a pharmacist, a physiatrist, a psychologist, a social worker, a dietitian. This was in 1978 or ‘79, and the nurses were wonderful. They were really available to the patients. It wasn't a busy acute ward. If they were in pain, they would get their medication as soon as possible. I gave methadone. It was before the days of some of the newer medications, but it was long-acting. I learned how to give that. We gave Dilaudid in between if necessary. And then we had Brompton solution, that was before there was really oral morphine.  And so the idea was all of these kinds of services should really be available to patients from the time of diagnosis until death. We never knew who was going to be leaving us the next few days or who was going to be living longer and receiving curative intent. We had support groups for the patients and their families. It was a wonderful infrastructure, something that I didn't actually have at UCLA, so it was a real luxury. And if you know the VA system, the rehabilitation services are wonderful. They had dental services for patients. We had mostly World War II veterans, some Korean, and for many of these individuals, they had worked and lived a good life, and then they were going to retire and then they got cancer. So this was kind of the sadness. And it was a suburban VA, so we had a lot of patients who were in the San Fernando Valley, had a lot of family support, and it was a wonderful opportunity for me to learn how to do good quality care for patients along the continuum.  Dave Johnson: How did you assemble this team? Or was it in place in part when you arrived, or what? Nobody was thinking about this multidisciplinary approach?  Dr. Patricia Ganz: I just designed it because these were kind of the elements that were in a hospice kind of program. And I actually worked with the visiting nurses and I was part of their boards and so forth. And UCLA didn't have any kind of hospice or palliative care program at that time. But because the VA infrastructure had these staff already, I didn't have to hire them, you didn't have to bill for anything. They just became part of the team. Plus there was a psychiatrist who I ultimately began doing research with. He hired a psychologist for the research project. And so there was kind of this infrastructure of interest in providing good supportive care to cancer patients. A wonderful social worker, a wonderful psychologist, and they all saw this patient population as very needy, deserving, and they were glad to be part of a team.  We didn't call it a hospice, we called it a palliative care unit. These were just regular staff members who, as part of their job, their mission was to serve that patient population and be available. I had never been exposed to a physiatrist before. I trained at UCLA, trained and did my residency and fellowship. We didn't have physiatry. For whatever reason, our former deans never thought it was an important physical medicine, it wasn't, and still isn't, part of our system. Pat Loehrer: Many decisions we make in terms of our careers are based on singular people. Your dad, maybe, suggesting going into medicine, but was there a patient that clicked with you that said, "Listen, I want to take this different direction?" Or was it just a collection of patients that you were seeing at the VA? Is there one that you can reflect back on? Dr. Patricia Ganz: I don't know if you all remember, but there was something called Consultation Liaison Psychiatry where, in that time, the psychiatrist really felt that they had to see medical patients because there were psychological and sometimes psychiatric problems that occurred on the medical ward, such as delirium. That was very common with patients who were very sick and very toxic, which was again due to the medical condition affecting the brain. And so I was exposed to these psychiatrists who were very behaviorally oriented when I was a resident and a fellow, and they often attended our team meetings in oncology on our service, they were on the transplant service, all those kinds of things. So they were kind of like right by our side.  And when I went to the VA, the psychiatry service there also had a couple of really excellent psychiatrists who, again, were more behaviorally focused. Again, you have to really remember, bless her heart, Jimmie Holland was wonderful as a psychiatrist. She and Barrie Cassileth were the kind of early people we would see at our meetings who were kind of on the leading edge of psychosocial oncology, but particularly, Jimmie was more in a psychiatric mode, and there was a lot of focus on coping. But the people that I began to work with were more behaviorally focused, and they were kind of interested in the impact of the disease and the treatment on the patient's life and, backwards, how could managing those kinds of problems affect the well-being of the patient. And this one psychiatrist, Richard Heinrich, had gotten money from the VA, had written a grant to do an intervention study with the oncology patients who I was serving to do a group intervention for the patients and their families. But, in order to even get this grant going, he hired a project manager who was a psychologist, a fresh graduate whose name was Anne Coscarelli, and her name was Cindie Schag at that time. But she said, "I don't know much about cancer. I've got to interview patients. I've got to understand what's going on." And they really, really showed me that, by talking to the patient, by understanding what they were experiencing, they could get a better handle on what they were dealing with and then, potentially, do interventions. So we have a wonderful paper if you want to look it up. It's called the “Karnofsky Performance Status Revisited.” It's in the second issue of JCO, which we published; I think it was 1984.  Dave Johnson: In the early 90s, you relocated back to UCLA. Why would you leave what sounds like the perfect situation to go back to a site that didn't have it? Dr. Patricia Ganz: Okay, over that 13 years that I was at the VA, I became Chief of the Division of Hem-Onc. We were actually combined with a county hospital. It was a wonderful training program, it was a wonderful patient population at both places. And we think that there are troubles in financing health care now, well, there were lots of problems then. Medicaid came and went. We had Reagan as our governor, then he became president, and there were a lot of problems with people being cared for. So it was great to be at the VA in the county, and I always felt privileged. I always had a practice at UCLA, which was a half-day practice, so I continued there, and I just felt great that I could practice the same wherever I was, whether it was in a public system, veteran system, or in the private system.   But what happened was, I took a sabbatical in Switzerland, '88 to '89. I worked with the Swiss International Breast Cancer Consortium group there, but it was really a time for me to take off and really learn about quality of life assessment, measurement, and so forth. When I came back, I basically said, "I want to make a difference. I want to do something at a bigger arena." If I just continue working where I am, it's kind of a midlife crisis. I was in my early 40s, and my office was in the San Fernando Valley at the VA, but my home was in West Los Angeles. One day I was in UCLA, one day I was at the VA, one day I was at the county, it was like, "Can I practice like this the next 20 years? I don't know that I can do this. And I really want to have some bigger impact.” So I went to Ellen Gritz who was my predecessor in my current position, and I was doing my NCI-funded research at UCLA still, and I said, “Ellen, I really would like to be able to do research full time. I really want to make a difference. Is there anything available? Do you know of anything?" And she said, "Well, you know, we're actually recruiting for a position that's joint between the School of Public Health and the Cancer Center. And oh my goodness, maybe I can compete for that, so that's what I did. And it was in what was then the department called Health Services, it's now called Health Policy and Management. I applied, I was competing against another person who I won't name, but I got the position and made that move.  But again, it was quite a transition because I had never done anything in public health, even though UCLA had a school of public health that was right adjacent to the medical school. I had had interactions with the former dean, Lester Breslow, who I actually took an elective with when I was a first-year medical student on Community Medicine. So it kind of had some inklings that, of what I was interested in. I had actually attendings in my medical clinic, Bob Brook, a very famous health policy researcher, Sheldon Greenfield. So I'd been exposed to a lot of these people and I kind of had the instinctive fundamentals, if you will, of that kind of research, but hadn't really been trained in it. And so it was a great opportunity for me to take that job and really learn a lot and teach with that.  And then took, part of my time was in the cancer center with funding from the core grant. And then, within a year of my taking this position, Ellen left and went to MD Anderson, so all of a sudden I became director of that whole population science research group. And it was in the early ‘90s, had to scramble to get funding, extramural funding. Everybody said to me, "How could you leave a nearly full-time position at the VA for a soft money position?" But, nevertheless, it worked out. And it was an exciting time to be able to go into a new career and really do things that were not only going to be in front and center beneficial to patients, but to a much larger group of patients and people around the world.  Pat Loehrer: Of all the work that you have done, what one or two things are you most proud of in terms of this field? Dr. Patricia Ganz: Recognizing the large number of people who are surviving cancer. And I think today we even have a more exciting part of that. I mean, clearly, many people are living long-term disease-free with and without sequelae of the disease. But we also have this new group of survivors who are living on chronic therapy. And I think the CML patients are kind of the poster children for this, being on imatinib or other newer, targeted agents over time, living with cancer under control, but not necessarily completely gone. And then melanoma with the immunotherapy, lung cancer, all of these diseases now being converted to ones that were really fatal, that are now enjoying long-term treatment.   But along with that, we all know, is the financial toxicity, the burdens, and even the ongoing symptoms that patients have. So the fact that we all call people survivors and think about people from the time of diagnosis as potentially being survivors, I think was very important. And I would say that, from the clinical side, that's been very important to me. But all of the work that I was able to do with the Institute of Medicine, now the National Academy of Medicine, the 2013 report that we wrote on was a revisit of Joe Simone's quality of care report, and to me was actually a very pivotal report. Because in 2013, it looked like our health care system was in crisis and the delivery of care. We're now actually doing a National Cancer Policy Forum ten-year follow-up of that report, and many of the things that we recommended, surprisingly, have been implemented and are working on. But the healthcare context now is so much more complicated.  Again, with the many diseases now becoming rare diseases, the cost of drugs, the huge disparities, even though we have access through the Affordable Care Act and so forth, there's still huge disparities in who gets care and treatment. And so we have so many challenges. So for me, being able to engage in the policy arena and have some impact, I think has been also very important to me. Dave Johnson: 20 years ago, the topic of survivorship was not that common within ASCO, and you led a 2004 task force to really strengthen that involvement by that organization, and you also were a founding member of the National Coalition for Cancer Survivorship. I wonder if you might reflect on those two activities for us for a moment. Dr. Patricia Ganz: In 1986, Fitzhugh Mullen, who in 1985 had written a really interesting special article for the New England Journal called "Seasons of Survivorship" - he was a young physician when he was found to have a mediastinal germ cell tumor and got very intensive chemotherapy and radiation therapy and survived that, but realized that there was no place in the healthcare system where he could turn to to get his questions answered, nor get the kind of medical care that was needed, and really wrote this very important article. He then, being somebody who was also kind of policy-oriented and wanting to change the world, and I would say this was a group of us who, I think went to college during the Vietnam era - so did Fitz - and we were all kind of restless, trying to see how we could make a difference in the world and where it was going.   And so he had this vision that he was going to almost develop an army of survivors around the country who were going to stand up and have their voices heard about what was going on. Of course, most people didn't even know they were a survivor. They had cancer treatment, but they didn't think about themselves as a survivor. And so he decided to get some people together in Albuquerque, New Mexico, through a support group that he had worked with when he was in the Indian Health Service in New Mexico. And there were various people from the American Cancer Society, from other support organizations, social workers, and a couple of us who are physicians who came to this meeting, some Hodgkin survivors who had been treated at Stanford and were now, including a lawyer, who were starting to do long term late effects work. And we gathered together, and it was a day and a half, really, just kind of trying to figure out how could a movement or anything get oriented to try and help patients move forward.  So that's how this was founded. And they passed the hat. I put in a check for $100, and that was probably a lot of money at that time, but I thought, well, this is a good investment. I'll help this organization get started. And that was the start. And they kind of ran it out of Living Beyond Cancer in Albuquerque for a few years. But then Fitz, who was in the Washington, DC. area decided they weren't going to be able to get organizations all over the country organized to do this, and they were going to have to do some lobbying. So Ellen Stovall, who was a Hodgkins survivor living in the Washington area, beginning to do policy work in this area, then became the executive director and took the organization forward for many years and championed this, got the Office of Cancer Survivors established at the NCI in the 1990s, and really did a lot of other wonderful work, including a lot of the work at the Institute of Medicine. She was very involved with the first Quality of Care report and then ultimately the survivorship report, the Lost and Transition report in 2005, 2006, I was on that committee. So that was really how things were evolving.  And by that time, I was also on the ASCO board, 2003 to 2006. And so all of these things were kind of coming together. We had 10 million survivors. That was kind of an important note and a lot of diseases now - lymphoma, breast cancer, multi-agent therapy had certain benefits, but obviously toxicities. We lived through the horrible time of high-dose chemotherapy and transplant for breast cancer in the ‘90s, which was a problem, but we saw a lot of toxicities after that. And so there were people living after cancer who now had sequelae, and the children obviously had been leading the way in terms of the large number of childhood cancer survivors. So this was this idea that the children were kind of the canary in the coal mine. We saw them living 20, 30 years later after their cancer diagnosis, and we were now beginning to see adults living 10, 15, 20 years later, and we needed to think about these long-term and late effects for them as well. Dave Johnson: I'm glad you mentioned Fitz's article in the New England Journal that still resonates today, and if listeners have not read it, "Seasons of Survivorship" is a worthwhile five-minute read.  What do you think the most pressing issues and challenges in cancer survivorship care today?  Dr. Patricia Ganz: Many people are cured with very little impact. You can think of somebody with T1 breast cancer maybe needing endocrine therapy for five years, and lumpectomy radiation. That person's probably not going to have a lot that they're going to be worried about. But if they're a young breast cancer patient, say they're 35 or 40, you're going to get five years of ovarian suppression therapy. You're going to be put into acute menopause. You're going to lose bone density. You're going to have cardiac risk acceleration. You may have cognitive changes. You may have also problems with cognitive decline later. I mean, all of these things, the more intense treatments are associated, what we're really thinking about is accelerated aging. And so a lot of what I've been studying the last 20-25 years in terms of fatigue and cognitive difficulties are related to neuroinflammation and what happens when somebody has intensive systemic therapy and that accelerated process that's, again, not everyone, but small numbers of patients, could be 10-15-20%. So I worry a lot about the young patients. So I've been very focused on the young adult population who are treated intensively for lymphoma, leukemia, and breast. And that's, I think, something that we need to be looking out for.  The other thing is with the newer therapies, whether it's immunotherapy or some of the targeted therapies, we just don't know what the late effects are going to be. Where we're very schooled now in what the late effects of radiation, chemo, and surgery could be for patients, we just don't know. And another wonderful part of my career has been to be able to do quality-of-life studies within the Clinical Trials Network. I've been affiliated with NSABP, I was SWOG previously, but NSABP is now NRG Oncology doing patient-reported outcomes and looking at long-term outcomes in clinical trials. And I think we're going to need this for all of these new agents because we have no idea what the long-term toxicities are going to be. And even though it's amazing to have people surviving where they wouldn't have been, we don't know what the off-target long-term effects might be. So that's a real challenge right now for survivorship.  And the primary care doctors who we would want to really be there to orchestrate the coordinated care for patients to specialists, they are a vanishing breed. You could read the New England Journal that I just read about the challenges of the primary care physician right now and the overfilled inbox and low level of esteem that they're given in health systems. Where are we going to take care of people who really shouldn't be still seeing the oncologist? The oncologist is going to be overburdened with new patients because of the aging of the population and the many new diagnoses. So this is our new crisis, and that's why I'm very interested in what we're going to be looking at in terms of a ten-year follow-up report to the 2013 IOM report. Dave Johnson: The industry-based trials now are actually looking at longer-term treatment. And the trials in which interest is cancer, we cut it down from two years of therapy down to nine weeks of therapy, looking at minimizing therapy. Those are difficult trials to do in this climate today, whereas the industry would just as soon have patients on for three to five years worth of therapy as opposed to three to five months. Talk a little about those pressures and what we should be doing as a society to investigate those kinds of therapies and minimizing treatments. Dr. Patricia Ganz: Minimizing treatments, this is the place where the government has to be, because we will not be able to do these de-escalation studies. Otherwise, there will be countries like the UK, they will be able to do these studies, or other countries that have national health systems where they have a dual purpose, if you will, in terms of both financing health care and also doing good science. But I think, as I've seen it, we have a couple of de-escalation trials for breast cancer now in NRG Oncology, which is, again, I think, the role that the NCTN needs to be playing. But it's difficult for patients. We all know that patients come in several breeds, ones who want everything, even if there's a 1% difference in benefit, and others who, “Gee, only 1 out of 100 are going to benefit? I don't want that.” I think that's also the challenge. And people don't want to be denied things, but it's terrible to watch people go through very prolonged treatments when we don't know that they really need it for so long.  Dave Johnson: Pat and I both like to read. I'm wondering if there's something you've read recently that you could recommend to us. Dr. Patricia Ganz: It's called A Gentleman in Moscow by Amor Towles. I do like to read historical fiction. This one is about a count at the time of the Bolshevik Revolution who then gets imprisoned in a hotel in Moscow and how constrained his life becomes, but how enriched it is and follows him over really a 50-year period of time and what was happening in the Soviet Union during that time. And of course, with the war in Ukraine going on, very interesting. Of course, I knew the history, but when you see it through the drama of a personal story, which is fictional, obviously it was so interesting.   My husband escaped from Czechoslovakia. He left in '66, so I had exposure to his family and what it was like for them living under communism. So a lot of that was interesting to me as well.  Dave Johnson: Thank you for joining us. It's been a wonderful interview and you're to be congratulated on your accomplishments and the influence you've had on the oncology world.  We also want to thank our listeners of Oncology, Etc., and ASCO Educational Podcast where we will talk about oncology, medicine and beyond. So if you have an idea for a topic or a guest you'd like us to interview, by all means, email us at education@asco.org. To stay up to date with the latest episodes and explore other ASCO educational content, please visit education.asco.org. 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.    

Increasing diversity in the field of oncology is an ongoing task. Our next guest has made it her mission to increase those ranks as well as becoming the first African American woman to be a Brigadier General in the US Air Force. Dr. Edith Mitchell describes her early years growing up in rural Tennessee (2:52), the motivation for joining the Air Force in the 70's (7:33) and strategizing to increase ethnic diversity in medicine and oncology (16:53). Speaker Disclosures Dr. David Johnson: Consulting or Advisory Role – Merck, Pfizer, Aileron Therapeutics, Boston University Dr. Patrick Loehrer: Research Funding – Novartis, Lilly Foundation, Taiho Pharmaceutical Dr. Edith Mitchell: Leadership – Corvus; Honoraria - Sanofi, Exelixis; Consulting or Advisory Role Company - Genentech, Novartis, Merck, Bristol Myers Squib; Speakers' Bureau – Ipsen; Research Funding Company - Genentech, Sanofi  Resources (related podcasts, courses or articles) If you liked this episode, please follow the show. To explore other educational content, including courses, visit education.asco.org. Contact us at education@asco.org. TRANSCRIPT  Disclosures for this podcast are listed on the podcast page.   Pat Loehrer:  Welcome to Oncology, Etc., an ASCO Education Podcast. I'm Pat Loehrer, Director of Global Oncology and Health Equity at Indiana University.  Dave Johnson: And I'm Dave Johnson, a Medical Oncologist at the University of Texas Southwestern in Dallas. If you're a regular listener to our podcast, welcome back. If you're new to Oncology, Etc., the purpose of the podcast is to introduce our listeners to interesting and inspirational people and topics in and outside the world of oncology. Pat Loehrer: Imagine knowing in your heart what you wanted to be in life. It usually takes people decades to figure that out, but our next guest knew at age three that she wanted to be a doctor and, later in high school, to be an oncologist. She's achieved much in her lifetime and has incorporated the "pay it forward" by mentoring many others. Dave Johnson: Our guest today is Dr. Edith Mitchell. I first met Edith over 40 years ago when we were both starting out our careers as junior faculty. She grew up in rural Tennessee, and as Pat mentioned, remarkably, she chose a career in oncology at a very early age in high school, despite the fact that oncology was barely a specialty at that time and the lack of role models, particularly role models of color, and women in particular. She received a Bachelor of Science degree in Biochemistry with distinction from Tennessee State University and a medical degree from the Medical College of Virginia and Richmond.   In 1973, while still attending medical school, Edith joined the Air Force, receiving a commission through the Health Profession Scholarship Program, and eventually rose to the rank of Brigadier General. She completed a residency in internal medicine at Meharry Medical College in Nashville and a fellowship at Medical Oncology at Georgetown University. Her research interests are broad and involve new drug evaluation, development of new therapeutic regimens, combined modality therapy strategies, patient selection criteria, and supportive care for patients with gastrointestinal malignancies.  She is the leader of the GI oncology program at Jefferson Medical College, Director of the Center to Eliminate Cancer Disparities, and Enterprise Vice President for Cancer Disparities at Jefferson's Sidney Kimmel Cancer Center. She's held a number of leadership positions, including those in ASCO, and she's a former president of the National Medical Association. I could go on forever. So, Edith, welcome, and thanks for joining us on Oncology, Etc.  Dr. Edith Mitchell: And thank you so much for the invitation, Dave and Pat, it is a pleasure.  Dave Johnson: You grew up on a farm, as I recall, in Tennessee. Perhaps you could tell us a little about your early life.  Dr. Edith Mitchell: I grew up on a farm that my great grandfather's mother received about 1863 when the Emancipation Proclamation was made. I was the fifth child in my family. My parents were working, my older siblings were in school, so my great-grandparents were my babysitters, so I spent a lot of time with them. He was 89 at the time, became ill, and I overheard family members and neighbors say that they couldn't take him to the hospital because Blacks were not treated properly in the hospital, so they were going to take care of him at home. A physician made a house call. When he left, I told my great-grandfather, “Pa, when I grow up, I'll be a doctor just like Dr. Logan and I'll make sure you get good health care.”  So, at three years, I decided I would become a doctor and I would make sure that Blacks received good health care. My work in disparity started when I was three. So, after my sophomore year in high school, there was a National Science Foundation program in Memphis at LeMoyne-Owen College. So, I applied and was accepted. And part of the time in Memphis that year, we were given opportunities to go to St. Jude. So my time at St. Jude made the decision that I would become an oncologist. I became really fascinated by cancers and in pathology, use of the microscope, and how cancers were all different, how they varied from the normal tissue for areas such as the colon or the stomach or the pancreas. Dave Johnson: It's amazing that that early in your life you made that kind of decision.  Can I back up just one moment? I want to ask you briefly about the doctor that visited your great-grandfather, Dr. Logan.  Dr. Edith Mitchell: Dr. Logan was a family physician, African American, and he had a great interest in Blacks being healthy. In fact, when the polio vaccine was made public, Blacks could only go one day per week because you couldn't go the times when whites were there. Dr. Logan obtained the vaccine and he would line the children up at his office. He gave me my first polio vaccine. He was a very handsome man. And, you know, Dave, I found out later that the medical school that he attended in Memphis was one of the ones closed as a result of the 1910 Flexner Report. So he had to go to Meharry in Nashville and take other courses to maintain his license to practice medicine.  Pat Loehrer: Were you the first one to go into medicine? Tell me about that background and how your family influenced you personally.  Dr. Edith Mitchell: Neither of my parents finished 8th grade, but they were very smart. They pushed their seven children to do well. They provided educational materials in our home and encouraged us to work and to take advantage of opportunities. Dave Johnson: Let's move forward a little bit. I thought I knew a lot about you, Edith, but I didn't realize that you were a Brigadier General. What was the motivation for joining the service in the ‘70s when you were at med school? Was it scholarship funding, or was there just patriotic zeal or a little of both? Dr. Edith Mitchell: My main objective was, for financial reasons - a scholarship covering all expenses of medical school, plus a monthly stipend. When I was in medical school, one of my laboratory instructors told me about this new scholarship program, and I said, "Okay, I just want to graduate from medical school." So he says, "Well, I know people in the surgeon general's office. I'll have them send you the information." He did, and I looked at it and didn't remember David, that my husband filled out the application. After my neurosciences final exam, I came home, and he says, "Your commission came in the mail today." So I said, "Okay." He says, "Well, I can swear you in. We can't do it at home because you have to have a witness. You take a nap, and then we're going out to job control, which was where all the aircraft controlled, the control room." We went there. We've got a picture of the swearing-in, and we then went to the officers club. It was Friday, and there were lots of people in his group from the Air Force Academy, from Citadel, Virginia Tech, and others. And they were all talking. "Yeah, Edith got a mail-order commission.”  So I owed the Air Force two years, and I practiced at Andrews Air Force Base, which was the presidential squadron. You hear the president always leaving Andrews Air Force Base. So I think I was 29 maybe, but I was young, and here I was taking care of senators and other important people in government, and these are people I'd only seen on TV before. So I had a really good experience. I received many accolades, but also many letters from people for whom I cared for. And I was therefore invited to stay on in the Air Force, either go to Walter Reed or to San Antonio. I said, "No, I'm going to Georgetown." So one of the VIPs, if I mentioned his name, you would know, said and wrote a letter for me that the Air Force should give me whatever I wanted and whatever I needed to continue in the Air Force. So I received my Air Force pay while I was a fellow at Georgetown.  So I stayed on. I got promoted early and engaged in Air Force work. I loved it, and I did well in that atmosphere and stayed on. After my second child was born, I decided I could not continue active duty and take care of two kids. So I left the Air Force, went to the University of Missouri, and someone called me one day and said, "You know, I hear you are at the University of Missouri now. Would you consider joining the National Guard?" I went, “ Joining the National Guard? Why would the National Guard want an oncologist?” And the information was, the Air National Guard wants good doctors, and you've got a great record. They invited me to St. Louis to just see the National Guard squadron there. I filled out the application while I was there and in a few days was appointed to the National Guard.  So after being there for a few years, I was discussing with one of the higher-ranking people in the National Guard who was in Washington, but visiting St. Louis. He said to me, "You know, you've done great work." He had gone through my record, and he said, "And you know, you're one of the people being considered to be in a group for promotion. Promotion at that time meant that it was a higher rank." So he said, "There's one thing you don't have in your records, however, and other competitors in your group have." I said, "What's that?" “You haven't been to flight school.” I said, "Okay." He said, "And everybody who is going to be competing with you will have gone to flight school, and having a flight record will be an important part."  So I was in my 40s. My oldest child was 14. I went to flight school and I got my certification, and obviously, I got promoted. And I am the first woman doctor to become a General in the history of the Air Force. And it was really interesting. I'm a Brigadier General. I'm invited to give a talk someplace, and there were lots of people there. So the person introducing me said, "And she is the first African American woman to become a General in the history of the United States Air Force." So I get up to speak and I thank him for this introduction. And I said, "Yes, I was the first Black woman physician to become a General. I said, but, you know, my ancestry says that I'm 30% something white. So I guess I was the first white woman, too." There was a big roar. But I loved every opportunity, and I worked hard at every opportunity.  So when I was in the active duty Air Force, I was chief of the cancer center at Travis Air Force Base. So I made my application for research with the Northern California Oncology group, got, they said, one of the highest ratings of the applicants at that time. And I received a phone call from Air Force administration saying “Congratulations, but the Air Force cannot accept this funding from the National Cancer Institute.” There is a law saying you can't transfer money from one area of the government to the other, as they called it, a "gift," but it was a grant. So I call Phil Schein and I tell him about the situation. And he already knew that I had received a top report, and he knew that I had the grant before I knew. So he says, "Well, let's see what we can do.”  Now, remember, Vince DeVita was the NCI Chair at that time and Dr. Rosenberg. At every ASCO meeting Phil, Vince, and Dr. Rosenberg would get together and they would bring their fellows. And Bill said, “Let me see what I can do.'" So somebody at NCI made some things happen. And I got this call from Saul Rosenberg. "Edith, congratulations." So I said, "Well, thank you, but I didn't expect a phone call from you." And he says, "Well, there have been some changes. Your grant, the face sheet has been changed." I said, "Oh.”  Pat Loehrer: Your husband again. Dr. Edith Mitchell: I can't say who or what, but it had Stanford on it. So my grant went to Stanford. I'm sure they appreciated the kick you get. But Dr. Rosenberg said, "Your grant is now Stanford. We're setting up an account for you at Stanford, and the funding goes to Stanford.” So I had people working for me at the Air Force Cancer Center who were Stanford employees. Dave Johnson: Edith, there are still too few African American and particularly African American men in medicine. What's your perspective on that?  Dr. Edith Mitchell: I think that many people are not given opportunities, and I've been concerned about Blacks and other racial and ethnic minorities not entering medicine, and particularly regarding oncology. So fewer than 5% of all practicing physicians in this country identify as Black. Little more than 5% identify as Hispanic. And I've been trying to do something about that. So ECOG-ACRIN has been very good about allowing me, and I set up with others, but I was the lead, a program for individuals - they could either be medical students, residents, fellows, or early faculty - to attend ECOG-ACRIN. And as a result of that program, we identified 12 individuals for each of the two ECOG-ACRIN annual meetings. We bring people in, and that has been a success. There's one person I introduced when she was a resident, she then did a fellowship in oncology, and it is now in her first year as faculty. And we have students mainly from Tennessee State. I do maintain very close relationships with Tennessee State, and I have the first Tennessee State student who has just been admitted to medical school at Jefferson. So trying to work with them.  As a result of my work with the National Medical Association and the International Myeloma Foundation, we have a group of medical students that have been mentored for oncology. Whether they will become oncologists, I don't know, but they all 12 are doing well in medical school, and with some anticipation they might select oncology as their area of specialty. We set them up with an individual mentor, various oncologists around the country, and they have conducted research with their mentor.  So I'm doing things that I think will be helpful to individuals. And I think we're not giving Blacks enough opportunities. Even in entering medical school, the number of Blacks entering most majority medical schools is still very low. Somewhere nine or ten students per year, Blacks entering medical schools. And also there has been a study conducted by the ACGME, which is the Accreditation Council for Graduate Medical Education, looking at graduate studies in oncology. Do you know that most of the oncologists have been trained at a few medical schools? And there are, I think it was 109 programs did not have a single minority student in the fellowship program. And that's terrible. I think that all fellowship programs should have some racial or ethnic fellows in their programs. Dave Johnson: Yeah. One of the disturbing statistics that I've read from the AAMC is that the number of African American men applying to medical school in 2023 and 2022 is actually less than the number that applied in the ‘70s. It's puzzling to me why we've not been able to attract young men into the medical profession, and perhaps it's because there's a sense of not being wanted or encouraged into the profession. More African American women are applying, but even that number is small, at least in terms of the increase in what we've seen. Pat Loehrer: Edith. You're also the Associate Director of Diversity Affairs at the Sidney Kimmel Cancer Center. What does the recent Supreme Court decision against Harvard in terms of admissions policy, how are you viewing that now at Jefferson? Dr. Edith Mitchell: So I think that the Supreme Court decision certainly was disappointing, but it is what it is, and we've got to deal with it. That is the Supreme Court. So my suggestion and what I am telling students that they have to do, you do have the essay. So when I applied to medical school, I did not talk about Dr. Logan, my growing up on the farm, or my parents not finishing 8th grade. But if I were applying to medical school now, I would use all of that background to include in my essay. And the Supreme Court didn't say that you couldn't include that information in your essay. It said the schools could not use your racial background as a part of the equation, but your letter is still there, and therefore, I would include all of that in the essay, so that you do have an advantage. We've just got to be able to do what we've got to do, not put the university or the medical school at risk because of the Supreme Court decision. But there's nothing in that decision that says you can't include that information in your letter. Dave Johnson: I have one question. What career advice would you offer your younger self? If you could speak to your 30-year-old self based on your knowledge, experience, what career advice would you give yourself? Dr. Edith Mitchell: So the one thing that I did not do when I was about 30 years old and I'm not sure I even knew about it, I think I could have done more in health policy, and the one thing that I have not done is become a White House fellow. And that's usually early in your career plan. But I think my research would have suffered had I done that. And I still say I don't know that I made bad choices. Dave Johnson: No, you didn't make bad choices. Knowing you, you could have been a White House fellow and done everything else you did. Pat Loehrer: And your husband did not make a bad choice either. Dave Johnson: Evidently not. Pat Loehrer: Edith, thank you so much for joining us. You've had such an incredible life, and it's so rich, and we deeply appreciate your spending time with us.  I want to also thank all our listeners of Oncology, Etc, which is an ASCO Education Podcast. This is as you know, where we talk about oncology medicine and everything else. If you have an idea for a topic or guest you'd like to see on the show, please email us at education@asco.org. To stay up to date with the latest episodes and explore other educational content, visit education.asco.org. 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.  

There are many treatments available for cancer  but how do you make csre delivery equitable? Given the various types of cancers how can you allocate the right resources to create equal outcomes? Dr. Lori Pierce has made equity a primary focus of her career. She describes how physics and radiology inspired her to be an engineer (6:06), and the moment she decided to transition from engineer to oncologist (12;54) and achieving the position of Vice-provost at the University of Michigan (23:01). Speaker Disclosures Dr. David Johnson: Consulting or Advisory Role – Merck, Pfizer, Aileron Therapeutics, Boston University Dr. Patrick Loehrer: Research Funding – Novartis, Lilly Foundation, Taiho Pharmaceutical Dr. Lori Pierce:    Stock and Other Ownership Interests Company - PFS Genomics;  Patents, Royalties, Other Intellectual Property Company - UpToDate, PFS Genomics; Uncompensated Relationships - Bristol-Myers Squibb, Exact Sciences Resources  If you liked this episode, please follow the show. To explore other educational content, including courses, visit education.asco.org. Contact us at education@asco.org. Disclosures for this podcast are listed in the podcast page.   Pat Loehrer: Welcome to Oncology, Etc. This is an ASCO Education Podcast. I'm Pat Loehrer, Director of Global Oncology and Health Equity at Indiana University.  Dave Johnson: Hi, I'm Dave Johnson at UT Southwestern in Dallas, Texas. I'm a Medical Oncologist. If you're a regular listener to our podcast, welcome back. If you're new to Oncology, Etc., the purpose of the program is to introduce listeners to interesting people and topics in and outside the world of oncology; hence the ‘et cetera' in our name. Pat, we've got a great guest today. And we've got a great guest today. Pat Loehrer: Our next guest was able to do this despite living at a time when in the United States, certain groups of people faced tremendous barriers to achieve even the basic hint of equality. Our next guest is Lori Pierce. Dr. Pierce attended Duke University School of Medicine and completed a radiation oncology residency and chief residency at the Hospital of the University of Pennsylvania. She was then appointed as a senior investigator at the National Cancer Institute, the National Institutes of Health in Bethesda, Maryland, from 1990 to 1992. And in 1992, she joined the faculty at the University of Michigan, where she currently is a professor with tenure in Radiation Oncology.  Since coming to Michigan, she has served as Residency Director and Clinical Director in the Department of Radiation Oncology. In August of 2005, she was appointed by the University Board of Regents to be the Vice-Provost for Academic and Faculty Affairs, a position she still holds. In 2020, she was ASCO President, and while she ascended to the ASCO Presidency, that year COVID descended upon the Earth, and we may hear some stories about that. She's dedicated her career to the treatment of breast cancer patients. She's published over 200 manuscripts and book chapters and has received numerous teaching awards from the University of Michigan, multiple national organizations, and many national awards.  Dr. Pierce, thank you so much for joining us today.  Dr. Lori Pierce: I am so happy to join you both today. What an incredibly nice introduction. Thank you so much.  Pat Loehrer: You were born and raised in Washington, DC. And the family eventually moved to Philadelphia when I think you were in junior high school. Can you paint a picture of what schooling was like for you growing up? Dr. Lori Pierce: Well, schooling, education was just so important to my family and myself. And so, as you said, I was born and raised in DC. Moved to Philadelphia when I was just entering high school. And my parents, who are just the best people on the planet, didn't have an opportunity to go to college. At that point, a lot of people of color didn't really have that opportunity. So education was so important in my family. So if you think about the important issues in my life, there was our faith, our family, and education. And so my sister, who is four years older, she went to college first. After about two years, I transferred and actually graduated from the University of Pennsylvania, and I did that. It was my idea.  My parents at that point were living in Philadelphia. My mother was working at Penn, and so I would have free tuition if I went to Penn. And Penn is a great place as is Brown. My parents didn't ask me to transfer, but I did. And I received, obviously, an excellent education at both institutions. I majored in biomedical engineering and I minored in chemical engineering and was pre-med. I had to be strategic in how I was going to pay for my education because my parents and they took out loans, they covered everything, almost everything. My sister and I had some loans, but they took out most of the loans.  But they always had an agreement. And the agreement was that both my sister and I would have our college education covered by them. But anything in the graduate arena, we had to cover. So I had to be kind of strategic about that. So I actually applied to medical school and, as you know, got in, and deferred my admission so I could work and earn some money so I could pay for medical school. And I tell you, I did that specifically for the reason, for financial issues. But now this kind of thing is called a gap year. And in retrospect, it was the smartest thing I could have ever done because I took some time away, and during that time away, it made me even more motivated to apply my full attention to medicine.  And so education was very important. But I think sometimes you have to kind of step away to then regain the commitment that you need to move forward. And so by the time I started Duke, I was more than ready to be in medical school. Pat Loehrer: I know we talk about underrepresented minorities. I was a mechanical engineer at Purdue. And I can tell you, I don't think there was a single woman in engineering in most of my classes. There were just a few. So to be a woman in engineering is extraordinarily unique. So tell me a little bit about that decision-making and how you got into that. It may have been different in 10 or 15 years later, but were there a lot of women in engineering? Dr. Lori Pierce: No, not at all. And while there may have been two or three in biomedical engineering, there were hardly any in chemical engineering, and as you said, very few in mechanical engineering. So no. But I always was interested in physics. I liked those kinds of things, and hence I went into radiation oncology. It was a perfect blend of my studies and my interest. But no, I often was the only woman, or maybe one of two or three women in my classes, and I was certainly the only person of color in my classes. It taught you things though. It taught you to be comfortable being in that position and to know that you could do it just like anyone else could, and to know that probably a lot of eyes were on you to succeed. Some of that was self-imposed, but some of that was real. But I think learning those lessons then certainly came in handy when I went into medicine because while there are more women in medicine, especially now, compared to what it was when I came through, still, at that point, we were in the minority. And there were very few people of color in medical school where I went to. I was at Duke, and very few people there. You learned lessons early on, right?  Dave Johnson: Where did this interest in engineering originate? Dr. Lori Pierce: So it was really more of physics and radiology. So I, as a kid was a really thin kid, and I broke a couple of bones, and I ended up going to get X-rays. And I was fascinated by the X-rays. I was fascinated by this physics. I was fascinated by how you could push this button and these images would appear and I could see my broken bone. So that was really where it came from.  So I was pre-med. I did a lot of my pre-med work at Brown, and during the summers I was working in an industry. I was actually in Scott Paper Products industry outside of Philadelphia. And a couple of the other people there who I worked with closely were engineers. And I was just fascinated by it and seemed to be a good way of moving forward my own interest in the physics and the machinery and how it all worked. So I actually switched into engineering. So I switched from Brown to Penn. And being an engineer, it was a great way to make a good living for a year and a half. And I think as an engineer, and Pat, you can probably attest to this, you think in a certain way; you become very methodical in how you approach things. And while I'm sure there are a lot of other disciplines that will give you a similar type of approach, engineering really does—you're very objective in how you make decisions, and I think that serves well. And then, as I said, going into radiation oncology it was just a match made in heaven, so it all worked out great, I think. Pat Loehrer: I think I read that your sister was also into math, is that right?  Dr. Lori Pierce: My sister's a systems engineer with IBM. Incredibly gifted. Pat Loehrer: Yeah. Tell me about your parents. How did they guide you? What were your role models in terms of both you and your sister, in terms of math, physics, engineering? Dr. Lori Pierce: I already said my parents were incredibly hardworking and good people. They both had high school graduation education. My mother went straight through, but my father had to get an equivalency for his high school diploma because he was born and raised in North Carolina, had to work on the farm, and didn't get a chance to stay in school. But he got the equivalency of his high school degree.  It was interesting, my dad was just incredibly gifted for math. My father was just amazing in math. And my father and I always hung out. He was like my best friend and so I think my emphasis on math in part came from my dad. And I'll say that both my parents didn't, weren't able to get a college education, but they were two of the smartest people I ever knew. My father and my mother, but I just hang out more with my dad, had amazing common sense and whipsmart math. I'm sure that a lot of where I ended up is because of my dad.  Dave Johnson: You mentioned that you had family in North Carolina. I remember reading that you were influenced by some of the people you met in North Carolina with respect to your medical career. Can you tell us a little bit about that? I think a Dr. Weaver, was it?  Dr. Lori Pierce: That's right. Doc Weaver. That's right. So I used to spend a lot of my summers in North Carolina with my father's family. And Dr. Weaver was an African American family medicine doctor who took care of the vast majority of people of color in the town of where my father's family is from. Whenever anyone had issues and needed medical care, he came to the house. He was the doctor for people of color. I sat back- and take it in a lot when you're young - people never really know how much you're listening and seeing, but you take in a lot. And you see just how revered he was, and he should have been, because he was largely the face of medicine that a large part of that town saw. And that stuck with me. A couple of times, I went with him when he would see patients. Without a doubt, this factored into my wanting to go into medicine. I think that coupled with my interest in those x-rays and the physics of the x-rays, I think that's how it all came together, but Doc Weaver. Pat Loehrer: So you mentioned you did a gap year, which was somewhat unusual at that point. I did a gap year as well for the exact same reason - I wanted to not incur a lot of debt or at least try to defer the debt as much as possible. What did you do in your gap year, and how did that impact your medical training or did it?  Dr. Lori Pierce: It definitely did. My gap year was actually 18 months. I moved to Austin, Texas, and I worked in Round Rock, Texas, that was at a time when Round Rock was just a sleepy little town just north of Austin. I haven't been back since. I know Dell computers is now there and now it's almost you can't see a difference between Austin and ROund rock, but that was not the way it was on those days. And I worked in Round Rock because McNeil Consumer Products was there.  I worked at McNeil Consumer Products, they make Tylenol. I was the second-shift Glatt supervisor for Tylenol. So Glatt is the machine that mixes up all of the ingredients for Tylenol and it was something that I knew going in that it was only going to be short-lived so I could probably live almost anywhere. And I thought, okay, I'd been on the east coast all my life, let me see what the rest of, another part of the country is like.  It was an amazing experience. To go from Brown to the University of Pennsylvania, DC, and Philadelphia, to Round Rock, Texas. In retrospect, I couldn't have picked a better place. I mean I soaked up a little local color, went to some things that the Texans do, and rodeo, that kind of thing. But more importantly, I met people who I would've never met on the east coast. These were people who largely had not been outside of the Austin area. One person said she'd never seen a black person before. That kind of surprised me.  So it was a swath of America that I had not been exposed to. It was not easy. But in the end, it was the best thing, because you realize, people are people. And while you might be put off at first because they're put off with you and you put off with them, at the end of the day, it was a great experience of getting to know people who can further enrich your life. And I think that has helped me in medicine in terms of interacting with patients no matter where they're from, no matter what their background, what their financial situation is, people are people.     I was on my own. I was truly on my own. And that gap year was invaluable far more than helping me pay off medical school loans.  Pat Loehrer: You've focused into radiology and obviously there's diagnostic radiology and therapeutic radiology. How did you end up choosing the career that you eventually championed so well?  Dr. Lori Pierce: At the time I went to medical school at Duke, at Duke, radiation oncology was a division of radiology so they had not separated yet. While I was at Duke, they recruited in their first chair of radiation oncology into separation. So long story short, when you're at Duke in medical school, your third year is all research. You could go into a lab and do research. And so when I met with my radiology advisor and looked at the list of options of projects I could sign on to, the one that happened to be most interesting was being done by a radiation oncology researcher in radiology. And I thought, well, it looks interesting, but I don't want to do that because I want to go in radiology so I need to have a radiology project. And my advisor said, “No, it's okay. Radiology programs, they'll take radiation experiments. You can still use that and apply to radiology.” So I said “Okay, that looks really interesting.” So I opted to go with that choice and it was during that year that radiation oncology separated. A chair came in, Dr. Lenny Prosnitz from Yale, and he said, “Why don't you just come down and see what it is that we do?” So when my experiments were set up, I would run down into the basement because we're always in the basement, and I would follow him around and I just loved it because it gave me the physics that I wanted, I got really interested in cancer biology. And I think with my personality, I work well with patients. I love patients. That patient interaction is when I'm at my best. And I wouldn't have had that in radiology. With all due respect, radiology is so important, but you have to do what you gravitate toward, and those interactions when I was following him around with patients. So I never looked back, I changed at that point and decided to go into radiation technology.   So I was at Penn for residency and chief residency. When I was getting ready to leave to go to the NCI, the person, Barbara Fowble, who was a well-known breast radiation oncologist, took a sabbatical and asked if would I stay the year she was taking sabbatical to run the breast service. So I deferred going to the NCI to stay at Penn for an additional year as an attending and then went to the NCI when she came back from her sabbatical. I worked with Eli when I got to the NCI.  Pat Loehrer: And Norm Coleman, too? Dr. Lori Pierce: And Norm from a distance. He's great. He came in for comedic relief. It was in a while, but he and Eli and Tom Delaney. It was a great time to be at the NCI. It was shortly after that, about a year or so into that when things started changing, Eli left to go to UT Southwestern. But it was a great time to be at the NCI. Dave Johnson: So you've worked with some of the giants of radiation oncology for sure?  Dr. Lori Pierce: I did. And the NCI was known as the places where the giants launched. So the Allen Lichters, the Joel Teppers. I mean, I could go through a list. They all had worked with Eli, and Allen was no longer there. Allen had already gone to the University of Michigan. He subsequently recruited me to Michigan. But the radiation oncology branch, the Marc Lippmans of the world, it was a magic time. Even though some of them weren't there, their footprint, their stamp was on the program, and it was really good. And working with Eli was just great. Dave Johnson: So is that where you're working with Barbara where your interest in breast cancer or was it that you mentioned you had an interest in the biology? Where did that interest in breast cancer originate?  Dr. Lori Pierce: It came from working with Barbara. So it was a combination. Barbara, who is one of the most amazing people to this day, that I've ever worked with, her command of the data, her synthesis of the data, her interaction with patients. Most people don't appreciate of just how great a clinician Barbara Fowble was. And so it was admiration for that. So she was a part of it, but John Glick was the other part.  So John, of course, who everyone knows, the giant in the field, and I think at the time, not sure if when I was a resident, he was the president of ASCO. Even if he wasn't the president at that point, he was certainly highly integrated with ASCO, and he kind of took me under his wing. I'm not sure why, but I was very interested in breast cancer. So he would like bring me over to the Med On clinic and teach me more about chemotherapy. So I had John and I had Barbara, and then also the mammography group was very supportive of me. I would come in literally on weekends and meet with the head of mammography, who would test me on mammograms, reading mammograms. So it was just a very supportive environment. And certainly, breast cancer was the area that I wanted to focus on. It was a great group to train under. Pat Loehrer: Dave and I had the opportunity a short time ago to interview John Glick. And as you're talking, one of the wonderful things about our field of oncology is how it's a close-knit network and there's so much mentoring. And John took both Dave and I underneath his wings, and he had no really rationale for doing that. But Eli, I mean, there are so many wonderful people that we've had the opportunity of meeting. And you yourself have mentored so many other people in another generation. It's hard to explain to people outside of oncology about how special this field is, I think. Dr. Lori Pierce: It absolutely is. And it's an honor for me to serve as a mentor because once you're a mentor, you always mentor. I mean, John, I'll run things by John to this day. Once you develop that closeness and you know them and they know you, you savor that, it never goes away. Dave Johnson: What would you tell a junior faculty or fellow are the characteristics of a great leader? What do you think makes for great leadership?  Dr. Lori Pierce: That's a great question. First and foremost, you listen. You need to listen and understand what your mentee, what it is they're seeking, what it is that they want to study, where they feel they are somewhat inadequate, and they want to improve. What is it that they want to accomplish with that relationship? Because as you and Pat both know, mentors come in all shapes and sizes. Mentors come in all locations. You may have someone who is at your institution where they're coming to you to help to shepherd through your institution and the policies and understand the practice of your institution. You may have those that are mentoring you from afar, or perhaps in addition to content, but also getting a sense of what the outside environment is like. So I think first rule of mentorship is to really understand why that mentee has sought you out and whether you are the right person to fill that void, whatever void that they think that they have.  I think another part of mentorship is making the time for that individual. We're all very busy people. Most people aren't looking at you to mentor them two hours a day. They are going to be very judicious in what they ask, and you should make sure that what they need, you can accommodate that, and if you can't, perhaps arrange for someone else who can. But in most cases, there's a lot that we all can do for people who approach us.  And then I think really understanding, kind of putting yourself in their position, where are they in their trajectory toward greatness, and how can you work with that. And I think most of us have a lot that we can share, and a lot of times we may be sharing things, we don't even realize that what we're saying is impactful to those individuals. But I really think it's starting out by listening and being honored that you are actually asked to be a mentor. Dave Johnson: You've also received numerous teaching awards. You obviously have a gift for that. Tell us, what's the secret to being a good teacher? What are the characteristics of a really great teacher, different than mentoring? Dr. Lori Pierce: Yeah. You have straightforward conversations with your residents and your fellows. I'll give you an example. We have teaching conferences. And teaching conferences have evolved over the years. I've been at Michigan for a long time, since ‘92. And in the old days, the morning conference, you discussed the literature and you had a discussion, and now it's evolved to slides. The residents give the slides and I'm old school. I like to go back to the old school. Some people call that the Socratic method. I think the Socratic method has gotten a bad rap because you can do the Socratic method in not a threatening way, and you can ask questions to residents and expect for them to give an answer. And it was interesting, long story short, when I few years into becoming Vice-Provost here, I'm not able to come to morning conferences very often. And I got a knock on my door here in the cancer center, and I opened up and it was the three chief residents. And I said, “Okay. Hi. Come in. What can I do for you?” And so all male, and they said, essentially, “We miss you. Our residents, we all prepare more for your conferences than anyone else. And even though you ask us questions, we don't feel threatened by your questions. We want that type of style of learning.” And I was bowled over by that because I'm just a simple person, and I don't beat around the bush. I ask questions because these are the kind of questions that you have to know when you manage patients. These are the kind of questions that you have to know when you're in a tumor board and you interact with medical oncologists and surgical oncologists. You have to know the literature, and you have to be able to state it in a clear way that, obviously, physicians get it, but patients get it, and you have to be aware of your audience.   And so that little vignette of when those three knocked at my door told me that, clearly, going back to the basics and just asking questions is well received.  Pat Loehrer: I'm thinking about your parents who did not go to college, and here you are now a Vice-Provost at one of the most prestigious universities in the country. It's got to be, if you reflect on that really cool. Tell us a little bit about that journey and what it takes. Or was that accidental journey or was this a purposeful journey of leadership that you wanted to go to?  Dr. Lori Pierce: It was absolutely not purposeful, for sure. So I can thank my dear Dr. Lichter for that. So, Allen Lichter, after he was chair of radiation oncology, as you probably know became the dean of the medical school. Well, Allen, who had brought me to Michigan, got to know me pretty well. And so, when he became dean, Allen's so strategic. He realized that it would be important to have someone from the medical school to work in the provost's office because the medical school is the largest school on campus, and we're the different ones. We approach life somewhat differently.   And so to have that perspective in the provost's office would be very helpful. So he came to me and said, “Would you be interested in doing it?” I didn't know what a provost was. I'd heard about it when I was at Brown, but I was like, “No, I'm not interested.” And he said, “Well, just go and talk with them. Meet with the provost of Central Campus and just see.” So I went and decided not to do it. But they did ask, would you just be a special counselor to the provost? If we have questions, we can call on you. So I said, sure. So I did that for a year, and then by the end of the year, had a much better awareness, understanding of what they did in that office, and a much better understanding of who they were, and they me. So I said, “Okay, if I decide to do this, I want it so that you can fire me at any time, and I can fire you at any time, but I'm never giving up my day job in terms of seeing patients. This is always my night and weekend job.” And so that's how we did it.  And so I've been doing it now for a long time—since 2005, 2006. The reason I've done it so long is we do work with amazing people across campus. We have 19 schools and colleges, and I now am the Vice-Provost for Faculty Affairs for the Health Science Schools. And it allows you to not only look at the university as a whole—we tend to have silos, we tend to live in silos. And when you're the Vice-Provost, you can look beyond those silos and you can bring together people and schools for common threads of work. If I see the nursing school is focusing on certain aspects of cancer treatment XYZ, I can bring together people from the medical school, I can bring together the school of public health and put some funding to it to give them seed funds, to then synthesize something which hopefully will then translate into a larger grant.  So it is very rewarding in that regard. You oversee promotions, the hiring, and promotions of the faculty, and it further opens your eyes to what can be. And so much of what we do, obviously, in cancer is multidisciplinary, interdisciplinary. We're not just radiation oncology, medical oncology surgeons. So much of what we do in medicine, we interact with public health, we interact with dentistry, we interact with the other health science schools. It has been a very interesting ride in terms of what can happen when you bring like-minded people from different disciplines and you concentrate on a certain topic. And we've started some seed funding. We've had efforts where it really has grown into very significant NIH funding.  Pat Loehrer: What are you most proud of as a Vice-Provost or your leadership at the university that we wouldn't know about necessarily? Dr. Lori Pierce: Two things. One, I was one of the key worker bees in changing our policy for time to tenure. We used to have an eight-year tenure clock. And in medicine, we need longer. It's more difficult to get funding, it's more difficult to manage all of the missions that we do and still end up right where you want to be. And so we now have a tenure clock. And so I helped to make that possible.  In more recent years, probably the jewel for my provost time is getting maternity leave and parental leave. Many academic institutions don't have maternity leave. Women have to take sick leave. I'm sorry, being pregnant is not sick. That's not a sickness. If you're a dad, you want to have time for bonding, you want to have time to be there when your child is born or adopted. And so I and two other people established a policy of maternity leave and parental leave that was wildly accepted. The leadership of the university could not agree more readily. And now we have a very robust policy, and this is not just for faculty, it's for staff. And I get people who thank me all the time, whether they're staff or faculty, especially the dads, for giving them the time to be with their child. So that's an easy question to answer. I think that has been a change that has been received positively throughout.   And even if it's a case where when a person is gone for their parental leave or maternity leave, other people have to step up to cover for them. But people don't complain because everyone knows that that is the way it should be and that people should be given that time. So it's been one of those win-wins. You don't get win-wins very often, and that's been a win-win. Dave Johnson: Kudos to you and your colleagues for pushing that through and making that happen. That's got to be a huge recruitment advantage for Michigan.  Dr. Lori Pierce: It absolutely is. And this is something where industry has done a long time ago. But academia, we have been much slower to adopt those family-friendly policies. And obviously, we are well compensated in our careers. People don't leave usually for the money. It's usually the other pieces. And it's pieces like this where people are recognized and rewarded for being a whole person. And that isn't just bringing in grants, it's also respecting their family lives and their family time. Dave Johnson: For sure. That was certainly my experience serving as chairman of a department. The things that prompted departure, there were some academic issues, of course, but the main ones were personal. And oftentimes it was family-related, particularly amongst our female faculty, but increasingly so amongst the male faculty as well. Dr. Lori Pierce: I agree on both counts. That's exactly right. And it's great to see that men want to be present for their children. Having a woman be able to take maternity leave is great, but having a man to take that parental leave is great as well. Dave Johnson: For sure. So let's pivot over to ASCO. ASCO is a huge professional organization, largely, but certainly not solely comprised of medical oncologists. You're one of the few radiation oncologists to lead that organization. What was that experience like? Dr. Lori Pierce: Being President of ASCO is without a doubt the highest point of my professional career. ASCO has always been a place where I felt at home. I always felt that ASCO wanted everyone under the tent. So yes, I know it's primarily medical oncology, but ASCO brings everyone together because in order to move the needle in cancer, we all contribute to improved outcomes.   So then fast forward to becoming president. I never, ever thought I would be president of ASCO. It wasn't like something I was like, “Oh, I have to be President of ASCO.” No, I just wanted to be active in ASCO and do the right thing. And so you hear you've been nominated and you're very honored, but you're never going to be president, and you find out that you've been voted president. And my time was an unusual time because it was right in the midst of COVID. And so 2021 was completely consumed with COVID. So my predecessor, Skip Burris, he had a normal year up until about March of 2020, and that's when the world shut down. So of course, that was the first ASCO meeting that was virtual.   Then my year came and from start to finish, I often tell people, I hope I will be the only president in ASCO history to say that they'd never had an in-person meeting for the entire time that they were president. All my meetings, every single meeting, were via Zoom. Yeah, you're a little disappointed by that, but in some ways, it worked to my advantage because, long story short, when I was voted president and you pick a theme, this was long before COVID; long before we knew the world was going to change, and I wanted to have an equity theme, but I worried that it wouldn't resonate with people. So I said, “Okay, I'm going to do this and just hope that it works well with the membership.” Well, then you fast forward, and the world changes. You have COVID and you have all these senseless murders that are on TV every night. And so even those who perhaps had their head in the sand before, they got it during COVID: there are so many inequities, and that ended up being, I think, the right theme for that time. And not being able to meet people because of COVID—yes, I missed it, but it was the reason that we missed it because of COVID and the inequities that were borne out during COVID—that really hit home that equity needs to be first and foremost in everyone's mind.  So it's a long answer to your very short question. It was an amazing time. I think the organization has gotten stronger because of it. So much of work with ASCO was in equity before, but ASCO really upped its game, and equity is now one of those topics that is ingrained in every aspect of the organization, and that is what you have to have to truly affect change. I remember when I was president-elect, you go through all these interviews, these people want to interview you, and one question they ask or post is what do you want your legacy to be as president? And I was like, you can't make a legacy in a year with an orientation like ASCO. You make a legacy in a year if you have a lousy organization that you can actually make a huge difference in one year. So what you aspire to do is take a great organization and make it even better during your time as president. I think we did that. The world is inequitable. We get so many issues here and there and it all ends up with delivering inequitable care that those who have, can get the care and those who don't have it, cannot. And so I think the biggest challenge is to be able to bring the people to the table who can really make a difference and act on what needs to be done to improve equity in care. Dave Johnson: Pat has devoted a significant portion of his career to the whole issue of equity and I'm sure would agree with you. Pat Loehrer: I want to close with this thought, if you will. Dave or I usually just talk about our books that we've read. And one of the books that I mentioned that I just got through reading is entitled The Things We Make. It's by a chemical engineer and biomedical engineer from the University of Illinois, Bill Hammack. And the whole purpose of the book is really kind of defining the differences between science and engineering. He defines engineering as solving problems using rules of thumb that can cause the best change in a poorly understood situation using available resources.  And he says, in a really tangible way, the scientific method creates knowledge while the engineering method creates solutions. Much of what we do in oncology really is really more engineering than it is science. We're trying to create solutions. He went on to talk about this and it ties into the last comment. He talks about the various technological explosions, eras that have great change occurred when science took a step forward and provided better rules of thumb for the engineers. So there was the Bronze Age and the quantum physics age and even the digital age. I would love for us to come up with the health equity age for which we could work together, taking the advances of science, but using these methods of engineering to make things better with the available resources that we have. And I think if we can do that, I think this would be something that I think we can all be very proud of. Dr. Lori Pierce: What an amazing summary of that book. And first of all, what amazing work that you have done, and I'm not just saying that—you are walking the walk and talking the talk. And to your point, Dave, of what is the biggest challenge for ASCO, I couldn't have answered it better than what Pat just said. That is it. That's it. That's it. ASCO can do it, but we can't do it alone. ASCO can't do it. Health can't do it alone. This is all hands on deck and it's bringing the other parts of society to the table so that we all understand the enormity of the problem and we have an action plan. Pat Loehrer: Is there a book you're reading, Lori, that you want to share? Dr. Lori Pierce: There is. I'm reading a book now called In Shock. It's by Rana Awdish, I don't know if you heard of it. I haven't gotten to the end of it, but just briefly, I met her because she's an ICU Doc at Henry Ford in Detroit and she gave the medical school graduation speech at our graduation a couple of weeks ago. So, in advance of her coming, I wanted to read through her book. It's an autobiography.  In a nutshell, she had a just horrendous experience, essentially almost died when she was seven months pregnant as a fellow. And she basically bled out and I think it was related to a benign tumor in her liver, which is probably hormonally affected by her pregnancy. And she had sepsis, DIC, liver failure, adrenal failure. So, it goes through what it's like to be on the other side and to be in her own hospital. She wanted to go to her own hospital. She was in ICU in the place that she wasn't attending.  Her experience though, as a book, really ends up talking about the hope of medicine because now she's thriving. She's well, she and her husband, she lost the pregnancy, then she and her husband now have a child. She's back to being an ICU attending, and she gave her medical school graduation speech two weeks ago. But in that book, you are reminded of the pitfalls in medicine. You're reminded that we as providers often forget that the patient is sitting right there, and she talks about situations where when she's on the vent, someone saying she's sitting right there, “She's circling the drain.” “She's trying to die on us.” “Your kidneys aren't cooperating.” And one resident who came in eating food and took out his back pocket said, “Oh, I'm sorry, I just had a really bad night last night.” She's dying. It's just yet another reminder that we are in this honorable profession. We have the honor of taking care of patients, and we always need to make sure that we respect every patient that we interact with. And so, it's a very interesting book.  Also, there's another book that I read that's probably been out 15, 20 years, it's called The Art of Racing in the Rain. Do either of you know that? It was a New York bestseller. My husband bought this years ago, it was in our library in the house, and I happened to pull it out. It's about a dog. So, I'm a dog person. I've always had dogs. I love dogs with a passion. And this is a book written in the voice of the dog. It's about this dog named Enzo. And it's humorous, but it's also very emotional in places because it talks about what he does to help his owner, who's a wonderful man, and the wife who ends up dying of a brain tumor. As an oncologist, you could see symptoms, and you knew where that was going, and their daughter, and the things that a dog can do to uplift a human. And even when you're at your lowest point and you're about to give up, and the owner goes through just the most horrible, horrible experiences, and you realize that all of a sudden, something very small can make you then take notice of what is really important to you and can turn the tide. This is a great read. It's a quick read. I highly recommend it. It's called The Art of Racing in the Rain by Garth Stein. It really is an inspiring story about human resilience. It's a great book.  Pat Loehrer: Lori, thank you so much for taking time from your incredibly busy schedule to spend a few minutes with Pat and me. We really enjoyed it. And I also want to thank the listeners to Oncology, Etc. an ASCO Educational podcast, where we will talk about oncology medicine and beyond. So, if you have an idea for a topic or a guest you would like for us to interview, by all means, email us at education@asco.org.  To stay up to date with the latest episodes and explore other educational ASCO content, visit education.asco.org. Thanks again.  And before we go, I have a question for you, Pat. How many ants does it take to fill an apartment?  Pat Loehrer: I have to cry uncle on this. Dave Johnson: Ten, tenants. Pat Loehrer: Tenants. I thought crying uncle was a pretty good response. Dave Johnson: All right. Thank you, Lori. That was wonderful. Pat Loehrer: Thanks, Lori. It's terrific.  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.      

Age is a main factor when determining cancer care. In this ASCO Education podcast we speak to one of the top leaders in treatment for older patients who has also credited mentorship as a foundation for his career. Dr. Hyman Muss describes his childhood in Brooklyn, serving as a general physician for troops in Vietnam (6:18), the doctor who influenced his choice of hematology and oncology (7:48) and creating one of the first geriatric oncology fellowships in in the country (21:58).  Speaker Disclosures Dr. David Johnson: Consulting or Advisory Role – Merck, Pfizer, Aileron Therapeutics, Boston University Dr. Patrick Loehrer: Research Funding – Novartis, Lilly Foundation, Taiho Pharmaceutical Dr. Hyman Muss: None More Podcasts with Oncology Leaders  Oncology, Etc. – Devising Medical Standards and Training Master Clinicians with Dr. John Glick Oncology, Etc. – Rediscovering the Joy in Medicine with Dr. Deborah Schrag (Part 1) Oncology, Etc. – In Conversation with Dr. Richard Pazdur (Part 1) If you liked this episode, please follow the show. To explore other educational content, including courses, visit education.asco.org. Contact us at education@asco.org. TRANSCRIPT Pat Loehrer: Welcome to Oncology, Etc., an ASCO Education Podcast. I'm Pat Loehrer, director of Global Oncology and Health Equity at Indiana University.  Dave Johnson: And I'm Dave Johnson of Medical Oncology at the University of Texas Southwestern in Dallas, Texas. If you're a regular listener to our podcast, welcome back. If you're new to Oncology, Etc., the purpose of our podcast is to introduce listeners to interesting and inspirational people and topics in and outside the world of Oncology. We have an inspirational guest today. Pat?  Pat Loehrer: If you ask anyone who's achieved any level of success and how they've achieved it, most likely they'll mention a number of people who've influenced them along the way. Quite often, these people reflect on their mentors, and after a certain time of accomplishment and reflection, they begin to mentor others. This is very much what our next guest has done. Dr. Hyman Muss has been a mentor to me and to Dave, and he's one of the most outstanding, wonderful people in the world, and we're so excited to have him today.   Dr. Hyman Muss served in the US Army in Vietnam, where he was awarded the Bronze Star Medal. He's an experienced Clinician Scientist, the Mary Jones Hudson Distinguished Professor of Geriatric Oncology at the University of North Carolina School of Medicine, and the Director of Geriatric Oncology Program at the UNC Lineberger Comprehensive Cancer Center Program. His interest in education and research is focused on cancer and older patients, and he is internationally recognized in this area. He's been the co-chair of the Alliance Committee on Cancer and Older Adults and won the BJ Kennedy Award from ASCO in Geriatric Care. His particular interest in research expertise is in the care of breast cancer patients, with a focus on the management of women who are of older ages. He's had a major interest in breast cancer survivorship and long-term toxicity of treatment and also served as the co-chair of the Breast Committee for the Alliance Group. He serves as a mentor for medical students, medical residents, junior faculty, and more recently, his Geriatric Oncology fellows. He served on the Board of Directors of the ASCO Foundation and on the ABIM, the American Board of Internal Medicine, where both Dave and I were privileged to work with him and witness his leadership and his deep breadth of knowledge.  Dr. Muss, thanks for joining us today. Dr. Hyman Muss: What a pleasure to be here. Thank you so much for inviting me. My mother would have loved the introduction.  Pat Loehrer: Well, speaking of that, tell us a little bit. You grew up in Brooklyn, so tell us a little bit about your parents. Your father was a dentist, I think, and your uncle was a general practitioner. So give us a little bit of the early life of Hy Muss. Dr. Hyman Muss: So I grew up in Brooklyn, New York. I was born and bred there. I went to Brooklyn Technical High School. I almost went to Brooklyn College, but I came back and went to Downstate Medical Center, which was just terrific. My tuition was $600 a year, but that's another story. My parents lived in the same neighborhood. My dad was a dentist, so we knew all the people. My uncle was the GP. You came into their office, sat down, and they saw you anytime, day or night, almost 24/7, something we're probably not going back to, but they had a profound influence on me. My uncle, as a GP, used to take me on house calls in Brooklyn when they were done, and he had an old Buick with MD plates. And I would go into these families, and they loved him, and they would give me ice cream and things. Maybe that's what made me a doctor. But it was a terrific and indelible experience. I had terrific parents. In those days, doctors and medical people usually lived in the same neighborhoods as their patients, so they really knew their people well. It was a terrific upbringing. I got to love medicine and have never had a look back. Dave Johnson: So your inspiration for a career in medicine obviously started at home. Tell us more about your formal education. You mentioned your high school education. What about college? And shortly thereafter?  Dr. Hyman Muss: Yeah, well, I went to Lafayette College. I was not the best high school student, but I had good college board scores or whatever they called them then. And I went to Lafayette and I thought I was going to be a chemist, a chemistry major. But I took enough premed courses and I spent a summer in a lab building cyclic ketones. And everybody was outside sitting on the lawn of the campus. And I was in there with all these distillation apparatus, and I said, “I don't think I can do this the rest of my life.” So I applied to medical school, and I got into several medical schools. But my father at that time was dying of metastatic bladder cancer. He had been a heavy smoker, and he was still working as a dentist. He worked until the day he unfortunately died. But I got into Downstate. We lived in Brooklyn, and my uncle, the GP, said, "Hy, you need to come home and help take care of your dad." I'm an only child, so I did. And I had a wonderful experience at Downstate.   Several years ago, I was listening to NPR and heard that one of my professors had won the Nobel Prize. Dr. Furchgott in physiology, one would have never thought. And I had a wonderful education and subsequently got into what was then Peter Bent Brigham in Boston, did my internship and residency there, joined the army and medical school, so I wasn't drafted, it was a program then. And then after first year of residency, I went to Vietnam, worked with an artillery battalion, a mystical experience, but no regrets. And then subsequently came back and did hematology and oncology at Brigham and at what was then the Jimmy Fund and Sidney Farber Cancer Center. And Tom Frei had just come. And I did hematology with a guy named Bill Moloney in Boston at Harvard. I'll tell you, a wonderful man. He was like a surrogate father. My dad had died by then, and I just feel I've had every opportunity to have a wonderful education and terrific mentors along the way. Dave Johnson: So we want to ask you about both of those gentlemen, but I would like to just, if I may, drop back to your experience in Vietnam. What was that like?  Dr. Hyman Muss: Well, I was 27 years old and I was put as the doctor for 500 men in artillery. My job was to take care of the general health of the troops. Fortunately, we didn't have many casualties. It wasn't a front war like my uncle, who was a GP actually in World War II, landed in Normandy about a week later and went all through World War II as a doctor. But Vietnam was an unusual war, there wasn't really a front. So my experience was I would go out to fire bases, which were units of about 100 men in the jungle, go out three days in a week in a helicopter, do sick call, check people. I dealt with really alcohol problems, unfortunately, a lot of drug problems. You had young people with really not a lot to do during the day, nothing much to do, and no real goal of being there. I did that for a while, and actually, the reason I got the Bronze Star was because I set up– It was nothing like standing in front of a machine gun. I'm not that kind of brave guy, but I set up a drug amnesty program so I got a lot of support from our regular field people to do this, so we didn't have to keep sending kids home with dishonorable discharges. And I learned a lot. I think we were reasonably successful. I learned a lot about artillery. I think overall it was a great experience in my life. Dave Johnson: Tell us how your interest in hematology and oncology originated. Where did that come from?  Dr. Hyman Muss: When I was an intern at the Brigham, Dr. Moloney was a very famous Harvard professor. He had studied war casualties after Hiroshima, he was one of the people that found the Philadelphia chromosome in CML. He was a guy that rounded on every single one of his leukemia patients every day. So I was an intern. So in those days I would go and see all the hematology people rounding because all the acute leukemia patients and all the serious cancer patients were right on the floors, right on the wards. We had 17-bed wards, and then we had some private rooms. And he loved what he did. And before I left for Vietnam, we didn't have Ara C and daunomycin. So every leukemia patient I saw died. This is '68 to '70. Yet we tried all these different regimens. Occasionally you got someone who did well for six months, a year. But his bedside manner was absolutely wonderful to me. He knew all the patients. He'd ask them about where they lived in Boston. His humanism was terrific, and yet I loved the diseases he treated. The stakes were high. We didn't have good treatment, and I decided that that's probably what I want to do.   So when I was in Vietnam, I applied and got back in the Hematology Fellowship and came back and did that. I saw Ara C and daunomycin. I gave the chemotherapy to them, and he'd say, "Go up and treat Harry Smith with Ara C and daunomycin." I had the syringes in my pocket, guys. Forget about hoods and mixing. And I'd go up and treat them and the marrow would be gone within four or five days. I did a bone marrow. They published their regimen in the New England Journal called COD, C-O-D because they also gave vincristine. So it was cytarabine, vincristine, and daunomycin, the COD regimen. It fit Boston. And I saw it was like the emergence of cisplatin after Larry Einhorn. You saw people that never survived going into remission and I saw some remissions in AML and it cemented it.  About my second year of residency, we had a child. I was running out of money. I was being paid $6,000 a year and I had the GI Bill. I went into Dr. Moloney and he talked with Dr. Franny Moore, who was head of surgery at the Brigham, and they made me the Sidney Farber Research Fellow, doubled my salary and I had to go to the Jimmy Fund and see cancer patients. And it so happened that was when Tom Frei came to Dana-Farber. And so I started rounding with Dr. Frei and seeing those patients. And I think the first day I walked in, I knew I wanted to do more than just leukemia because I saw groups of patients with every disease. We treated everybody with CMFEP, it didn't matter what cancer they had. And I just loved it and said, "My God, there's so much we can learn. What a great career." And so that got me into the oncology portion.   And then I was offered to stay at Harvard. They were going to make me an assistant professor, but they wanted me to do lab work. And I knew my personality, it just wasn't for me. I worked with a lovely guy named Frank Bunn, one of the world's great hem guys in his lab, and he's still a close friend in his 80s. And he told me one day, he said, "Hy, I don't think the lab is for you." And he actually helped me get my first job at Wake Forest University, which turned out to be wonderful. So that's how I ended up with my circuitous in HemOnc. And it's really from great mentors, it's from Bill Moloney, it's from Tom Frei, Dave Rosenthal, tons of wonderful people along the way that not only taught me a lot, but they seemed to love what they do, which is a gift in life to love what you do and love the people you're doing it with. They instilled that in me. Pat Loehrer: From there you went to Wake Forest and there's a couple of colleagues down there, I believe, that inspired you, Charlie Spurr and Bill Hazzard, who was the founding founder of geriatrics. Tell us about that experience and how'd that shape your life.  Dr. Hyman Muss: I was looking for a clinical job and I looked at Rochester, and I got snowed in one night in Wake Forest, and I said, “Where's the contract?” And I signed it. And my mother, who was living in New York City, didn't know where North Carolina was. My mother was from a family, was born over a candy store in Greenwich Village, and said, “Where are you going?” And then I showed her where it was, and she says, “They're going to kill you down there.” And it turned out to be one of the best decisions of my life. My wife Loretta, who both of you know so well, we got out of our VW with our dog and our daughter when we moved here, and VW bug, by the way, not a van, and she cried. It turned out it was one of the best opportunities.  Charlie Spurr was an iconic oncology leader. He actually did some of the early work on nitrogen mustard in Chicago during the war, the first chemotherapy drug. He was a terrific leader. He had patients programmed in on those IBM punch cards. He had little cards for the protocols, CMFEP, CMF, AC on little laminated index cards. I learned so much from him, and he was to me, great leaders and great mentors morph from things they do themselves to teaching other people, and whose brains have the ability of having the same dopamine shot when you see one of your fellows or young faculty present a wonderful study as you do. And your brain isn't saying, “I wish I was up there.” It's saying, “Isn't this so cool that this young man or woman or fellow or medical student is doing such a wonderful job?” And I had something to do with providing the soil for this seed to grow. That's the kind of guy he was. And so it was wonderful there.  And as I moved on, we got a new Chief of Medicine, Bill Hazzard. And I still hear from Bill on rare occasions, but Bill was one of the first geriatricians in the United States. He wrote the textbook, and his wish was that all the faculty and all the specialties get involved in a geriatric project. And so I had all those little index cards, and I looked and saw how many older people with metastatic breast cancer we'd given chemotherapy to. And these were little protocols, nothing like the protocols today, no 50-page consent forms, 50 pages of where your data is stored. They were like, here's the treatment, here's the dose mods. And I looked at those 70 patients with one of our residents, Kathy Christman, she may be retired now, but in any event, we wrote a paper and showed the old people did as well as the young with breast cancer. And we published it in JAMA. And it's one of the few papers in my career, I got no reviewers. They accepted the paper. I got no reviewers. So because I'm from Brooklyn, and my English is not what it should be, I had my friends read it to just make sure I didn't say anything egregious. But it got published and the next thing I know, my friends in medical oncology in the state were calling me. They said, “I got a 75-year-old woman here.” I'm saying, “Guys, I just wrote this paper. I really don't know anything about older people.” But slowly, with Bill Hazzard and others, I got more and more interested. I started reading about Geriatrics and I ended up making it a focal point of my career. It was kind of happenstance. And Bill was a wonderful mentor.  And then as I subsequently moved on, I worked with terrific people like Harvey Cohen, Lodovico Balducci, and Martine Extermann, all of them heavily involved with ASCO over the years as well, and B.J. Kennedy. They were wonderful to work with. And BJ was inspirational because BJ would get up at an ASCO meeting and he'd say when he saw the age cut off, he'd say, “How come you didn't let old people on that study? There'd be 1000 people in the audience.” And so he really was a great mentor. And I had the bittersweet opportunity of writing his obit for JCO years ago and kept up with his family a few years, but he was a wonderful man. Dave Johnson: I'm just reflecting on the fact that today, patient registries are sort of mainstream, but certainly in the ‘70s, ‘80s, even into the ‘90s, having a list of patients with a particular disorder seemed almost novel in many respects. And to have that was a godsend.  Dr. Hyman Muss: It was a godsend. I still remember those little file cards. And he called it the Oncology Research Center and it was a godsend. And you've got to remember, this is like ‘74, ‘75, it's a long time ago. Dave Johnson: So many of our listeners may not be as familiar with Wake Forest as they are with Duke and North Carolina, the other medical schools located there. But you were at right at a point where I mean, it was one of the top oncology programs in the country at that time. Still is, I don't mean to diminish it, but there was a who's who of people there at the time. And you were also involved in creating, I think, one of the first cooperative groups of sorts. It was the Piedmont Oncology Group. Tell us about that.  Dr. Hyman Muss: Oh, yeah, well, that brings back memories. So the NCI at that time wanted to get more, I think, rural and other smaller places involved in research. And they put out an RFA to form like regional cooperative groups. And we formed the Piedmont Oncology Association, the POA. We actually did well for a few years. We wrote some really good studies. We got one or two New England Journal articles. I worked with all the people, mainly in the community, community docs who would go on, and put people on the protocol. I mean, I looked at all the X-rays and scans in a lot of these patients myself as part of the studies we did. And it turned out to be a wonderful organization and it's still run today by Bayard Powell, who is one of our terrific fellows who's the head of Oncology at Wake Forest.  But after a while, we just couldn't compete with CALGB, of which I was a member of also, and ECOG and SWOG, even North Central Group, which was kind of formed in a similar venue, eventually merged. So we did a wonderful job for a while but the truth is we just didn't have the manpower to write studies for every disease site. So eventually we kind of petered out as a clinical trials group. But it's been maintained for educational programs and it's really served as a good resource for a lot of good education for the community oncologists who give most of the care in this country in the state. So it's been good. I think Pat kind of exceeded us with HOG, the Hoosier Oncology Group, which was in a similar vein. But it was a great experience and it was all Dr. Spurr, who thought of doing this and built it.  Dave Johnson: Certainly, it was inspirational in many people in and outside of Wake Forest. So with such an idyllic life, what in the world possessed you to move north to Vermont?  Dr. Hyman Muss: Well, you get this urgent life. You want to be a leader, you want to be a chief. Now, I tell younger people, if they love what they do, don't do it. So I got a wonderful opportunity at the University of Vermont to go up there and be Head of HemOnc. Chief of Medicine was a terrific guy, Burt Sobel. The university at that time, at one time it had a wonderful Oncology program. It had a federally funded cancer center with Irwin Krakoff and Jerry Yates, two other iconic guys. I don't know what the politics were but it had lost a tremendous amount of faculty, especially its clinical faculty, and they needed to rebuild it. And I went up and I thought, “Well, I'm in my 50s. This is going to be a great opportunity. If I don't do it now, I may never get the chance.” So I went up there and actually, it was a great opportunity. We hired terrific people. We got CALGB and we participated. We had actually a very good accrual for a small place and we had a very small but very effective cancer center. So it turned out to be a really good experience.  I worked with wonderful people. I recruited some wonderful people. But over time, the issues of the business of medicine, all the issues that happened, I'm saying I'm kind of losing my focus on clinical care and clinical trials, which I love to do. I don't need to tell either of you. I mean, Dave, you've been chief and department chair and Pat has run cancer centers. After a while, the administrative tasks just were so overwhelming and I didn't enjoy them, that I said, “I've got to get back in some type of more clinical focus.” And that's when I decided to look around and fortunately found what's turned out to be a dream job at UNC.  But it was a time of life. Maybe my ego got in the way of my logic. I don't regret it. I met and I think we rebuilt a wonderful clinical program. But you realize some of the resources of big places with-  we never had the research infrastructure to hire a lot of people and get big programs going on and great translational programs, just didn't have the funding. But it was great, and I have no regrets. And I learned how to tolerate the cold weather. And I have a lovely daughter, Sarah, who still lives up there. So we get back occasionally. And I've kept up with a lot of the people there. There are some wonderful people at UVM.  Pat Loehrer: From there, though, you were pulled down to North Carolina, where you've, again, built an incredible breast program there is outstanding. But you've created a Geriatric Oncology program, one of the first geriatric fellowships in oncology in the country. So tell us a little bit about that and what you feel may be your legacy is there at North Carolina.  Dr. Hyman Muss: Well, I had the opportunity over the years when I was at Wake, really, I got to know Shelley Earp, who's our cancer center director. I think maybe you were close to him, Pat. The longest surviving cancer center director on the planet, or among them. And we were good friends. And North Carolina's legislature actually gave the University of North Carolina substantial funding to improve cancer care in North Carolina, not just research. And so I had talked with Shelley about maybe moving, and because of the generosity of the state, really, he was able to really get me going, start a Geriatric Oncology program. And what I wanted to do was develop trials. As Dave says, I built a registry in 2009 here for older cancer patients using geriatric assessment. I have 2000 patients, which has been a resource for all types of faculty and fellows, and students to write papers. But I was able, with the support, to do things like this right from the get-go. And plus, I joined probably one of the best breast groups on the planet with Lisa Carey and Chuck Perou, and Larry, terrific people, Claire Dees. I had great luck in doing this, so I was able to really focus, get great support from my colleagues to build studies focusing on older people.  And then I had the great fortune of meeting Ned Sharpless, our prior NCI director. And Ned is one of the world's great aging biologists. And I don't mean aging as an adjective, he's really been a master on why we age, the biology of aging, cell senescence. So Ned taught me all about cell senescence and the mechanisms, especially the gene expression p16, which is like our own CDK inhibitor. And so I was able to start using his lab, collect samples, treat people with chemotherapy, follow them off with geriatric assessment. It was a great opportunity to do that here, and we got a lot of studies going and we showed what the pediatricians have known for years, that chemotherapy dramatically ages people, not just children, but adults. But it also allowed me to work with my colleagues in lymphoma and lung cancer to do little studies along the way.  And we eventually then built a T32 program. We got a T32, which we're kind of completing now our first five years to train oncology specialists in geriatrics. So the way we do it is they can be surgical oncologists, GU, we had a GYN oncologist, medical. With their HemOnc training, they do a year where they work with the geriatricians, so they go on geriatric inpatient service for a month and they really learn about older people. And part of it is a project. So we've been able to build that and develop a lot of programs with that. And I should say we've been very successful with mentorship and with ASCO support for things like YIAs, the late and great Arti Hurria, who absolutely an amazing woman. Some of her legacy at ASCO, the YIAs, and things. We've been successful in applying for some. So we've been able to build a whole spectrum of med and hematologists. We have an interest in Myeloma and AML focusing on older people. We've been able to build a whole team approach, including translational projects related to older people. And it's just been a great opportunity, and hopefully, my legacy here will be, too, and I'm working on it.  We have a wonderful guy, Bill Wood, who is very effective and has built this incredible coaching program to continue this legacy. Like many of us in this field, we are bothered because we all know the stats, we all know that first slide of the demographics of cancer, and yet it's been very hard in our culture to provide a lot of the services and build the clinical trials we need to best care for older people. It's still a major problem in this country. So as I cut back on my clinical care, I'm going to still advocate to try to improve the care of older people. Do geriatric assessment, build it into your clinical programs, get your hospitals to support you, convince them, build business plans, et cetera. And hopefully, that'll be my ultimate legacy, that we've made greater awareness of the older people, other than the usual stats, and we're really trying to care for them in a much more global sense, in a much more holistic sense than we've done. I hope we'll be successful. It's a slow haul, but we've got lots of great young people coming up through the pipelines, ASCO has been a great player in this. Many of you know people like Supriya Mohile and William Dale, Heidi Klepin, people, the next generation that's going to keep building this. So I hope the legacy will be that we get more buy-in, more interest, more trained people in other oncology-related subspecialties RadOnc, SurgOnc that will really focus on the care of older people. Dave Johnson: I don't think there's any doubt that that will be a part of your legacy Hy, but I think your legacy will be much broader than the world of geriatric oncology. Your mentorship leadership, your clinical skills, your educational capabilities, all of that will certainly last for many, many years in the future.  Well, I don't want to bring up a touchy topic, but you yourself are geriatric and we're wondering what your plans are for your semi-retirement. I recognize you're not retiring, but what do you like to do outside of medicine? Dr. Hyman Muss: I'll tell everybody who's interested in hearing this. On Tuesday, I had my 80th birthday.  Dave Johnson: Congratulations.  Dr. Hyman Muss: And I think I'm one of the most blessed guys. I'm pretty healthy. I married up -  my wife Loretta, who both of you, Pat Loehrer and Dave Johnson, know well.  Dave Johnson: Yeah, you definitely married up.  Dr. Hyman Muss: Yes. It's really carried me most of my life. She's great and so she flew up our three kids and we celebrated and I'm very fortunate. I have the enthusiasm and strength to do more clinical medicine. But I think the time has come for me to cut back my clinical medicine, so I'm going to do that in June. The hardest thing I've done is say goodbye to so many of my patients here.  We've been blessed. We have a lovely family. We're pretty close. I'm never bored, probably you two know well, I love to do things like fishing, outdoor stuff. I've really gotten into woodworking, so I'm not going to be bored. But there will be a small piece out of me when I walk out of that clinic in June. I know that and my two close psychiatry friends think it's going to really be a hard fall, but I don't think so. I still have some grants. In fact, I'm working with a fellow in City of Hope, Mina Sedrak, who's been very involved in ASCO, too. We are hoping to get an R01 looking at senolytic drugs that may prevent aging, and exercise in older women with breast cancer to see if we can reverse the trends of chemo. So my brain is still on that stuff, but the clinical care is going to be tough.  I had a note and for some reason, we talked about so many things. I wanted to mention that one of my great opportunities was joining the CALGB and then the Alliance and getting the support of Dr. Schilsky, Rich Schilsky, who's been one of the icons of ASCO to build cancer in the elderly working group with Dr. Harvey Cohen at Duke. And Harvey is one of the world's great geriatricians. And using that to get studies done, to incorporate studies with Arti Hurria on geriatric assessment, and really have it as a place where a lot of younger investigators could get started on a career in geriatric oncology. And that was really a great opportunity. It was kept on by Dr. Bertagnolli, who now is our NCI director, and I think was really the first group to really give good support for this. Dave Johnson: So we want to thank you very much for being our guest today.  We also want to thank our listeners of Oncology, Etc. This is an ASCO Educational Podcast where we talk about oncology medicine and much more. So if any of our listeners have an idea or a guest they would like for us to interview, please email us at education@asco.org. To stay up to date with the latest episodes and explore other educational content, visit ASCO's website at education.asco.org.   Thanks again for being our guest, Hy.  Dr. Hyman Muss: My pleasure. Thank you so much. 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.  

The early 1970's saw the start of the medical specialty we now know as oncology. How does one create standards and practices for patient care during that time? Dr. John Glick is a pioneer during the dawn of oncology. He says that early work involved humanity, optimism, and compassion, all of which were the foundation of his career. Dr Glick describes the clinical experiences that drove him to oncology (4:28), his rapport with patients, which was portrayed in Stewart Alsop's book Stay of Execution (9:21), and his groundbreaking work developing the medical oncology program at the University of Pennsylvania (12:22). Speaker Disclosures Dr. David Johnson: Consulting or Advisory Role – Merck, Pfizer, Aileron Therapeutics, Boston University Dr. Patrick Loehrer: Research Funding – Novartis, Lilly Foundation, Taiho Pharmaceutical Dr. John Glick: None More Podcasts with Oncology Leaders    Oncology, Etc. – In Conversation with Dr. Richard Pazdur (Part 1) Oncology, Etc. – HPV Vaccine Pioneer Dr. Douglas Lowy (Part 1) Oncology, Etc. – Rediscovering the Joy in Medicine with Dr. Deborah Schrag (Part 1)  If you liked this episode, please follow the show. To explore other educational content, including courses, visit education.asco.org. Contact us at education@asco.org.   TRANSCRIPT Disclosures for this podcast are listed in the podcast page. Pat Loehrer: Welcome to Oncology, Etc. This is an ASCO education podcast. I'm Pat Loehrer, Director of Global Oncology and Health Equity at Indiana University. Dave Johnson: And I'm Dave Johnson, a medical oncologist at the University of Texas Southwestern in Dallas, Texas. If you're a regular listener to our podcast, welcome back. If you're new to Oncology, Etc., the purpose of our podcast is to introduce listeners to interesting people and topics in and outside the world of oncology. Today's guest is someone well-known to the oncology community. Dr. John Glick is undoubtedly one of oncology's most highly respected clinicians, researchers, and mentors. I've always viewed John as the quintessential role model. I will add that for me, he proved to be a role model even before I met him, which hopefully we'll talk about a little bit later.   To attempt to summarize John's career in a paragraph or two is really impossible. Suffice it to say, he is to the University of Pennsylvania Cancer Center what water is to Niagara Falls. You can't have one without the other. After completing his fellowship at NCI in Stanford, John joined the Penn faculty in 1974 as the Ann B. Young Assistant Professor. Some five decades later, he retired as the director of one of the most highly respected comprehensive cancer centers in the nation. Among his many notable accomplishments, I will comment on just a few. He established the Medical Oncology program at Penn and subsequently directed the Abramson Cancer Center from 1985 to 2006. Interestingly, he established the Penn Medicine Academy of Master Clinicians to promote clinical excellence in all subspecialties across the health system. He's been a driving force in philanthropy at Penn Medicine, culminating in his role as Vice President Associate Dean for Resource Development.  Over the past several decades, he has helped raise over half a billion dollars for Penn Med. We need you on our team, John. As a clinician scholar, John's research has helped shape standards of care for both breast cancer and lymphomas. For example, he pioneered the integration of adjuvant chemotherapy and definitive breast irradiation for early-stage breast cancer. In 1985, he chaired the pivotal NCI Consensus Conference on adjuvant chemotherapy for breast cancer. He also was a driving force in a clinical landmark study published in The New England Journal some 20 or so years ago about the role of bone marrow transplant for advanced breast cancer. Most impressive of all, in my opinion, is John's legacy as a mentor to multiple generations of medical students, residents, and fellows.   So, John, we want to thank you for joining us and welcome. Thought we might start by having you tell us a little about your early life, your family, your parents, where you grew up, and how you got into medicine. Dr. John Glick: Well, thank you for having me on the podcast, Pat and David, it's always a pleasure to be with you and with ASCO. I grew up in New York City in Manhattan. My father was a well-known dermatologist. He was my role model. And from the age of eight, I knew I wanted to be a doctor. Nothing else ever crossed my mind. But having seen my father's many interests outside of medicine, I realized from very early that there was much more to medicine than just science. And that really induced me, when I went to college, to major in the humanities, in history, art history, and I actually took the minimum number of science courses to get into medical school. That probably wouldn't work today, but it was the start of my interest in humanism, humanities, and dealing with people outside of the quantitative sciences.  Dave Johnson: So that's reflected in how we all view you, John. You're one of the most humanistic physicians that I know personally. I wonder if you could tell us about your interest in medical oncology, and in particular, as one of the pioneers in the field. I mean, there wasn't really even a specialty of medical oncology until the early 1970s. So, how in the world did you get interested in oncology and what drew you to that specialty? Dr. John Glick: Well, I had two clinical experiences that drove me into oncology. The first, when I was a third year medical student at Columbia PNS, my first clinical rotation in internal medicine, I was assigned a 20-year-old who had acute leukemia, except he was not told his diagnosis. He was told he had aplastic anemia, receiving blood and platelets, and some form of chemotherapy. And I spent a lot of time just talking to him as an individual, not just taking care of him. And we became friends. And he was then discharged, only to be readmitted about two weeks later. And in the elevator, the medical assistant had his admission sheet, and unfortunately, it was facing the patient, and it had his diagnosis, acute leukemia. So he came into the ward and he confronted me. "Why didn't you tell me I had acute leukemia?" Well, I couldn't say the attendees forbade me to do that. So I took what today we would call ‘the hit', and apologized. But it stimulated me to reflect that honesty with patients was extremely important, and that oncology was just in its infancy. We knew nothing about it. It was not considered even a specialty. I don't think we used the word "oncology."  But that inspired me to take an elective in my fourth year at PNS, at an indigent cancer hospital called the Francis Delafield Hospital. It only took care of indigent cancer patients, and there were wards, twelve patients in a ward, six on each side, and nobody would go see the patients. It was almost as if they were afraid that if they were to touch the patient, they would get cancer. And I started talking to the patients, and they were human beings, but nobody had told them their diagnosis. Nobody had told them if they were terminal. And there were a few patients who were getting a new drug at that time for multiple myeloma called melphalan, and they actually had relief of some of the symptoms, of their bone pain. But I realized that there was a huge void in medicine that I could possibly help to fill.  And that was the era of Vietnam, and so I applied to the National Cancer Institute to become a commissioned officer in the Public Health Service to avoid the draft, to be on a service with, at that time, some very notable oncologists Vince DeVita, Ed Henderson, Paul Carbone. I had read some of their papers, and I was lucky to be accepted. And I was a clinical associate at the National Cancer Institute. And that was life-changing because there every patient was considered to be potentially curable. The advances at that time using MOPP for Hodgkin's disease, C-MOPP for lymphoma, some treatments for leukemia. George Canellos pioneered the use of CMF for metastatic breast cancer. It was an amazing, amazing experience. That was in 1971 to ‘73. Oncology did not become a true specialty till ‘73, but my two years at NCI were formative.  However, I realized that there was something missing in my training. Everybody was considered curable, but I had never seen a patient with metastatic colon cancer, metastatic lung cancer. The radiotherapists there did not like to teach clinical associates, and I knew that there was a place called Stanford. And Stanford had Saul Rosenberg in medical oncology for lymphomas and Henry Kaplan in radiotherapy. So, everybody was going to California, and my wife and I packed up and went to California and spent a year at Stanford, which, combined with my training at the NCI, led me to the principles that guided my career in oncology; humanity, optimism, reality, compassion, and a love for clinical trials.  I was very, very fortunate to be there at the dawn of medical oncology shortly after I decided to go to Penn, which at that time did not have a medical oncologist. In fact, I was the only medical oncologist at Penn for four years and did every consult in the hospital for four years, much to the chagrin of my wife. But I was fortunate to have great mentors in my career: Paul Carbone, Vince DeVita, Saul Rosenberg, Henry Kaplan, among many, many others. And that impressed me about the importance of mentorship because my career would never have been where it was or is without these mentors. Pat Loehrer: John, just to echo what Dave said, you've been such a tremendous mentor for us. Dave and I particularly, you took us under your wings when you didn't know who we were. We were people in the Midwest. We weren't from any place shiny, but we really appreciate that. Dave Johnson: So, John, I mentioned at the very beginning that I met you before I met you, and the way I met you was through Stewart Alsop's book, Stay of Execution. He portrayed you as an extraordinarily caring individual, and it tremendously impacted me. It was one of the reasons why I chose oncology as a specialty. I realize it's been 50 or more years ago and most of our listeners will have no idea who Stewart Alsop was. And I wonder if you might share with us a little bit of that experience interacting with someone who was particularly well-known in that time as a columnist for The New York Times.  Dr. John Glick: His brother Joe Alsop and Stu Alsop were two of the most famous columnists at that time. Joe Alsop was a hawk right-winger who lived in the Vietnam War. Stewart was charming, was a centrist Democrat, wrote the back page for Newsweek for years. He and I had very similar educational backgrounds and interests. And we functioned on two different levels—one as a physician-patient, and then we became friends. And he and his wife adopted us into the Georgetown set.  And I received a lot of criticism for socializing with a patient. But over the years, I've been able to become friends with many of my patients, and I've been able to compartmentalize their medical care from our friendship. And I use the analogy if I was a doctor in a small town and I was the only doctor,  I'd be friends with people in town, with the pastor and likely the mayor. But I have always believed that patients can become your friends if they want it and if they initiated it.   Taking care of Stewart Alsop was an amazing, amazing experience. We didn't know what he had. People initially thought he had acute leukemia. In reality, he had myelodysplastic syndrome, but that hadn't been described yet. He had a spontaneous remission, which I rarely see, probably due to interferon released from a febrile episode, all his blasts went away in his marrow. One of my children's middle name is Stewart. But professionally and personally, it was an incredible experience. It taught me the importance of being available to patients. They had my home phone number. We didn't have cell phone numbers in those days. We had beepers, but they didn't work. And from that point on, I gave my home phone number to patients, and I actually trained my children how to answer the phone. “This is Katie Glick. How can I help you? My father's not home. You need my father? Can I have your phone number? I'll find him and he'll call you back.” Patients still remember my children and their way of answering the phone. Pat Loehrer: One of the things you did do is create this medical oncology program at Penn, which has graduated some incredible fellows that have become outstanding leaders in our field. But can you reflect a little bit about the process of creating something that was never created before, like a medical oncology program? Dr. John Glick: Well, I came to Penn, my first day. Person who recruited me was on sabbatical. I asked where my office was and there was no office. There was an exam room. There was a clinic for indigent patients which we scrubbed by hand. There was another office for patients who paid. Within two months, I had abolished that. We had one– I hate to use the word clinic, people still use the word clinic today, but one office that took care of all patients, irregardless of means.   I saw every oncology consult in the hospital for four years. But I had a mentor, not only Buz Cooper, but fortunately, Jonathan Rhoads was Chairman of Surgery, and he was also Chairman of the President's Cancer panel. And what he said at Penn in surgery became the law. And then when we introduced lumpectomy for breast cancer and radiotherapy, he endorsed it immediately. All the other surgeons followed suit. I don't think there's any hospital in the country that adopted lumpectomy and radiotherapy for breast cancer as quickly. And the surgeons were instrumental in my career.  Now, I was taking care of gliomas, head and neck cancers, and it was difficult. If I had a colorectal patient, I'd call Charles Moertel at Mayo Clinic and say, “What do I do?” I was there when Larry Einhorn in 1975 presented his data on testicular cancer with the platinum. Unbelievably inspiring, transformational. It also showed the importance of single-arm studies. You didn't have to do randomized studies because the results were so outstanding. And so in my career, I did both single-arm studies, proof of principle studies, and then many randomized trials through the cooperative groups.  But the first four years were very difficult. I didn't know what the word ‘work-life balance' meant in those days. If somebody was sick, I stayed and saw them. It was difficult introducing new principles. When I first mentioned platinum after Larry's presentation, I was laughed out of the room because this was a heavy metal. When patients were dying, they died in the hospital, and I wanted to hang up morphine to assist them. The nurses reported me to the administration. I had to fight to get the vending machines for cigarettes out of the hospital. So there were a lot of victories along the way and a lot of setbacks.  It took me several years to have an oncology unit of six beds, and now I think we have 150 or 160 beds and need more. So it was an interesting and, in retrospective, a wonderful experience, but I didn't know any better. Fortunately, I had a great wife who was working at Penn and then at Medical College of Pennsylvania, and she was incredibly understanding, never complained. And I think my kids knew that on Tuesdays and Thursdays, don't bring up anything difficult with dad because he's had a really tough day in clinic. Dave Johnson: We were not in that era, but we were very close. And many of the struggles that you had were beginning to dissipate by the time we were completing our training. But it was still a challenge. I mean, all those things. I gave my own chemotherapy for the first few years I was in practice. I don't know that our colleagues today who have trained in the last, say, 10 or 15 years, actually realize that that was what we did. Most of the chemo was given in the hospital. It was not uncommon in the early days to have 20, 30, 40 inpatients that you would round on because there just wasn't an outpatient facility. But the corporate mind made a big difference, allowing us to give drugs like platinum in the outpatient arena. You span all of that era, and so you've seen the whole panoply of change that has taken place.  John, the other thing you did that has impressed me, in part because of my time as a Chair of Medicine, is you created this Academy of Master Clinicians. Can you tell us a bit about that and what was the motivation behind that?  Dr. John Glick: Ben had a strategic plan, and one of the pillars was talking about valuing clinical medicine and clinical excellence. But there was no implementation plan. It was sort of just words and left in the air. And I was no longer director of the cancer center, and I realized we had a lot of awards for research, awards for education, and no awards for clinical excellence. So I created the idea of having an academy and master clinician spend six months talking to all constituencies, chairs of various departments, directors of centers to get a buy-in. Wrote a three-page white paper for the dean, who approved it immediately. And then, as typical at Penn, I raised all the money for it. I went to one of my patients who was an executive at Blue Cross. I said I need $500,000 to start this program. And then subsequently, I raised $4 million to endow it. Today, it is the highest honor that a Penn clinician can receive.  You could be on any one of our multiple tracks. You have to see patients at least 60% of the time. You not only have to be a great doctor, you have to be a humanist. So the world's best thoracic surgeon who has a demeanor in the operating room that is not conducive to working with a nurse as a team doesn't get in. We emphasize professionalism, mentorship, citizenship, teaching, national reputation, local reputation, and clinical excellence. And so we've elected over 100 people, maybe 3% of the Penn faculty. We give an honorarium. We have monthly meetings now by Zoom. We have monthly meetings on various topics. We never have a problem getting any dean or CEO to come talk to us.  We were the first to do Penn's professionalism statement. The school subsequently adopted, and it's become the highest honor for a Penn clinician. It's very competitive. It's peer-reviewed. The dean has no influence. And we're very proud that 40% of the members of the academy are women. We have a high percentage of diversity compared to the numbers on our faculty, but you really have to be elected on merit, and some people that you might expected to be members of the academy aren't. It's one of the things I'm proudest of. It will go on in perpetuity because of the money we've raised. I think many of my accomplishments as a researcher will fade, as they typically do, but I'm very proud of the Academy, and I'm very proud of the people that I've mentored. Dave Johnson: It speaks to your values, John, and I think it's one of the reasons why you're so widely admired. Thank you for creating that. It proved to be a model for other institutions. I know that for a fact. One would think that valuing clinical care would be preeminent in medical schools, but in fact, it's often ignored. So again, I know that your colleagues at Penn appreciate your efforts in that regard.  Tell us a little about your term as ASCO president. What are you most proud about and what were your most difficult challenges? Dr. John Glick: Well, the most difficult challenge was that ASCO was in transition. I had to fire the company that ran the meeting. We had to decide that ASCO was going to hire a CEO. We hired John Durant, made a small headquarters, tiny staff, and did a lot of the work as being chief operating officer myself. It was the year that email was just getting started, and ASCO wasn't using it. So every Saturday from 8:00 to 6:00, I came into the office and my secretary wrote letters inviting people to be on the program committee or various committees. But it was a society in transition. The growth of membership was huge. The meeting sites had to be changed. We emphasized science. Some of the things that we did are still in existence today.  We formed the ASCO ACR Clinical Research Methods course. It's still given. That's one of our real highlights. We forged relationships with other societies, the National Coalition for Survivorship. We made the ASCO guidelines much more prominent. And I remember that we were going to publish the first guidelines on genetic testing for breast cancer, and the MCI went up in absolute arms, so I arranged a meeting. I was at the head of the table. On my right were Francis Collins, Richard Klausner, Bob Wittes, and a few other people. Then the ASCO people who wrote the guideline were on the left, and they didn't want us to publish it. They thought it was premature to have a guideline about genetic testing. And what I learned from that meeting is that you can agree to disagree with even the most prominent people in oncology and still maintain those relationships. But we did what's right, and we published a guideline on the JCO. There were so many wonderful things that happened at ASCO that I can hardly restate all that happened I guess 27 years later. It was exciting. ASCO was still young. There was a lot we had to do, and we could do it. You could just go ahead and do it. It was exciting. It was gratifying. It was one of the most fun years of my life. Dave Johnson: I mean, that transition from an outside company in many respects, controlling the premier activity of ASCO, its annual meeting to ASCO, taking that on, that defined ASCO, and that's what I remember most about your time as president. It was a bold move, and the hiring of John Durant was brilliant. I mean, he was such an incredible individual, and it was great that you guys were able to pull that off. Pat Loehrer: Thank you for what you've done.  You've had a number of your mentees if you will, and colleagues that have gone on to prominent positions, including, I think, at least three directors of NCI Cancer Centers. Can you just talk briefly how you would describe your mentoring style because you've been so successful? Dr. John Glick: First, there are two aspects. One is when people come to you, and then when you go to people, you sense they're in need. The key aspect of mentoring is listening. Not talking, listening. Looking for the hidden meanings behind what they're saying, not telling them what to do, presenting options, perhaps giving them clues on how to weigh those options in pros and cons, being available for follow-up. Mentoring is never a one-time exercise. Not criticizing their decisions. You may disagree with their decision, but it's their decision, especially if they've considered it. Being proud of the mentee, being proud of their accomplishments, following them over the years. And when they've gotten in trouble or failed to get the job that they wanted, always be there for them, not just in the good times, but in the times that are difficult for them professionally. I think that's one of the most important things.  Even today, I mentor three or four clinical department chairmen, and people ranging from full professors to newly appointed assistant professors. Now that I'm retired, mentoring is the one activity that I've really retained. It's extraordinarily satisfying, and I'm proud of the people that I've mentored. But it's their accomplishments, and the key aspect of mentoring is never to take credit. Dave Johnson: I'll give you credit for mentoring me, and I appreciate it. You were very instrumental at a very decisive point in my career when the old Southeast Cancer Group disbanded, and we were looking for a new cooperative group home. And you were instrumental in helping my institution come into the ECOG fold, and not just as a very junior member, but really as a player. And I'll never forget that, and we'll always appreciate that very much. Pat Loehrer: Ditto on my side, too. Dave Johnson: John, you mentioned that you're retired. What do you like to do in your "free time” if you're not mentoring? Dr. John Glick: Life is good. My daughter says I have a disease, O-L-D. My grandson says, “He's not old; he's almost 80. Look how well he's done.” “Here's $20.” I'm having fun. We are fortunate to have homes in different places. We spend the summer up in the Thousand Islands on the St. Lawrence River, spring and fall down in Charleston, then lots of time in Philadelphia. We travel. I play golf poorly. I'm getting a chance to read history again, go back to one of my great loves. I'm with my children and grandchildren more. I lost my first wife. I've been remarried for about twelve years, and I'm enjoying every moment of that. I'm not bored, but I do wake up in the morning with no anxiety, no realization that I have to herd sheep or herd cats. I have no metrics, I have no RVUs,  not behind of the EMR.  Dave Johnson: You're making it sound too good, John.  Dr. John Glick: We're having fun. And I have not been bored. I've not been down in the dumps. Each day brings a different aspect. We see a lot more of our friends. I exercise. I deal with the health problems that people get when they get older, and I have plenty of those. Seeing doctors takes a lot of time, but I'm grateful that I'm having these few years of retirement. I'm one of the people who is most fortunate to have attained everything they wanted to do in their professional life, and now I'm trying to do some of the same in my personal life. Dave Johnson: John, Pat and I both love to read. We love history. You mentioned that you're reading some history. Is there a book that you've read recently that you might recommend to us? Dr. John Glick: “the Last of the Breed” {With the Old Breed} It's about a private in the Pacific campaign who was not a commissioned officer; it's just a grunt on the ground. It brings the horrors of the Pacific island campaigns to life. But there's a huge number of books, some historical fiction. I'm a great fan of Bernard Cornwell, who's written about the Medieval times, Azincourt, 1356. I'll read two or three books a week. I'm devoted to my Kindle. Dave Johnson: If you could go back in time and give your younger self a piece of advice, what would that advice be?   Dr. John Glick: Try and achieve more of a work-life balance. I didn't have any choice. If I didn't do the consult, it didn't get done. That's not the situation today. But I have a second piece of advice, don't treat medicine as a 9 to 5 job. If a patient is sick, stay with the patient. Give the patient your home or cell phone number. Remember, medicine is not just a profession, but it can be a calling. Too few of our physicians today regard medicine as a calling. And even if you're employed, as most of us are by an academic or other institution, do what's right for the patient, not just what's right for your timesheet or the EMR. Remember that the patient is at the center of all we do and that medicine is a calling for some people, as it was for me. Dave Johnson: Great advice, John. Great advice.  Well, I want to thank Dr. Glick for joining Pat and me. This has been a delight. You're one of our role models and heroes.  I want to thank all of our listeners of Oncology, Etc., which is an ASCO educational podcast where we will talk about oncology medicine and other topics. If you have an idea for a topic or a guest you'd like us to interview, please email us at education@asco.org. To stay up to date with the latest episodes and explore other educational content of ASCO, please visit education.asco.org. Thanks again. Pat, before we go, I've got an important question for you. I've been trying to school you recently, and you've failed miserably. So I'm going to ask you, why is it that McDonald's doesn't serve escargot? Pat Loehrer: I can't do it. I don't know. I give up.  Dave Johnson: It's not fast food. Pat Loehrer: I like that. It's good.  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, experiences, 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.    

The availability and quality of cancer care varies in different parts of the globe. Some locations find it difficult to have proper equipment, access to medications or even trained staff on hand. In this ASCO Education podcast we look how a group of doctors are sharing their skills and experience to set up training programs to help improve outcomes for patients with cancer in Kenya. Our guests will explore the creation of a pediatric oncology fellowship program in Kenya (11:48), how a young doctor found herself interested in improving global health (14:30), and discuss lessons learned that are applicable to health care in the United States (21:07).  Speaker Disclosures Dr. David Johnson: Consulting or Advisory Role – Merck, Pfizer, Aileron Therapeutics, Boston University Dr. Patrick Loehrer: Research Funding – Novartis, Lilly Foundation, Taiho Pharmaceutical Dr. Terry Vik: Research Funding Takeda, Bristol Myers Squibb Foundation Dr. Jennifer Morgan: None Resources: Podcast: Oncology, Etc. - Dr. Miriam Mutebi on Improving Cancer Care in Africa Podcast: Oncology, Etc. – Global Cancer Policy Leader Dr. Richard Sullivan (Part 1) Podcast: Oncology, Etc. – Global Cancer Policy Leader Dr. Richard Sullivan Part 2 If you liked this episode, please follow the show. To explore other educational content, including courses, visit education.asco.org. Contact us at education@asco.org. TRANSCRIPT Disclosures for this podcast are listed in the podcast page. Dave Johnson: Welcome, everyone, to a special edition of Oncology, Etc., an oncology educational podcast designed to introduce our listeners to interesting people and topics in and outside the world of Oncology. Today's guest is my co-host, Dr. Pat Loehrer, who is the Joseph and Jackie Cusick Professor of Oncology and Distinguished Professor of Medicine at Indiana University, where he serves as the Director of Global Health and Health Equity. Pat is the Director Emeritus of the Indiana University Simon Comprehensive Cancer Center. Pat has many different accomplishments, and I could spend the next hour listing all of those, but I just want to point out, as many of you know, he is the founder of what formerly was known as the Hoosier Oncology Group, one of the prototypes of community-academic partnerships which have been hugely successful over the years.  He's also the founding director of the Academic Model for Providing Access to Healthcare Oncology Program, which has grown rather dramatically over the last 17 years. This includes the establishment of fellowship programs in GYN oncology, pediatric oncology, and medical oncology through the Moi University School of Medicine in Kenya. Through its partnership with the Moi Teaching and Referral Hospital, over 8000 cancer patients a year are seen, and over 120,000 women from western Kenya have been screened for breast and cervical cancer in the past five years. Pat is also the co-PI of the U-54 grant that focuses on longitudinal HPV screening of women in East Africa. He currently serves as a Senior Consultant of the NCI Cancer for Global Health.  So, Pat, welcome. We have with us today two special guests as well that I will ask Pat to introduce to you. Pat Loehrer: Dave, thanks for the very kind introduction. I'm so pleased today to have my colleagues who are working diligently with us in Kenya. The first is Terry Vik, who is Professor of Pediatrics here at Indiana University and at Riley Hospital. He's been the Director of the Fellowship Program and the Pediatric Hematology-Oncology Program and Director of the Childhood Cancer Survivor Program. He got his medical degree at Johns Hopkins and did his residency at UCLA and his fellowship at Dana-Farber. And he's been, for the last 10 to 15 years, been one of my co-partners in terms of developing our work in Kenya, focusing on the pediatric population, where he helps spearhead the first pediatric oncology fellowship in the country.  And then joining us also is Dr. Jennifer Morgan. Jenny is a new faculty member with us at Indiana University as an Assistant Professor. She, I think, has 16 state championship medals for track and field in high school. I've never met an athlete like that in the past. She ended up going to Northwestern Medical School. She spent time in Rwanda with Partners in Health, and through that, eventually got interested in oncology, where she completed her fellowship at University of North Carolina and has spent a lot of her time in Malawi doing breast cancer research. I don't know of anyone who has spent as much time at such a young age in global oncology.  Dave Johnson: So Pat, obviously, you and I have talked a lot over the years about your work in Kenya, but our listeners may not know about Eldoret. Maybe you can tell us a little bit about the history of the relationship between your institution and that in Kenya. Pat Loehrer: It's really a remarkable story. About 30 some odd years ago, Joe Mamlin and Bob Einterz, and Charlie Kelly decided they wanted to do a partnership in Global Health. And they looked around the world and looked at Nepal and looked at Mexico, and they fell upon Eldoret, which was in Western Kenya. They had the birth of a brand new medical school there, and this partnership developed. In the midst of this came the HIV/AIDS pandemic. And these gentlemen worked with their colleagues in Kenya to develop one of the most impressive programs in the world focused on population health and dealing with the AIDS pandemic. They called it the Academic Model for Prevention and Treatment of HIV/AIDS or AMPATH, and their success has been modeled in many other places. They have many different institutions from North America and Europe that have gone there to serve Western Kenya, which has a catchment area of about 25 million people.  About 15 to 20 years ago, I visited AMPATH, and what they had done with HIV/AIDS was extraordinary. But what we were seeing there in cancer was heartbreaking. It reminded us, Dave, as you remember back in the ‘60s and ‘70s with people coming in with advanced cancers of the head and neck and breast cancers that were untreated. And in addition, we saw these young kids with Burkitt's Lymphomas with huge masses out of their jaws. And seeing that and knowing what was possible, what we saw in the States and what seemed to be impossible in Kenya, spurred me on, as well as a number of other people, to get involved. And so, we have built up this program over the last 15 and 20 years, and I think it's one of the most successful models of global oncology that's in existence.  Dave Johnson: That's awesome. Terry, tell us a little bit about your involvement with the program at Moi University.  Terry Vik: Sure. So, I took an unusual path to get to Eldoret because I started off in work in signal transduction and protein kinases, then morphed into phase I studies of kinase inhibitors that was happening in the early 2000s. But by the end of the decade, Pat was beginning to establish oncology programs in Kenya. And because half the population is children and there were lots of childhood cancers, and many of them can be curable, he mildly twisted my arm to go with him to set up pediatric oncology in Kenya. And through his help and Matt Strother, who is a faculty member on the ground, establishing that, I first went in 2010 just to see how things were running and to see all the things that Pat had recognized as far as things that needed to be done to make Eldoret a center for cancer care.   And so, the last 13 years now, I've been working, going anywhere from one to four times a year to Kenya, mainly helping the Kenyans to develop their medical care system. Not so much seeing patients or taking care of patients, other than talking about best practices and how we do things in the US that can be readily translated to what's going on in Kenya. And so, we've been able to establish a database, keep track of our patients in pediatric oncology, recognize that lots of kids are not coming into care, not being diagnosed. There's a huge gap between numbers who you would expect to have childhood cancer versus the numbers actually coming to the hospital. As the only pediatric treatment center for a catchment area of 25 million, half of whom are under the age of 20, we should be seeing a lot of kids with cancer, but we are probably only seeing 10% of what we would expect.  So, myself, many of my colleagues from Indiana University, as well as colleagues from the Netherlands Princess Maxima Hospital for Pediatric Cancer, we've been partnering for these past 13 years to train Kenyans to recognize cancer, to have treatment protocols that are adapted for the capabilities in Kenya, and now finally starting to show real progress in survival for childhood cancer in Kenya, both in leukemias, lymphomas, and solid tumors, with a fair number of publications in Wilms tumor and Burkitt lymphoma and acute lymphoblastic leukemia. So, it's been really heartening, I think.  I tell people that the reason I go to Kenya studying signal transduction and protein kinase inhibitors in pediatric cancer, I can maybe save a couple of kids over a career by that kind of work. But going to Kenya to show people how to find and treat kids with leukemia, I'm literally seeing the impact of hundreds of kids who are alive today that wouldn't be alive otherwise. So, that's really been the success of pediatric oncology there. Dave Johnson: Is the spectrum of childhood cancer in Kenya reflective of what we see in the States, or are there some differences? Pat Loehrer: It really is surprisingly similar. I think the only thing that– Well, two things that are more common in Kenya because of the so-called ‘malaria belt' and the association with Burkitt Lymphoma, there's a fair number of kids with Burkitt's Lymphoma there. Although, as mosquito control and malaria control has improved, actually, the numbers of cases of Burkitt's have been dropping, and a lot of cancers were sort of hidden, not recognized as leukemia or not recognized as other lymphomas. Just because if Burkitt's is endemic, then every swelling is Burkitt's. And I think that's been shown by looking at pathology retrospectively to say a lot of what they thought was Burkitt's was maybe not necessarily Burkitt's. And then nasopharyngeal carcinoma with Epstein-Barr virus prevalence also is a little bit more common than I'm used to seeing, but otherwise, the spectrum of cancers are pretty similar. So, it's heartening to know that we've been treating childhood cancers with simple medicines, generic medicines, for 50 years in the US. And so I like to tell people, I just want to get us up to the ‘90s, maybe the 2000s in Kenya, and that will really improve the survival quite a bit. Dave Johnson: You mentioned that there were adjustments that you were making in the therapies. Could you give us some examples of what you're talking about? Terry Vik: The biggest adjustments are that the ability to give blood product support, transfusions of platelets is somewhat limited. So, for instance, our ability to treat acute myeloid leukemia, which is heavily dependent on intensive myelosuppressive chemotherapy, we're not so good at that yet because we don't have the support for blood products. Similarly, the recognition and treatment of infections in patients is somewhat limited. Yet, just the cost of doing blood cultures, getting results, we actually have the antibiotics to treat them, but figuring out that there actually is an infection, and we're just beginning to look at resistance patterns in bacteria in Kenya because I think that's an indiscriminate use of antibiotics. In Kenya, there are a lot of resistant organisms that are being identified, and so figuring out how best to manage those are the two biggest things. But now, in Eldoret, we have two linear accelerators that can give contemporary radiation therapy to kids who need it. We have pediatric surgeons who can resect large abdominal tumors. We have orthopedic surgeons and neurosurgeons to assist. All those things are in place in the last three to five years. So, really, the ability to support patients through intensive chemotherapy is still one of the last things that we're working diligently on improving. Dave Johnson: So one thing that I've read that you've done is you're involved heavily in the creation of a pediatric oncology fellowship program. If I read it correctly, it's a faculty of one; is that correct? Terry Vik: Well, now that two have just graduated, it's a faculty of three, plus some guest lecturers. So I feel quite good about that.  Dave Johnson: So tell us about that. That must have been quite the challenge. I mean, that's remarkable. Terry Vik: That goes back to one of my longtime colleagues in Kenya, Festus Njuguna, who is Kenyan. He did his medical school training at Moi University and then did pediatric residency there. They call it a registrar program there. And then he was, since 2009, 2010, he's been the primary pediatric oncologist. Although he always felt he did not have the formal training. He'd spent time in the US and in Amsterdam to get some added training for caring for kids. But it was his vision to create this fellowship program. So Jodi Skiles, one of my colleagues who had spent some time in Kenya and myself and he worked on creating the fellowship document that needs to go through the university to get approved. That finally got approved in 2019. And so the first two fellows…I was on a Fulbright Scholar Award to start that fellowship program for a year right in the middle of the pandemic, but we were able to get it started, and I was able to continue to go back and forth to Kenya quite a bit in the last two years to get through all of the training that was laid out in our curriculum. And two fellows, Festus and another long-standing colleague of mine, Gilbert Olbara, both completed the fellowship and then sat for their final exams at the end of last year and graduated in December. So it really was heartwarming for me to see these guys want to build up the workforce capacity from within Kenya, and being able to support them to do that was a good thing. Pat Loehrer: Parenthetically, Dave, we had the first Gynecology Oncology program in the country, too, led by Barry Rosen from Princess Margaret, and they have 14 graduates, and two of them now are department chairs in Kenya. Jenny's spearheading a medical oncology curriculum now so that we have that opened up this year for the first time. Dave Johnson: It's uncommon to find a junior faculty as accomplished as Jenny. Jenny, tell us a little about your background and how you got interested in global health, and your previous work before moving to IU.  Jennifer Morgan: I was an anthropology major at undergrad at Michigan, and I think I really always liked studying other cultures, understanding different points of view. And so I think part of that spirit when you study anthropology, it really sticks with you, and you become a pretty good observer of people and situations, I think, or the goal is that you become good at it. I think my interest in medicine and science, combined with that desire to learn about different cultures really fueled a lot of my interests, even from undergrad and medical school. I really felt strongly that access to health is a human right, and I wanted to work for Partners in Health when I graduated from residency. I had heard a lot about that organization and really believed in the mission around it.   And so I went to work in Butaro in Rwanda, and I really didn't have any plans to do cancer care, but then I just kind of got thrown into cancer care, and I really loved it. It was a task-shifting model that really where you use internists to deliver oncology care under the supervision of oncologists from North America. So, most of them were from Dana-Farber or a variety of different universities. And so it made me feel like this high-resource field of Oncology was feasible, even when resources and health systems are strained. Because I think a lot of people who are interested in Oncology but also kind of this field of global health or working in underserved settings really struggle to find the way that the two fit sometimes because it can feel impossible with the hyper-expensive drugs, the small PFS benefits that drive the field sometimes. And so I think, Butaro for me, and Partners in Health, and DFCI, that whole group of people and the team there, I think, really showed me that it's feasible, it's possible, and that you can cure people of cancer even in small rural settings. And so that drove me to go to fellowship, to work with Satish Gopal and UNC. And because of COVID, my time in Malawi was a bit limited, but I still went and did mainly projects focused on breast cancer care and implementation science, and they just really have a really nice group of people. And I worked with Tamiwe Tomoka, Shakinah Elmore, Matthew Painschab, really just some great people there, and I learned a lot.  And so, when I was looking for a job after fellowship, I really wanted to focus on building health systems. And to me, that was really congruent with the mission of AMPATH, which is the tripartite mission of advancing education and research and clinical care. And I knew from Pat that the fellowship program would be starting off, and I think to me, having been in Rwanda and Malawi and realizing how essential building an oncology workforce is, being a part of helping build a fellowship as part of an academic partnership was really exciting. And then also doing very necessary clinical outcomes research and trying to do trials and trying to bring access to care in many systems that are very resource constrained. So that's kind of how I ended up here.  Pat Loehrer: That's awesome. So tell us a little bit about your breast cancer work. What exactly are you doing at the moment? Jennifer Morgan: In Malawi, during my fellowship, we looked at the outcomes of women with breast cancer and really looking at late-stage presentations and the fact that in Malawi, we were only equipped with surgery, chemotherapy, and hormone therapy, but not radiation. You see a lot of stage four disease, but you also see a lot of stage three disease that you actually have trouble curing because it's so locally advanced, really bulky disease. And so that first study showed us the challenge of trying to cure patients– They may not have metastatic disease, but it can be really hard to locally even treat the disease, especially without radiation. And so that's kind of what we learned.   And then, using an implementation science framework, we were looking at what are the barriers to accessing care. And I think it was really interesting some of the things that we found. In Malawi, that has a high HIV rate, is that the stigma around cancer can be far more powerful than the stigma around HIV. And so, we are seeing a lot of women who are ostracized by their communities when they were diagnosed with cancer. And really, they had been on, many HIV-positive women, on ARVs for a long time living in their communities with no problem, and so HIV had kind of been destigmatized, but we're seeing the stigma of cancer and the idea that kids are as a death sentence was a really prominent theme that we saw in Malawi.  So some of these themes, not all of them, but some of them are very similar in Kenya, and so what I'm helping work on now is there's been this huge effort with AMPATH called the Breast and Cervical Cancer Screening Program, where around 180,000 women have been screened for breast cancer in a decentralized setting which is so important - so in counties and in communities. We're looking at who showed up to this screening and why did women only get breast cancer screening and why did some of them only get cervical, and why did some get what was intended - both. Because I think many people on the continent and then other LMICs are trying to do breast and cervical cancer co-screening to really reduce the mortality of both of those cancers. And the question is, I think: is mammography a viable screening mechanism in this setting or not? That's a real question in Kenya right now. And so we're going to be looking to do some studies around mammography use and training as well.  Dave Johnson: So, I have a question for all three of you. What lessons have you learned in your work in Kenya or Malawi that you've brought back to the States to improve care in the United States? Pat Loehrer: One is that the cost of care is ever present there. And so one of the things that we need to think about here is how can we deliver care more cheaply and more efficiently. It goes against the drug trials that are going on by industry where they want to use therapy for as long as they can and for greater times. And there are a lot of common things like access to care is a big issue there, and it's a big issue in our country. So we have used in IU some community healthcare workers in rural parts of our state as well as in the urban centers so that they can go to people's houses to deliver care.  Terry was involved with a wonderful project. It was a supplement from the NCI, which looked at barriers to care and abandonment of therapy. And just by giving patients and their families a small stipend that would cover for their travel and their food, the abandonment rate went down substantially, and they were able to improve the cure rate of Burkitt's Lymphoma. It's probably about 60% now. And so those are issues that I think we see here in our state, where people can't come to IU because of the cost of parking, that's $20 a visit. The lesson there is that we really need to get down to the patients and to their families and find out what their obstacles are.  Terry Vik: My favorite example, since I deal with kids and parents, is how striking parents are the same worldwide. They all want the best for their child. They all want anything that can be done to potentially cure them, treatment, they do anything they could. And I think the hardest thing, as Pat said, is the financial burden of that care. And the other thing that I bring back to my fellows in the US is that you don't have to do Q4-hour or Q6-hour labs to follow somebody when they start their therapy. Once a day, every 3 days, works quite well also. And just the realization that things can be done with a lot less stress in the US if you only decide to do it. Dave Johnson: Jenny, any thoughts from you on that? Jennifer Morgan: I think for me, decentralized cancer care is so important. Even being back on the oncology wards in Indiana in December, I saw a couple of really advanced patients who were really unfortunate, and they had tried to go through the system of referrals and getting to cancer care. And unfortunately, I think there are disparities in the US health system, just like in Kenya, and maybe on different scales. But cancer care that's accessible is so important, and accessible versus available, I think we a lot of time talk about therapies that may be available, but they're not accessible to patients. And that's really what we see in Kenya, what we see in rural Indiana. There are a number of grants that talk about reciprocal innovation because some of these things that we do in Kenya to minimize burden on the system are things that can be done in rural Indiana as well. And so, partnership on these issues of trying to improve decentralized care is important everywhere.  Pat Loehrer: And again, from the perspective as a medical oncologist, we see patients with late-stage diseases. We could eradicate the number one cause of cancer in Sub-Saharan Africa, cervical cancer, from the face of the earth just by doing prevention. We don't do enough in our country about prevention. The other dimension I guess I wanted to bring up as far as multidisciplinary care - when we think about that in our country, it's radiation therapy, surgery, medical oncology, but one of the lessons learned there is that the fourth pillar is policy. It's really about cancer policy and working with the government, Ministry of Health to affect better insurance cover and better care and to work with a different discipline in terms of primary care, much more strongly than we do in our country.  Dave Johnson: Are you encountering similar levels of vaccine hesitancy in Kenya as you might see in the States, or is that something that's less of an issue? Pat Loehrer: I'll let Terry and Jenny answer that. Terry Vik: I think there is some degree of vaccine hesitancy, and not so much that it's fear of the vaccine, but it's fear of the people pushing the vaccine. If it's coming from the government or if it's coming from outside drug companies or outside physician recommendations, it's less likely to be taken up. And if it's coming from within their own community or if it's their chiefs and their community leaders they respected, then I think there is less vaccine hesitancy certainly in a lot of things we do in pediatrics. So I think there is hesitancy, but it's coming from a different source than what we see in the US.   Jennifer Morgan: I would agree, and I think also COVID has changed the game on vaccine perceptions everywhere, and I don't think Kenya is spared from that either. So it may take a few years to see really what's going on with that.   Pat Loehrer: Jenny and I were at this conference, it's a Cancer Summit in Nairobi a couple of weeks ago, and we saw this little documentary there. And this notion of misinformation, as we've seen in our country, is also common over there. They were interviewing a number of men and women from Northern Kenya about prostate cancer, which is a very serious problem in Kenya. The notion was that even doing PSA screening caused infertility, and so the men and women didn't want their husbands to get screened for prostate cancer because they would become less fertile by doing that. So, again, there are lessons that we– as Jenny mentioned from the top about anthropology, I think we're all connected, we all have different ways of viewing communications in health, but I do think that we can learn from each other substantially. Dave Johnson: I mean, it's remarkable work. How is it funded?  Pat Loehrer: Well, I've been fortunate to be able to work with some friends who are philanthropists. We've had strong support as we've told our story with various different foundations. And we've been very grateful to Pfizer, who are very helpful to us in the early stages of this - Lilly Foundation, Takeda, Celgene. And I think as we basically share our vision of what we're trying to accomplish, we've been very humbled by the support that we have gotten for us. The U54 helps support some of the research. We have D43 we're doing through Brown University. So we plan to increase our research funding as best as we can. But this is active generosity by some wonderful people. We have a $5.5 million cancer and chronic care building in which a large sum of it came from Indiana University and the Department of Radiation Oncology. Dr. Peter Johnstone helped lead that. There was a Lilly heir that gave us quite a bit of money. An Indian Kenyan named Chandaria also donated money. So it's a matter of presenting the vision and then looking for people that want to invest in this vision.  Well, I just want to say, from my perspective, I am more of a cheerleader than on the field. But Terry, I know you spent a tremendous amount of time on the ground in Kenya, and Jenny, you're living there. I just wanted to say publicly that you guys are my heroes. Dave Johnson: Yeah. I think all of our listeners will be impressed by what they heard today, and we very much appreciate you both taking time to chat with us.  So at this point, I want to thank our listeners of Oncology, Etc., an ASCO Educational Podcast. This is where we'll talk about oncology medicine and beyond. So if you have an idea for a topic or a guest you'd like us to interview, please email us at education@asco.org. To stay up to date with the latest episodes and explore other educational content, please visit education.asco.org.  Pat, before we go, I have an important question to ask you. Pat Loehrer: I can't wait. Dave Johnson: Do you know how snails travel by ship?  Pat Loehrer: As cargo! Dave Johnson: Awesome. You got it. All right. Well, Terry and Jenny, thank you so much for taking time to chat with us. It's been great. I'm very impressed with the work you guys are doing. Really appreciate your efforts. Terry Vik: Great. Thank you. Jennifer Morgan: Thank you. 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.  

For some, pursuing a medical career is an all-consuming passion. What do you do if you have two? In this ASCO Education podcast, we look at the influences that propelled Dr. Lisa Rosenbaum to become a practicing cardiologist at Brigham and Women's Hospital in Boston and a national correspondent for the New England Journal of Medicine. Dr. Rosenbaum will explain the family legacy that impacted her choice to pursue medicine (1:46), her discovery of the love of writing (5:02) and what prompts her to write about specific topics (15:53). Speaker Disclosures Dr. Lisa Rosenbaum: None Dr. David Johnson: Consulting or Advisory Role – Merck, Pfizer, Aileron Therapeutics, Boston University Dr. Patrick Loehrer: Research Funding – Novartis, Lilly Foundation, Taiho Pharmaceutical Resources:  Gray Matters: Analysis and Ambiguity by Lisa Rosenbaum, MD Podcast: Oncology, Etc. - In Conversation with Dr. Peter Bach (Part 1) Podcast: Oncology, Etc. – In Conversation with Dr. Peter Bach (Part 2) If you liked this episode, please follow the show. To explore other educational content, including courses, visit education.asco.org. Contact us at education@asco.org. TRANSCRIPT Disclosures for this podcast are listed in the podcast page.  Pat Loehrer: Welcome to Oncology, Etc. an ASCO Education Podcast. I'm Pat Loehrer, Director of Global Oncology and Health Equity at Indiana University. Dave Johnson:  Hi, I'm Dave Johnson, a medical oncologist at the University of Texas Southwestern in Dallas, Texas. If you're a regular listener to our podcast, welcome back. If you're new to Oncology, Etc., the purpose of our podcast is to introduce listeners to interesting people and topics in and outside the world of oncology, hence the "etcetera" in our name. Today's guest is an example of the "etcetera" aspect of our podcast. Dr. Lisa Rosenbaum is a practicing cardiologist at the Brigham and Women's Hospital in Boston and a member of the Harvard Medical School faculty. She's a highly respected national correspondent for the New England Journal of Medicine. Dr. Rosenbaum began her writing career while she was still an undergraduate at Stanford. She later attended med school at the University of California, San Francisco, completed an internal medicine residency at the Mass General Hospital in Boston, and a cardiology fellowship at Weill Cornell in New York. She spent an additional year of fellowship at The New England Journal, where she learned about writing, reporting, and investigative journalism. Subsequently, she was hired for an academic position at Brigham and presented with an opportunity to write on a regular basis for The New England Journal. She's written on a whole variety of topics, ranging from physician burnout to cognitive bias, resident duty hours, conflicts of interest, vaccine hesitancy, and many other topics.  So, Lisa, thank you for joining us today. We're very excited to have you on the program.  Dr. Lisa Rosenbaum: Thank you so much for having me. Dave Johnson: Well, perhaps we could start by asking you to just tell us a little about your background and your family. Dr. Lisa Rosenbaum: I grew up in Portland, Oregon. My parents are both physicians. My father is a rheumatologist and my mom is a cardiologist, and now my sister is also an endocrinologist. And we have several family members who are physicians, including my grandfather, who was also a rheumatologist and a writer and played a pretty pivotal role in my life, both in terms of my decision to become a physician and also a writer. When he was in his 70's, he got laryngeal cancer and he was treated with radiation therapy and cured. But after, he wrote a book about the experience of being a patient called A Taste of My Own Medicine, which I think was published in the late 80's. It's an autobiography. And then in the early 90's, Disney bought the rights to the book and made it into the movie The Doctor, starring William Hurt. He has a cameo, actually, and apparently it took him like 17 takes just to get it right, to wave his hand when he's sitting in the waiting room.   That was a pretty formative experience in my life, because basically he ended up, after writing that book and, you know, having a lot of success with it, wanting to write another book. And by then he was in his late 80's, and he ended up getting Parkinson's disease, which steadily progressed. He died at 94, so he lived a long, good life. But when I got into medical school, he decided he wanted to write a book with me and that it was sort of the follow up to A Taste of My Own Medicine, because he sort of recognized medicine's shortcomings in the book and asked a lot of questions, but he would always say, "I have more questions than I have answers." And when I got into medical school, he had this idea that we were going to come up with all the answers and make medicine as wonderful as it had once been for him. So obviously that was a big part of my life, both in terms of my career as a writer and also my career as a doctor. Though I think I really never questioned whether or not I wanted to be a doctor. That just sort of seemed so obvious to me as a kid that the work was so meaningful. And I don't know, there's something about growing up where everywhere you go, people tell you how one of your relatives made their lives better. That's pretty inspiring, as a kid.   Pat Loehrer: It's interesting that both your parents were physicians, but you claim that your grandfather is the one that got you into medicine. But I think your early career, I think you were actually kind of focused on writing and writing creative fiction, and there was another event in your life that kind of turned you back over to medicine too, right? Dr. Lisa Rosenbaum: Right, right. And I don't want to not give credit to my parents. They played a huge, wonderful role in my life as well, and they still do.  So anyway, I did take a detour in my career. So, in college I ended up, the fall of my junior year, taking a creative writing class. I'd done all the pre-med requirements by then and probably like many pre-meds, it felt very robotic to me. It's also, you're surrounded by all these people who are really ambitious, and you can feel like you're not very good, right? I remember I made a B-minus on my first organic chemistry exam, and I called my mom crying, and I was like, "I'm not going to be a doctor. This is a disaster." So all of a sudden, once I had gotten through those classes and I took this creative writing class, it was just this transformative experience for me because it was intensely creative. And I've always been just really interested in people, like what makes people do what they do, and character. I am just so fascinated by people's characters.  But the other part of the creative writing classes that I loved so much was just the sense of community. So you go from this setting where you're all sort of pitted against one another in these classes, and then you're in this place where everybody's trying to help each other and you're learning about each other through writing because we're all really just like writing about ourselves, even when we pretend otherwise. And I made some of the best friends of my life who've gone on to have actually remarkable writing careers. So sort of on a whim because it was so enriching for me and I felt like I couldn't live without it, I applied for MFA's in Creative Writing in my senior year, and I got rejected everywhere but waitlisted at Columbia. And then I got in. So I moved to New York in 2001, basically a week before September 11th, and I truly fell apart. Not in a way that I regret at all now. I think that a lot of us, when we are not productive, feel like our time is wasted. And I don't think I wrote a word that entire year. Like, I got really depressed and I just spent a lot of time wandering the city and I ate a lot of bagels, but I was really sad. I spent a lot of time downtown, like, looking at the faces of all these people who had died. And it was so unfathomable to me. And I wasn't able to use writing to cope with it as I might be able to now. I think I was just too young. And I had challenges with my writing professor who sort of felt like we shouldn't be writing about that.  And so I ran away from writing. I mean, I dropped out of creative writing school and went to medical school, and that was clearly the right move. More than anything in my life, I love being a doctor, so I don't regret that at all. And I think it actually was really helpful to me to recognize that I'm not cut out to just be a writer. I need to be inside people's lives, and there's no better way to do that than as a physician. And writing is this extra bonus that I have still that helps me just like it did when I was writing fiction, sort of try to understand the world. But I don't think I could function if I didn't get to take care of patients. And that became clear when I was 22 years old, essentially.  Dave Johnson: So, Lisa, you did this fellowship at the New England Journal of Medicine. Can you tell us about that? What was that like? And how much influence did that have in your current position?  Dr. Lisa Rosenbaum: It was awesome on so many levels. I think the first was that I really loved listening to people talk about science. That was new for me. And the rigor of the conversations at The Journal is really just hard to describe, and I just felt like I was like a kid in a candy shop. I'm interested in science, obviously, as a practicing physician, but I'm interested in science always in these meta ways. I'm interested in how we communicate science and the words we use and the conflicts that we focus on and those that we don't. And so much was always going on in my mind. ‘I was like, oh, my God, these are the data that are going to shape our practice. And then you have, like, a bunch of humans making these decisions.' And so that was inherently fascinating to me.  And the other thing that was really transformative was just sort of watching Jeff Drazen, who was the editor in chief at the time, and just how he led was so amazing to me. And I still think about it because, you know, in an ideal environment, I mean, people study this their whole lives, you know, organizational psychology and things like that. But, you know, to create a work environment where you can have, like, all these brilliant people sort of have a conversation and argue with each other and still come out friends was really remarkable to me. I don't think I could ever tell you what the recipe for that is, but I loved watching Jeff do his thing. And then, of course, on the most personal level, it was eleven years after I had tried and failed to be a writer in New York and all of a sudden I had medical training under my belt and I had a lot I wanted to say and I was capable in a way that I wasn't before of spending my days writing. So it turned out that I was able to structure my time and not just fall into a deep depression. So that was really important to me in terms of shaping my ambition. I still didn't believe that it was possible to have a job as a doctor and a writer until I was actually offered that job. But at least I knew that I loved it as much as I ever had.   They published what I wrote, and it's hard to describe, like, how that changes you in terms of realizing that, like, anybody might care what you had to say. You know, my experience until then had been writing this stuff with my grandfather, which was so inherently meaningful, but I could never get it published. I mean, the piece that I think that I'm still most proud of is what I ultimately wrote about my grandfather and this book project and it's called ‘The Art of Doing Nothing.'  I had a knee injury at the time, and I was in med school, and I couldn't get the doctor to do anything about it. And I was really compromised. I couldn't walk, and I was going into internship. And the prospect that I wasn't going to be able to do what I needed to do as an intern was just so terrifying to me. And so it sort of goes back and forth between that experience and my grandfather's ambition for us to fix medicine and his sense that something so fundamental had been lost. And it ends—I'm going to start crying when I talk about this—it ends with his death and how I wasn't planning to speak at his funeral, but then I just remembered this sense of something pushed me to walk onto the pulpit after all the other eulogies had been given. And I remember feeling the sense like, ‘Okay, he spent the last seven years wanting me to tell these stories, and I'm never going to be able to convey what he means or the point of his stories. And I could never describe the way he touched people's lives.' And I just remember when I was standing up there, I looked out and there were hundreds of people, patients, their children, who had just come to celebrate his life. And then this feeling that I didn't have to say anything because everybody already knew. So ‘The Art of Doing Nothing' is this idea that we're so reliant now on all these things that we can do. And my sort of tension with my own doctor was wanting an MRI. And by the way, I completely believe in a lot of the things we can do. I don't see how you could spend a day in the hospital as a cardiologist and not feel some awe for advances in our technologies and what they can do for patients. But I do think a lot of it has come at the expense of our humanity, not by the fault of any physicians, but in a system that just doesn't allow us to give people our time, our attention, or make them feel how much we care about them.  And so I think for me, the idea that my grandfather practiced at a time where he didn't have an MRI machine and he couldn't revascularize—I mean, he was a rheumatologist, but at that time, he would see patients having MI's and he did house calls and all these things, but that he could give them his love, for lack of a better word—it's a different type of love, but the love that we can give to patients, and that so many people then remembered him and showed up for him.  Pat Loehrer: If I can speak on behalf of your grandfather, if he was here, he would say that you have honored him.  Dave Johnson:Yeah, for sure.  Dr. Lisa Rosenbaum: That's very kind.  Dave Johnson: Lisa, you write about so many different things. They're all wonderful. I really appreciate your willingness to bear your soul, so to speak. And speaking of soul, one of my favorite pieces that you wrote was I think it was ‘Heart and Sole', where you talked about-  Dr. Lisa Rosenbaum: -broke my feet?  Dave Johnson: Yeah, your feet. That was great. You, in a sense, mentioned your father. And your father is also a Rheumatologist, actually, your father gave a grand rounds here about seven or eight years ago that was one of the best lectures I've ever heard on uveitis.  Dr. Lisa Rosenbaum: No, my dad is also huge. I've talked about my mom. I've talked about my grandfather. My dad is a huge part of my life, too. I just love him a whole lot.  Dave Johnson: Well, that came through in the article about your feet. What I wanted to ask you is obviously a lot of your ideas for writing come from personal experience, but you've also written about things like conflict of interest. You wrote a three-piece article in The New England Journal that actually generated some interesting conversation in the letters to the editor, including from former editors of The New England Journal. I wonder how you come upon these ideas. I mean, what prompts you to write about a particular topic?  Dr. Lisa Rosenbaum: The two things in my life that like, drive my writing. I mean, I'm not talking about medicine specifically, but I'm extremely emotional. I feel things very intensely, and I think because of that, I've always been interested in the way emotions affect reason, because it's been clear to me for a long time that my emotions could get in the way of my ability to make good decisions. So then I became very interested in sort of the nature of how we make decisions and the role emotion plays in that. And so conflicts of interest were, like, the perfect example of this, both at a very individual level of the way emotion shapes reasoning, but also I'm very interested in sociology, how humans affect one another's perceptions. And I think that series was published in 2015, so it was sort of a little bit before social media became so much more pervasive in our lives, but this idea of sort of collective pile-ons and canceling people that hadn't picked up as much.  But I was very interested in this tension between advancing care and how that had gotten lost in this sort of desire to vilify people who worked with industry, because it just seemed very obvious to me that we needed that. And I was perplexed as to why we sort of seized on this one aspect of bias when so many biases shape how we behave. And again, that goes back to the fact that I spend my entire life thinking about what is biasing my own behavior. And so I remember very clearly, and I tell this story in the series, in the second essay, how I used to get called when I was a cardiology fellow about transfers from other hospitals overnight and whether or not they should give TPA en route, because if you wait too long to revascularize them, at that time, people were getting TPA. I've only ever worked at a hospital where people get revascularized, so we don't really do it a lot. But anyway, I remember being so tired and so wanting to not go in that I would feel inclined to say, just give TPA, even though it would be better for the patient to get revascularized. And if they would get revascularized, it meant that I would be up all night, because after they would have, like, a sheath, and I would have to pull the sheath, and it was over. And so I remember thinking, like, ‘I'm making a decision out of, like, fatigue and laziness.' I mean, I didn't actually make decisions this way, but I remember how powerful those forces were in shaping my medical advice. And we all know when we practice in these busy hospitals that so many of our interactions are not about what the science says to do. There are other factors that come into play that are deeply embedded in sort of the sociology of medicine or people's feelings about one another or themselves. And so conflicts of interest was just like, at the nexus of all these things that fascinate me.  And then the third one was about sort of moral outrage. And again, this was before our politics were as polarized as they are today, for instance. But this idea that when you feel moral outrage, that you lose the ability to weigh trade-offs was extremely interesting to me because, again, it seemed to be at the crux of what was happening in sort of our ability as a profession to talk about how to optimize our relationships with industry so that we could get our patients the best treatments. And that instead of vilifying scientists who either had unique expertise that could be shared with companies to develop treatments, or who were on FDA panels because they were the ones who knew the most, it just seemed to me kind of strange that we weren't able to have those conversations.  And then when you mentioned all the blowback, I mean, that was the first time in my career, and I've since experienced it again and again. But that felt to me very much part of the problem in the first place, that that like, just saying that this was more nuanced than we were recognizing, you know, generated a lot of anger, and I was, like, totally okay with that, because it it was why I wrote it in the first place. And if I felt that in 2015, I feel that even more now, which is essentially you cannot write about anything interesting anymore without risking being canceled. Like, it's just things are so volatile, and everything I write, I think this might be the end of me. And you sometimes can't predict what is going to enrage people, but it feels, speaking of trade-offs, like a worthwhile trade-off for me because I could write what I know everybody wants to hear, or what they already know, and there's clearly a market for that. But that is so boring to me. And I don't learn anything, and I don't think readers learn anything, so that just doesn't feel like my role in this universe. Dave Johnson: When do you find time to read?  Dr. Lisa Rosenbaum: I read like, every night, every afternoon. I mean, I'm constantly reading or listening to podcasts and thinking about what I'm writing, or I'm interviewing people. I read like, all the time. Pat Loehrer: What are you reading now that you would recommend it?  Dr. Lisa Rosenbaum: The best books that I've read recently were Tomorrow, and Tomorrow and Tomorrow by Gabrielle Zevin. I don't know if you've read it. It's actually my computer is literally sitting on the book. She also wrote a book that has some oncology relevance. It's called The Storied Life of AJ. Fikry, I think. I finished it the night before I was going on the consult service, and for some reason I wept. There's a cancer part of the story, so you'll see when you read it, I don't want to give it away. But it was one of those moments I think I'll remember forever, just because even though I'm saying all these things about caring about humanity, I still lose it sometimes. And the consult service can be really hard because this goes back to this whole bias thing, because you're just going as fast as you can. It's not because you don't care, it's because there are ten people also who need to be seen. And so you're triaging your time, but also your emotional bandwidth, and you walk into the room and you just hope that you don't get asked a lot of questions and that you can move quickly so you can go see the next consult. And so I finished this book, and I hope it's not giving me too much away. But anyway, someone in the book has cancer and isn't treated very well by the medical system. And so it was like the night before I was going on consults, and it stayed with me in the same way my grandfather stays with me. Just like, take a deep breath, the week will end and you never get a second chance to see these people. So do it right. Pat Loehrer: I can't wait to read it. One of my residents, when I was an intern, I had a patient that died, and I was just really distraught, but she just quietly said that the beauty of medicine is that it has such a great joy, but it also has these downs, and that's unlike any other profession. And that's really what makes it such a marvelous profession, because of the feeling that you have.  You're a physician writer. Which physician writers do you think are the most meaningful? Or which ones do you admire the most?  Dr. Lisa Rosenbaum: I have to tell you, I teach a writing class.  Pat Loehrer: It's you.  Dr. Lisa Rosenbaum: For what?  Pat Loehrer: You're the one that you admire.  Dr. Lisa Rosenbaum: Oh, God, no. That wasn't what I was going to say. It's the opposite. So in the writing class, my editor of the journal and I teach a class to people, mostly to Brigham, but over the years, people from all over have started to join, and we do it on Zoom. And I have to say that there are some people in the class I just think are so talented. And what has struck me most about the experience beyond their talent, is just that physicians often just don't have an opportunity to get to write. And so I lucked out, like I really did. I lucked out in terms of having the opportunity to journal. I lucked out to grow up in a family that was just so loving toward me, telling me I could do whatever I wanted. But not everybody has that luck or privilege. And so to get to be in this writing workshop and see all these people who are just having their first chance to process what they've experienced and narrate it has been really awesome for me. And so they are not the people who are household names yet, but I have been struck by many of their talents. And also my editor and I taught one at Colorado this past summer, and there were some people who are just so equally talented. So that said, I think Gawande is like a masterful storyteller. He's able to sort of narrate in a way that is so accessible to people, and I think that is a mark of genius. So I do find myself studying his work. I have to tell you that I read mostly fiction, so I don't read a ton of doctor writers anymore. I used to when I was, before I was more established as a doctor writer, and I would do it to study them. But now I just find myself wanting to either read about culture or some sort of nonfiction that is unrelated to medicine or just read pure fiction. I'm mostly interested in how people tell stories and develop characters, and I could think about that forever. It never stops. Dave Johnson: What advice do you have, Lisa, for young physicians who may be contemplating a career with writing as a part of it? What advice do you have for them? Dr. Lisa Rosenbaum: When you write, you have to expect to fail. And I think that one of the hardest things about being within the institution of medicine and trying to be a writer is that we have these metrics for success that we're all so accustomed to in terms of publications and putting things on our CV and also how those are valued in advancing our careers. And if you really want to write, if it's really important to you, you have to let all of that go. And again, if people meet me at this moment in my life, they don't realize that I had this chunk of time for seven to ten years where I was writing and writing and writing, and I wasn't publishing anything, and I was getting rejected all over. And I did it because it meant so much to me and it meant so much to my grandfather. But if it becomes this thing that is meant to, like, advance your career, I think first of all, it becomes much more frustrating, but also you take away what makes it so meaningful, and I think that ends up detracting from the writing itself because it's just like the purity of it goes away. So I think that's one thing I would say.  The other thing is if you want to write, you just have to write. There's no other way about it. It's not fun. I mean, I wish people could see how much of my writing gets thrown away. It's so bad. But if you think of it as an act of discovery, which it is, I never know what I'm going to say until I get there. Then you can sort of forgive yourself for all of that time wasted. But it's pretty empathetical to how we function as doctors. I mean, when I go into the hospital, it's like a switch flips in my brain. I move into this extremely efficient, concrete sort of way of existing, and it's just so different from the mode I'm in when I'm creating.  Dave Johnson: That's extremely helpful. Thank you for that Lisa.  We want to thank all of our listeners of Oncology, Etc. This is an ASCO educational podcast. This is where we will talk about oncology medicine and beyond. So if you have an idea for a topic or a guest you would like us to interview, please email us at education@asco.org. To stay up to date with the latest episodes and explore other educational content, please visit education.asco.org. Thanks again.  Pat Loehrer: Hey, Dave, I got something for you. Dave Johnson: A present?  Pat Loehrer: No. A question for you. Which knight of King Arthur invented the roundtable? Sir Cumference. Doesn't get any better than that.  Dave Johnson: No, the snail joke was better. 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.

On this episode the CPT staff discusses a new grant initiative from the CPT in partnership with the Lilly Foundation. We discuss the evangelical theology of preaching, the place of the sermon in ecclesial theology, and a preview of what we'll be up to at the CPT for the next three years.

"Various places on the globe lack the proper knowledge, infrastructure and workforce to adequately treat cancer. In Africa, one doctor is focusing her efforts to change all that. This ASCO Education podcast spotlights Dr. Miriam Mutebi, the first female breast surgeon in Kenya. One of Dr. Mutebi's goals is to improve women's health and cancer care in Africa and includes attaining her pilot's license to reach remote areas of the continent. Dr. Mutebi reflects on her life growing up in Kenya (1:21) and her inspiration for getting into medicine and pursuing what was at the time a male-dominated specialty (5:07). She also details how cancer care has improved in Kenya in the last decade (12:49) while there are ongoing challenges of working in low-resource settings (23:25). Speaker Disclosures Dr. Miriam Mutebi: None Dr. David Johnson: Consulting or Advisory Role – Merck, Pfizer, Aileron Therapeutics, Boston University Dr. Patrick Loehrer: Research Funding – Novartis, Lilly Foundation, Taiho Pharmaceutical Resources: ASCO Podcast: Oncology, Etc. – Global Cancer Policy Leader Dr. Richard Sullivan (Part 1) ASCO Podcast: Oncology, Etc. – Global Cancer Policy Leader Dr. Richard Sullivan (Part 2) If you liked this episode, please follow the show. To explore other educational content, including courses, visit education.asco.org. Contact us at education@asco.org. TRANSCRIPT Pat Loehrer: Welcome to Oncology, Etc. an ASCO Education Podcast. I'm Pat Loehrer, Director of Global Oncology and Health Equity at Indiana University. Dave Johnson: And I'm Dave Johnson, a medical oncologist at the University of Texas Southwestern in Dallas, Texas. Pat, we have a terrific guest today that ties in very nicely with your interest in global health. I'd love for you to introduce her. Pat Loehrer: Thanks, Dave. Battling cancer is truly a global effort, both in research and in treatment. However, there are various degrees of quality in these fields, depending on the economic health of a particular region. Our next guest is trying to optimize cancer care in Africa. We're very excited to talk to her. Dr. Miriam Mutebi is one of the most prominent cancer doctors in Africa. Dr. Mutebi is the first female breast surgeon in Kenya, and she's currently assistant professor in the Department of Surgery at the Aga Khan University in Nairobi, Kenya. She's on the board of directors for the Union of the International Cancer Control. She has trained and studied at top hospitals in New York and South Africa. Dr. Mutebi is so focused on increasing women's health in Africa that she's trained to be an airplane pilot in order to connect with hard-to-reach areas. Disclosures for this podcast are listed on the podcast page. Thank you so much, Dr. Mutebi, for joining us from Kenya. Can you start off by telling us a little bit about what it was like growing up there? Dr. Miriam Mutebi: I grew up in Nairobi, which is a pretty urban setting to grow up in. So, most of my childhood was spent…I think it was probably a much simpler time where, you know, you would play in the street, go off to somebody's house, spend the rest of the day there and come back at the end of the day. But in terms of growing up, I think I was one of those super nerdy kids, for want of a better word. One of the sorts of things that got me interested in reading and learning and challenging myself was actually my dad. Because what would happen was we had to go to school, I would say almost about 30 kilometers bus ride, and my dad would be like, “Well, if you're on the bus for that long, you can as well, you know, carry a book and made it nice and exciting.” So I remember sort of discovering the library at my primary school and going like, “My word!” Because you get access to all these different experiences and worlds. I mean, you're going in and reading, you know, The Chronicles of Narnia, you're reading about Enid Blyton and different experiences, you're reading all these different worlds and getting to, you know, identify to some extent with the core values that exist. It doesn't matter where the books were centered. And so that for me was an almost, I would say, idyllic growing up, because for me it was like, “Yes, books, check; running around, check.” That's, I think, what I remember most about my childhood. Dave Johnson: It sounds like your father was a powerful influence in your youth. Can you tell us more about your father? Dr. Miriam Mutebi: Sure. My dad, how old is he now? He's going to turn 74. One of the things that he always says, “It costs you nothing to be kind.” And so he would generally– Sorry, I'm just going to stop a little bit. I'm getting weepy. Dave Johnson: I'm sorry. Dr. Miriam Mutebi: It's okay, it's okay. Shame. Dave, you pushed the button. Dave Johnson: It's not our intent to push a button. It sounds like your dad's a wonderful person. Dr. Miriam Mutebi: No, it's fine. Pat Loehrer: Both Dave and I have daughters, and we feel the same way. So as weepy as you're getting, I can guarantee you that he's going to feel the same way on the other end. Dr. Miriam Mutebi: No, it's just that he hasn't been well recently, so it's just– Dave Johnson: Oh, I'm sorry. Dr. Miriam Mutebi: Yeah. Okay, cool. Let me see if I can stop getting a little weepy. Yeah. So one of the things that he frequently says is that it costs you nothing to be kind, and I think that's one of the things that he sort of instilled in us that you need to think beyond yourself. You always need to sort of think about what is the other person going through and how can I help to make it better. Now, my dad, he has a really interesting sense of humor. I think it's where I get my cheesy humor from as well. But he always talks about what we call the 11th commandment, which is, don't take yourself too seriously. And so I think that was part of the grounding steps that he sort of helped to instill in us because he was working– I mean, sort of looking back, our parents, I would say, got married at a very young age and had several kids that they were raising. And sort of looking back, you're thinking they were probably just doing the best that they can, right? But I think he did a fairly decent job, I hope. Dave Johnson: So, Miriam, when did your interest in medicine begin, and who was the inspiration for that? Or if there was someone that inspired that? Dr. Miriam Mutebi: At the end of high school, I remember I wanted to do five or, rather, was it six different things. And so I wanted to do medicine, I wanted to write, I wanted to do architecture, I wanted to do law, I even forget what the other things were. There was like two other things on my to-do list. And I think part of the genesis of that was because, as part of the high school training that we go through, we had to do the international sort of baccalaureate, and what that entails is we have to do components of creativity, action, and service. And so at the end, I'm like holding back to father dearest, and I'm like, “Dad, I have six different things I want to do, and I don't really know about.” And he was like, “So why don't you spend a bit of time, sort of just going through each of those, like shadowing these different specialties?” And so we managed to track down his lawyer friend, spent time in the hospital, spent time in the pharmacy, just shadowing the pharmacist. I actually went to work briefly for a publication house. Eventually– Oh, yes, in architecture as well. So then I managed to narrow it down to, “Yes, okay, I want to do medicine, and I want to write.” And so I went back to my dad and said, “Dad, okay, I have two things I want to do.” And my dad was like, “Well, if you do medicine, you can write. But if you write, then you might not necessarily be able to do medicine.” So that's how I sort of wandered into medicine. Although I still say there's still the great African novel waiting to get out. But again, with medicine, I think I'm guilty of what we call ‘end of rotationitis', where at the end of the day, you finish a rotation, and you're like, “I can do this. I can do this.” So I think going through different rotations– I think for me, the drive– Well, the slow narrowing down to surgery was really around, unfortunately, the time when we were doing our rotations, and this was just really at the start of the 2000s in Kenya. And the challenge around that time was we're really just at the tail end of the HIV epidemic, and not everyone had access to antiretrovirals. And it was an incredibly harrowing time, I would say, for the healthcare profession, just because there was still a lot of stigma around HIV. And what was happening was that we would go to the wards and find patients had been abandoned. And there was a general sort of pervasive sense of hopelessness because people didn't have access to the medication, they'd been abandoned, and unfortunately, not much was being done in terms of active management to patients. Whereas then that was like on the 7th floor, and then you would go four floors down to the surgical ward where patients come in, they're bleeding; you take them to OR, they get better, you send them home. And so, for me, the timing was like, “I need to do this. At least I could see where I was making an impact.” And so that's sort of how I wandered into surgery. And I'm sure, as I said, with, of course, the developments now, the experience, of course, for medical rotations, they're entirely different, but that's how I sort of ended up in surgery. But then, how I sort of found myself in breast surgery was actually because– for me, what stood out about my breast rotation was really looking at what we were reading in the textbooks, which was breast cancers, the disease of the sixth and seventh decade and a “poster child” for this is the elderly nun who's never had any children, who's had this prolonged [inaudible]. And I'm sitting there and looking at the clinic, and I'm like, “These patients are in their 30's and 40's. All of these traditionally protected factors, like having multiple children, having breastfed, ticking all the boxes, but they're still coming in with these kinds of cancers.” And so just thinking this is totally different from what the textbook is saying, and somebody needs to get to the bottom of this, and that's how I found myself going in along breast cancer surgery and also research into women's cancers and things. Pat Loehrer: My sense is that Kenya and many African nations were male-dominated. I don't know what it was like for you going to medical school, but particularly in surgery, it tends to be a male-dominated field. What was that like as a woman? In many ways, I think you were breaking some glass ceilings. I'm sure other women are doing similar things, but tell me a little bit about that experience. Dr. Miriam Mutebi: I would say bewildering for both parties. Because we had to do several interviews just in different institutions before getting into a surgical residency, and I remember these senior professors sort of peering down their glasses and looking frankly bewildered and asking the most bizarre of questions, which I don't think anyone would sort of get away with in this day and age. I remember somebody asked me, and this one always stands out in my mind because somebody asked me on the interview route, “So what happens if you get a patient in ICU and you start to cry?” I'm like, “Well, first of all, I'm guessing that I am crying because I'm having a bit of empathy for the patient. And I think that actually probably makes me a better clinician because I am really truly seeing the patient rather than bed X with diagnosis Z. This is like Mary, mother of one, two, three, and whatever.” But it was really bizarre. Then somebody asked me as well, “Okay, so what happens when you're on call, and you have to breastfeed?” And I'm like, “Well, let's see. This is a tough one.” You could tell as well that they were really out of their depth. So,  eventually I settled on the Aga Khan just because, in terms of the faculty and the interviews, I got a sense that they were a little more open to the idea. And that's because I think one of my earlier mentors, Prof. Raja, who is our former chair of surgery, had come in from the Aga Khan in Pakistan. And for him, it wasn't anything unusual to see women in surgery. So, like, “Yeah, come along. We'll train you and stuff.” And he was also pretty inspiring in terms of the decision to get into surgery because, for him, their approach to at least surgical training– and we always tease him and say, we all drunk the Kool-Aid because we kind of came back. Because it wasn't about just training surgeons for surgery's sake, it's about how do we become leaders, how do you impact care in your region. And so it was never about just learning surgery; it's how do you use the tools that you have in order to improve the health of those around you. In the Aga Khan, you're sort of, one would say, in a position of privilege. Just the backstory to those listening who might not know about the Aga Khan, it's a private university hospital. But I mean, as a private center, then, of course, I would say there isn't any difference, one would say, between the Aga Khan and most of the international hospitals anywhere in the world. But it was always sort of driven into us that this is a privilege that you're having. And how do you use this privilege to elevate the communities around you? Pat Loehrer: Let's talk about breast cancer, if you will, in Kenya. You mentioned it that when you first went into it, patients were coming in with advanced disease, they still do. But how has the field of medicine changed in Kenya during your professional lifetime as it pertains to breast cancer? Dr. Miriam Mutebi: While we still have the majority of patients diagnosed with advanced disease, the scenario ten years ago was that patients would get diagnosed with advanced disease and frequently would not complete their care. And if we did a deeper dive into the reasons behind this, we saw a constellation of factors. One being the fact that patients were having to pay out of pocket, resulting in financial toxicity, catastrophic health expenditure. And then the other major barrier was the health system itself. And again, to some extent, that still exists where we know, at least on average in sub-Saharan Africa, patients are going to see 4 to 6 healthcare providers before a definitive diagnosis of their cancer is made, which of course, again, translates into delays in ultimate treatment. Another area that we frequently don't necessarily talk about as much are the social-cultural barriers that exist and, to some extent, are still pervasive in some communities. What we see is, one, there's a lot of use of alternative therapies. There is still quite a bit of stigma around cancers. There is what we call collectivism, where we always say in Africa, ‘our community is our strength'. But sometimes, that sense of community is a double-edged sword because then, if the patient is losing agency, then that becomes a real concern. Because what we find, for instance– I'll give you an example, I'll have a patient come in and discuss, and maybe she has early cancer, and discuss the options of having breast conservation versus a mastectomy. And then you will find maybe she goes home to have a think, and then a couple of days or whatever later, there's a community gathering, and the clan elder is saying, “We have decided.” And I'm like, “Who's we? That's not your breast coming off. Like, what right do you have to decide on patient decision-making?” But you see, as much as we would like to sort of say have the patients have autonomy over the decision-making, it's really a question of equity and access to care. Because even if you're giving the patient autonomy, and she's saying at the end of the day, “Well, they're the ones paying for the treatment so let them decide what it is I'm going to have”, then we haven't really adequately empowered our women. And so those are some of the challenges that existed, I would say, about ten years ago. We're definitely seeing an improvement. One in the patient's ability to pay, and this, I think, has been a concerted effort by the government to come up with a National Health Insurance Fund, which initially wasn't covering cancer care but has definitely helped to ensure that the number of patients who actually complete their care or going through their entire cancer journey are probably more.   I remember when I was doing my internship, there were like truly heartbreaking because, as interns, we would have the medical internists sometimes– and because there weren't that many medical oncologists– prescribe the chemotherapy and as interns, we were the ones who would administer the chemotherapy. And so, you would have a patient come in and it involves– Basically, we give the prescriptions like chemotherapy, but they'll also have to buy their own saline, the IV line, and everything else,,, and then they get the first cycle, and they just disappear. And then those were the times when mobile phones weren't that common. They literally just disappear. But then they come back six months later, and they're like super excited, and they're like, “Doc, we've raised enough money for the next cycle.” And we're like, “Well, it doesn't quite work like that.” So, with the National Hospital Insurance Fund, it's not perfect, but we definitely see more patients going through the entire care continuum, which is gratifying. I'm sort of putting on my  [inadudible] hat as the chair of Kenya Society for Hematology and Oncology, and we've been working closely with the National Cancer Control Program, really to advise the National Hospital Insurance Fund on maybe getting more comprehensive covers. Because what was happening initially was, for instance, they would cover maybe four cycles of chemotherapy. Then the patient has to come up with the remaining four, for instance, and sometimes if they're not able to afford that, then you're sort of giving them the side effects without the therapeutic benefits of some of these. So they are currently in the process of really looking more at treatment plans, and that's also been, at least, a truly– And the fact that they are willing to listen has also at least been a huge stride. And then, of course, in terms of the real efforts, I would say by the National Cancer Control Program to ensure some of the decentralization of cancer services. Initially, we had only one radiotherapy center at the tertiary referral hospital in Nairobi that was having patients traveling from across the country, 400 kilometers or more, coming in. And you come in from a rural area, you come into Kenyatta and somebody tells you have to live there for a month, you have no family, nowhere to stay. People say, “You know what? I don't need to have this stage or rather have this additional treatment.” And so with the deliberate development of or decentralization of the radiotherapy services, we now have at least regional centers in planning and so really looking at how do we bring the services closer to people. And so, we now have, in addition to the tertiary referral centers, we now have two regional centers in Mombasa and in– Pat Loehrer: Eldoret. Dr. Miriam Mutebi: Yes. I think beyond Nairobi, Eldoret, we now have a comprehensive center in Mombasa. Nakuru's just launched a comprehensive center and Garissa as well, so really looking at enhancing our capability to bring these services closer. And there has also been the development of the chemotherapy units across the country that have at least tried to ensure that these services are more readily accessible to populations. And really just underpinning that with the support from the National Hospital Insurance Fund has helped to basically have more patients completing their care. One of the other things that I think deserves particular mention is really the grassroots advocacy that has really tried to increase awareness around cancers. And as a result, we definitely are seeing, as much as we are saying the majority of patients are still diagnosed with advanced disease, we are definitely seeing the entire continuum all the way from screen-detected tumors, early stage I, stage II cancers to more advanced tumors. So with that, it also really shows that there is a continuing consciousness that's really sort of driving these education efforts and awareness in the community. Of course, we definitely do need to do more because we still see that the advocacy's efforts sometimes tend to center largely around urban areas. And also, the question is how do we then sort of percolate that down to more rural areas? It's definitely something that's improved in the last ten years. And then, of course, we've also seen an expansion in the cancer workforce. And that, I think, has also been largely driven by the fact that we're having in-country training for clinical oncology, medical oncology, gyne-oncology, so we're really thinking about how to expand the workforce but– Of course, we are still looking at the patient-to-population ratios, those are still pretty low and we still recognize that there are deficits along the care continuum. But we're now having pharmaco-oncologists, we are having psycho-oncologists, increase in palliative care specialists. So there's definitely been an exponential growth of all the cadres of healthcare providers, whether it's oncology nurses and things. We've had an oncology nursing chapter now that's been developed. We really see the rise of the professional societies like the Kenya Society of Hematology and Oncology, and there is a lot of crosstalk between the academic institutions that are running the oncology training programs. So it's really a positive move in the right direction, but I think what needs to happen is, as I would say, more deliberate investment in the workforce. Because, again, even as we increase the spectrum of the oncology workforce, there's really a need to carry along the primary care providers because they invariably are the gatekeepers to access. And so unless the primary care providers are empowered and knowledgeable to facilitate early and timely diagnosis and referrals to the appropriate pathways, then it doesn't matter how many people or how much of a workforce you have on top of the pyramid. It just means you're invariably going to be still getting patients diagnosed at later stages. And so there's also been efforts around that to come up with, from healthcare provider courses to educating common signs and symptoms. This is something that the Kenya Society of Hematology and Oncology has been doing in collaboration with the National Cancer Control Program. There's a deliberate effort to come up with an online platform that are actually able to give real-time information to primary care providers. And so, I would say there are definitely steps in the right direction, but there definitely needs to be more investment in the entire spectrum of care. Dave Johnson: Miriam, what you've done is astonishing. What you've just described is an amazing infrastructure in a relatively short period of time. What you're talking about took us in the United States half a century. You're trying to do that in a matter of five to ten years. You've trained in both Kenya and in the United States. I wonder if you might just take a few moments to compare and contrast those experiences. Dr. Miriam Mutebi: In terms of working in different spaces and sort of working in the US, working in South Africa, working in Kenya, what you realize is perhaps a very different patient profile. Whereas in countries like the US, where you have vibrant screening programs, and you're definitely having a lot more discussions around 4-millimeter, 5-millimeter tumors that you are doing an MRI-guided biopsy for and maybe a lot more screen-detected tumors. Whereas working in settings, especially when you get out of the urban areas, whether it's in Kenya or South Africa, you find that you tend to have a lot more diagnoses of patients coming in with fungating tumors and advanced disease, and so it's really that spectrum. And that's what I'm saying in terms of the current state of flux that we're in. We're now, as clinicians, at least working in Nairobi, you're sort of seeing the entire spectrum and much less and less of the sort of fungating tumors. So I think in terms of the principles, and the good thing is that irrespective of where you are, principles do not change. But I think you sort of have to rapidly innovate and iterate in settings where you may not necessarily have a say, MRI to do an MRI-guided biopsy, but you also sort of look at what makes sense for the patient. Working in lower-resource settings, I think, is actually a good thing because it challenges you to constantly think about value-based care. People talk about value-based care as a concept, but you're doing it on a day-to-day basis, even between different patients in clinic, because you have to think about the cost and you have to think about how do I deliver care that's still of good quality, that's not necessarily going to break the bank. And so these are some of, I think, more challenging or at least questions that we have to think about deliberately. Whereas in the US, if you have insurance, then it's pretty much carte blanche, for want of a better word. Which we did realize, especially with COVID - and I'm sure Pat and Dave you can bear testament to this - these disparities exist globally. And so you'll find that in your patients who have no insurance or are underinsured, they're still coming in with the same, sort of, challenges. I was talking to my colleague at NYU who works at Bellevue. When she was giving me the profile of her patients, it was interesting to see that there wasn't really– and these are patients who don't necessarily have insurance, there really wasn't any difference in the images we are seeing from patient they're seeing and the patients we're seeing. So really it's an opportunity for us to sort of rethink collectively our approach to care and really thinking about how do we provide quality care. Pat Loehrer: I was in Washington this week, and President Biden had a three-day African US summit, and at the end of this, he basically pledged to spend $55 billion in Africa to help relations with them. We also had a discussion about the Moonshot 2.0, in which President Biden wants to end cancer as we know it, with a particular emphasis, I think, and now, in linking with LMICs. Briefly, what would you tell President Biden in terms of what would be very helpful for the United States to help with the cancer problem in sub-Saharan Africa? What would you say in a sentence or two? Dr. Miriam Mutebi: As we say, perhaps have the Moonshot, but stay grounded in the sense that– even before we think about complex molecules, we are still struggling as a continent with the basics of care. And so, investing in health systems and the basics will ultimately give more or improve outcomes rather than sort of focusing on specific molecules. So if we have the basics in place to deliver the basics of care, then that would go a long way toward shifting outcomes. The other bit that does need to happen is, again, with research because there is a paucity of cancer research. We did a recent bibliometric analysis and found that as a continent, we are only contributing to less than 8% of all sort of cancer research globally. And we do know that one, we have, I would say, the breadth of diversity in terms of genetic diversity. We do know that the responses to care and treatments are different. We do know that we do need to think about implementation science and what structures we can put into place, and what strategies. What works in different settings might not necessarily work in ours, and it does need to be backed by evidence. So there are opportunities to expand care and strengthen systems, but really do this in an evidence-based, pragmatic way that ultimately [inaudible] its own outcomes and outputs for the patient. Dave Johnson: Thank you for that, Miriam. Pat Loehrer: Well said. Thank you. Dave Johnson: Great advice. I hope the President is listening. Pat Loehrer: Dr. Mutebi, what was the first book that you remember that you really loved? Dr. Miriam Mutebi: I think it was actually The Lion, the Witch, and the Wardrobe. It was just the whole sort of just stepping into a different world. And then, of course, we all had crushes on Aslan, the lion, but it was more because he was like this sort of guy who would swoop in and was morally just and get to mediate the world. And so I went through the whole series, I just gobbled it down, and I think that's one of the things that really stands out for me as one of the books that I sort of remember early on. Pat Loehrer: It's such a great pleasure today. I'm really excited. We're typically talking about books. And here's a book, Dave, I know that you have not read; it's entitled 101 Things I've Learned in Engineering School. It was an interesting book. As you know, I'm an engineer background, but there were a few quotes in here that I– Dave Johnson: Pat, I live on Purdue Avenue, so I have some engineering background. Pat Loehrer: Oh, that's true. Good for you. So you might like this one, Dave. One of the quotes I have is: "Inventing is a mixing of brains and materials. The more brains you use, the less materials you need." And another one - do you know the difference between accuracy and precision? They're really different things. And so, the best example that came from the book, which I thought was interesting, was pi, so pi is what? Dave Johnson: Round. Pat Loehrer: Okay, this is going to be painful. Pi is 3.14. Right? So that's accurate. But if you say pi is 3.1415926535, that's accurate and precise. And if you said pi is 3.98, that's just inaccurate and imprecise. As I think about engineering as we move forward, I'm thinking about the Lung Pragmatic trial that has just been announced, where we're trying to do trials a lot more simply in which I think we can be accurate, but perhaps not as precise as we always deem to be important. And I think we're really excited about that and that project. Dave Johnson: Well, that's really all the time we have for today. And we really want to thank you, Miriam, for a wonderful interview. And knowing that you're up very late at home makes it all the more special. We also want to thank our listeners to Oncology, Etc. This is an ASCO educational podcast where Pat and I will talk about just about anything. If you have an idea for a topic or a guest you'd like us to interview, please email us at education@asco.org. Thanks again. Pat, I have an important question for you before we leave. What do you call a snail that's not moving? Pat Loehrer: You got me, man. Dave Johnson: Escarstay. Pat Loehrer: I love it. Miriam, Asante sana. Dr. Miriam Mutebi: Nime Shukuru. 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.      

"Battling cancer takes place in many parts of the world and our next guest has led initiatives to do just that. In Part Two of this Oncology, Etc. Podcast episode, Professor of Cancer and Global Health at King's College London Dr Richard Sullivan shares with us his research into cancer care in conflict zones around the world (0:58), his thoughts on “colonial” cancer research (5:50), his advice to people interested in pursuing a career in global oncology field (10:08) and using “pooled procurement” as an innovative approach to cancer care (11:13). Participant Disclosures Dr. Richard Sullivan: Honoraria – Pfizer; Consulting or Advisory Role – Pfizer Dr. David Johnson: Consulting or Advisory Role – Merck, Pfizer, Aileron Therapeutics, Boston University Dr. Patrick Loehrer: Research Funding – Novartis, Lilly Foundation, Taiho Pharmaceutical If you liked this episode, please follow the podcast. To explore other episodes, as well as courses visit https://education.asco.org or contact us at education@asco.org. TRANSCRIPT The disclosures for guests on this podcast can be found in the show notes.  Pat Loehrer: Hi. I'm Pat Loehrer, director of Global Oncology and Health Equity at Indiana University. I'm here with Dave Johnson, a medical oncologist at the University of Texas Southwestern in Dallas, Texas, and a friend of mine. This is the second half of our Oncology Etc. conversation with the professor of cancer and global health at King's College in London and the director of the King's Institute of Cancer Policy and the co-director of the Conflict and Health Research Group, Dr. Richard Sullivan. In part one, we chatted with Professor Sullivan about his international travels as a child to his transition from biochemistry and finally to a great career in health policy and research. Today we're going to continue our conversation with Professor Sullivan by asking him about his insight into the current state of the progress in global health care. Richard Sullivan: Conflict and fragile populations around the world are sadly growing. They're unique ecosystems for a whole variety of reasons. I think fundamentally, though, to do research in those systems requires a huge amount of sensitivity and experience and expertise because you're dealing with the most vulnerable of the most vulnerable. And then, of course, whatever research you do, you're constantly thinking in the back of your mind how you then tie this into any form of impact. There is a tendency, often with research in these populations, that the research is just done for the researcher's sake rather than actually being utilized to help improve those lives you're actually involving and studying. But I admit it's a very tricky area to work in. Cancer in conflict populations, a particular interest is a relatively new domain. It's only really been around for the last eight to ten years for a variety of very understandable reasons. Let's be honest, 30 years ago, cancer was not a significant factor in humanitarian conflict operations. You were dealing with demographically untransitioned societies, much younger. Really the group one, infectious diseases, child and maternal mortality, et cetera, were the primary foci. That still is the case. But what we're seeing now is much more transitioned populations being impacted by conflicts. And you think about in Mexico, in the Narco Wars, Syria, Iraq, even Afghanistan, and all of those have changed dramatically the nature of how care is delivered and how patients move. And we call these new therapeutic pathways, and we consider them kind of post-Westfalian. We're not talking about cancer care anymore that's boundaried within nation states. Patients moving across national lines, we have patients moving in pathways which are absolutely unique and we've never experienced or seen before in the high-income West. And that means you have to have a different paradigm for care and a different paradigm for building cancer control systems. And I guess for the last ten to fifteen years that's what we've really been interested in is this dynamic of conflict populations and how you deliver care and who delivers it. And there, of course, you're talking with a very mixed act, a bunch: humanitarian organizations, the big NGOs, the ICRCs, Medecins Sans Frontières. You're talking about the militaries in many countries. The militaries are very powerful in many countries in terms of providing care. And then finally there is, of course, the health services or systems that exist to varying degrees in the individual countries infected by conflict. So our program really tries to understand how you strengthen health systems per se in these conflict populations. And obviously, my particular interest is in cancer and palliative care. But I'm going to be honest, for that we have a very large team, some remarkable colleagues I've worked with over the years, sub-Saharan Africa, the Middle East, and increasingly, there's a lot of leadership coming out from these countries taking these sorts of programs forward. It's an important time, and I think Ukraine has taught us as well that if you don't think about, for example, cancer care within humanitarian operations, within UNHCR, you can end up in serious trouble in terms of planning, financing, sustainability. So I think Ukraine is going to be an interesting turning point in generally thinking about cancer care and conflict and humanitarian operations because it's really illuminated to everyone very clearly in Europe and the USA, what cancer and conflict really is, because I think the Middle East has felt a little bit far away, and it's been quite difficult selling all that kind of policy and work. But Ukraine is really having a dramatic impact and I think it's producing a lot of learning points. Dave Johnson: You recently published, along with colleagues, I thought, a very provocative paper in JAMA Open Network about the participation of lower and upper middle-income countries in oncology clinical trials led by high-income countries. You made the point, be sure to correct me if I'm wrong on this, that first of all, Ukraine and Russia are actually two of the top participants in these kinds of trials. Number one. Number two, the question is, is it exploitative of the higher-income countries to be conducting these trials in these two countries and then more particularly, what the recent conflict in Ukraine has done to the participation of patients? And I wonder if you might comment on those points. Richard Sullivan: I'll maybe talk to the last point first. The conflict has been devastating for recruitment. It's also important to realize a lot of these sorts of clinical trials are funded by industry and they've been the backbone of funding research and also to a greater degree also access to certain types of medicines in these countries. Is it exploitative? I think it's a very hard judgment call to make and I think if you ask my Ukrainian colleagues, the answer is no. We know exactly what we were getting into. When companies work in these places, they pay and they pay properly. The difficulty I think is, generally speaking, there is obviously this discussion now ongoing about neocolonialism and exploitation of low middle-income settings more generally. It's very hard, all the research we've been doing, it's very hard to make generalizations. There is absolutely no doubt. I want to recognize right up front that there has been some appalling exploitation and what I would consider to be colonial cancer research going on over the last 20 years. And it's blindingly obvious when you read papers, when you look at authorship, when you undo this sort of analysis, that there has been a lot of exploitation where high-income countries are parachuted in. Investigators have taken whatever they needed data, samples, interview data, made good careers on the back of it and good research funding, and not really put much back into the ecosystem they've been working with. So that's absolutely clear up front. Then we have this other problem, as well as research funding generally, because if you step back and look at the data, and this is something we've published on, actually, with Julie Gralow, and ASCO, we talk the talk about funding global cancer, that's big, high, powerful, wealthy, high-income countries. But when you actually look at the data and you ask that question, of all the cancer research publications, how many from the USA, the UK, the Frances, the Germany are actually with lower middle-income countries, you barely get above 4%. It doesn't take a rocket scientist to realize we taught the talk here, but we're not walking the walk. The money is not being provided to do genuinely equal collaborative work. We've not built capacity and capability in many countries in terms of clinical research methodologies and strengths. We failed to back up a lot of the rhetoric. We talk about global cancer with actually proper cancer research system strengthening. And I think there's that realization, and there's been that realization over the last five or six years that that's been the case. And when you take countries like India who kind of realized, you know, maybe ten to fifteen years ago this was the case, they've obviously gone themselves and driven their own agenda. So the National Cancer Grid of India, the development of Credo, the methodology workforces led by Dr. C.S. Pramesh from the Tata Memorial Centre, has been absolutely superb work. I mean, it's been amazing. A real master class in national development. But I think we do, as high-income countries have to think, look ourselves in the mirror and ask the question, is this what we mean by global cancer? Are we really putting enough money in? And are our research priorities right? You've heard me argue about this enormous amount, about how much money goes into discovery science and biopharmaceuticals. Where's the money going into implementation science, health services research, social science research, health economics, all the stuff that actually leads to direct improvements by strengthening cancer systems. It's a drop in the ocean compared to the billions and billions a year that have been spent in these other areas. So I think the agenda is unbalanced. But I think when you talk about exploitation, you have to be kind of more nuanced about that argument. Pat Loehrer: Richard, we were just at the World Cancer Congress and it was heartening to see all these wonderful young people from around the world thinking about global oncology and various different aspects of things. But I'm thinking about Brexit. I'm thinking about some of the issues going on in our country in which we are hunkered down to issues in our own country. P30 grants for the cancer centers are focused on issues in our catchment area. They have an illusion of global stuff, but it's really not a priority. What would you say to young people who are interested in pursuing a career in global oncology? Is this something that's worthwhile for them to do, and what would you advise them? Richard Sullivan: Yes, it's absolutely worthwhile to do. And I think two pieces of advice I would have is develop, first of all, your interests with friends. The work we do around the world is with friends. These are close colleagues. This is not some instrumental transactional research program of sending your samples to a genome lab for them to sequence it and send back to you. These are really long-term true friendships. That's what makes the difference, is that long-term commitment, year after year, decade after decade. So find out where it is and what it is you're really passionate about. Make those friends and then develop the suite of knowledge that you're going to require to do the kind of research. I mean, the thing with global cancer is it requires a very broad outlook. It doesn't matter what you are the master of; whether you're an epidemiologist or social scientist - mixed methods is absolutely the way to go. What you have to be able to do then is sort of think more broadly about other sorts of disciplines to bring out, because most of the really complex problems require a very transdisciplinary approach methodologically, and that takes a few years to build the insight into these other disciplines and also to make research relationships. And again, there is no substitute for experience in terms of going to places, working with people, working on projects. And of course, with that comes the advocacy. Cancer crosses borders, the advocacy for global cancer. You need people who are going to be passionate about this, who are really going to stand up and shout from the rooftops what's really needed and change, I think, the minds of both national and the philanthropic funders, which, as you said, Pat, you're spot on, are still very, very insular, very inward looking in terms of how they see the world of cancer research. And I think it needs a bit of a sea change. But the opportunities are out there. There's some, as we know, wonderful, wonderful people working all over the world on really, really different problems. Building capacity in surgery in Zambia is not the same as building capacity in surgery in one of the states in India, for example. So there's an incredible richness and diversity. It's a really, really important area. And I think younger crowds don't get put off because there's no clear pathway and there's a reason there's no clear pathway. It's so diverse, but it's absolutely worth it. And there's plenty of us, I think, out there now that can help. There's some great conferences like the Word Cancer Congress, amazing regional conferences like AORTIC, which is happening in Senegal next year, the big conferences in India. Absolutely superb. Just go immerse yourself in this. Dave Johnson: You've talked about a lot of different innovative approaches to cancer care and lower- and middle-income countries. One thing that I read that you'd written about was something that I had never thought about. I think you called it pooled procurement. Can you talk about that? Where maybe two countries can join together? It seems irrational to me that we could expect something like that to happen. Are you aware of any examples? Richard Sullivan: It's interesting because I've the pleasure of working with a lot of colleagues over the years on access to essential cancer medicines. And it's interesting because we're now getting into a domain in global health, which again is very rich for more learning, for more people coming into which is the political economy of cancer. Because this is where the disciplines of health economics, decision procurement, logistics, all kind of fuse together, as well as an understanding of power and decision making in individual countries. So, in and of itself, procurement is where groups of countries or centers within a particular country will come together to create sufficient volume to negotiate with suppliers for a particular consumable. And that drives down the prices. You become much more powerful in negotiating prices if you can all get together. One of the biggest problems, and again, there's some amazing work that's been done, for example, by Chai on this, who have really innovated in the pool procurement medicine space. But we've also seen pool procurement as well for radiotherapy. If you can come together as large groups with common needs, you've got a lot more power to negotiate prices with individual suppliers. And more importantly, one of the problems with suppliers, whether it's essential medicines or other sorts of consumables, is if the market is too small, if you're trying to negotiate on a center by center basis, it's often it's just not worthwhile for the supplier to come to attend a deal with you. They don't want to contract with you because the volumes are too small and the margins are therefore too small. So pooled procurement is one way of getting around this. But I speak very easily about something that's actually a very complicated and complex subject. There's a lot of law involved in this, there's a lot of economics in this, there's a lot of business work in this. Again, it's one of those areas of research and expertise in the cancer area that's really quite thin and really needs to be bolstered. And here we're talking about the second translational gap is you've got the Essential Cancer Medicines list - how on Earth do you deliver that in an equitable and affordable manner to population X and country Y? That is in of itself a research question, that falls under the political economy of cancer in terms of research, but again, also falls out with most research funding organizations who don't quite know how to handle supporting this sort of research and capacity building. But as you can see, absolutely crucial. Great. You've invented the drug, you've invented the new surgical technique, or the new form of radiotherapy. It delivers clinically meaningful benefits. So how on Earth do you embed that in a sustainable manner in a health system? And that is a big missing gap in the global research agenda. Pat Loehrer: You can have all the drugs and radiation equipment in the world, but if you don't have the healthcare professionals trained to give it, it's worthless. I think one statistic was that there's 176 physicians in the United States for every one in Uganda. And how do you deliver cancer care by trained oncologists? It's getting more and more complex for us, too. But this has been just a wonderful discussion. Just as a quick question, though, Richard, Dave mentioned his book. Anything you're reading right now or anything of interest? Richard Sullivan: Yeah, yes, I've just started reading a fascinating book called Dadland by Keggie Carew. And it's fascinating because this is a marvelous piece of work, actually. And this is a daughter trying to make sense of her father's life. And she really sort of spends years patiently collecting all these details of her father's life and growing up with it. And she sort of takes, juxtaposes– when she starts the book, he's got dementia. But this is a man who in his early days was in Jedburgh, was a Special Operations executive, fought behind enemy lines in France in D-Day, went to the Far East in Burma. And there's this extraordinary pathos and sensitivity in this book about watching his decline with dementia, as she puts it, as he slowly disconnects from reality and then he disconnects from himself, and trying to make sense of it with the individual he once was and the kind of individual. And through that, she gets to explore all the kind of boxes of letters and things that were all stuck in the attic. Memento mori, essentially, of his time in Burma and France. But it's very, very touching, and I would really recommend your listeners to read it because it unpacks dementia in a way I've never seen a book unpack before in terms of the impact it makes to an individual. And it asks that question about - what makes you you? And when this father, he dies, is he still the same man who jumped out of airplanes in the middle of the night in France? Is he still the same man as he was in Burma? It's very touching. It's one of the most impressive books of exploration into human nature and an identity that I've read for a long time. So, yeah, Dadland, excellent. Pat Loehrer: I'll get it. Dave Johnson: Absolutely. Sounds great. Well, that's all the time we have for today, and I want to thank Richard Sullivan so much for joining Pat and me. This has been a fascinating conversation and you're to be congratulated on all of your many accomplishments and all the things that I'm sure you'll do in the future.   I want to take the opportunity to thank our listeners for tuning in to Oncology, etc. This is an ASCO Educational podcast where we'll talk about almost anything and everything. So if you have an idea for a topic or a guest you'd like to hear on our show, please email us at education@asco.org.       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.

Battling cancer takes place in many parts of the world and our next guest has led initiatives to do just that. In Part One of this Oncology, Etc. Podcast episode, Dr. Richard Sullivan, Professor of Cancer and Global Health at King's College London, shares with us his intriguing life trajectory, encompassing a childhood in various parts of the world, aspirations for a veterinary career that turned to basic science, medicine, health policy (4:27), and even a long-term stint with the British Army Intelligence (12:22). Dr. Sullivan, who served as Director of Cancer Research UK for nearly a decade also discusses traits he looks for in a cancer investigator (19:21), and how to be happy (21:16)! Guest Disclosures Dr. Richard Sullivan: Honoraria – Pfizer; Consulting or Advisory Role – Pfizer Dr. David Johnson: Consulting or Advisory Role – Merck, Pfizer, Aileron Therapeutics, Boston University Dr. Patrick Loehrer: Research Funding – Novartis, Lilly Foundation, Taiho Pharmaceutical If you liked this episode, please follow. To explore other episodes, as well as courses visit https://education.asco.org. Contact us at education@asco.org. TRANSCRIPT  Pat Loehrer: Hi, I'm Pat Loehrer. I'm director of the Center of Global Oncology and Health Equity at Indiana University Cancer Center.   Dave Johnson: And I'm Dave Johnson at UT Southwestern in Dallas, Texas.   Pat Loehrer: And this is Oncology, Etc. Dave, what book have you read this last month?   Dave Johnson: I have one I wanted to recommend to you. It's very interesting. It's by Steven Johnson, not of the syndrome fame. It's entitled Extra Life: A Short History of Living Longer. You may have heard of this because PBS made a special documentary about this particular book. But in it, Johnson talks about the remarkable increase in human lifespan, especially over the 20th century, and the various factors that contributed to increased years of life from on average in the United States of about 48-49 in 1900 to just about 80 in the year 2000. So that beats anything in the history of mankind before.   And he has a chapter about each of the factors that contribute to this, and some of which I think we all recognize. Things like antibiotics playing a role, but some of the things that I hadn't thought about were improved drug regulation and the development of randomized controlled trials, which all of us have participated in. How important that is.   He also talked about, at least in the United States, the importance of automotive safety. And I'm sure some of us on this podcast are old enough to remember cars that did not have safety belts and certainly not other safety maneuvers that have really improved lifespan in that regard. So I found it a fascinating book. I think our listeners who are interested in medical history would also enjoy this text.   Pat Loehrer: Did he mention this podcast?   Dave Johnson: No, actually it wasn't mentioned, and I thought that was a tremendous oversight. So, I've sent him a letter and recommended that he add it.   Pat Loehrer: We may not live longer, but it just seems like we're living longer. When you listen to this podcast, time stands still.   Pat Loehrer: Well, it's my real great pleasure to introduce our interviewee today, Richard Sullivan. I met Richard several years ago through the late Professor Peter Boyle in Leon, and it's one of the greatest highlights of my life to be able to know Richard.   Professor Richard Sullivan's Research Group studies health systems and particularly chronic disease policy and the impact of conflict on health. He's a professor of cancer and Global Health at King's College in London and director of the Institute of Cancer Policy and Co-director of Conflict and Health Research Group. As well as holding a number of visiting chairs, Richard is an NCD advisor to the WHO, a civil military advisor to the Save the Children Foundation, and a member of the National Cancer Grid of India. His research focuses on global cancer policy and planning and health system strengthening, particularly in conflict ecosystems. He's principal investigative research programs ranging from automated radiotherapy planning for low resource settings to the use of augmented or virtual reality for cancer surgery through the political economy to build affordable equitable cancer control plans around the world.   Richard has led more Lancet Oncology commissions than anyone else. In fact, Lancet is talking about calling it the Sullivan Commissions. He's led five Lancet Oncology commissions and worked on four others. He's currently co-leading the Lancet Oncology Commission on the Future of Cancer Research in Europe and Cancer Care and Conflict in the conflict systems. His research teams have had major programs in capacity building in conflict regions across the Middle East and North Africa. He's done studies on the basic packages of health services in Afghanistan and worked in Pakistan, Syria, and the Democratic Republic of Congo. He's been a member of the British Army, intelligence and security, and in that capacity he's worked many years in biosecurity and counterterrorism issues. I think in some ways, this is the most interesting man in the world, and it's our pleasure today to have Richard join us. Richard, thank you for coming.   Richard Sullivan: Pat, Dave, you're really too kind. Marvelous to be with you. Thank you for the invitation.   Pat Loehrer: Can you tell us a little about your upbringing and early life before you became Dr. James Bond?   Richard Sullivan: I'm not sure that's anywhere close to the truth, sadly. But, yeah, I have had a very interesting, eclectic life. I was born in Aden just on the cusp of where the British Aden Protectorate met a country which actually no longer exists, the People's Democratic Republic of Yemen. Because after the British left Aden, essentially the East Germans, and what was then the Soviet Union took over southern Yemen. So I was born in a very unusual part of the world, which sadly, since then has just deteriorated. I spent many years of my life with my parents, who were in the diplomatic service and doing other things, wandering around the globe, mainly in the Middle East and East Africa. We spent quite a lot of time, strangely enough, we washed up on the shores in the USA once as well. Dayton, Ohio, and eventually-   Pat Loehrer:  Not to interrupt you, Richard, there are no shores in Dayton, Ohio. So just correct you there.   Richard Sullivan: That is so true. My memory - cornfields everywhere. I had a wonderful dog then, that's how I remember it so well. And I didn't really come back to the UK until, oh, gosh, I was nearly 10-11 years old. So, coming back to the UK was actually a bit of a culture shock for me. And then relatively classical in terms of the UK, sort of minor public school and then into medical school. In the old days when it was in the 80's. I had a fabulous childhood, going all over the place, seeing lots of things, being exposed to lots of different cultures. I think it remained with me all my life. I never really feel a foreigner in a foreign land. That's nice. That's really unique and it's been marvelous being able to tie in the passion for global health with my upbringing as well. So, yeah, I had a wonderful childhood.   Dave Johnson: Would you mind expanding on your medical training, Richard? Tell us a little bit about that.   Richard Sullivan: Yeah, so when I, when I went to medical school in the UK, we were still running the old system. And by the old system, I mean, you know, these small medical schools with entries of, you know, 70, 80 individuals, particularly in London, you had that St. Mary's Hospital Medical School, which is where I went, Charing Cross, Guy's, St. Thomas', and they were all individual medical schools. Now, most of these now have merged together into these super medical schools. But certainly when I went to medical school, I'll be absolutely honest with you, I wanted to be a vet to begin with, but actually discovered I wasn't bright enough to be a vet. It was harder to become a vet than it was to become a doctor. In my day going into medicine, and people listening to this, or some people who understand the A level system in the UK will recognize if you're offered a BCD, that's quite low grades to get into medical school. So I went to Mary's, to be absolutely honest with you, because I heard that they took people that played rugby, and I came from a rugby-playing school. And sure enough, 90% of the interview was based on my rugby prowess, and that was St. Mary's Hospital Medical School. So it was wonderful.   And we'd already had people going there who were big rugby players. And again, it was, I remember thinking to myself, am I making the right decision here? But it was interesting, as soon as I went into medical school, I realized that was the life for me. I had done myself a favor by not going into veterinary science, which I would have been awful at. We had six years of very, very intensive pre-medicine, the classical medical rotations, and then that movement into the old schools of pre registration house officers, registrar jobs. We were quite an early stage. I kind of slightly went off-piste and started doing more academic work. Interestingly, most of my academic early days academic work was not in health policy and research. It was actually in very hard core cell signaling. So my doctorate was in biochemistry, and we worked on small GTPases, calcium-sensing proteins.   There were some really extraordinary heady days, and I'm talking here about the early nineties and the mid-nineties of tremendous discovery, real innovation. I was at UCL at the time, but mixing and matching that up with a sort of surgical training, and again, surgical training in those days was pretty classical. You went into your general surgery, then sort of specialized. It was really, really interesting but it was full on. I mean, you spent your entire life working. Morning to night so these were the days of 100 hours week rotations. You were doing one in twos, one in threes. That's every other night and every other weekend on call. It was incredibly intense, but there was a lot more diversity and plasticity in those days. You could dip in and out of medicine because of the way you were chosen and how you were recruited. So it suited my personality because I liked moving around and doing different things and that sort of took me through, really until the late 1990s.   Pat Loehrer: You became a urologist, right?   Richard Sullivan: That's right. Exactly. So I trained up until the late 1990s, it was all pretty standard, I would say. And then I decided I was bored and moved into the pharmaceutical industry and I went to work in for Merck Damstadt at the time, which was relatively small. I was going to say family owned, but it was quite family-owned pharmaceutical company that was just moving into oncology. And because I'd done the background in cell signaling and cell signaling was really the backbone of the new era of targeted therapies, this seemed like a great move. To be absolutely blunt with you, I didn't last very long, less than a couple of years, I think, mainly because I just found the whole environment way too constraining. But what it did provide me with was a springboard to meet the wonderful late Gordon McVie, who I met at a conference. And he said to me, ‘You're absolutely wasting your time and life by staying in the pharmaceutical industry. Why don't you come out, get an academic job at University College London and become my head of clinical programs?” - for what was then the Cancer Research Campaign. This Cancer Research Campaign and the Imperial Cancer Research Fund were the forerunners of Cancer Research UK. So, you know, this was an offer that was too good to be true.   So I jumped ship immediately, went back into academic life and joined CRC. And really the next ten years was this extraordinary blossoming of the merger of CRC with the Imperial College Research Fund, the creation of Cancer Research UK, and that was Paul Nurse, and obviously Gordon and me, bringing that all together. And it was the heady days of that resurgence of cancer, the importance of cancer care and research in the UK. And coupled with that, of course, it was the blossoming of my interest, really then into the global health aspects of cancer, which really, Gordon, people like you mentioned already, the late, wonderful Peter Boyle, all those individuals were already engaged in and they were the ones that really kind of catapulted me into a more international scene.   Dave Johnson: Did you know Dr. McVie before you met him at this conference, or was it just a chance encounter?   Richard Sullivan: No, he actually met me via John Mendelson, because John had picked up a paper I'd been writing on basically the very early versions of Rituximab that we were working on and we were looking for pharmacodynamic endpoints. And of course, one of the things I noticed with the patients is they were getting all these skin rashes on their faces, and I thought, that's terrific. Just seemed to be the skin rashes seemed to be together with those individuals that had better responses. And I remember writing this paper for Signal, which was a kind of relatively minor journal, and I think it was John Mendelson who picked it up and must have mentioned something to Gordon. Gordon hunted me out down at a particular conference, said, "How on earth do you know about this, that you're not anything more than a surgeon?" He was absolutely right about, goodness sake, what do you know about pharmacodynamic endpoints, and I kind of had to sort of confess that I've gone kind of slightly off-piste by doing biochemistry and cells signaling and working with these extraordinary people. And that's how I essentially met Gordon. He was very good for spotting slightly unusual, eclectic human beings.   Pat Loehrer: I'm very curious about the intersection of your work and how you got into the British Army and Intelligence with medicine and how that even may continue even today. So explain that story, that part of your life a little bit to us.   Richard Sullivan: Yeah, it was very early on, as I went into medical school, one of the key concerns was making money. I looked around for ways of doing something interesting to make money, and most of the jobs on offer were bar jobs, et cetera. Then I thought, what about the Territorial Army, which, in the early days of the 1980s, was, and still is, a very large component of the UK Armed Forces. So I actually joined the Royal Army Medical Corps, as you would expect for someone going into medicine. I thought, okay, I'll join the Royal Army Medical Corps, and I was a combat Medical Training Technician, et cetera. So I went along, signed up, and I think I was about three months into training when I was at a place called Kew Barracks and some chap came up to me and handed me a little bit of paper. It said "Intelligence Security Group" and gave a phone number. He said, "This is more your line of work. Why don't you give them a ring?"   It was interesting because, in those early days, they were looking for analysts who could work on lots of different areas. In those days, most of the work was domestic.. Of course, there was counterterrorism with Northern Ireland, but there was also the Soviet Union, and the fallout from the Warsaw Pact, so they were still actively recruiting into that area. There are lots of details I can't talk about, but it was relatively, to begin with, quite hard work and low level. It was a lot of learning foreign equipment recognition. It was what we consider to be standard combat intelligence. But the more time you spend in it, the more interesting it gets.   One of the areas they were looking to recruit into, which I didn't realize at the time but only later, was bioweapons and biosecurity. They needed people who understood biotechnology and the language of science, and who could be taught the language of infectious disease on top of that. That is quite a difficult combination to find. It's very easy to teach people trade craft and intelligence, it's very hard to teach them subject matter expertise. And they were really missing people who specialized in that area.   It was interesting because it was still a relatively open domain. There was still a lot of work going on in the counterterrorism front with biological weapons, and a lot around the Verification of the Biological Weapons and Toxin Convention. And it was an interesting, and I'd almost say parallel life. But your medical knowledge and the scientific knowledge I had already gained and was gaining was what was being looked for. So that was very early on and it has expanded over the years. More and more now we talk about health security and intelligence so that goes beyond what you would consider classic medical intelligence or Armed Forces - this is more about putting together the disciplines of intelligence with the securitized issues of, for example Ebola. That is a classic example. The big outbreaks in West Africa, the DRC, these are sort of the classic security intelligence issues - even COVID 19 for example - and mostly around the world, what we've seen is the intelligence apparatus taking front and center in that, whether you're looking at states like South Korea, et cetera. So I've moved more into that, and we do a lot of work and research into this as well. So we look at, particularly now, how to improve human intelligence in this area, the pros and cons of signal intelligence collection. And we go as far as to kind of ask sort of deep ethical and moral issues, for example, about how far should these sorts of apparatus of state be applied to public good issues like health. Because at the end of the day, when you're talking about the armed forces security sector, their primary job is for defense of the realm. So applying them in other areas obviously comes with a whole load of moral and ethical challenges. So, yes, it's been a fascinating journey, which, as I said, it extends all the way back to the late 1980s. It's been both complementary and different.   Dave Johnson: So, Richard, there's so many things in your resume that warrant exploration, but you served as Clinical Director of Cancer Research UK for nearly a decade. What was that experience like, and what accomplishment are you most proud of?   Richard Sullivan: It was an enormous privilege. In your life, you always look at some jobs and you think, “How lucky I was to be there at that time with those people.” I think, first of all, enormous respect for the people that ran both Cancer Research Campaign, Imperial Cancer Research Fund – I mean, Paul Nurse and Gordon McVeigh, Richard Treisman – I mean, some extraordinary people who were leading both of these charities. And so to be there at that moment when they both came together, but more importantly as well, they had this most amazing global network of literally the illuminati of cancer research, spanning from basic science all the way through to epidemiology, public health, health systems. And in those days, of course, those individuals would come on site visits to the UK to look at the different units and evaluate them. So you can imagine when you're bringing those sorts of individuals across, you get a chance to go out with them, go drinking, talk to them, learn about their research, and also learn about the extraordinary breadth of research that was there in the UK. So you're condensing almost a lifetime's worth of learning into a few years. It was an absolute privilege to have been able to serve the community like that.   What I'm most proud of? Gosh, I like to think I suspect that most proud of trying to help a lot of the fellows get through to where they were going to actually get the most out of their careers. When I look back, there are lots and lots of names of people who started at a very early stage with funding from Cancer Research Campaign or the Imperial College Research Fund, who are now very, very senior professors and global research leaders. And I like to think that we did a little bit to help them along that way and also help to support individual research programs actually reach their full potential. Because I think research management and planning is often overlooked. People think of this as very transactional – it's not transactional. It's an incredibly important, serious discipline. It requires very careful handling to get the very best out of your research ecosystem. You've really, really got to get under the skin and really have a clear view of how you're going to help people. So I think that's what I'm most proud of – is the individuals who made it all the way through and now these great leaders out there.   But it was also, let's be honest, it was halcyon days. Great innovations, great discoveries, new networks growing, incredible expansion of funding in the UK, in Europe, in the USA. They were very, very good days. And it was, as I said, it was a real privilege to be there almost at the center for nearly a decade.   Dave Johnson: Let me follow up on that, if I may, just for a moment. You have had such an incredible influence. What characteristics do you think are most desired in a cancer investigator? What sorts of things do you look for, especially when you're thinking about funding someone?   Richard Sullivan: Creativity. I think creativity is really important. We talk about the word innovation a lot, and it's an interesting engineering term, but creativity is that spark that you can see it in people, the way they talk about what they're doing. They have this really creative approach. And with that, I think you have to have the passion. Research careers are long and difficult, and I'd probably suggest there's probably more downs than there are ups, and you have to have that passion for it. And I think along with that passion is the belief in what you're doing – that first of all, you have that belief that actually drives you forward, that what you know you're doing is good work, and that you're really dedicated to it. But obviously, hand on heart, when you're looking at researchers, it's that passion and that creativity.   I think it's a brave person to judge how any person's career or program is going to go. I don't think any of us are prophets. Even in our own land. We might be able to see slightly into the future, but there are so many elements that make up  “success”. It's funny when I look back and I think those who've been successful, it's people who've also been generally happy in their lives. They've found their careers in whatever shape or form, fulfilling, and they've generally been happy human beings, and they've managed to create a life around research which has given them meaning.   Pat Loehrer: Richard, you have reinvented yourself a number of times – this transition of going from like a basic scientist, a surgeon, moving into public policy and global policy. Tell me a little bit about the journey that's been in terms of academics. How do you learn? What were the transition points in each of these things to get you now to be, as I mentioned before, kind of the key person for Lancet's commissions to somebody who was a rugby player?   Richard Sullivan: I suppose if you're being mean, you say, he clearly gets bored easily. But it's not that. Actually, I'm not very instrumental about life either. I mean, there are many people you will meet who have got their lives and strategies mapped out. They know they're going to do X next year, Y the following year. And for me, it's never been like that. For me, it's that excitement, that creativity of working on new and interesting things, but also knowing when you've run out of road in a particular area, where it no longer gets you out of bed in the morning, where you no longer feel happy, where you no longer feel you're contributing. All of us talking today have the great privilege of having choice about our lives, about what direction our lives should take. And it's not a privilege one should squander lightly because many people do not have choices about their lives. It's all about chance. And having that choice to be able to move into different areas is really important because I said you can stick in the same thing because you think you have to. And you can become an unhappy, miserable human being. And that makes you a miserable researcher to be around. It makes you a terrible doctor. Probably makes you a terrible person, actually, generally, if you're having a miserable life.   So finding new things, that really you're passionate about how you do it, there's no shortcut in this. It's hard work. Readily admit I went back to law school of economics, retaught myself lots of things. There are no shortcuts for. Deciding if you're going to a new area is learning, learning, practice, practice, practice, and just doing the hard work. I think that's an ethos that was probably drilled into us quite early anyway in medical school, because that's how you approach medicine. That's how you approach science when I was growing up. And it was that idea of humility that you can never have enough learning, you will always learn off other people. That's probably what drove me and how I've managed to change and as I say, who knows what the future is? I don't know. Maybe one day I'll think about doing a bit of poetry.   Dave Johnson: Your comments about happiness and work resonate with Pat and me. I think we both feel like humor is really important for happiness and career success. And, you know, Osler once said, “The master word of medicine is work.” You can't get around that. It is what it is. And I think you just reaffirmed that.   Well, this concludes part one of our interview with Richard Sullivan, professor of Cancer and Global Health at King's College, London and director of the King's Institute of Cancer Policy and co-director of the Conflict and Health Research Group. In the second part of this episode, Professor Sullivan will speak about the progress of global health, especially in conflict areas, and the need for young people to enter into the world of oncology and oncology research.   Thank you to all of our listeners for tuning into Oncology, Etc. This is an ASCO educational podcast where we will talk about just about anything and everything. So if you have an idea for a topic or a guest you would like us to interview, please email us at education@asco.org. Thank you again for listening.  Thank you for listening to the ASCO Education podcast. To stay up to date with the latest episodes, please click subscribe. Let us know what you think by leaving a review. For more information, visit the Comprehensive Education Center at education ASCO.org. 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. 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.  

Dale B. Martin is a New Testament scholar and historian of Christianity, currently Woolsey Professor Emeritus of Religious Studies at Yale University. Professor Martin specializes in New Testament and Christian Origins, including attention to social and cultural history of the Greco-Roman world.  -> Apoie este projecto e faça parte da comunidade de mecenas do 45 Graus em: 45grauspodcast.com _______________ Index: (5:57) [Beginning of the conversation] How an historian studies the Bible and early Christianity (Historical criticism). | Gospel of Thomas. | Q source (21:36) How separate true from fiction in the gospels? Criteria: multiple attestation, dissimilarity (see also this book) Jesus saying in all four gospels that “a prophet has no honor in his own country” [e.g. Mark 3:33-35: «Who are my mother and my brothers?” he asked. Then he looked at those seated in a circle around him and said, “Here are my mother and my brothers! Whoever does God's will is my brother and sister and mother.»  How Christianity changed Jesus from being the «Son of Man» (Mark) to becoming «God the Son, the second Person in the Trinity | Council of Nicea |  A puzzling passage in the Bible - Mark 14:51: “A young man, wearing nothing but a linen garment, was following Jesus. When they seized him, he fled naked, leaving his garment behind.» (32:14) The historical Jesus. Was Jesus literate? Archeological findings in Nazareth. Miracles and the resurrection. | Science vs myth | Similarities between Asclepius and Christ. (49:24) What did really Jesus believe in? How Jesus was influenced by the Book of Isaiah. And Jeremiah. |  The puzzle of Jesus's speech in the Sermon on the Mount in Mathew 5 (1:05:25) The message of Paul the Apostle (St Paul). | The role of James (Jesus's brother). | The role of Mary. (1:12:43) How the Christian message on death evolved from the resurrection of the body to the resurrection of the soul.  Book recommendation: Demon Copperhead by Barbara Kingsolver _______________ O convidado deste episódio é Dale Martin, professor na Universidade de Yale, e tem uma especialidade académica tão incomum no nosso país que nem temos (que eu saiba) uma expressão corrente para ela. O convidado é aquilo a que em inglês se designa por “New Testament scholar” -- ou seja, um investigador que se decida ao estudo histórico do Novo Testamento e das origens do Cristianismo, combinando análises histórica, cultural e linguística.  Dale Martin tem uma longa carreira de investigador sobre o Novo Testamento, com vários livros publicados. E podem encontrar também no Youtube os vídeos de uma cadeira sua dada em Yale sobre precisamente a História do Novo Testamento e do Cristianismo. E foi precisamente com essa cadeira que esta conversa surgiu. As ditas aulas --  a leitura da Bíblia -- deixaram-me com muitas dúvidas que não tinha a quem perguntar, por isso decidi que estava na altura trazer Dale Martin ao 45 Graus.  Foi, como vão ver, uma conversa fascinante, em que falámos da Bíblia, da figura de Jesus e do Mundo antigo em que Jesus e os primeiros cristãos viveram. O convidado, além disso, tem uma perspectiva interessante, porque, embora seja um historiador de pleno direito, que fala dos textos cristãos com uma frieza implacável quando usa o chapéu de historiador, é também crente, o que é uma combinação invulgar neste meio dos estudos bíblicos, onde, normalmente, sobretudo nos Estados Unidos, há uma espécie de diálogo de surdos entre teólogos e historiadores agnósticos.  Nesta conversa -- porque o tempo não chega para tudo -- acabámos por abordar sobretudo a figura de Jesus, pelo que nos focámos mais nos quatro evangelhos -- ou cinco, porque também falámos do “Evangelho de Tomé”, um dos muitos evangelhos apócrifos (não incluídos na Bíblia) a que os historiadores também dão muita importância.  Comecei a nossa conversa por perguntar ao convidado como é que um historiador aborda o estudo da Bíblia e dos escritos religiosos. Isso levou-nos aos evangelhos, e que critérios os historiadores usam para tentar separar o que há neles de histórico do que é …criatividade literária ou religiosa. Falámos também, inevitavelmente, da figura de Jesus: do que podemos dizer sobre quem era, se sabia ler, o que pensava realmente, e o modo como o entendimento que o Cristianismo faz de Jesus foi galgando terreno nos primeiros séculos do Cristianismo, começando como o “filho da Humanidade”, em Marcos, e culminando no Deus-Filho, na Santíssima Trindade. No final, tivemos ainda tempo para falar um pouco do Apóstolo Paulo, de Tiago (irmão de Jesus -- pouco relevante nos evangelhos mas que se tornou uma figura relevante no início do Cristianismo) e, claro, de Maria, mãe de Jesus (em quem o contraste entre o papel que tem no Novo Testamento e o papel importantíssimo que veio a assumir no Cristianismo é ainda maior). Espero que gostem. Para mim, foi uma conversa muito interessante e destas que puxam pela cabeça -- embora, deva dizer, que talvez tenha saído com mais dúvidas ainda do que tinha antes.  _______________ Obrigado aos mecenas do podcast: Julie Piccini, Ana Raquel Guimarães Galaró family, José Luís Malaquias, Francisco Hermenegildo, Nuno Costa, Abílio Silva, Salvador Cunha, Bruno Heleno, António llms, Helena Monteiro, BFDC, Pedro Lima Ferreira, Miguel van Uden, João Ribeiro, Nuno e Ana, João Baltazar, Miguel Marques, Corto Lemos, Carlos Martins, Tiago Leite Tomás Costa, Rita Sá Marques, Geoffrey Marcelino, Luis, Maria Pimentel, Rui Amorim, RB, Pedro Frois Costa, Gabriel Sousa, Mário Lourenço, Filipe Bento Caires, Diogo Sampaio Viana, Tiago Taveira, Ricardo Leitão, Pedro B. Ribeiro, João Teixeira, Miguel Bastos, Isabel Moital, Arune Bhuralal, Isabel Oliveira, Ana Teresa Mota, Luís Costa, Francisco Fonseca, João Nelas, Tiago Queiroz, António Padilha, Rita Mateus, Daniel Correia, João Saro João Pereira Amorim, Sérgio Nunes, Telmo Gomes, André Morais, Antonio Loureiro, Beatriz Bagulho, Tiago Stock, Joaquim Manuel Jorge Borges, Gabriel Candal, Joaquim Ribeiro, Fábio Monteiro, João Barbosa, Tiago M Machado, Rita Sousa Pereira, Henrique Pedro, Cloé Leal de Magalhães, Francisco Moura, Rui Antunes7, Joel, Pedro L, João Diamantino, Nuno Lages, João Farinha, Henrique Vieira, André Abrantes, Hélder Moreira, José Losa, João Ferreira, Rui Vilao, Jorge Amorim, João Pereira, Goncalo Murteira Machado Monteiro, Luis Miguel da Silva Barbosa, Bruno Lamas, Carlos Silveira, Maria Francisca Couto, Alexandre Freitas, Afonso Martins, José Proença, Jose Pedroso, Telmo , Francisco Vasconcelos, Duarte , Luis Marques, Joana Margarida Alves Martins, Tiago Parente, Ana Moreira, António Queimadela, David Gil, Daniel Pais, Miguel Jacinto, Luís Santos, Bernardo Pimentel, Gonçalo de Paiva e Pona , Tiago Pedroso, Gonçalo Castro, Inês Inocêncio, Hugo Ramos, Pedro Bravo, António Mendes Silva, paulo matos, Luís Brandão, Tomás Saraiva, Ana Vitória Soares, Mestre88 , Nuno Malvar, Ana Rita Laureano, Manuel Botelho da Silva, Pedro Brito, Wedge, Bruno Amorim Inácio, Manuel Martins, Ana Sousa Amorim, Robertt, Miguel Palhas, Maria Oliveira, Cheila Bhuralal, Filipe Melo, Gil Batista Marinho, Cesar Correia, Salomé Afonso, Diogo Silva, Patrícia Esquível , Inês Patrão, Daniel Almeida, Paulo Ferreira, Macaco Quitado, Pedro Correia, Francisco Santos, Antonio Albuquerque, Renato Mendes, João Barbosa, Margarida Gonçalves, Andrea Grosso, João Pinho , João Crispim, Francisco Aguiar , João Diogo, João Diogo Silva, José Oliveira Pratas, João Moreira, Vasco Lima, Tomás Félix, Pedro Rebelo, Nuno Gonçalves, Pedro , Marta Baptista Coelho, Mariana Barosa, Francisco Arantes, João Raimundo, Mafalda Pratas, Tiago Pires, Luis Quelhas Valente, Vasco Sá Pinto, Jorge Soares, Pedro Miguel Pereira Vieira, Pedro F. Finisterra, Ricardo Santos _______________ Esta conversa foi editada por: Hugo Oliveira _______________ Bio: Dale B. Martin is a New Testament scholar and historian of Christianity, currently Woolsey Professor Emeritus of Religious Studies at Yale University. Professor Martin specializes in New Testament and Christian Origins, including attention to social and cultural history of the Greco-Roman world. Before joining the Yale faculty in 1999, he taught at Rhodes College and Duke University. His books include: Slavery as Salvation: The Metaphor of Slavery in Pauline Christianity; The Corinthian Body; Inventing Superstition: from the Hippocratics to the Christians; Sex and the Single Savior: Gender and Sexuality in Biblical Interpretation; Pedagogy of the Bible: an Analysis and Proposal; New Testament History and Literature; and most recently, Biblical Truths: The Meaning of Scripture in the Twenty-First Century. He has edited several books, including (with Patricia Cox Miller), The Cultural Turn in Late Ancient Studies: Gender, Asceticism, and Historiography. He was an associate editor for the revision and expansion of the Encyclopedia of Religion, published in 2005. He has published several articles on topics related to the ancient family, gender and sexuality in the ancient world, and ideology of modern biblical scholarship, including titles such as: “Contradictions of Masculinity: Ascetic Inseminators and Menstruating Men in Greco-Roman Culture.” He currently is working on issues in biblical interpretation, social history and religion in the Greco-Roman world, and sexual ethics. He has held fellowships from the National Endowment for the Humanities, the Alexander von Humboldt Foundation (Germany), the Lilly Foundation, the Fulbright Commission (USA-Denmark), and the Wabash Center for Teaching and Learning in Theology and Religion. He is a fellow of the American Academy of Arts and Sciences (elected 2009).

Dr. David Wang is a licensed psychologist and associate professor of psychology and pastoral counseling at the Rosemead School of Psychology, at Biola University. He is the editor of the Journal of Psychology and Theology and serves on the editorial board for Spirituality in Clinical Practice (an APA journal). He also leads research funded by the John Templeton Foundation and the Lilly Foundation investigating the spiritual and character/virtue development of seminary students. Dr. Wang teaches and speaks internationally, maintains a small clinical practice in Fullerton, CA and is the pastor of spiritual formation at One Life City Church    

Colleges have extraordinary responsibilities in the lives of their students. Sometimes overlooked is guiding students into purposeful careers.Tim Clydesdale is the author of The Purposeful Graduate. It's an evaluation of a large-scale program funded by the Lilly Foundation that paid for 88 colleges to create purpose programs for their students. In this episode, you'll learn the lessons from these programs, including  what worked and what didn't. In this episode, you'll learn about:Research on fostering purpose among college studentsThe power of narrative in exploring purposeThe longterm effect of college students finding purposeThe value of hands-on experience related to purposeThe best year in college for exploring matters of purposeTim's LinksWebsiteBooksThe Purposeful GraduateThe Twentysomething SoulThe First Year Out***Want to connect? Email me at bradleywrightphd@gmail.com or connect on my LinkedIn page. Want to start your own podcast? This podcast is edited and produced (and music too) by Josh Gilbert. Contact him at   joshgilbertmedia@gmail.com. He specializes in working with early podcasters.

This week Mildred interviews Dr. John Giggie on People+Culture. Dr. John Giggie is Associate Professor of History and African American Studies and Director of the Summersell Center for the Study of the South at the University of Alabama. He is Co-Creator of “History of Us,” the first Black history class taught daily in a public school in Alabama; and the West Side Scholars Academy, a middle school enrichment program teaching about social justice and civil rights. Dr. Giggie is also Director of “Alabama Memory,” an effort that seeks to recapture and memorialize the over 400 lives lost to lynching in Alabama; Director of “Queer History South,” on oral history program documenting the lives of LGBTQ+ citizens in West Alabama, and a founding member of the Tuscaloosa Civil Rights History and Reconciliation Foundation. He has been a commentator on matters of southern history for National Public Radio, Alabama Public Radio, CNN, C-Span, USA Today, The Christian Science Monitor, Smithsonian Magazine, BET.com, ReckonSouth, The Birmingham Watch and local presses and television outlets. As a teacher at the University of Alabama, Prof. Giggie specializes in southern and Civil Rights history. He has been recognized as a Distinguished Fellow in Teaching by the College of Arts and Sciences and awarded the Outstanding Faculty-Initiated Engagement Effort by the Center for Community-Based Partnerships. At the University of Texas at San Antonio, Prof. Giggie was awarded the Presidential Distinguished Achievement Award for Teaching and the Honors Alliance Award for Outstanding Teaching. As a scholar, Dr. Giggie has authored or edited five books and is currently completing a civil rights manuscript titled, Bloody Tuesday: The Fight for Civil Rights in Tuscaloosa. He coedits the Religion and American Culture series for the University of Alabama Press, sits on the Commission on Local Government Records and the Commission of State Government Records with the Alabama Department of Archives and History, and previously served of the Executive Council of the American Society of Church Historians. His research has been funded by the National Endowment for the Humanities, the Louisville Center for the Study of American Religion, the Lilly Foundation, the Pew Foundation, the Center for the Study of American Religion at Princeton University, and the American Historical Association.

“Remember those three minutes for the rest of your life.”   In this episode, Al White, Advisor for Corporate Responsibility and VP of The Lilly Foundation at Eli Lilly and Company, joins Derrin Slack for a conversation about breaking the cycle of crime and making the most of every opportunity.   Al’s father was a well-known drug dealer in Delaware, and his grandfather was murdered as a result of his involvement with organized crime. When Al was arrested before his senior year of highschool, it seemed he would follow the pattern.    As he shares his story, you’ll hear how he was given a second chance, and what he did next to take full advantage of it.

The Tolton Spirituality Center has been a fruit of the pandemic. Beth White, the Host of On the Way, interviews Fr. Gerard Jordan, OPraem, about the newly announced Center to serve the parishes of the Archdiocese of Chicago. With a $1 million grant from the Lilly Foundation, this new initiative will lead the way in healing and building vitality in parishes. Fr. Gerard shares the ways in which Fr. Tolton was not deterred by racism or struggle and how his experience can help all of us as we face the challenges of the pandemic, “isms” in our society and Church, and the outcomes of parish communities uniting under a new roof.

Interview with Rev. Dr. Randy Bush discussing Christianity. Rev. Dr. Randy Bush Instagram: @bushrandybush Rev. Dr. Randy Bush Twitter: @revrandybush East Liberty Presbyterian Church Twitter: @EastLibertyPres East Liberty Presbyterian Church Instagram: @eastlibertypresbyterian East Liberty Presbyterian Church: https://cathedralofhope.org/ Donate to East Liberty Presbyterian Church: https://cathedralofhope.org/donate/ Reverend Randy Bush has been a senior pastor at East Liberty Presbyterian Church since 2006. Prior, he was the pastor at First Presbyterian Church in Racine, Wisconsin and designated pastor at Lomagundi Church in Zimbabwe. Reverend Bush has also served as an adjunct faculty member at the Pittsburgh Theological Seminary teaching courses in Church and Society, Pastoral Care, Preaching an Ethics, and Pastoral Theology and has also taught courses in World Religions and Christian Ethics at the Carthage College in Kenosha, Wisconsin. Reverend Bush received his Masters of Divinity degree from Princeton Theological Seminary and his PhD from Marquette University. In 2012, Reverend Bush received a Lilly Foundation grant for his sabbatical study in New Zealand. --- Support this podcast: https://podcasters.spotify.com/pod/show/michelle-werner/support

Dr. David Wang is a licensed psychologist and associate professor of psychology and pastoral counseling at the Rosemead School of Psychology, at Biola University. He is the editor of the Journal of Psychology and Theology and serves on the editorial board for Spirituality in Clinical Practice (an APA journal). He also leads research funded by the John Templeton Foundation and the Lilly Foundation investigating the spiritual and character/virtue development of seminary students. Dr. Wang teaches and speaks internationally, maintains a small clinical practice in Fullerton, CA and is the pastor of spiritual formation at One Life City Church       https://www.drdavidcwang.com/about-dr-wang For Dr. Wang's sermons on Lament: https://www.onelifecitychurch.org/sermons   Online Small Groups Training

Our “Men in Black” are shepherds who lead us to a better life here and now and in the hereafter. So, who is helping them and tending to their needs? Bill Marianes welcomes his special guests including Reverend Dr. Nicholas Louh and Presvytera Dr. Roxanne Louh as well as Dr. George Koulianos. Dr. Koulianos is an internationally recognized medical doctor helping to address specific Clergy needs as a part of the $1 million grant from the Lilly Foundation to the Center for Family Care of the Greek Orthodox Archdiocese of America.

Fight 4 Lilly Foundation with Serra Frank. Serra is a Mother of 3 from Boise, ID, with an Education in Criminal Justice and Applied Psychology. Serra's credentials include being the Founding Director of Moms for Marijuana International, and Co-Founder at The Fight 4 Lilly Foundation (a family advocacy/CPS and family courts watchdog organization). Serra is also The Founder of New Approach Idaho as well as Compassionate Idaho, and the President and Event Coordinator of Boise Idaho Hempfest. And Serra is the team Director for Legalize Idaho.

How do multinational companies incorporate CSR? Al White, vice president of the Lilly Foundation and CSR advisor to Eli Lilly and Co., shares insight into the company’s approach to CSR and employee relations on this week’s episode! The post Episode 71: Al White of Eli Lilly and Company appeared first on Taking Care in Business.

I’m thrilled to have made friends with Dr. Amy Laura Hall. Not only is she back on the podcast to talk about Stanley Hauerwas’ influence on her work and theology, she’ll be our special guest in June at our annual live podcast at Annual Conference in Roanoke, Va. Amy Laura Hall was named a Henry Luce III Fellow in Theology for 2004-2005 and has received funding from the Lilly Foundation, the Josiah Trent Memorial Foundation, the American Theological Library Association, the Child in Religion and Ethics Project, the Pew Foundation and the Project on Lived Theology.At Duke University, Professor Hall has served on the steering committee of the Genome Ethics, Law, and Policy Center and as a faculty member for the FOCUS program of the Institute on Genome Sciences and Policy. She has served on the Duke Medical Center’s Institutional Review Board and as an ethics consultant to the V.A. Center in Durham. She served as a faculty adviser with the Duke Center for Civic Engagement (under Leela Prasad), on the Academic Council, and as a faculty advisor for the NCCU-Duke Program in African, African American & Diaspora Studies. She currently teaches with and serves on the faculty advisory board for Graduate Liberal Studies and serves as a core faculty member of the Focus Program in Global Health.Professor Hall was the 2017 Scholar in Residence at Foundry United Methodist Church in Washington D.C., served on the Bioethics Task Force of the United Methodist Church, and has spoken to academic and ecclesial groups across the U.S. and Europe. An ordained elder in the United Methodist Church, Hall is a member of the Rio Texas Annual Conference. She has served both urban and suburban parishes. Her service with the community includes an initiative called Labor Sabbath, an effort with the AFL-CIO of North Carolina to encourage congregations of faith to talk about the usefulness of labor unions, and, from August 2013 to June 2017, a monthly column for the Durham Herald-Sun. Professor Hall organized a conference against torture in 2011, entitled “Toward a Moral Consensus Against Torture,” and a “Conference Against the Use of Drones in Warfare” October 20-21, 2017. In collaboration with the North Carolina Council of Churches and the United Methodist Church, she organized a workshop with legal scholar Richard Rothstein held October, 2018.Amy Laura Hall is the author of four books: Kierkegaard and the Treachery of Love, Conceiving Parenthood: The Protestant Spirit of Biotechnological Reproduction, Writing Home with Love: Politics for Neighbors and Naysayers, and Laughing at the Devil: Seeing the World with Julian of Norwich. She has written numerous scholarly articles in theological and biomedical ethics. Recent articles include "The Single Individual in Ordinary Time: Theological Engagements in Sociobiology," which was a keynote lecture given with Kara Slade at the Society for the Study of Christian Ethics in 2012, and "Torture and American Television," which appeared in the April 2013 issue of Muslim World, a volume that Hall guest-edited with Daniel Arnold. Her essay “Love in Everything: A Brief Primer to Julian of Norwich" appeared in volume 32 of The Princeton Seminary Bulletin. Word and World published her essay on heroism in the Winter 2016 edition, and her essay "His Eye Is on the Sparrow: Collectivism and Human Significance" appeared in a volume entitled Why People Matter with Baker Publishing. Her forthcoming essays include a new piece on Kierkegaard and love for The T&T Clark Companion to the Theology of Kierkegaard, to be published by Bloomsbury T&T Clark.Laughing at the Devil was the focus of her 2018 Simpson Lecture at Simpson College in Iowa and has been chosen for the 2019 Virginia Festival of the Book. She continues work on a longer research project on masculinity and gender anxiety in mainstream, white evangelicalism.

I’m thrilled to have made friends with Dr. Amy Laura Hall. Not only is she back on the podcast to talk about Stanley Hauerwas’ influence on her work and theology, she’ll be our special guest in June at our annual live podcast at Annual Conference in Roanoke, Va. Amy Laura Hall was named a Henry Luce III Fellow in Theology for 2004-2005 and has received funding from the Lilly Foundation, the Josiah Trent Memorial Foundation, the American Theological Library Association, the Child in Religion and Ethics Project, the Pew Foundation and the Project on Lived Theology.At Duke University, Professor Hall has served on the steering committee of the Genome Ethics, Law, and Policy Center and as a faculty member for the FOCUS program of the Institute on Genome Sciences and Policy. She has served on the Duke Medical Center’s Institutional Review Board and as an ethics consultant to the V.A. Center in Durham. She served as a faculty adviser with the Duke Center for Civic Engagement (under Leela Prasad), on the Academic Council, and as a faculty advisor for the NCCU-Duke Program in African, African American & Diaspora Studies. She currently teaches with and serves on the faculty advisory board for Graduate Liberal Studies and serves as a core faculty member of the Focus Program in Global Health.Professor Hall was the 2017 Scholar in Residence at Foundry United Methodist Church in Washington D.C., served on the Bioethics Task Force of the United Methodist Church, and has spoken to academic and ecclesial groups across the U.S. and Europe. An ordained elder in the United Methodist Church, Hall is a member of the Rio Texas Annual Conference. She has served both urban and suburban parishes. Her service with the community includes an initiative called Labor Sabbath, an effort with the AFL-CIO of North Carolina to encourage congregations of faith to talk about the usefulness of labor unions, and, from August 2013 to June 2017, a monthly column for the Durham Herald-Sun. Professor Hall organized a conference against torture in 2011, entitled “Toward a Moral Consensus Against Torture,” and a “Conference Against the Use of Drones in Warfare” October 20-21, 2017. In collaboration with the North Carolina Council of Churches and the United Methodist Church, she organized a workshop with legal scholar Richard Rothstein held October, 2018.Amy Laura Hall is the author of four books: Kierkegaard and the Treachery of Love, Conceiving Parenthood: The Protestant Spirit of Biotechnological Reproduction, Writing Home with Love: Politics for Neighbors and Naysayers, and Laughing at the Devil: Seeing the World with Julian of Norwich. She has written numerous scholarly articles in theological and biomedical ethics. Recent articles include "The Single Individual in Ordinary Time: Theological Engagements in Sociobiology," which was a keynote lecture given with Kara Slade at the Society for the Study of Christian Ethics in 2012, and "Torture and American Television," which appeared in the April 2013 issue of Muslim World, a volume that Hall guest-edited with Daniel Arnold. Her essay “Love in Everything: A Brief Primer to Julian of Norwich" appeared in volume 32 of The Princeton Seminary Bulletin. Word and World published her essay on heroism in the Winter 2016 edition, and her essay "His Eye Is on the Sparrow: Collectivism and Human Significance" appeared in a volume entitled Why People Matter with Baker Publishing. Her forthcoming essays include a new piece on Kierkegaard and love for The T&T Clark Companion to the Theology of Kierkegaard, to be published by Bloomsbury T&T Clark.Laughing at the Devil was the focus of her 2018 Simpson Lecture at Simpson College in Iowa and has been chosen for the 2019 Virginia Festival of the Book. She continues work on a longer research project on masculinity and gender anxiety in mainstream, white evangelicalism.

Mary Margaret Funk, OSB, is a member of Our Lady of Grace Monastery in Beech Grove, Indiana. She entered this Benedictine community in 1961 and served as the prioress from 1985 to 1993. In 1994 Sister Meg became the Executive Director of the Monastic Interreligious Dialogue Board. She has been in formal dialogue with people of the Hindu, Zen Buddhist, Islamic, Confucian, and Taoist traditions. Sr. Meg chats with Fran, Carl and Kevin via Skype. She holds graduate degrees from Catholic University (1973) and Indiana University (1979). She is a graduate of Epiphany Certification Program of Formative Spirituality (2002). She received a grant from the Lilly Foundation to explore the history of Christian spirituality and its ongoing relevant to women religious today. "Music is the closest thing there is to silence, actually; it's a way to taste silence." — Sister Mary Margaret Funk, OSB Sr. Meg is the author of numerous books, including the "Matters Series" books on traditional Christian spirituality: Thoughts Matter: Discovering the Spiritual Journey, Tools Matter: Beginning the Spiritual Journey, Humility Matters: Toward Purity of Heart, Lectio Matters: Before the Burning Bush, and Discernment Matters: Listening with the Ear of the Heart. Her other books include Renouncing Violence: Practice from the Monastic Tradition and Islam Is: An Experience of Dialogue and Devotion. Our Lady of Grace Monastery When we approached Sister Meg to invite her to join our conversation on silence, we were delighted to learn that her monastery is only a short drive from Cassidy's new home in Indiana! So this episode was recorded by Cassidy in person at the music room of Our Lady of Grace Monastery. In part two of this interview, Kevin and Carl — and Carl's wife, Fran — joined the conversation via Skype. "Solitude gives you a house in which to be silent." — Sister Mary Margaret Funk, OSB Sr. Meg is a gifted teacher, and our conversation quickly turned into a lesson in spiritual history and practice. Using the themes of her books as an organizing principle, Sr. Meg skillfully explained the central role that silence plays to Benedictine spirituality — and indeed to Christian spirituality as a whole. And while her insights dove deep into her "home tradition" of Christian spirituality, her years of insight into interreligious dialogue added a richness and depth to her reflections on how Christians and persons of other faiths can learn from one another — and how honoring the integrity of their own traditions enhances interfaith dialogue. Sr. Meg playing the recorder As if all this weren't enough, Sr. Meg is also an amateur musician, and played several tunes for us on her tenor and alto recorders! She now has the distinction of being our first guest to explore silence not only with her words, but with her music as well. Today’s episode is part one of a two-part interview. Click here to listen to part two. "Everybody knows what violence is, but they don't know what renouncing is." — Sister Mary Margaret Funk Some of the resources and authors we mention in this episode: Mary Margaret Funk, Thoughts Matter Mary Margaret Funk, Tools Matter Mary Margaret Funk, Humility Matters Mary Margaret Funk, Lectio Matters Mary Margaret Funk, Discernment Matters Mary Margaret Funk, Renouncing Violence Mary Margaret Funk, Islam Is St. Benedict, The Rule of Saint Benedict John Cassian, The Institutes John Cassian, The Conferences The Dalai Lama, The Art of Happiness Evagrius Ponticus, The Greek Ascetic Corpus Pseudo-Macarius, The Fifty Spiritual Homilies Columba Stewart, Prayer and Community Henri de Lubac, Medieval Exegesis, Volume I

Mary Margaret Funk, OSB, is a member of Our Lady of Grace Monastery in Beech Grove, Indiana. She entered this Benedictine community in 1961 and served as the prioress from 1985 to 1993. In 1994 Sister Meg became the Executive Director of the Monastic Interreligious Dialogue Board. She has been in formal dialogue with people of the Hindu, Zen Buddhist, Islamic, Confucian, and Taoist traditions. Sr. Meg chats with Fran, Carl and Kevin via Skype. She holds graduate degrees from Catholic University (1973) and Indiana University (1979). She is a graduate of Epiphany Certification Program of Formative Spirituality (2002). She received a grant from the Lilly Foundation to explore the history of Christian spirituality and its ongoing relevant to women religious today. "Music is the closest thing there is to silence, actually; it's a way to taste silence." — Sister Mary Margaret Funk, OSB Sr. Meg is the author of numerous books, including the "Matters Series" books on traditional Christian spirituality: Thoughts Matter: Discovering the Spiritual Journey, Tools Matter: Beginning the Spiritual Journey, Humility Matters: Toward Purity of Heart, Lectio Matters: Before the Burning Bush, and Discernment Matters: Listening with the Ear of the Heart. Her other books include Renouncing Violence: Practice from the Monastic Tradition and Islam Is: An Experience of Dialogue and Devotion. Our Lady of Grace Monastery When we approached Sister Meg to invite her to join our conversation on silence, we were delighted to learn that her monastery is only a short drive from Cassidy's new home in Indiana! So this episode was recorded by Cassidy in person at the music room of Our Lady of Grace Monastery. In part two of this interview, Kevin and Carl — and Carl's wife, Fran — joined the conversation via Skype. "Solitude gives you a house in which to be silent." — Sister Mary Margaret Funk, OSB Sr. Meg is a gifted teacher, and our conversation quickly turned into a lesson in spiritual history and practice. Using the themes of her books as an organizing principle, Sr. Meg skillfully explained the central role that silence plays to Benedictine spirituality — and indeed to Christian spirituality as a whole. And while her insights dove deep into her "home tradition" of Christian spirituality, her years of insight into interreligious dialogue added a richness and depth to her reflections on how Christians and persons of other faiths can learn from one another — and how honoring the integrity of their own traditions enhances interfaith dialogue. Sr. Meg playing the recorder As if all this weren't enough, Sr. Meg is also an amateur musician, and played several tunes for us on her tenor and alto recorders! She now has the distinction of being our first guest to explore silence not only with her words, but with her music as well. Today’s episode is part one of a two-part interview. Click here to listen to part two. "Everybody knows what violence is, but they don't know what renouncing is." — Sister Mary Margaret Funk Some of the resources and authors we mention in this episode: Mary Margaret Funk, Thoughts Matter Mary Margaret Funk, Tools Matter Mary Margaret Funk, Humility Matters Mary Margaret Funk, Lectio Matters Mary Margaret Funk, Discernment Matters Mary Margaret Funk, Renouncing Violence Mary Margaret Funk, Islam Is St. Benedict, The Rule of Saint Benedict John Cassian, The Institutes John Cassian, The Conferences The Dalai Lama, The Art of Happiness Evagrius Ponticus, The Greek Ascetic Corpus Pseudo-Macarius, The Fifty Spiritual Homilies Columba Stewart, Prayer and Community Henri de Lubac, Medieval Exegesis, Volume I Henri de Lubac, Medieval Exegesis, Volume II Henri de Lubac, Medieval Exegesis, Volume III Thomas Keating, Open Mind Open Heart Rene Girard, Things Hidden Since the Foundation of the World Episode 52: Silence Matters: A Conversation with ...

Executives from the United Negro College Fund discuss their recent career pathways leadership convening, the role of HBCUs in training the 21st-century workforce, and how HBCUs are adapting to new industrial demands. The convening is a part of a UNCF partnership with the Lilly Foundation to spur HBCU leadership in increasing career access to a more diverse field of potential employees.

Our “Men in Black” are shepherds who lead us to a better life here and now and in the hereafter. So, who is helping them and tending to their needs? Bill Marianes welcomes his special guests including Reverend Dr. Nicholas Louh and Presvytera Dr. Roxanne Louh as well as Dr. George Koulianos. Dr. Koulianos is an internationally recognized medical doctor helping to address specific Clergy needs as a part of the $1 million grant from the Lilly Foundation to the Center for Family Care of the Greek Orthodox Archdiocese of America.

A brief historical overview of theatrical performances in prison, particularly in Iran. The presentation is based on an essay. Nasser Rahmaninejad, a foremost, celebrated Iranian artist started his career in theatre in 1959 Iran. In response to the authoritarian cultural policies and harsh censorship of the Shah’s regime, he founded his alternative, independent theatre group, Mehr in 1966. His group, which later changed its name to Iran Theatre Association, became very influential in the field, competing with other well-financed, state-sponsored theatre groups until it was closed down by the SAVAK, the Shah’s secret police in 1974. All members of the group were arrested and Rahmaninejad was sentenced to twelve years in prison to be freed by the 1979 revolution that toppled the Shah’s regime. After the revolution Rahmaninejad resumed his artistic activities, staging several plays while teaching in the Faculty of Dramatic Arts, and writing articles and lecturing on theatre and politics for a range of audiences. Following the Islamic regime’s crack down on the opposition Rahmaninejad was forced into exile. However he continued his artistic activities writing essays, translating into Persian articles on theatre and politics, giving invited lectures in variety of academic and artistic organizations in Europe and the United States, such as the International Writing Program (University of Iowa), and the Center for Iranian Research and Analysis (CIRA). His plays, in exile include My Heart, My Homeland, produced by the Society for Creativity and sponsored by the Lilly Foundation, Office of Student Life, Liberal Education Department and Hokin Center and performed by Department of Theatre of the Columbia College of Chicago (1995); One Page of Exile, in the first festival of New Windows on Old Pasadena (1996). Rahmaninejad lives in Berkeley, California.

Talking Kids and Cannabis as Russ talks to Serra Frank with Moms for Marijuana International, New Approach Idaho, The Fight for Lilly Foundation and Boise Hempfest.

Talking Kids and Cannabis as Russ talks to Serra Frank with Moms for Marijuana International, New Approach Idaho, The Fight for Lilly Foundation and Boise Hempfest.