Podcasts about Pennell

Heather Pennell is back on the No More Wasted Days podcast, and this episode feels like catching up with an old friend. In this conversation, Sara and Heather talk about Heather's five-year alcohol-free anniversary, what life has looked like since stepping away from the podcast, and how she has been rebuilding after a season of burnout, health challenges, major life disruptions, and emotional overwhelm. Heather shares what helped her begin to feel more regulated, including slowing down, creating calmer mornings, delaying phone use, supporting blood sugar, and increasing her window of tolerance. She also opens up about emotional sobriety, taking up space, letting go of “nice girl” conditioning, and learning how to live alcohol-free in a way that feels grounded, calm, and sustainable. This episode is a reminder that alcohol-free living is not just about removing alcohol. It is also about learning how to care for your nervous system, protect your energy, and build a life you no longer need to escape from.   Resources and Links: Join the Day Makers Community Looking for alcohol-free support, weekly group coaching calls, and a private community of like-minded alcohol-free badasses? Come join us inside Day Makers. You can try your first two weeks for just $7. CLICK HERE to join.   Work with Heather 1:1 If Heather's story and coaching style spoke to you, check out her one-on-one coaching options for deeper support on your alcohol-free or personal reset journey. CLICK HERE to work with Heather.   Join Heather's Real Life Reset Heather's Real Life Reset is a 40-day group coaching program designed to help you feel more like yourself again by focusing on sleep, mornings, food, anxiety, motivation, habits, and emotional regulation. The next round starts June 15th. CLICK HERE to join the Real Life Reset.   Connect with Heather: Instagram: @heatherpennellcoaching   Support the Podcast: If you love the No More Wasted Days podcast, please take a moment to leave a review on Apple Podcasts or rate and comment on Spotify. It helps more people find the show and begin their own alcohol-free journey. ***************************************   Follow the podcast on Social Media: IG: @nomorewasteddays.pod   Follow Sara on Social Media: IG: @no_more_wasted_days TikTok: @no_more_wasted_days Facebook: www.facebook.com/NoMoreWastedDaysOfficial

Kicking off a new season of the LINKS Golf Podcast, the hosts are joined by LINKS contributing writer Richard Pennell for a conversation about their favorite clubhouses in golf, making three picks each and throwing in a few honorable mentions. This episode of the LINKS Golf Podcast is presented by FootJoy. Properties mentioned in this episode: Woking Golf Club—Woking, England Winged Foot Golf Club—Mamaroneck, N.Y. Oakmont Country Club—Oakmont, Pa. New Zealand Golf Club—Surrey, England Royal Lytham & St. Annes—Lytham St. Annes, England Indian Creek Country Club—Indian Creek, Fla. Covesea Links—Elgin, Scotland Pinehurst Resort—Pinehurst, N.C. Baltusrol Golf Club—Springfield, N.J. What did you think of the episode? Tell us in the comments below! Also, reach out to us on social media at X, Facebook, or Instagram! Learn more about your ad choices. Visit megaphone.fm/adchoices

She didn't pitch herself - she rewired her body to hold global visibility, and the opporutnity to facilitate her life-changing body of work found her This isn't strategy. This is what happens when your nervous system can hold being seen on a global level. She encoded this new identity by breaking the rich rules during Tap + Twerk. What Katelyn shares is going to blow your damn mind. Tune in! Experience Tap + Twerk at RICHCODED LIVE - Grab your ticket here Access the Free Training: Unapologetically THAT B!TCH Here - hosted inside our free telegram channel Apply to the RICHCODED Mastermind Connect on Instagram   Connect with Katelyn Experience her Body-Based Scaling Listen to The Walking Trophy    

In this episode, we discuss Eagle Pennell's Last Night at the Alamo, including character introductions, the parallels between Cowboy and Pennell, and the film's anti-Hollywood aesthetic.See where Last Night at the Alamo is available to watch.Supplemental Material:• Last Night at the Alamo (Remaster)• The King of Texas: The Life and Death of Independent Filmmaker Eagle Pennell• Inside/Outside• Last Night at the Alamo Q&A• How Austin Movies Shaped the City's Culture and Identity by Michael Barnes• How A Little-Known Film From The 1970s Kickstarted The Austin Film Scene by Terri Langford & Laura Rice• In Memoriam by Chronicle Staff• Eagle Pennell, the Last Cowboy by Nadine Smith• Remembering a Different 'Alamo,' 40 years Later by Nathan Cone• The Most Authentically Texan Movie You've Never Heard Of by Sean O'Neal• King for a Day by Steve McVicker• Indie Legend Who Inspired Sundance, ‘Reservoir Dogs' And More Will Have Classic Films Restored by Louis Black• The Defiant Defeatist: Eagle Pennell by Daniel Stuyck• Fade to Black by Steve McVickerAdditional Audio Sources:• Last Night at the Alamo Remaster Teaser• Last Night at the Alamo (Remaster)If you'd like to support the show, subscribe to the podcast on Apple Podcasts, Spotify, or wherever you listen to your podcasts, leave a review on Apple Podcasts, and share the podcast with someone who might enjoy it.If you have any thoughts, comments, or questions about the show, you can email us at scenebyscenepodcast@gmail.comFollow the Scene by Scene Instagram account for announcements and updates.Follow us on Letterboxd: Joe | Justin

What does it actually take to lead a major real estate network in one of Australia's most dynamic markets? Award-winning offices. A focus on people over process. And a CEO who believes trust and transparency aren't optional. On the REB Podcast, Barry Plant CEO Lisa Pennell joins deputy editor Emilie Lauer to share the story behind REB's back-to-back Major Network of the Year. Pennell reflects on the dedication and collaboration that underpin the network's success, revealing how a culture of shared achievement and ethical leadership drives both growth and resilience. She also outlines Barry Plant's strategic approach to navigating upcoming anti-money laundering (AML) compliance, rising living costs, and a rapidly evolving Victorian property market. From fostering trust in an industry where it's often in short supply to making technology work for people rather than replace them, Pennell explains how Barry Plant balances innovation with human values. She offers insights on regulatory shifts, building sustainable growth, and why a strong moral compass is the foundation of real estate leadership. Enjoy the podcast, The REB team Did you like this episode? Show your support by rating us or leaving a review on Apple Podcasts (REB Podcast Network) and by liking and following Real Estate Business on social media: Facebook, X and LinkedIn. If you have any questions about what you heard today, any topics of interest you have in mind, or if you'd like to lend a voice to the show, email editor@realestatebusiness.com.au for more insights.

Dr. Derek Stitt and Dr. Page B. Pennell discuss antiseizure medication management during pregnancy and postpartum, based on the MONEAD study.  Show citation:  Pennell PB, Li D, Kerr WT, et al. Antiseizure Medication Dosing Strategy During Pregnancy and Early Postpartum in Women With Epilepsy in MONEAD. Neurology. 2026;106(2):e214483. doi:10.1212/WNL.0000000000214483 

Dr. Derek Stitt talks with Dr. Page B. Pennell about antiseizure medication management during pregnancy and postpartum, based on the MONEAD study.  Read the related article in Neurology®.  Disclosures can be found at Neurology.org. 

Send a textREPRISE - After attending a recent event featuring Dr. Jemar Tisby, I had the chance to connect with the host of that gathering, Professor Jessica Wai-Fong Wong, Associate Professor of Systematic Theology at Azusa Pacific University and author of the groundbreaking book Disordered: Holy Icons and Racial Myths.In this episode, we reflect on that event, where Dr. Tisby shared moving stories about his relationship with the late Dr. Bill Pennell of Fuller Theological Seminary—a pioneering voice in racial awareness whose bold challenges to white evangelicalism began in the late '60s and continued for decades.Dr. Wong, herself deeply influenced by Dr. Pennell's legacy, joins me for a conversation that dives into the concept of whiteness as an archetype and its enduring impact on Christian theology and the history of race. Drawing from her own journey as a Chinese American woman raised in predominantly white spaces in Texas, Dr. Wong shares insights from her book, including what it means to "aspire to whiteness" and the painful experience of being cast as an "anti-icon" in a white-dominated religious context.We also explore my own experience within a Korean megachurch in Southern California, examining how whiteness becomes synonymous with order, while everyone else—Black, brown, Asian, Jewish, or female—is often seen as a threat to it.This is more than a theological discussion—it's a deep dive into history, identity, and the present-day political and spiritual moment we're all navigating. SHOW NOTESOriginally aired April 2025Support the showBecome a Patron - Click on the link to learn how you can become a Patron of the show. Thank you! Ken's Substack Page The Podcast Official Site: TheBeachedWhiteMale.com

Auctions and the Consumption of Second-Hand Goods in Georgian England (Bloomsbury, 2026) by Dr. Sara Pennell & Professor Jon Stobart provides the first comprehensive examination of household auctions as the key mechanism for recirculating household goods through the 18th and early 19th century. Dr. Pennell and Dr. Stobart contextualise and historicise the importance of used goods to consumer choices, experiences and identities. They tell the stories of the people and things, as well as the broader processes, practices and attitudes that were bound up in the commercial recirculation of used goods through auctions.Auctions and the Consumption of Used Goods in Georgian England rebalances the historiography of second-hand consumption – currently dominated by used clothing and the sale of books, art and antiques – and brings second-hand into the mainstream of household consumption. It also explodes the twin myths that second-hand was the last resort of the poor and that it declined rapidly as Britain industrialised and the supply of new consumer goods increased. The book demonstrates that consumer motivations were far more complex than simple financial necessity and household auctions did not fade to the margins; they remained an important part of how households acquired a wide variety of goods and fulfilled a variety of consumer needs. This interview was conducted by Dr. Miranda Melcher whose book focuses on post-conflict military integration, understanding treaty negotiation and implementation in civil war contexts, with qualitative analysis of the Angolan and Mozambican civil wars. You can find Miranda's interviews on New Books with Miranda Melcher, wherever you get your podcasts. Learn more about your ad choices. Visit megaphone.fm/adchoices Support our show by becoming a premium member! https://newbooksnetwork.supportingcast.fm/new-books-network

Auctions and the Consumption of Second-Hand Goods in Georgian England (Bloomsbury, 2026) by Dr. Sara Pennell & Professor Jon Stobart provides the first comprehensive examination of household auctions as the key mechanism for recirculating household goods through the 18th and early 19th century. Dr. Pennell and Dr. Stobart contextualise and historicise the importance of used goods to consumer choices, experiences and identities. They tell the stories of the people and things, as well as the broader processes, practices and attitudes that were bound up in the commercial recirculation of used goods through auctions.Auctions and the Consumption of Used Goods in Georgian England rebalances the historiography of second-hand consumption – currently dominated by used clothing and the sale of books, art and antiques – and brings second-hand into the mainstream of household consumption. It also explodes the twin myths that second-hand was the last resort of the poor and that it declined rapidly as Britain industrialised and the supply of new consumer goods increased. The book demonstrates that consumer motivations were far more complex than simple financial necessity and household auctions did not fade to the margins; they remained an important part of how households acquired a wide variety of goods and fulfilled a variety of consumer needs. This interview was conducted by Dr. Miranda Melcher whose book focuses on post-conflict military integration, understanding treaty negotiation and implementation in civil war contexts, with qualitative analysis of the Angolan and Mozambican civil wars. You can find Miranda's interviews on New Books with Miranda Melcher, wherever you get your podcasts. Learn more about your ad choices. Visit megaphone.fm/adchoices

Auctions and the Consumption of Second-Hand Goods in Georgian England (Bloomsbury, 2026) by Dr. Sara Pennell & Professor Jon Stobart provides the first comprehensive examination of household auctions as the key mechanism for recirculating household goods through the 18th and early 19th century. Dr. Pennell and Dr. Stobart contextualise and historicise the importance of used goods to consumer choices, experiences and identities. They tell the stories of the people and things, as well as the broader processes, practices and attitudes that were bound up in the commercial recirculation of used goods through auctions.Auctions and the Consumption of Used Goods in Georgian England rebalances the historiography of second-hand consumption – currently dominated by used clothing and the sale of books, art and antiques – and brings second-hand into the mainstream of household consumption. It also explodes the twin myths that second-hand was the last resort of the poor and that it declined rapidly as Britain industrialised and the supply of new consumer goods increased. The book demonstrates that consumer motivations were far more complex than simple financial necessity and household auctions did not fade to the margins; they remained an important part of how households acquired a wide variety of goods and fulfilled a variety of consumer needs. This interview was conducted by Dr. Miranda Melcher whose book focuses on post-conflict military integration, understanding treaty negotiation and implementation in civil war contexts, with qualitative analysis of the Angolan and Mozambican civil wars. You can find Miranda's interviews on New Books with Miranda Melcher, wherever you get your podcasts. Learn more about your ad choices. Visit megaphone.fm/adchoices

Auctions and the Consumption of Second-Hand Goods in Georgian England (Bloomsbury, 2026) by Dr. Sara Pennell & Professor Jon Stobart provides the first comprehensive examination of household auctions as the key mechanism for recirculating household goods through the 18th and early 19th century. Dr. Pennell and Dr. Stobart contextualise and historicise the importance of used goods to consumer choices, experiences and identities. They tell the stories of the people and things, as well as the broader processes, practices and attitudes that were bound up in the commercial recirculation of used goods through auctions.Auctions and the Consumption of Used Goods in Georgian England rebalances the historiography of second-hand consumption – currently dominated by used clothing and the sale of books, art and antiques – and brings second-hand into the mainstream of household consumption. It also explodes the twin myths that second-hand was the last resort of the poor and that it declined rapidly as Britain industrialised and the supply of new consumer goods increased. The book demonstrates that consumer motivations were far more complex than simple financial necessity and household auctions did not fade to the margins; they remained an important part of how households acquired a wide variety of goods and fulfilled a variety of consumer needs. This interview was conducted by Dr. Miranda Melcher whose book focuses on post-conflict military integration, understanding treaty negotiation and implementation in civil war contexts, with qualitative analysis of the Angolan and Mozambican civil wars. You can find Miranda's interviews on New Books with Miranda Melcher, wherever you get your podcasts. Learn more about your ad choices. Visit megaphone.fm/adchoices Support our show by becoming a premium member! https://newbooksnetwork.supportingcast.fm/british-studies

Sam sits down for a catch-up with friend of the pod, West Byfleet membership secretary and exceptional writer Richard Pennell. Together, they cover a wide range of topics, including Richard's latest book, Common Grounds, which chronicles his journeys to some of the rawest and purest forms of the game.Building on the success of his first book - Grass Routes - you can secure a copy through the wonderful folks over at Grant Books here.  Send us a message if you liked the showIf you've enjoyed this episode, please leave us a review on Apple Podcasts or Spotify!You can follow us along below @cookiejargolf Instagram / Facebook / Twitter / YouTube / Website

Friend of the pod Richard Pennell returns to chat about his new book Common Grounds. Over the course of the episode we chat about Richard's focus on slightly more rustic golfing adventures throughout the UK, Ireland and farther afield. Common Grounds is published by those lovely people at Grant Books, if you are interested in purchasing the book, please follow the link below: https://pitchmarks.bigcartel.com/category/books Remember to enter the competition to be in with a chance of winning one of two copies of Common Grounds that we are giving away. Details on how to enter are included in the introduction to the episode. Images can be found on the following channels X (https://x.com/firmandfastgolf) Instagram (https://www.instagram.com/firmandfastgolfpodcast/) Bluesky (https://bsky.app/profile/firmandfastgolf.bsky.social) For listeners interested in purchasing Eamon Mangan's book on building Carne Golf Links, please follow the link below. https://www.mayobooks.ie/Building-Carne?search=building%20carne A link to the Cookie Jar Course Diaries feature on Royal Worlington & Newmarket can be found below: https://www.cookiejargolf.com/315-course-diaries-royal-worlington-newmarket/ By no means least a link to Richard's Pitchmarks substack account can be found below https://pitchmarks.substack.com/ Episode music - Nectar by Dye O Supplied under license from Epidemic Sound Special Guest: Richard Pennell.

In questo episodio da In Laguna Film Fesitival a Venezia Leo e Marco Grifò di Salotto Monogatari dialogano con John Smith, ospite d'onore del festival, e i registi di alcuni film in concorso: Miranda Pennell, David Depesseville e Virgilio Villoresi.(Alcune parti dell'episodio sono in inglese senza sottotitoli)00:00:00 - Virgilio Villoresi00:22:26 - John Smith (ENG)00:54:18 - Miranda Pennel (ENG)01:11:46 - David Depesseville

Secondo appuntamento dalla quinta edizione di InLaguna Film Festival (https://www.inlagunafilmfestival.com/), in compagnia di Virgilio Villoresi, John Smith, Miranda Pennell e David Depesseville! Con Leo Canali (Casaba Podcast), Giulia Briccardi (direttrice artistica di InLaguna, presidente di Rete Cinema in Laguna) e Denis Previtera (programmer di InLaguna). Grazie a Panorama Venezia per l'ospitalità!Argomenti:00:00 - Virgilio Villoresi22:33 - John Smith54:28 - Miranda Pennell01:11:56 - David DepessevilleIl nostro canale Telegram per rimanere sempre aggiornati e comunicare direttamente con noi: https://t.me/SalottoMonogatariSpotify: https://open.spotify.com/show/2QtzE9ur6O1qE3XbuqOix0?si=mAN-0CahRl27M5QyxLg4cwApple Podcasts: https://podcasts.apple.com/it/podcast/salotto-monogatari/id1503331981Google Podcasts: https://www.google.com/podcasts?feed=aHR0cHM6Ly9hbmNob3IuZm0vcy8xNmM1ZjZiNC9wb2RjYXN0L3Jzcw==Logo creato da: Massimo ValentiSigla e post-produzione a cura di: Alessandro Valenti / Simone MalaspinaPer il jingle della sigla si ringraziano: Alessandro Corti e Gianluca NardoPer la gestione dei canali social si ringrazia:Selene Grifò

When Dale Earnhardt Jr. had his longtime friend and crew member Kevin “Two Beers” Pennell on the Download last time, their conversation was so engrossing that he had to come back for more. They pick up where they left off, in Dale Jr.'s rookie season in the famed Bud 8 car. They recall some choice encounters with Dale Sr., including a wreck at Bristol and their Cup debut at Martinsville, where Dale Jr. couldn't get out of the way quickly enough. Dale and Kevin relive their thrilling victory in the 2000 All-Star race, where some key decision-making by Tony Eury Jr. helped put them in contention. The 2001 Daytona 500 is also discussed, with both men sharing their respective experiences of the post-race events after Dale Sr.'s tragic accident. Dale and Kevin talk about some “ingenuity” and “innovation” that was taking place in the shop and on pit road to help close the gap on the more established Cup teams. They rehash the highs and lows of the 2001 season and their hot streak at Daytona and Talladega, which led up to the winning of the 2004 Daytona 500. Dale asks Kevin for his perspective on the team switch at Dale Earnhardt Inc., which stemmed from a falling out with Eury Jr. They also chat about Dale and Eury Jr. leaving for Hendrick Motorsports, and Kevin's decision to stay loyal to DEI. The interview goes on to cover the whirlwind years of DEI, which saw it get absorbed by Ginn Racing, the acquisition by Tony Stewart, and the inception of Stewart Haas Racing and its eventual closure at the end of the 2024 season. And for more content check out our YouTube page: https://www.youtube.com/@DirtyMoMediaReal fans wear Dirty Mo. Hit the link and join the crew.

Dale Earnhardt Jr. revisits some of his glory days in NASCAR as he sits down with longtime friend and crew member, Kevin “Two Beer” Pennell. Kevin's journey into the world of Dale Earnhardt Inc. came through his friendship with Tony Eury Jr. and their short track endeavors.Kevin recalls his first encounter with Dale Earnhardt Sr., which came while he was working underneath a late model with Tony Jr. When he was finishing his high school education, Dale Sr. encouraged him to stick it out despite teasing from his shop co-workers. Kevin says that the day he finished school, Dale hired him full-time.The guys also chat about the inception of the AC Delco Busch Series team, Dale Jr.'s path to becoming a full-time racer and the Bud-8 team's rookie season. This interview is chock-full of incredible memories and never before heard stories, and this is just the beginning of the discussion. Expect to see Kevin back on the Dale Jr. Download soon. And for more content check out our YouTube page: https://www.youtube.com/@DirtyMoMediaReal fans wear Dirty Mo. Hit the link and join the crew.

The Cognitive Crucible is a forum that presents different perspectives and emerging thought leadership related to the information environment. The opinions expressed by guests are their own, and do not necessarily reflect the views of or endorsement by the Information Professionals Association. During this episode, Dr. John Pennell discusses his book and Ph.D. research: Assessing Russia's Actions in Ukraine and Syria, 2014–2022 Implications for the Changing Character of War. Recording Date: 4 Sep 2025 Research Question: John Pennell suggests an interested student or researcher examine:  How can we better inform the American public about the information space; focusing on informing the American public about threats from adversaries and discerning fact from fiction. How Russian information operations has evolved since 2022; studying the evolving Russian information operations since 2014, including the shift in approach in 2022, as well as the influence of non-state actors like criminal syndicates and drug cartels in the information space. Resources: Cognitive Crucible Podcast Episodes Mentioned #151 Daniel Runde on Chinese Soft Power #230 Randy Rosin on Warfare is Informational; the Case for a New DoD Information Paradigm Assessing Russia's Actions in Ukraine and Syria, 2014–2022 Implications for the Changing Character of War By John A. Pennell Link to full show notes and resources Guest Bio:  Dr. Pennell is a highly accomplished, retired US senior foreign service officer (Minister-Counselor rank), with 20+ years of executive-level experience leading multidisciplinary, interagency, and joint teams to oversee US cooperation programs across Africa, Eurasia, the Indo-Pacific, Latin America, and the Middle East. He has deep expertise in irregular warfare, strategic competition, public diplomacy, strategic communications, and countering hybrid threats including in high-threat, gray-zone, and/or active combat environments.  He's currently a Senior Diplomacy Fellow with Narrative-Strategies, Senior Strategic Advisor with Pax Strategies LLC, and Senior Practitioner (pro bono) with the US Department of Defense's Irregular Warfare Center (IWC) in the intelligence, operations in the information environment, and emerging tech networks. He's also a subject matter expert reviewer (pro bono) for National Defense University's Joint Forces Quarterly (JFQ) and an International Advisory Board Member of Ukraine Foundation, a Swiss-based organization focused on peace processes and conflict resolution in Ukraine. In addition to being a lifetime member of the Information Professionals Association (IPA), he's a member of the American Foreign Service Association (AFSA), Baltimore Council on Foreign Affairs (BCFA), Foreign Policy for America (FP4A), Intelligence and National Security Alliance (INSA), and National Security Leaders for America (NSL4A).  He has a PhD in War & Defense Studies from King's College London and Masters degrees from the National War College and American University. His book on Russia's irregular warfare activities in Syria and Ukraine is available from Bloomsbury, Amazon, Waterstones, etc. You can also visit his website. About: The Information Professionals Association (IPA) is a non-profit organization dedicated to exploring the role of information activities, such as influence and cognitive security, within the national security sector and helping to bridge the divide between operations and research. Its goal is to increase interdisciplinary collaboration between scholars and practitioners and policymakers with an interest in this domain. For more information, please contact us at communications@information-professionals.org. Or, connect directly with The Cognitive Crucible podcast host, John Bicknell, on LinkedIn. Disclosure: As an Amazon Associate, 1) IPA earns from qualifying purchases, 2) IPA gets commissions for purchases made through links in this post.

What happens when your dream job starts crushing your values instead of honoring them?In this episode, Steph Pennell—founder of The Event Critic and former marketing leader—opens up about the moments that pushed her to reevaluate everything. From getting a shocking piece of feedback about wearing red lipstick to quitting a high-profile job with no backup plan, Steph shares what it takes to walk away from misalignment and rebuild your career around who you actually are.We talk about the events industry, the power of self-awareness, and how manifestation, ADHD diagnosis, and human design helped her take back control. Whether you've ever felt like you're “too much” or you're navigating burnout behind the scenes, this one's for you.In this conversation, you'll learn:How Steph went from bartending to running high-impact eventsWhat it feels like when your work and values are out of syncHow to navigate inappropriate or personal feedbackWhat manifestation and human design taught her about leadershipThings to listen for:(00:00) Intro(02:29) Foundation-setting experiences(06:19) Finding the right career path(07:31) Thank you to our sponsors, Navattic and Appcues(11:33) Losing love for events and getting it back(14:21) Coaching, core values, and finding alignment(22:16) ADHD, rest cycles, and human design(23:14) Giving feedback without repeating past mistakes(26:36) Balancing professional and personal boundaries(42:21) Manifestation and human design insights(46:43) What's holding you back?This episode is presented by:Navattic: Interactive Product Demo Software - https://navattic.com/value Appcues: User Engagement for SaaS - https://appcues.com/value Resources:Connect with Steph:LinkedIn: https://www.linkedin.com/in/theeventcritic/The Event Critic: https://www.linkedin.com/company/eventcriticofficial/Connect with Andrew:LinkedIn: https://www.linkedin.com/in/andrewcapland/ Substack: https://media.deliveringvalue.coHire Andrew as your coach: https://deliveringvalue.co/coaching

Dr. Vamsi Velcheti and Dr. Nate Pennell discuss novel treatment approaches in small cell and non-small cell lung cancer that were featured at the 2025 ASCO Annual Meeting. TRANSCRIPT Dr. Vamsi Velcheti: Hello, I'm Dr. Vamsi Velcheti, your guest host of the ASCO Daily News Podcast. I'm a professor of medicine and chief of hematology and oncology at the Mayo Clinic in Jacksonville, Florida. The 2025 ASCO Annual Meeting featured some exciting advancements in small cell lung cancer, targeted therapies for non-small cell lung cancer, and other novel [treatment] approaches. Today, I'm delighted to be joined by Dr. Nate Pennell to discuss some of the key abstracts that are advancing the lung cancer field. Dr. Pennell is the co-director of the Cleveland Clinic Lung Cancer Program and also the vice chair of clinical research at the Taussig Cancer Institute. Our full disclosures are available in the transcript of this episode. Nate, it's great to have you back on the podcast. Thanks so much for being here. Dr. Nate Pennell: Thanks, Vamsi. Always a pleasure. Dr. Vamsi Velcheti: Let's get started, and I think the first abstract that really caught my attention was Abstract 8516, “The Randomized Trial of Relevance of Time of Day of Immunotherapy for Progression-Free and Overall Survival in Patients With Non-Small Cell Lung Cancer.” What are your thoughts about this, Nate? Dr. Nate Pennell: I agree. I thought this was one of the most discussed abstracts, certainly in the lung cancer session, but I think even outside of lung cancer, it got some discussion. So, just to put this in perspective, there have been a number of publications that have all been remarkably consistent, and not just in lung cancer but across multiple cancer types, that immunotherapy, immune checkpoint inhibitors, are commonly used. And all of them have suggested, when looking at retrospective cohorts, that patients who receive immune checkpoint inhibitors earlier in the day – so in the morning or before the early afternoon – for whatever reason, appear to have better outcomes than those who get it later in the day, and this has been repeated. And I think many people just sort of assumed that this was some sort of strange association and that there was something fundamentally different from a prognostic standpoint in people who came in in the morning to get their treatment versus those who came later in the afternoon, and that was probably the explanation. The authors of this randomized trial actually decided to test this concept. And so, about 210 patients with previously untreated advanced non-small cell lung cancer were randomly assigned to get chemo and immune checkpoint inhibitor – either pembrolizumab or sintilimab – and half of them were randomly assigned to get the treatment before 3 PM in the afternoon, and half of them were assigned to get it after 3 PM in the afternoon. And it almost completely recapitulated what was seen in the retrospective cohorts. So, the median progression-free survival in those who got earlier treatment was 13.2 months versus only 6.5 months in those who got it later in the day. So, really enormous difference with a hazard ratio of 0.43, which was statistically significant. And perhaps even more striking, the median overall survival was not reached in the early group versus 17.8 months in the late group with a hazard ratio of 0.43, also highly statistically significant. Even the response rate was 20% higher in the early patients; 75% response rate compared to 56% in the late-time-of-day patients. So very consistent across all measures of efficacy with pretty good matched characteristics across the different groups. And so, I have to tell you, I don't know what to make of this. I certainly was a skeptic about the retrospective series, but now we have a prospective randomized trial that shows essentially the same thing. So, maybe there is a difference between getting treated in the morning, although I have yet to hear someone give a very good mechanistic explanation as to why this would be. What were your thoughts on this? Dr. Vamsi Velcheti: It's indeed fascinating, Nate, and I actually think this was a very interesting abstract. Really, I was caught off guard looking at the data. I mean, if it were a drug, we would be so excited, right? I mean, with those kind of survival benefits. I don't know. I think circadian rhythm probably has something to do with it, like different cytokine profiles at the time of administration. I mean, who knows? But I think it's a randomized trial, and I think I would expect to see a mad rush for treatment appointments early in the morning given this, and at least I want my patients to come in first thing in the morning. It'll be interesting to see. Dr. Nate Pennell: It's important to point out that in this study, everyone got chemo and immunotherapy. And, at least in our cancer center, most patients who are getting platinum-doublet chemotherapy and immunotherapy actually do get treated earlier in the day already, just because of the length of the infusion appointment that's needed. So it really is oftentimes people getting single-agent immunotherapy who are often getting the later, shorter visits. But if you have a choice, I think it would be very reasonable to have people treated earlier in the day. And I do think most of the impressions that I got from people about this is that they would like to see it reproduced but certainly well worth further investigation. And I personally would like to see more investigation into what the rationale would be for this because I still can't quite figure out, yes, if you got it at, say, you know, 5 PM, that's later in the day and I can understand that maybe your immune system is somewhat less receptive at that point than it would be in the morning. But because these checkpoint inhibitors have such long half-lives, it's still in your system the next morning when your immune system is supposedly more receptive. So I don't quite understand why that would be the case. Well, let's move on to the next study. I would like to hear your thoughts on Abstract 8515, “Plasma-Guided, Adaptive First-Line Chemoimmunotherapy for Non-Small Cell Lung Cancer.” Dr. Vamsi Velcheti: Yeah, this was another abstract that seems to be really interesting in my opinion. I think there's kind of a lot of emphasis lately on ctDNA and MRD-based assays to monitor disease. In the lung cancer space, we haven't had a lot of clinical trials looking at this prospectively, and this was one of those pilot studies where they looked at circulating free DNA (cfDNA)-based response-adaptive strategy for frontline patients who are PD-L1 positive. So, patients started with pembrolizumab monotherapy, and based on plasma molecular response after 2 cycles, those patients without response received early treatment intensification with a platinum doublet. So the approach essentially was to reduce the chemotherapy exposure in patients who respond to immunotherapy. And only about 17.5% of the patients on the trial received chemotherapy based on lack of molecular response. So, in this trial, what they found was patients with the cfDNA response had a markedly improved PFS of 16.4 months versus 4.8 months. So essentially, like, this is a really nice study to set a foundation on which we have to do larger studies to incorporate molecular markers trying to look at cfDNA response to inform treatment strategy, either escalation or de-escalation strategies. So, I thought it was a very interesting study. Dr. Nate Pennell: Yeah. I mean, we always have this question for patients, “Should they get immunotherapy alone or combined with chemo?” and I think this certainly is intriguing, suggesting that there may be ways you can monitor people and perhaps rescue those that aren't going to respond to single agent. I'd like to see a randomized trial against, you know, this strategy, perhaps against everyone getting, say, chemoimmunotherapy or make sure that you're not potentially harming people by doing this strategy. But I agree, it's time to move beyond just observing that cell-free DNA is prognostic and important and start using it to actually guide treatment. Dr. Vamsi Velcheti: Yeah, and I would just caution though, like, you know, I think we need more data, but, however, it's certainly a very interesting piece of data to kind of help inform future trials. So, there was another abstract that caught my attention, and I think this would be a very interesting abstract in the EGFR space. Abstract 8506, "Patritumab Deruxtecan (HER3-DXd) in Resistant EGFR-Mutant Advanced Non-Small Cell Lung Cancer Patients After Third-Generation EGFR TKI," it's the HERTHENA-Lung02 study. What do you think about the results of this study? Dr. Nate Pennell: Yeah, this was, I would say, very widely anticipated and ultimately a little disappointing, despite being a positive trial. So, these are patients with EGFR-mutant non-small cell lung cancer who have progressed after a third-generation EGFR TKI like osimertinib. This is really an area of major unmet need. We do have drugs like amivantamab in this space, but still definitely an area where essentially patients move from having a highly effective oral therapy to being in the realm of chemotherapy as their best option. So, this HER3 antibody-drug conjugate, patritumab deruxtecan, had some good single-arm data for this. And we're sort of hoping this would become an available option for patients. This trial was designed against platinum-doublet chemotherapy in this setting and with a primary endpoint of progression-free survival. And it actually was positive for improved progression-free survival compared to chemo with a hazard ratio of 0.77. But when you look at the medians, you can see that the median PFS was only 5.8 versus 5.4 months. It was really a modest difference between the two arms. And on the interim analysis, it appeared that there will not be a difference in overall survival between the two arms. In fact, the hazard ratio at the interim analysis was 0.98 for the two arms. So based on this, unfortunately, the company that developed the HER3-DXd has withdrawn their application to the FDA for approval of the drug, anticipating that they probably wouldn't get past approval without that overall survival endpoint. So, unfortunately, probably not, at least for the near future, going to be a new option for these patients. Dr. Vamsi Velcheti: Yeah, I think this is a space that's clearly an unmet need, and this was a big disappointment, I should say. I think all of us were going into the meeting anticipating some change in the standard of care here. Dr. Nate Pennell: Yeah, I agree. It was something that I was telling patients, honestly, that I was expecting this to be coming, and so now, definitely a bit of a disappointment. But it happens and, hopefully, it will still find perhaps a role or other drugs with a similar target. Certainly an active area. Well, let's leave the EGFR-mutant space and move into small cell. There were a couple of very impactful studies. And one of them was Abstract 8006, “Lurbinectedin Plus Atezolizumab as First-Line Maintenance Treatment in Patients With Extensive-Stage Small Cell Lung Cancer, Primary Results from the Phase III IMforte Trial.” So, what was your impression of this? Dr. Vamsi Velcheti: Yeah, I think this is definitely an interesting study, and small cell, I remember those days when we had barely any studies of small cell at ASCO, and now we have a lot of exciting developments in the small cell space. It's really good to see. The IMforte trial is essentially like a maintenance lurbinectedin trial with atezolizumab maintenance. And the study was a positive trial. The primary endpoint was a PFS, and the study showed improvement in both PFS and OS with the addition of lurbinectedin to atezolizumab maintenance. And definitely, it's a positive trial, met its primary endpoint, but I always am a little skeptical of adding maintenance cytotoxic therapies here in this setting. In my practice, and I'd like to hear your opinion, Nate, most patients with small cell after 4 cycles of a platinum doublet, they're kind of really beaten up. Adding more cytotoxic therapy in the maintenance space is going to be tough, I think, for a lot of patients. But also, most importantly, I think this rapidly evolving landscape for patients with small cell lung cancer with multiple new, exciting agents, actually like some FDA-approved like tarlatamab, also like a lot of these emerging therapeutics like I-DXd and other ADCs in this space. You kind of wonder, is it really optimal strategy to bring on like another cytotoxic agent right after induction chemotherapy, or do you kind of delay that? Or maybe have like a different strategy in terms of maintenance. I know that the tarlatamab maintenance trial is probably going to read out at some point too. I think it's a little challenging. The hazard ratio is also 0.73. As I said, it's a positive trial, but it's just incremental benefit of adding lurbi. And also on the trial, we need to also pay attention to the post-progression second-line treatments, number of patients who received tarlatamab or any other investigational agents.  So I think it's a lot of questions still. I'm not quite sure I'd be able to embrace this completely. I think a vast majority of my patients might not be eligible anyway for cytotoxic chemotherapy maintenance right away, but yeah, it's tough. Dr. Nate Pennell: Yeah. I would call this a single and not a home run. It definitely is real. It was a real overall survival benefit. Certainly not surprising that a maintenance therapy would improve progression-free survival. We've known that for a long time in small cell, but first to really show an overall survival benefit. But I completely agree with you. I mean, many people are not going to want to continue further cytotoxics after 4 cycles of platinum-doublet chemo. So I would say, for those that are young and healthy and fly through chemo without a lot of toxicity, I think certainly something worth mentioning. The problem with small cell, of course, is that so many people get sick so quickly while on that observation period after first-line chemo that they don't make it to second-line treatment. And so, giving everyone maintenance therapy essentially ensures everyone gets that second-line treatment. But they also lose that potentially precious few months where they feel good and normal and are able to be off of treatment. So, I would say this is something where we're really going to have to kind of sit and have that shared decision-making visit with patients and decide what's meaningful to them. Dr. Vamsi Velcheti: Yeah, I agree. The next abstract that was a Late-Breaking Abstract, 8000, “Overall Survival of Neoadjuvant Nivolumab Plus Chemotherapy in Patients With Resectable Non-Small Cell Lung Cancer in CheckMate-816.” This was a highly anticipated read-out of the OS data from 816. What did you make of this abstract? Dr. Nate Pennell: Yeah, I thought this was great. Of course, CheckMate-816 changed practice a number of years ago when it first reported out. So, this was the first of the neoadjuvant or perioperative chemoimmunotherapy studies in resectable non-small cell lung cancer. So, just to review, this was a phase 3 study for patients with what we would now consider stage II or stage IIIA resectable non-small cell lung cancer. And they received three cycles of either chemotherapy or chemotherapy plus nivolumab, and that was it. That was the whole treatment. No adjuvant treatment was given afterwards. They went to resection. And patients who received the chemoimmunotherapy had a much higher pathologic complete response rate and a much better event-free survival. And based on this, this regimen was approved and, I think, at least in the United States, widely adopted.  Now, since the first presentation of CheckMate 816, there have been a number of perioperative studies that have included an adjuvant component of immunotherapy – KEYNOTE-671, the AEGEAN study – and these also have shown improved outcomes. The KEYNOTE study with pembrolizumab also with an overall survival benefit. And I think people forgot a little bit about CheckMate-816. So, this was the 5-year overall survival final analysis. And it did show a statistically and, I think, clinically meaningful difference in overall survival with the 3 cycles of neoadjuvant chemo-nivo compared to chemo with a hazard ratio of 0.72. The 5-year overall survival of 65% in the chemo-IO group versus 55% with the chemo alone. So a meaningful improvement. And interestingly, that hazard ratio of 0.72 is very similar to what was seen in the peri-operative pembro study that included the adjuvant component. So, very much still relevant for people who think that perhaps the value of those neoadjuvant treatments might be really where most of the impact comes from this type of approach. They also gave us an update on those with pathologic complete response, showing really astronomically good outcomes. If you have a pathologic complete response, which was more than a quarter of patients, the long-term survival was just phenomenal. I mean, 95% alive at 5 years if they were in that group and suggesting that in those patients at least, the adjuvant treatment may not be all that important.  So, I think this was an exciting update and still leaves very much the open question about the importance of continuing immunotherapy after surgery after the neoadjuvant component. Dr. Vamsi Velcheti: Yeah, I completely agree, Nate. I think the million-dollar question is: “Is there like a population of patients who don't have complete response but like maybe close to complete response?” So, would you like still consider stopping adjuvant IO? I probably would not be comfortable, but I think sometimes, you know, we all have patients who are like very apprehensive of continuing treatments. So, I think that we really need more studies, especially for those patients who don't achieve a complete CR. I think trying to find strategies for like de-escalation based on MRD or other risk factors. But we need more trials in that space to inform not just de-escalation, but there are some patients who don't respond at all to a neoadjuvant IO. So, there may be an opportunity for escalating adjuvant therapies. So, it is an interesting space to watch out for. Dr. Nate Pennell: No, absolutely. Moving to KRAS-mutant space, so our very common situation in patients with non-small cell lung cancer, we had the results of Abstract 8500, “First-Line Adagrasib With Pembrolizumab in Patients With Advanced or Metastatic KRASG12C-Mutated Non-Small Cell Lung Cancer” from the phase 2 portion of the KRYSTAL-7 study. Why was this an interesting and important study? Dr. Vamsi Velcheti: First of all, there were attempts to kind of combine KRASG12C inhibitors in the past with immune checkpoint inhibitors, notably sotorasib with pembrolizumab. Unfortunately, those trials have led to like a lot of toxicity, with increased especially liver toxicity, which was a major issue. This is a phase 2 study of adagrasib in combination with pembrolizumab, and this is a study in the frontline setting in patients with the G12C-mutant metastatic non-small cell lung cancer. And across all the PD-L1 groups, the ORR was 44%, and the median PFS was 11 months, comparable to the previous data that we have seen with adagrasib in this setting. So it's not like a major improvement in clinical efficacy. However, I think the toxicity profile that we were seeing was slightly better than the previous trials in combination with sotorasib, but you still have a fair amount of transaminitis even in the study. At this point, this is not ready for clinical primetime. I don't think we should be using sotorasib or adagrasib in the frontline or even in the second line in combination with checkpoint inhibitors. Combining these drugs with checkpoint inhibitors in the clinical practice might lead to adverse outcomes. So, we need to wait for more data like newer-generation G12C inhibitors which are also being studied in combination, so we'll have to kind of wait for more data to emerge in this space. Dr. Nate Pennell: I agree, this is not immediately practice changing. This is really an attempt to try to combine targeted treatment with immune checkpoint inhibitor. And I agree with you that, you know, it does appear to be perhaps a little bit better tolerated than some of the prior combinations that have tried in this space. The outcomes overall were not that impressive, although in the PD-L1 greater than 50%, it did have a better response rate perhaps than you would expect with either drug alone. And I do think that the company is focusing on that population for a future randomized trial, which certainly would inform this question better. But in the meantime, I agree with you, there's a lot of newer drugs that are coming along that potentially may be more active and better tolerated. And so, I'd say for now, interesting but we'll wait and see. Dr. Vamsi Velcheti: Yeah, so now moving back again to small cell. So, there was a Late-Breaking Abstract, 8008. This is a study of tarlatamab versus chemotherapy as second-line treatment for small cell lung cancer. They presented the primary analysis of the phase III DeLLphi-304 study. What do you think about this? Dr. Nate Pennell: Yeah, I thought this was really exciting. This was, I would say, perhaps the most important lung study that was presented. Tarlatamab is, of course, the anti-DLL3 bispecific T-cell engager compound, which is already FDA approved based on a prior single-arm phase II study, which showed a very nice response rate as a single agent in previously treated small cell lung cancer and relatively manageable side effects, although somewhat unique to solid tumor docs in the use of these bispecific drugs in things like cytokine release syndrome and ICANS, the neurologic toxicities. So, this trial was important because tarlatamab was approved, but there were also other chemotherapy drugs approved in the previously treated space. And so, this was a head-to-head second-line competition comparison between tarlatamab and either topotecan, lurbinectedin, or amrubicin in previously treated small cell patients with a primary endpoint of overall survival. So, a very well-designed trial. And it did show, I think, a very impressive improvement in overall survival with a median overall survival in the tarlatamab group of 13.6 months compared to 8.3 months with chemotherapy, hazard ratio of 0.6. And progression-free survival was also longer at 4.2 months versus 3.2 months, hazard ratio of 0.72. In addition to showing improvements in cancer-related symptoms that were improved in tarlatamab compared to chemotherapy, there was actually also significantly lower rates of serious treatment-related adverse events with tarlatamab compared to chemotherapy. So, you do still see the cytokine release syndrome, which is seen in most people but is manageable because these patients are admitted to the hospital for the first two cycles, as well as a significant number of patients with neurologic side effects, the so-called ICANS, which also can be treated with steroids. And so, I think based upon the very significant improvement in outcomes, I would expect that this should become our kind of standard second-line treatment since it seems to be much better than chemo. However, tarlatamab is definitely a new drug that a lot of places are not used to using, and I think a lot of cancer centers, especially ones that aren't tied to a hospital, may have questions about how to deal with the CRS. So, I'm curious your thoughts on that. Dr. Vamsi Velcheti: Yeah, thank you, Nate. And I completely agree. I think the data looked really promising, and I've already been using tarlatamab in the second-line space. The durability of response and overall, having used tarlatamab quite a bit - like, I participated in some of the early trials and also used it as standard of care - tarlatamab has unique challenges in terms of like need for hospitalization for monitoring for the first few treatments and make sure, you know, we monitor those patients for CRS and ICANS. But once you get past that initial administration and monitoring of CRS, these patients have a much better quality of life, they're off chemotherapy, and I think it's really about the logistics of actually administering tarlatamab and coordination with the hospital and administration in the outpatient setting. It's definitely challenging, but I think it definitely can be done and should be done given what we are seeing in terms of clinical efficacy here. Dr. Nate Pennell: I agree. I think hospital systems now are just going to have to find a way to be able to get this on formulary and use it because it clearly seems to be more effective and generally better tolerated by patients. So, should move forward, I think. Finally, there's an abstract I wanted to ask you about, Abstract 8001, which is the “Neoadjuvant osimertinib with or without chemotherapy versus chemotherapy alone in resectable epidermal growth factor receptor-mutated non-small cell lung cancer: The NeoADAURA Study”. And this is one that I think was also fairly highly anticipated. So, what are your thoughts? Dr. Vamsi Velcheti: You know, I wasn't probably surprised with the results, and I believe we were all expecting a positive trial, and we certainly were handed a positive trial here. It's a phase III trial of osimertinib and chemotherapy or osimertinib in the neoadjuvant space followed by surgery, followed by osimertinib. It's a global phase 3 trial and very well conducted, and patients with stage II to stage IIIB were enrolled in the study. And in the trial, patients who had a neoadjuvant osimertinib with or without chemotherapy showed a significant improvement in major pathologic response rates over chemotherapy alone. And the EFS was also positive for osimertinib and chemotherapy, osimertinib monotherapy as well compared to chemotherapy alone. So overall, the study met its primary endpoint, and I think it sheds light on how we manage our patients with early-stage lung cancer. I think osimertinib, we know that osimertinib is already FDA approved in the adjuvant space, but what we didn't really know is how was osimertinib going to work in the neoadjuvant space. And there are always situations, especially for stage III patients, where we are on the fence about, are these patients already close to being metastatic? They have, like, almost all these patients have micrometastatic disease, even if they have stage III. As we saw in the LAURA data, when you look at the control arm, it was like a very short PFS. Chemoradiation does nothing for those patients, and I think these patients have systemic mets, either gross or micrometastatic disease at onset. So, it's really important to incorporate osimertinib early in the treatment course. And I think, especially for the locally advanced patients, I think it's even more important to kind of incorporate osimertinib in the neoadjuvant space and get effective local control with surgery and treat them with adjuvant. I'm curious to hear your thoughts, Nate. Dr. Nate Pennell: I am a believer and have long been a believer in targeted adjuvant treatments, and, you know, it has always bothered me somewhat that we're using our far and away most effective systemic therapy; we wait until after they go through all their pre-op treatments, they go through surgery, then they go through chemotherapy, and then finally months later, they get their osimertinib, and it still clearly improves survival in the adjuvant setting. Why not just start the osimertinib as soon as you know that the patient has EGFR-mutant non-small cell lung cancer, and then you can move on to surgery and adjuvant treatment afterwards? And I think what was remarkable about this study is that all of these patients almost - 90% in each arm - went to surgery. So, you weren't harming them with the neoadjuvant treatment. And clearly better major pathologic response, nodal downstaging, event-free survival was better. But I don't know that this trial is ever going to show an overall survival difference between neoadjuvant versus just surgery and adjuvant treatment, given how effective the drug is in the adjuvant setting. Nonetheless, I think the data is compelling enough to consider this, certainly for our N2-positive, stage IIIA patients or a IIIB who might be otherwise surgical candidates. I think based on this, I would certainly consider that. Dr. Vamsi Velcheti: Yeah, and especially for EGFR, like even for stage IIIB patients, in the light of the LAURA study, those patients who do not do too well with chemoradiation. So you're kind of delaying effective systemic therapy, as you said, waiting for the chemoradiation to finish. So I think probably time to revisit how we kind of manage these locally advanced EGFR patients. Dr. Nate Pennell: Yep, I agree. Dr. Vamsi Velcheti: Nate, thank you so much for sharing your fantastic insights today on the ASCO Daily News Podcast. It's been an exciting ASCO again. You know, we've seen a lot of positive trials impacting our care of non-small cell lung cancer and small cell lung cancer patients. Dr. Nate Pennell: Thanks for inviting me, Vamsi. Always a pleasure to discuss these with you. Dr. Vamsi Velcheti: And thanks to our listeners for your time today. You will find links to all of the abstracts discussed today in the transcript of the episode. Finally, if you value the insights that you hear from the ASCO Daily News Podcast, please take a moment to rate, review, subscribe wherever you get your podcast. Disclaimer: The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. Guest statements on the podcast do not express the opinions of ASCO. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement. More on today's speakers:    Dr. Vamsi Velcheti   @VamsiVelcheti    Dr. Nathan Pennell   @n8pennell   Follow ASCO on social media:     @ASCO on Twitter     ASCO on Facebook     ASCO on LinkedIn   ASCO on BlueSky   Disclosures:   Dr. Vamsi Velcheti:   Honoraria: ITeos Therapeutics   Consulting or Advisory Role: Bristol-Myers Squibb, Merck, Foundation Medicine, AstraZeneca/MedImmune, Novartis, Lilly, EMD Serono, GSK, Amgen, Elevation Oncology, Taiho Oncology, Merus   Research Funding (Inst.): Genentech, Trovagene, Eisai, OncoPlex Diagnostics, Alkermes, NantOmics, Genoptix, Altor BioScience, Merck, Bristol-Myers Squibb, Atreca, Heat Biologics, Leap Therapeutics, RSIP Vision, GlaxoSmithKline   Dr. Nathan Pennell:     Consulting or Advisory Role: AstraZeneca, Lilly, Cota Healthcare, Merck, Bristol-Myers Squibb, Genentech, Amgen, G1 Therapeutics, Pfizer, Boehringer Ingelheim, Viosera, Xencor, Mirati Therapeutics, Janssen Oncology, Sanofi/Regeneron    Research Funding (Inst): Genentech, AstraZeneca, Merck, Loxo, Altor BioScience, Spectrum Pharmaceuticals, Bristol-Myers Squibb, Jounce Therapeutics, Mirati Therapeutics, Heat Biologics, WindMIL, Sanofi 

Dr. Nathan Pennell and Dr. Cheryl Czerlanis discuss challenges in lung cancer screening and potential solutions to increase screening rates, including the use of AI to enhance risk prediction and screening processes. Transcript Dr. Nate Pennell: Hello, and welcome to By the Book, a monthly podcast series for ASCO Education that features engaging discussions between editors and authors from the ASCO Educational Book. I'm Dr. Nate Pennell, the co-director of the Cleveland Clinic Lung Cancer Program and vice chair of clinical research for the Taussig Cancer Center. I'm also the editor-in-chief for the ASCO Educational Book.  Lung cancer is one of the leading causes of cancer-related mortality worldwide, and most cases are diagnosed at advanced stages where curative treatment options are limited. On the opposite end, early-stage lung cancers are very curable. If only we could find more patients at that early stage, an approach that has revolutionized survival for other cancer types such as colorectal and breast cancer.  On today's episode, I'm delighted to be joined by Dr. Cheryl Czerlanis, a professor of medicine and thoracic medical oncologist at the University of Wisconsin Carbone Cancer Center, to discuss her article titled, "Broadening the Net: Overcoming Challenges and Embracing Novel Technologies in Lung Cancer Screening." The article was recently published in the ASCO Educational Book and featured in an Education Session at the 2025 ASCO Annual Meeting. Our full disclosures are available in the transcript of this episode.  Cheryl, it's great to have you on the podcast today. Thanks for being here. Dr. Cheryl Czerlanis: Thanks, Nate. It's great to be here with you. Dr. Nate Pennell: So, I'd like to just start by asking you a little bit about the importance of lung cancer screening and what evidence is there that lung cancer screening is beneficial. Dr. Cheryl Czerlanis: Thank you. Lung cancer screening is extremely important because we know that lung cancer survival is closely tied to stage at diagnosis. We have made significant progress in the treatment of lung cancer, especially over the past decade, with the introduction of immunotherapies and targeted therapies based on personalized evaluation of genomic alterations. But the reality is that outside of a lung screening program, most patients with lung cancer present with symptoms related to advanced cancer, where our ability to cure the disease is more limited.  While lung cancer screening has been studied for years, the National Lung Screening Trial, or the NLST, first reported in 2011 a significant reduction in lung cancer deaths through screening. Annual low-dose CT scans were performed in a high-risk population for lung cancer in comparison to chest X-ray. The study population was comprised of asymptomatic persons aged 55 to 74 with a 30-pack-year history of smoking who were either active smokers or had quit within 15 years. The low-dose CT screening was associated with a 20% relative risk reduction in lung cancer-related mortality. A similar magnitude of benefit was also reported in the NELSON trial, which was a large European randomized trial comparing low-dose CT with a control group receiving no screening. Dr. Nate Pennell: So, this led, of course, to approval from CMS (Centers for Medicare and Medicaid Services) for lung cancer screening in the Medicare population, probably about 10 years ago now, I think. And there are now two major trials showing an unequivocal reduction in lung cancer-related mortality and even evidence that it reduces overall mortality with lung cancer screening. But despite this, lung cancer screening rates are very low in the United States. So, first of all, what's going on? Why are we not seeing the kinds of screening rates that we see with mammography and colonoscopy? And what are the barriers to that here? Dr. Cheryl Czerlanis: That's a great question. Thank you, Nate. In the United States, recruitment for lung cancer screening programs has faced numerous challenges, including those related to socioeconomic, cultural, logistical, and even racial disparities. Our current lung cancer screening guidelines are somewhat imprecise and often fail to address differences that we know exist in sex, smoking history, socioeconomic status, and ethnicity. We also see underrepresentation in certain groups, including African Americans and other minorities, and special populations, including individuals with HIV. And even where lung cancer screening is readily available and we have evidence of its efficacy, uptake can be low due to both provider and patient factors. On the provider side, barriers include having insufficient time in a clinic visit for shared decision-making, fear of missed test results, lack of awareness about current guidelines, concerns about cost, potential harms, and evaluating both true and false-positive test results.  And then on the patient side, barriers include concerns about cost, fear of getting a cancer diagnosis, stigma associated with tobacco smoking, and misconceptions about the treatability of lung cancer. Dr. Nate Pennell: I think those last two are really what make lung cancer unique compared to, say, for example, breast cancer, where there really is a public acceptance of the value of mammography and that breast cancer is no one's fault and that it really is embraced as an active way you can take care of yourself by getting your breast cancer screening. Whereas in lung cancer, between the stigma of smoking and the concern that, you know, it's a death sentence, I think we really have some work to be made up, which we'll talk about in a minute about what we can do to help improve this.  Now, that's in the U.S. I think things are probably, I would imagine, even worse when we leave the U.S. and look outside, especially at low- and middle-income countries. Dr. Cheryl Czerlanis: Yes, globally, this issue is even more complex than it is in the United States. Widespread implementation of low-dose CT imaging for lung cancer screening is limited by manpower, infrastructure, and economic constraints. Many low- and middle-income countries even lack sufficient CT machines, trained personnel, and specialized facilities for accurate and timely screenings. Even in urban centers with advanced diagnostic facilities, the high screening and follow-up care costs can limit access. Rural populations face additional barriers, such as geographic inaccessibility of urban centers, transportation costs, language barriers, and mistrust of healthcare systems. In addition, healthcare systems in these regions often prioritize infectious diseases and maternal health, leaving limited room for investments in noncommunicable disease prevention like lung cancer screening. Policymakers often struggle to justify allocating resources to lung cancer screening when immediate healthcare needs remain unmet. Urban-rural disparities exacerbate these challenges, with rural regions frequently lacking the infrastructure and resources to sustain screening programs. Dr. Nate Pennell: Well, it's certainly an intimidating problem to try to reduce these disparities, especially between the U.S. and low- and middle-income countries. So, what are some of the potential solutions, both here in the U.S. and internationally, that we can do to try to increase the rates of lung cancer screening? Dr. Cheryl Czerlanis: The good news is that we can take steps to address these challenges, but a multifaceted approach is needed. Public awareness campaigns focused on the benefits of early detection and dispelling myths about lung cancer screening are essential to improving participation rates. Using risk-prediction models to identify high-risk individuals can increase the efficiency of lung cancer screening programs. Automated follow-up reminders and screening navigators can also ensure timely referrals and reduce delays in diagnosis and treatment. Reducing or subsidizing the cost of low-dose CT scans, especially in low- or middle-income countries, can improve accessibility. Deploying mobile CT scanners can expand access to rural and underserved areas.  On a global scale, integrating lung cancer screening with existing healthcare programs, such as TB or noncommunicable disease initiatives, can enhance resource utilization and program scalability. Implementing lung cancer screening in resource-limited settings requires strategic investment, capacity building, and policy interventions that prioritize equity. Addressing financial constraints, infrastructure gaps, and sociocultural barriers can help overcome existing challenges. By focusing on cost-effective strategies, public awareness, and risk-based eligibility criteria, global efforts can promote equitable access to lung cancer screening and improve outcomes.  Lastly, as part of the medical community, we play an important role in a patient's decision to pursue lung cancer screening. Being up to date with current lung cancer screening recommendations, identifying eligible patients, and encouraging a patient to undergo screening often is the difference-maker. Electronic medical record (EMR) systems and reminders are helpful in this regard, but relationship building and a recommendation from a trusted provider are really essential here. Dr. Nate Pennell: I think that makes a lot of sense. I mean, there are technology improvements. For example, our lung cancer screening program at The Cleveland Clinic, a few years back, we finally started an automated best practice alert in our EMR for patients who met the age and smoking requirements, and it led to a six-fold increase in people referred for screening. But at the same time, there's a difference between just getting this alert and putting in an order for lung cancer screening and actually getting those patients to go and actually do the screening and then follow up on it. And that, of course, requires having that relationship and discussion with the patient so that they trust that you have their best interests. Dr. Cheryl Czerlanis: Exactly. I think that's important. You know, certainly, while technology can aid in bringing patients in, there really is no substitute for trust-building and a personal relationship with a provider. Dr. Nate Pennell: I know that there are probably multiple examples within the U.S. where health systems or programs have put together, I would say, quality improvement projects to try to increase lung cancer screening and working with their community. There's one in particular that you discuss in your paper called the "End Lung Cancer Now" initiative. I wonder if you could take us through that. Dr. Cheryl Czerlanis: Absolutely. "End Lung Cancer Now" is an initiative at the Indiana University Simon Comprehensive Cancer Center that has the vision to end suffering and death from lung cancer in Indiana through education and community empowerment. We discuss this as a paradigm for how community engagement is important in building and scaling a lung cancer screening program.  In 2023, the "End Lung Cancer Now" team decided to focus its efforts on scaling and transforming lung cancer screening rates in Indiana. They developed a task force with 26 experts in various fields, including radiology, pulmonary medicine, thoracic surgery, public health, and advocacy groups. The result of this work is an 85-page blueprint with key recommendations that any system and community can use to scale lung cancer screening efforts. After building strong infrastructure for lung cancer screening at Indiana University, they sought to understand what the priorities, resources, and challenges in their communities were. To do this, they forged strong partnerships with both local and national organizations, including the American Lung Association, American Cancer Society, and others. In the first year, they actually tripled the number of screening low-dose CTs performed in their academic center and saw a 40% increase system-wide. One thing that I think is the most striking is that through their community outreach, they learned that most people prefer to get medical care close to home within their own communities. Establishing a way to support the local infrastructure to provide care became far more important than recruiting patients to their larger system.  In exciting news, "End Lung Cancer Now" has partnered with the IU Simon Comprehensive Cancer Center and IU Health to launch Indiana's first and only mobile lung screening program in March of 2025. This mobile program travels around the state to counties where the highest incidence of lung cancer exists and there is limited access to screening. The mobile unit parks at trusted sites within communities and works in partnership, not competition, with local health clinics and facilities to screen high-risk populations. Dr. Nate Pennell: I think that sounds like a great idea. Screening is such an important thing that it doesn't necessarily have to be owned by any one particular health system for their patients. I think. And I love the idea of bringing the screening to patients where they are. I can speak to working in a regional healthcare system with a main campus in the downtown that patients absolutely hate having to come here from even 30 or 40 minutes away, and they'd much rather get their care locally. So that makes perfect sense.  So, under the current guidelines, there are certainly things that we can do to try to improve capturing the people that meet those. But are those guidelines actually capturing enough patients with lung cancer to make a difference? There certainly are proposals within patient advocacy communities and even other countries where there's a large percentage of non-smokers who perhaps get lung cancer. Can we expand beyond just older, current and heavy smokers to identify at-risk populations who could benefit from screening? Dr. Cheryl Czerlanis: Yes, I think we can, and it's certainly an active area of research interest. We know that tobacco is the leading cause of lung cancer worldwide. However, other risk factors include secondhand smoke, family history, exposure to environmental carcinogens, and pulmonary diseases like COPD and interstitial lung disease. Despite these known associations, the benefit of lung cancer screening is less well elucidated in never-smokers and those at risk of developing lung cancer because of family history or other risk factors. We know that the eligibility criteria associated with our current screening guidelines focus on age and smoking history and may miss more than 50% of lung cancers. Globally, 10% to 25% of lung cancer cases occur in never-smokers. And in certain parts of the world, like you mentioned, Nate, such as East Asia, many lung cancers are diagnosed in never-smokers, especially in women. Risk-prediction models use specific risk factors for lung cancer to enhance individual selection for screening, although they have historically focused on current or former smokers.  We know that individuals with family members affected by lung cancer have an increased risk of developing the disease. To this end, several large-scale, single-arm prospective studies in Asia have evaluated broadening screening criteria to never-smokers, with or without additional risk factors. One such study, the Taiwan Lung Cancer Screening in Never-Smoker Trial, was a multicenter prospective cohort study at 17 medical centers in Taiwan. The primary outcome of the TALENT trial was lung cancer detection rate. Eligible patients aged 55 to 75 had either never smoked or had a light and remote smoking history. In addition, inclusion required one or more of the following risk factors: family history of lung cancer, passive smoke exposure, history of TB or COPD, a high cooking index, which is a metric that quantifies exposure to cooking fumes, or a history of cooking without ventilation. Participants underwent low-dose CT screening at baseline, then annually for 2 years, and then every 2 years for up to 6 years. The lung cancer detection rate was 2.6%, which was higher than that reported in the NLST and NELSON trials, and most were stage 0 or I cancers. Subsequently, this led to the Taiwan Early Detection Program for Lung Cancer, a national screening program that was launched in 2022, targeting 2 screening populations: individuals with a heavy history of smoking and individuals with a family history of lung cancer.  We really need randomized controlled trials to determine the true rates of overdiagnosis or finding cancers that would not lead to morbidity or mortality in persons who are diagnosed, and to establish whether the high lung detection rates are associated with a decrease in lung cancer-related mortality in these populations. However, the implementation of randomized controlled low-dose CT screening trials in never-smokers has been limited by the need for large sample sizes, lengthy follow-up, and cost.  In another group potentially at higher risk for developing lung cancer, the role of lung cancer screening in individuals who harbor germline pathogenic variants associated with lung cancer also needs to be explored further. Dr. Nate Pennell: We had this discussion when the first criteria came out because there have always been risk-based calculators for lung cancer that certainly incorporate smoking but other factors as well and have discussion about whether we should be screening people based on their risk and not just based on discrete criteria such as smoking. But of course, the insurance coverage for screening, you have to fit the actual criteria, which is very constrained by age and smoking history. Do you think in the U.S. there's hope for broadening our screening beyond NLST and NELSON criteria? Dr. Cheryl Czerlanis: I do think at some point there is hope for broadening the criteria beyond smoking history and age, beyond the criteria that we have typically used and that is covered by insurance. I do think it will take some work to perhaps make the prediction models more precise or to really understand who can benefit. We certainly know that there are many patients who develop lung cancer without a history of smoking or without family history, and it would be great if we could diagnose more patients with lung cancer at an earlier stage. I think this will really count on there being some work towards trying to figure out what would be the best population for screening, what risk factors to look for, perhaps using some new technologies that may help us to predict who is at risk for developing lung cancer, and trying to increase the group that we study to try and find these early-stage lung cancers that can be cured. Dr. Nate Pennell: Part of the reason we, of course, try to enrich our population is screening works better when you have a higher pretest probability of actually having cancer. And part of that also is that our technology is not that great. You know, even in high-risk patients who have CT scans that are positive for a screen, we know that the vast majority of those patients with lung nodules actually don't have lung cancer. And so you have to follow them, you have to use various models to see, you know, what the risk, even in the setting of a positive screen, is of having lung cancer.  So, why don't we talk about some newer tools that we might use to help improve lung cancer screening? And one of the things that everyone is super excited about, of course, is artificial intelligence. Are there AI technologies that are helping out in early detection in lung cancer screening? Dr. Cheryl Czerlanis: Yes, that's a great question. We know that predicting who's at risk for lung cancer is challenging for the reasons that we talked about, knowing that there are many risk factors beyond smoking and age that are hard to quantify. Artificial intelligence is a tool that can help refine screening criteria and really expand screening access. Machine learning is a form of AI technology that is adept at recognizing patterns in large datasets and then applying the learning to new datasets. Several machine learning models have been developed for risk stratification and early detection of lung cancer on imaging, both with and without blood-based biomarkers. This type of technology is very promising and can serve as a tool that helps to select individuals for screening by predicting who is likely to develop lung cancer in the future.  A group at Massachusetts General Hospital, represented in our group for this paper by my co-authors, Drs. Fintelmann and Chang, developed Sybil, which is an open-access 3D convolutional neural network that predicts an individual's future risk of lung cancer based on the analysis of a single low-dose CT without the need for human annotation or other clinical inputs. Sybil and other machine learning models have tremendous potential for precision lung cancer screening, even, and perhaps especially, in settings where expert image interpretation is unavailable. They could support risk-adapted screening schedules, such as varying the frequency and interval of low-dose CT scans according to individual risk and potentially expand lung cancer screening eligibility beyond age and smoking history. Their group predicts that AI tools like Sybil will play a major role in decoding the complex landscape of lung cancer risk factors, enabling us to extend life-saving lung cancer screening to all who are at risk. Dr. Nate Pennell: I think that that would certainly be welcome. And as AI is working its way into pretty much every aspect of life, including medical care, I think it's certainly promising that it can improve on our existing technology.  We don't have to spend a lot of time on this because I know it's a little out of scope for what you covered in your paper, but I'm sure our listeners are curious about your thoughts on the use of other types of testing beyond CT screening for detecting lung cancer. I know that there are a number of investigational and even commercially available blood tests, for example, for detection of lung cancer, or even the so-called multi-cancer detection blood tests that are now being offered, although not necessarily being covered by insurance, for multiple types of cancer, but lung cancer being a common cancer is included in that. So, what do you think? Dr. Cheryl Czerlanis: Yes, like you mentioned, there are novel bioassays such as blood-based biomarker testing that evaluate for DNA, RNA, and circulating tumor cells that are both promising and under active investigation for lung cancer and multi-cancer detection. We know that such biomarker assays may be useful in both identifying lung cancers but also in identifying patients with a high-risk result who should undergo lung cancer screening by conventional methods. Dr. Nate Pennell: Anything that will improve on our rate of screening, I think, will be welcome. I think probably in the future, it will be some combination of better risk prediction and better interpretation of screening results, whether those be imaging or some combination of imaging and biomarkers, breath-based, blood-based. There's so much going on that it is pretty exciting, but we're still going to have to overcome the stigma and lack of public support for lung cancer screening if we're going to move the needle. Dr. Cheryl Czerlanis: Yes, I think moving the needle is so important because we know lung cancer is still a very morbid disease, and our ability to cure patients is not where we would like it to be. But I do believe there's hope. There are a lot of motivated individuals and groups who are passionate about lung cancer screening, like myself and my co-authors, and we're just happy to be able to share some ways that we can overcome the challenges and really try and make an impact in the lives of our patients. Dr. Nate Pennell: Well, thank you, Dr. Czerlanis, for joining me on the By the Book Podcast today and for all of your work to advance care for patients with lung cancer. Dr. Cheryl Czerlanis: Thank you, Dr. Pennell. It's such a pleasure to be with you today. Thank you. Dr. Nate Pennell: And thank you to our listeners for joining us today. You'll find a link to Dr. Czerlanis' article in the transcript of this episode.  Please join us again next month for By the Book's next episode and more insightful views on topics you'll be hearing at the education sessions from ASCO meetings throughout the year, and our deep dives on approaches that are shaping modern oncology. Disclaimer: The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. Guest statements on the podcast do not express the opinions of ASCO. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement. Follow today's speakers:     Dr. Nathan Pennell    @n8pennell   @n8pennell.bsky.social Dr. Cheryl Czerlanis Follow ASCO on social media:     @ASCO on X (formerly Twitter)     ASCO on Bluesky    ASCO on Facebook     ASCO on LinkedIn     Disclosures:    Dr. Nate Pennell:        Consulting or Advisory Role: AstraZeneca, Lilly, Cota Healthcare, Merck, Bristol-Myers Squibb, Genentech, Amgen, G1 Therapeutics, Pfizer, Boehringer Ingelheim, Viosera, Xencor, Mirati Therapeutics, Janssen Oncology, Sanofi/Regeneron       Research Funding (Institution): Genentech, AstraZeneca, Merck, Loxo, Altor BioScience, Spectrum Pharmaceuticals, Bristol-Myers Squibb, Jounce Therapeutics, Mirati Therapeutics, Heat Biologics, WindMIL, Sanofi    Dr. Cheryl Czerlanis: Research Funding (Institution): LungLife AI, AstraZeneca, Summit Therapeutics

For women exiting the US correctional system, support is limited while the hurdles set in front of them seem endless. The post-carceral ecosystem is changing, however, bolstered by nonprofits that elevate rather than penalize people for their time served. On this episode of Transforming Trauma, host Emily Ruth welcomes Samantha Garcia Pennell, Manager of Workforce Partnerships at Arouet Foundation, in Phoenix, AZ, a nonprofit organization committed to empowering women impacted by the justice system, helping them lead successful lives and build stronger communities. Samatha shares her personal journey from traumatic childhood to challenging adulthood to prison with our audience, and the alternative path to reintegration that Arouet afforded her. The pair also explores Arouet's programs, including mentorship, job skills, and reentry simulation. About Samantha Garcia Pennell: Samantha Garcia Pennell is Manager of Workforce Partnerships at Arouet Foundation. She is dedicated to empowering others by sharing her journey and encouraging them to embrace their unique strengths. With more than a decade of experience in training, she specializes in helping individuals rebrand themselves through education and support. Samantha holds a bachelor's degree in Career and Technical Education from Northern Arizona University, which she applies to create strategic pathways for individuals transitioning from incarceration back into their communities. Her passion lies in nonprofit work, where she is committed to providing services that open doors for women impacted by the criminal justice system,fostering connections, and supporting their successful reintegration into society. Learn More: Arouet Foundation To read the full show notes and discover more resources, visit https://complextraumatrainingcenter.com/transformingtrauma *** SPACE: SPACE is an Inner Development Program of Support and Self-Discovery for Therapists on the Personal, Interpersonal, and Transpersonal Levels offered by the Complex Trauma Training Center. This experiential learning program offers an immersive group experience designed to cultivate space for self-care, community support, and deepening vitality in our professional role as therapists. Learn more about how to join. The Complex Trauma Training Center: https://complextraumatrainingcenter.com View upcoming trainings: https://complextraumatrainingcenter.com/schedule/ The Complex Trauma Training Center (CTTC) is a professional organization providing clinical training, education, consultation, and mentorship for psychotherapists and mental health professionals working with individuals and communities impacted by Adverse Childhood Experiences (ACEs) and Complex Trauma (C-PTSD). CTTC provides NARM® Therapist and NARM® Master Therapist Training programs, as well as ongoing monthly groups in support of those learning NARM. CTTC offers a depth-oriented professional community for those seeking a supportive network of therapists focused on three levels of shared human experience: personal, interpersonal & transpersonal.  The Transforming Trauma podcast embodies the spirit of CTTC – best described by its three keywords: depth, connection, and heart - and offers guidance to those interested in effective, transformational trauma-informed care. We want to connect with you! Facebook @complextraumatrainingcenter Instagram @complextraumatrainingcenter LinkedIn YouTube  

Register for the Myrtle Beach 24 Hour!! https://ultrasignup.com/register.aspx?did=123625Follow Chris Pennell on Instagram @money2432.

Host Dr. Nate Pennell and his guest, Dr. Chloe Atreya, discuss the ASCO Educational Book article, “Integrative Oncology: Incorporating Evidence-Based Approaches to Patients With GI Cancers,” highlighting the use of mind-body approaches, exercise, nutrition, acupuncture/acupressure, and natural products. Transcript Dr. Nate Pennell: Welcome to ASCO Education: By the Book, our new monthly podcast series that will feature engaging discussions between editors and authors from the ASCO Educational Book. We'll be bringing you compelling insights on key topics featured in Education Sessions at ASCO meetings and some deep dives on the approaches shaping modern oncology.  I'm Dr. Nate Pennell, director of the Cleveland Clinic Lung Cancer Medical Oncology Program as well as vice chair of clinical research for the Taussig Cancer Institute. Today, I'm delighted to welcome Dr. Chloe Atreya, a professor of Medicine in the GI Oncology Group at the University of California, San Francisco, Helen Diller Family Comprehensive Cancer Center, and the UCSF Osher Center for Integrative Health, to discuss her article titled, “Integrative Oncology Incorporating Evidence-Based Approaches to Patients With GI Cancers”, which was recently published in the ASCO Educational Book. Our full disclosures are available in the transcript of this episode.  Dr. Atreya, it's great to have you on the podcast today. Thanks for joining me. Dr. Chloe Atreya: Thanks Dr. Pennell. It's a pleasure to be here. Dr. Nate Pennell: Dr. Atreya, you co-direct the UCSF Integrative Oncology Program with a goal to really help patients with cancer live as well as possible. And before we dive into the review article and guidelines, I'd love to just know a little bit about what inspired you to go into this field? Dr. Chloe Atreya: Yeah, thank you for asking. I've had a long-standing interest in different approaches to medicine from global traditions and I have a degree in pharmacology, and I continue to work on new drug therapies for patients with colorectal cancer. And one thing that I found is that developing new drugs is a long-term process and often we're not able to get the drugs to the patients in front of us. And so early on as a new faculty member at UCSF, I was trying to figure out what I could do for the patient in front of me if those new drug therapies may not be available in their lifetime. And one thing I recognized was that in some conversations the patient and their family members, even if the patient had metastatic disease, they were able to stay very present and to live well without being sidelined by what might happen in the future. And then in other encounters, people were so afraid of what might be happening in the future, or they may have regrets maybe about not getting that colonoscopy and that was eroding their ability to live well in the present.  So, I started asking the patients and family members who were able to stay present, “What's your secret? How do you do this?” And people would tell me, “It's my meditation practice,” or “It's my yoga practice.” And so, I became interested in this. And an entry point for me, and an entry point to the Osher Center at UCSF was that I took the Mindfulness-Based Stress Reduction Program to try to understand experientially the evidence for this and became very interested in it. I never thought I would be facilitating meditation for patients, but it became a growing interest. And as people are living longer with cancer and are being diagnosed at younger ages, often with young families, how one lives with cancer is becoming increasingly important.   Dr. Nate Pennell: I've always been very aware that it seemed like the patients that I treated who had the best quality of life during their life with cancer, however that ended up going, were those who were able to sort of compartmentalize it, where, when it was time to focus on discussing treatment or their scans, they were, you know, of course, had anxiety and other things that went along with that. But when they weren't in that, they were able to go back to their lives and kind of not think about cancer all the time. Whereas other people sort of adopt that as their identity almost is that they are living with cancer and that kind of consumes all of their time in between visits and really impacts how they're able to enjoy the rest of their lives. And so, I was really interested when I was reading your paper about how mindfulness seemed to be sort of like a formal way to help patients achieve that split. I'm really happy that we're able to talk about that. Dr. Chloe Atreya: Yeah, I think that's absolutely right. So, each of our patients is more than their cancer diagnosis. And the other thing I would say is that sometimes patients can use the cancer diagnosis to get to, “What is it that I really care about in life?” And that can actually heighten an experience of appreciation for the small things in life, appreciation for the people that they love, and that can have an impact beyond their lifetime. Dr. Nate Pennell: Just in general, I feel like integrative medicine has come a long way, especially over the last decade or so. So, there's now mature data supporting the incorporation of elements of integrative oncology into comprehensive cancer care. We've got collaborations with ASCO. They've published clinical practice guidelines around diet, around exercise, and around the use of cannabinoids. ASCO has worked with the Society for Integrative Oncology to address management of pain, anxiety, depression, fatigue – lots of different evidence bases now to try to help guide people, because this is certainly something our patients are incredibly interested in learning about. Can you get our listeners up to speed a little bit on the updated guidelines and resources supporting integrative oncology? Dr. Chloe Atreya: Sure. I can give a summary of some of the key findings. And these are rigorous guidelines that came together by consensus from expert panels. I had the honor of serving on the anxiety and depression panel. So, these panels will rate the quality of the evidence available to come up with a strength of recommendation. I think that people are at least superficially aware of the importance of diet and physical activity and that cannabis and cannabinoids have evidence of benefit for nausea and vomiting. They may not be aware of some of the evidence supporting these other modalities. So, for anxiety and depression, mindfulness-based interventions, which include meditation and meditative movement, have the strongest level of evidence. And the clinical practice guidelines indicate that they should be offered to any adult patient during or after treatment who is experiencing symptoms of anxiety or depression. Other modalities that can help with anxiety and depression include yoga and Tai Chi or Qigong. And with the fatigue guidelines, mindfulness-based interventions are also strongly recommended, along with exercise and cognitive behavioral therapy, Tai Chi and Qigong during treatment, yoga after treatment.  And some of these recommendations also will depend on where the evidence is. So, yoga is an example of an intervention that I think can be helpful during treatment, but most of our evidence is on patients who are post-treatment. So, most of our guidelines separate out during treatment and the post-treatment phase because the quality of evidence may be different for these different phases of treatment.  With the pain guidelines, the strongest recommendation is for acupuncture, specifically for people with breast cancer who may be experiencing joint pain related to aromatase inhibitors. However, acupuncture and other therapies, including massage, can be helpful with pain as well. So those are a few of the highlights. Dr. Nate Pennell: Yeah, I was surprised at the really good level of evidence for the mindfulness-based practices because I don't think that's the first thing that jumps to mind when I think about integrative oncology. I tend to think more about physical interventions like acupuncture or supplements or whatnot. So, I think this is really fantastic that we're highlighting this.  And a lot of these interventions like the Qigong, Tai Chi, yoga, is it the physical practice of those that benefits them or is it that it gives them something to focus on, to be mindful of? Is that the most important intervention? It doesn't really matter what you're doing as long as you have something that kind of takes you out of your experience and allows you to focus on the moment. Dr. Chloe Atreya: I do think it is a mind, body and spirit integration, so that all aspects are important. We also say that the best practice is the one that you actually practice. So, part of the reason that it's important to have these different modalities is that not everybody is going to take up meditation. And there may be people for whom stationary meditation, sitting and meditating, works well, and other people for whom meditative movement practices may be what they gravitate to. And so, I think that it's important to have a variety of options. And one thing that's distinct from some of our pharmacologic therapies is that the safety of these is, you know, quite good. So, it becomes less important to say, “Overall, is Tai Chi better or is yoga better?” for instance. It really depends on what it is that someone is going to take up. Dr. Nate Pennell: And of course, something that's been really nice evidence-based for a long time, even back when I was in my training in the 2000s with Jennifer Temel at Massachusetts General Hospital, was the impact of physical activity and exercise on patients with cancer. It seems like that is pretty much a universally good recommendation for patients. Dr. Chloe Atreya: Yes, that's absolutely right. Physical activity has been associated with improved survival after a cancer diagnosis. And that's both cancer specific survival and overall survival.  The other thing I'll say about physical activity, especially the mindful movement practices like Tai Chi and Qigong and yoga, is that they induce physiologic shifts in the body that can promote relaxation, so they can dampen that stress response in a physiologic way. And these movement practices are also the best way to reduce cancer-associated fatigue. Dr. Nate Pennell: One of the things that patients are always very curious about when they talk to me, and I never really feel like I'm as well qualified as I'd like to be to advise them around dietary changes in nutrition. And can you take me a little bit through some of the evidence base for what works and what doesn't work? Dr. Chloe Atreya: Sure. I do think that it needs to be tailored to the patient's needs. Overall, a diet that is plant-based and includes whole grains is really important. And I often tell patients to eat the rainbow because all of those different phytochemicals that cause the different colors in our fruits and vegetables are supporting different gut microbiota. So that is a basis for a healthy gut microbiome. That said, you know, if someone is experiencing symptoms related to cancer or cancer therapy, it is important to tailor dietary approaches. This is where some of the mindful eating practices can help. So, sometimes actually not just focusing on what we eat, but how we eat can help with symptoms that are associated with eating. So, some of our patients have loss of appetite, and shifting one's relationship to food can help with nutrition. Sometimes ‘slow it down' practices can help both with appetite and with digestion. Dr. Nate Pennell: One of the things that you said both in the paper and just now on our podcast, talking about how individualized and personalized this is. And I really liked the emphasis that you had on flexibility and self-compassion over rigid discipline and prescriptive recommendations here. And this is perhaps one of the real benefits of having an integrative oncology team that can work with patients as opposed to them just trying to find things online. Dr. Chloe Atreya: Yes, particularly during treatment, I think that's really important. And that was borne out by our early studies we called “Being Present.” So, after I was observing the benefits anecdotally among my patients of the ability to be present, we designed these pilot studies to teach meditation and meditative practices to patients. And in these pilot studies, the original ones were pretty prescriptive in a way that mindfulness-based stress reduction is fairly prescriptive in terms of like, “This is what we're asking you to do. Just stick with the program.” And there can be benefits if you can stick with the program. It's really hard though if someone is going through treatment and with GI cancers, it may be that they're getting chemotherapy every two weeks and they have one week where they're feeling really crummy and another week where they're trying to get things done. And we realized that sometimes people were getting overwhelmed and feeling like the mindfulness practice was another thing on their to-do list and that they were failing if they didn't do this thing that was important for them. And so, we've really kind of changed our emphasis. And part of our emphasis now is on incorporating mindfulness practices into daily life. Any activity that doesn't require a lot of executive function can be done mindfully, meaning with full attention. And so, especially for some of our very busy patients, that can be a way of, again, shifting how I'm doing things rather than adding a new thing to do. Dr. Nate Pennell: And then another part I know that patients are always very curious about that I'm really happy to see that we're starting to build an evidence base for is the use of supplements and natural products. So, can you take us a little bit through where we stand in terms of evidence behind, say, cannabis and some of the other available products out there? Dr. Chloe Atreya: Yeah, I would say that is an area that requires a lot more study. It's pretty complicated because unlike mindfulness practices where there are few interactions with other treatments, there is the potential for interactions, particularly with the supplements. And the quality of the supplements matters. And then there tends to be a lot of heterogeneity among the studies both in the patients and what other treatments they may be receiving, as well as the doses of the supplements that they're receiving.  One of my earliest mentors at Yale is someone named Dr. Tommy Chang, who has applied the same rigor that that we apply to testing of biomedical compounds to traditional Chinese medicine formulas. And so, ensuring that the formulation is stable and then formally testing these formulations along with chemotherapy. And we need more funding for that type of research in order to really elevate our knowledge of these natural products. We often will direct patients to the Memorial Sloan Kettering ‘About Herbs, Botanicals, and Other Products' database as one accessible source to learn more about the supplements. We also work with our pharmacists who can provide the data that exists, but we do need to take it with a grain of salt because of the heterogeneity in the data. And then it's really important if people are going to take supplements, for them to take supplements that are of high quality. And that's something in the article that we list all of the things that one should look for on the label of a supplement to ensure that it is what it's billed to be. Dr. Nate Pennell: So, most of what we've been talking about so far has really been applying to all patients with cancer, but you of course are a GI medical oncologist, and this is a publication in the Educational Book from the ASCO GI Symposium. GI cancers obviously have an incredibly high and rising incidence rate among people under 50, representing a quarter of all cancer incidence worldwide, a third of cancer related deaths worldwide. Is there something specific that GI oncologists and patients with GI cancers can take home from your paper or is this applicable to pretty much everyone? Dr. Chloe Atreya: Yeah, so the evidence that we review is specifically for GI cancers. So, it shows both its strengths and also some of the limitations. So many of the studies have focused on other cancers, especially breast cancer. In the integrative oncology field, there are definitely gaps in studying GI cancers. At the same time, I would say that GI cancers are very much linked to lifestyle in ways that are complicated, and we don't fully understand. However, the best ways that we can protect against development of GI cancers, acknowledging that no one is to blame for developing a GI cancer and no one is fully protected, but the best things that we can do for overall health and to prevent GI cancers are a diet that is plant-based, has whole grains. There's some data about fish that especially the deep-water fish, may be protective and then engaging in physical activity.  One thing I would like for people to take away is that these things that we know that are preventative against developing cancer are also important after development of a GI cancer. Most of the data comes from studies of patients with colorectal cancer and that again, both cancer specific and overall mortality is improved with better diet and with physical activity. So, this is even after a cancer diagnosis. And I also think that, and this is hard to really prove, but we're in a pretty inflammatory environment right now. So, the things that we can do to decrease stress, improve sleep, decrease inflammation in the body, and we do know that inflammation is a risk factor for developing GI cancers. So, I think that all of the integrative modalities are important both for prevention and after diagnosis. Dr. Nate Pennell: And one of the things you just mentioned is that most of the studies looking at integrative oncology and GI cancers have focused on colorectal cancer, which of course, is the most common GI cancer. But you also have pointed out that there are gaps in research and what's going on and what needs to be done in order to broaden some of this experience to other GI cancers. Dr. Chloe Atreya: Yeah, and I will say that there are gaps even for colorectal cancer. So right now, some of the authors on the article are collaborating on a textbook chapter for the Society for Integrative Oncology. And so, we're again examining the evidence specifically for colorectal cancer and are in agreement that the level of evidence specific to colorectal cancer is not as high as it is for all patients with adult cancers. And so even colorectal cancer we need to study more.  Just as there are different phases of cancer where treatments may need to be tailored, we also may need to tailor our treatments for different cancer types. And that includes what symptoms the patients are commonly experiencing and how intense the treatment is, and also the duration of treatment. Those are factors that can influence which modalities may be most important or most applicable to a given individual. Dr. Nate Pennell: So, a lot of this sounds fantastic. It sounds like things that a lot of patients would really appreciate working into their care. Your article focused a little bit on some of the logistics of providing this type of care, including group medical visits, multidisciplinary clinics staffed by multiple types of clinicians, including APPs and psychologists, and talked about the sustainability of this in terms of increasing the uptake of guideline-based integrative oncology. Talk a little bit more about both at your institution, I guess, and the overall health system and how this might be both sustainable and perhaps how we broaden this out to patients outside of places like UCSF. Dr. Chloe Atreya: Yes, that's a major focus of our research effort. A lot of comprehensive cancer centers and other places where patients are receiving care, people may have access to dietitians, which is really important and nutritionists. In the article we also provide resources for working with exercise therapists and those are people who may be working remotely and can help people, for instance, who may be in, in rural areas. And then our focus with the mind-body practices in particular has been on group medical visits. And this grew out of, again, my ‘being present' pilot studies where we were showing some benefit. But then when the grant ends, there isn't a way to continue to deliver this care. And so, we were asking ourselves, you know, is there a way to make this sustainable? And group medical visits have been used in other settings, and they've been working really well at our institution and other institutions are now taking them up as well. And this is a way that in this case it's me and many of my colleagues who are delivering these, where I can see eight or ten patients at once. In my case, it's a series of four two-hour sessions delivered by telehealth. So, we're able to focus on the integrative practices in a way that's experiential. So, in the clinic I may be able to mention, you know, after we go over the CT scans, after we go over the labs and the molecular profiling, you know, may be able to say, “Hey, you know, meditation may be helpful for your anxiety,” but in the group medical visits we can actually practice meditation, we can practice chair yoga. And that's where people have that experience in their bodies of these different modalities. And the feedback that we're receiving is that that sticks much more to experience it then you have resources to continue it. And then the group is helpful both in terms of delivery, so timely and efficient care for patients. It's also building community and reducing the social isolation that many of our patients undergoing treatment for cancer experience. Dr. Nate Pennell: I think that makes perfect sense, and I'm glad you brought up telehealth as an option. I don't know how many trained integrative oncologists there are out there, but I'm going to guess this is not a huge number out there. And much like other specialties that really can improve patients' quality of life, like palliative medicine, for example, not everyone has access to a trained expert in their cancer center, and things like telemedicine and telehealth can really potentially broaden that. How do you think telehealth could help broaden the exposure of cancer patients and even practitioners of oncology to integrative medicine? Dr. Chloe Atreya: Yes, I think that telehealth is crucial for all patients with cancer to be able to receive comprehensive cancer care, no matter where they're receiving their chemotherapy or other cancer-directed treatments. So, we will routinely be including patients who live outside of San Francisco. Most of our patients live outside of San Francisco. There's no way that they could participate if they had to drive into the city again to access this. And in the group setting, it's not even safe for people who are receiving chemotherapy to meet in a group most times. And with symptoms, often people aren't feeling so well and they're able to join us on Zoom in a way that they wouldn't be able to make the visit if it was in person. And so, this has really allowed us to expand our catchment area and to include patients, in our case, in all of California. You also mentioned training, and that's also important. So, as someone who's involved in the [UCSF] Osher Collaborative, there are faculty scholars who are at universities all over the US, so I've been able to start training some of those physicians to deliver group medical visits at their sites as well via telehealth. Dr. Nate Pennell: I'm glad we were able to make a plug for that. We need our political leadership to continue to support reimbursement for telehealth because it really does bring access to so many important elements of health care to patients who really struggle to travel to tertiary care centers. And their local cancer center can be quite a distance away.  So, sticking to the theme of training, clinician education and resources are really crucial to continue to support the uptake of integrative oncology in comprehensive cancer care. Where do you think things stand today in terms of clinician education and professional development in integrative oncology. Dr. Chloe Atreya: It's growing. Our medical students now are receiving training in integrative medicine, and making a plug for the Educational Book, I was really happy that ASCO let us have a table that's full of hyperlinks. So that's not typical for an article. Usually, you have to go to the reference list, but I really wanted to make it practical and accessible to people, both the resources that can be shared with patients that are curated and selected that we thought were of high-quality examples for patients. At the bottom of that table also are training resources for clinicians, and some of those include: The Center for Mind-Body Medicine, where people can receive training in how to teach these mind-body practices; The Integrated Center for Group Medical Visits, where people can learn how to develop their own group medical visits; of course, there's the Society for Integrative Oncology; and then I had just mentioned the Osher Collaborative Faculty Fellowship. Dr. Nate Pennell: Oh, that is fantastic. And just looking through, I mean, this article is really a fantastic resource both of the evidence base behind all of the elements that we've discussed today. Actually, the table that you mentioned with all of the direct hyperlinks to the resources is fantastic. Even recommendations for specific dietary changes after GI cancer diagnosis. So, I highly recommend everyone read the full paper after they have listened to the podcast today.  Before we wrap up, is there anything that we didn't get a chance to discuss that you wanted to make sure our listeners are aware of? Dr. Chloe Atreya: One thing that I did want to bring up is the disparities that exist in access to high quality symptom management care. So, patients who are racial and ethnic minorities, particularly our black and Latinx patients, the evidence shows that they aren't receiving the same degree of symptom management care as non-Hispanic White patients. And that is part of what may be leading to some of the disparities in cancer outcomes. So, if symptoms are poorly managed, it's harder for patients to stay with the treatment, and integrative oncology is one way to try to, especially with telehealth, this is a way to try to improve symptom management for all of our patients to help improve both their quality of life and their cancer outcomes. Dr. Nate Pennell: Well, Dr. Atreya, it's been great speaking with you today and thank you for joining me on the ASCO Education: By the Book Podcast and thank you for all of your work in advancing integrative oncology for GI cancers and beyond. Dr. Chloe Atreya: Thank you, Dr. Pennell. It's been a pleasure speaking with you. Dr. Nate Pennell: And thank you to all of our listeners who joined us today. You'll find a link to the article discussed today in the transcript of the episode. We hope you'll join us again for more insightful views on topics you'll be hearing at the Education Sessions from ASCO meetings throughout the year and our deep dives on approaches that are shaping modern oncology. Disclaimer: The purpose of this podcast is to educate, educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. Guest statements on the podcast do not express the opinions of ASCO. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement. Follow today's speakers:    Dr. Nathan Pennell   @n8pennell  @n8pennell.bsky.social  Dr. Chloe Atreya  Follow ASCO on social media:    @ASCO on X (formerly Twitter)    ASCO on Bluesky   ASCO on Facebook    ASCO on LinkedIn    Disclosures:   Dr. Nate Pennell:       Consulting or Advisory Role: AstraZeneca, Lilly, Cota Healthcare, Merck, Bristol-Myers Squibb, Genentech, Amgen, G1 Therapeutics, Pfizer, Boehringer Ingelheim, Viosera, Xencor, Mirati Therapeutics, Janssen Oncology, Sanofi/Regeneron      Research Funding (Institution): Genentech, AstraZeneca, Merck, Loxo, Altor BioScience, Spectrum Pharmaceuticals, Bristol-Myers Squibb, Jounce Therapeutics, Mirati Therapeutics, Heat Biologics, WindMIL, Sanofi   Dr. Chloe Atreya: Consulting or Advisory Role: Roche Genentech, Agenus Research Funding (Institution): Novartis, Merck, Bristol-Myers Squibb, Guardant Health, Gossamer Bio, Erasca, Inc.

Send us a textAfter attending a recent event featuring Dr. Jemar Tisby, I had the chance to connect with the host of that gathering, Professor Jessica Wai-Fong Wong, Associate Professor of Systematic Theology at Azusa Pacific University and author of the groundbreaking book Disordered: Holy Icons and Racial Myths.In this episode, we reflect on that event, where Dr. Tisby shared moving stories about his relationship with the late Dr. Bill Pennell of Fuller Theological Seminary—a pioneering voice in racial awareness whose bold challenges to white evangelicalism began in the late '60s and continued for decades.Dr. Wong, herself deeply influenced by Dr. Pennell's legacy, joins me for a conversation that dives into the concept of whiteness as an archetype and its enduring impact on Christian theology and the history of race. Drawing from her own journey as a Chinese American woman raised in predominantly white spaces in Texas, Dr. Wong shares insights from her book, including what it means to "aspire to whiteness" and the painful experience of being cast as an "anti-icon" in a white-dominated religious context.We also explore my own experience within a Korean megachurch in Southern California, examining how whiteness becomes synonymous with order, while everyone else—Black, brown, Asian, Jewish, or female—is often seen as a threat to it.This is more than a theological discussion—it's a deep dive into history, identity, and the present-day political and spiritual moment we're all navigating. SHOW NOTESSupport the showBecome a Patron - Click on the link to learn how you can become a Patron of the show. Thank you! Ken's Substack Page The Podcast Official Site: TheBeachedWhiteMale.com

Overtime with William Patteson HR 2 4.1.25: "Eyes on the Tournament with Max Pennell" by Fanrun Radio

Overtime with William Patteson 3.27.25: "Countdown to Kentucky / Sweet 16 with Max Pennell" by Fanrun Radio

Overtime with William Patteson HR 2 3.25.25: "Eyes on the Tournament with Max Pennell" by Fanrun Radio

In this gripping episode, I sit down with Jamie Pennell, a highly decorated New Zealand SAS soldier awarded the New Zealand Gallantry Star for his extraordinary actions on the battlefield. This is an intimate and raw conversation about resilience, leadership, and the realities of serving in one of the world's most elite military units.What You'll Learn in This Episode:The Journey to the SAS: Jamie's early aspirations, what drew him to special forces, and the brutal selection process that pushed him to his limits.Fear and Failure: How an initial failure in SAS selection became the fuel for success.The Psychological Battle: The mental toughness required to operate in extreme conditions and why mindset is more critical than physical strength.Afghanistan & High-Stakes Missions: The reality of life on the battlefield, working behind enemy lines, and leading critical operations.The Intercontinental Hotel Siege: Jamie's first-hand account of one of the most intense counter-terrorism operations ever conducted by the New Zealand SAS.Life After Combat: The challenges of reintegration, navigating civilian life, and finding purpose beyond the battlefield.Lessons on Leadership & Resilience: How Jamie's experiences in the SAS apply to leadership, teamwork, and mental fortitude in everyday life.Why You Should Listen:This episode is more than a military story—it's a lesson in perseverance, discipline, and personal growth. Whether you're an entrepreneur, a leader, or someone striving to push past your limits, Jamie's insights will inspire you to take ownership of your challenges and lead with courage.This episode was proudly sponsored by NZ Mortgages. You can contact them here - https://www.nzmortgages.co.nzGrab your copy of “Serviceman J” here - https://www.harpercollins.co.nz/9781775542384/serviceman-j/Get the Growth Weekly Newsletter sent straight to your inbox and join 1000's of other high-performers on the road to self-mastery  - https://www.jjlaughlin.com/newsletter-----Website: https://www.jjlaughlin.com YouTube: https://www.youtube.com/channel/UC6GETJbxpgulYcYc6QAKLHA Facebook: https://www.facebook.com/JamesLaughlinOfficial Instagram: https://www.instagram.com/jameslaughlinofficial/ Apple Podcast: https://podcasts.apple.com/nz/podcast/life-on-purpose-with-james-laughlin/id1547874035 Spotify: https://open.spotify.com/show/3WBElxcvhCHtJWBac3nOlF?si=hotcGzHVRACeAx4GvybVOQ LinkedIn: https://www.linkedin.com/in/jameslaughlincoaching/James Laughlin is a High Performance Leadership Coach, Former 7-Time World Champion, Host of the Lead On Purpose Podcast and an Executive Coach to high performers and leaders. James is based in Christchurch, New Zealand.Send me a personal text messageSupport the show

Overtime with William Patteson HR 2 3.6.25 "Around College Basketball Max Pennell Joins" by Fanrun Radio

Overtime With William Patteson HR 2 2.20.25 " Max Pennell Joins; Around College Basektball" by Fanrun Radio

Overtime With William Patteson HR 2 2.12.25: "Max Pennell Joins to Talk College Basketball" by Fanrun Radio

In this episode Jacob chats with longtime friend and fellow business owner, Matthew Pennell. Together, they reflect on their entrepreneurial journeys, lessons learned in 2024, and how to stay focused while balancing family, business, and personal growth. They dive into the power of narrowing your focus, scaling your business effectively, and exploring exciting new ventures like fitness, nutrition, and longevity programs. Tune in for insights, laughs, and actionable tips to kickstart your 2025 goals!

The year is 1903, Buffalo society is shocked by Ed Burdick's murder.  Scandalous affairs, private investigators and red herrings all lead to one question: Who killed Ed Burdick in his study with a golf club? Special thanks to Kimberly Tilley, author of "Cold Heart: The Great Unsolved Mystery in Turn of the Century Buffalo." ★ Support this podcast on Patreon ★

Tonight, we'll read the chapter “On Soup” from The Feasts of Autolycus by Elizabeth Robins Pennell, in which Pennell draws from her experiences as a food critic and essayist to explore the role of soup in culinary culture. Snoozecast first read this back in 2020. An American writer who lived much of her life in Europe, Pennell was known for her travel writing and gastronomic studies, often blending personal observations with cultural critique. Her perspective reflects a deep familiarity with both English and French cuisines, informed by her broader interest in art and domestic life.— read by 'V' —Sign up for Snoozecast+ to get expanded, ad-free access by going to snoozecast.com/plus! Learn more about your ad choices. Visit megaphone.fm/adchoicesSee Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

Tonight, we'll read the chapter “On Soup” from The Feasts of Autolycus by Elizabeth Robins Pennell, in which Pennell draws from her experiences as a food critic and essayist to explore the role of soup in culinary culture. Snoozecast first read this back in 2020. An American writer who lived much of her life in Europe, Pennell was known for her travel writing and gastronomic studies, often blending personal observations with cultural critique. Her perspective reflects a deep familiarity with both English and French cuisines, informed by her broader interest in art and domestic life. — read by 'V' — Sign up for Snoozecast+ to get expanded, ad-free access by going to snoozecast.com/plus! Learn more about your ad choices. Visit megaphone.fm/adchoices

Dr. Nathan Pennell and Dr. John Sweetenham discuss the evolving landscape of oncology in 2025 and the challenges oncologists will be facing, including the impact of Medicare drug price negotiations, ongoing drug shortages, and the promising role of AI and telehealth in improving patient outcomes and access to clinical trials. TRANSCRIPT Dr. John Sweetenham: Hello, I'm Dr. John Sweetenham, the host of the ASCO Daily News Podcast. 2025 promises to be a year of continued progress in drug development, patient care, and technological innovations that will shape the future of cancer care. Oncologists will also be grappling with some familiar challenges in oncology practice and probably face a few new ones as well. I'm delighted to be joined today by Dr. Nathan Pennell to discuss some of these challenges. Dr. Pennell is the co-director of the Cleveland Clinic Lung Cancer Program and vice chair of clinical research at the Taussig Cancer Center. He also serves as the editor-in-chief of the ASCO Educational Book.  You'll find our full disclosures in the transcript of this episode.  Nate, it's great to have you on the podcast today. Dr. Nathan Pennell: Thanks for inviting me, John. I'm excited to be here. Dr. John Sweetenham: Thanks. So, Nate, we've been hearing a lot recently about implementation science in oncology particularly. This has been the case, I would say, over the past decade and of course the goal is to how do we figure out the best way to integrate evidence-based practice into oncology care? There's been a lot of very good guidance from organizations like ASCO and every year we're reminded of the need for clinical decision support for practicing oncologists at the point of care. Although I think we all agree it is the right thing to do, and this has been a matter of discussion for probably more than 10 years, for the most part, I don't think we've really got there. Some big practices probably have a truly well-integrated clinical decision support tool, but for many of us this is still lacking in the field. I wonder whether we do need some kind of global clinical decision support tool. What do you think about the future of clinical decision support at the point of care? And do you think this is going to continue to be a need? Dr. Nathan Pennell: I think that's a fantastic question and it absolutely is something we're going to continue to work towards. We're in an incredibly exciting time in oncology. We've got all these exciting predictive biomarkers, effective treatments that are working better than anything we've had in our careers up to this point. But when we actually look to see who is benefiting from them, what we find is that outside of clinical trial populations, many of our patients aren't actually accessing these. And so publications that look at real-world use of these, one that jumps to mind for me is a publication looking at biomarker testing for driver oncogenes in lung cancer showed that while everyone who treats lung cancer says, “Absolutely, we need to test for biomarkers such as EGFR mutations,” in the real world, probably only slightly over a third of people ever access these drugs because there are so many different gaps in care that fall through the cracks. And so decision support is absolutely critical.  You mentioned this has been going on for a decade. Actually, the Institute of Medicine in 2013 recommended that with the uptake of electronic medical records, that we move forward with building these true learning health care systems that would improve quality and use every patient's information to help inform their care. And in 2023, as a representative of ASCO, I was able to look back at the last decade, and the uniform conclusion was that we had failed to build this learning health care system. So, what can we do going forward? The good news is there are improvements in technology. There are, for better or for worse, some consolidation of electronic medical records that has allowed larger numbers of patients to sort of have data sets shared. ASCO started CancerLinQ to try to improve quality, which is now part of OpenAI, and is still working on technology solutions to help provide decision support as we are better able to access patient data. And I think we're going to talk a little bit later about some of the technological advances that are going on in artificial intelligence that are really going to help improve this. So I think this is very close to impacting patient care and improving quality of care. I think for, as you'd mentioned, large health care systems and users of the major EMRs, this is going to be extremely close. Dr. John Sweetenham: Thanks, Nate. And just to extend the conversation into another area, one of the constant, I think, pain points for practicing oncologists has been the issue of prior authorization and the amount of time and energy it takes to deal with insurance denials in cancer care. And I think in a way, these two things are linked in as much as if we had clinical decision support tools at the point of care which were truly functional, then hopefully there would be a more facile way for an oncologist to be able to determine whether the patient in front of him or her is actually covered for the treatment that the oncologist wants to prescribe. But nevertheless, we're really not there yet, although, I think we're on the way to being there. But it does remain, like I said, a real pain point for oncologists.  I wonder if you have any thoughts on the issue of prior authorization and whether you see in the coming year anything which is going to help practicing oncologists to overcome the time and effort that they spend in this space. Dr. Nathan Pennell: I think many oncologists would have to list this among, if not the least favorite aspects of our job these days is dealing with insurance, dealing with prior authorizations. We understand that health care is incredibly expensive. We understand that oncology drugs and tests are even more expensive, probably among, if not the most rapidly growing costs to the health care system in the U.S., which is already at about 20% of our GDP every year. And so I understand the concern that costs are potentially unsustainable in the long term. Unfortunately, the major efforts to contain these costs seem to have fallen on the group that we would least like to be in charge of that, which are the payers and insurance companies, through use of prior authorization. And this is good in concept, utilization review, making sure that things are appropriate, not overutilizing our expensive treatments, that makes perfect sense. Unfortunately, it's moved beyond expensive treatments that have limited utility to more or less everything, no matter how inexpensive or standard. And there's now multiple publications suggesting that this is taking on massive amounts of time. Some even estimated that for each physician it's a full 40-hour work week per physician from someone to manage prior authorizations, which costs billions of dollars for practices every year. And so this is definitely a major pain point.  It is, however, an area where I'm kind of optimistic, maybe not necessarily in 2025, but in the coming several years with some of the technology solutions that are coming out, as we've talked about, with things like clinical pathways and whatnot, where the insurance company approvals can be tied directly to some of these guideline concordance pathway tools. So the recent publication at the ASCO Quality [Care] Symposium looking at a radiation oncology practice that had a guideline concordant prior auth tool that showed there was massive decrease in denials by using this. And as this gets rolled out more broadly, I think that this can increase the concept of gold carding, where if practices follow these clinical guidelines to a certain extent, they may be even exempt from prior authorization. I think I can envision that this is very close to potentially removing this as a major problem. I know that ASCO certainly has advocated on the national level for changes to this through, for example, advocating for the Improving Seniors Timely Access to Care Act. But I think, unfortunately, the recent election, I'm not sure how much progress will be made on the national level for progress in this. So I think that the market solutions with some of the technology interventions may be the best hope. Dr. John Sweetenham: Yeah, thanks. You raised a couple of other important points in that answer, Nate, which I'll pick up on now. You mentioned drug prices, and of course, during 2025, we're going to see Medicare negotiating drug prices. And we've already seen, I think, early effects from that. But I think it's going to be really interesting to see how this rolls out for our cancer patients in 2025. And of course, the thing that we can't really tell at the moment that you've alluded to is how all this is going to evolve with the new administration of President Trump. I understand, of course, that none of us really knows at this point; it's too early to know what the new administration will do. But would you care to comment on this in any way and about your concerns and hopes for Medicare specifically and what the administration will do to cancer care in general? Dr. Nathan Pennell: I think all of us are naturally a little bit anxious about what's going to happen under the new administration. The good news, if there's good news, is that under the first Trump administration, the National Cancer Institute and cancer care in general was pretty broadly supported both in Congress and by the administration. And if we look at specifically negotiating drug prices by Medicare, you can envision that having a businessman president who prides himself in negotiations might be something that would be supported and perhaps even expanded under the incoming Trump administration. So I think that's not too hard to imagine, although we don't really know. On the other hand, there are very valid concerns about what's going to happen with the Affordable Care Act, with Medicaid expansion, with protections for preexisting conditions, which impact our patients with cancer. And obviously there are potential people in the new administration who perhaps lack trust in traditional evidence-based medicine, vaccines, things like that, which we're not sure where they're going to fall in terms of the health care landscape, but certainly something we'll have to watch out for. Dr. John Sweetenham: Yeah. Certainly, when we regroup to record next year's podcast, we may have a clearer picture of how that's going to play out. Dr. Nathan Pennell: I mean, if there's anything good from this, it's that cancer has always been a bipartisan issue that people support. And so I don't want to be too negative about this. I do think that public support for cancer is likely to continue. And so overall, I think we'll probably be okay. Dr. John Sweetenham: Yeah, I agree with that. And I think one of the things that's important to remember, I do remember that one of the institutions I've worked at previously that there from time to time was some discussion about politics and cancer care. And the quote that I always remember is “We all belong to the cancer party,” and that's what's really important. So let's just keep our eye on the board. I hope that we can do that.  I'm going to switch gears just a little bit now because another issue which has been quite prominent in 2024 and in a few years before that has been supply chain issues and drug shortages. We've seen this over many years now, but obviously the problems have apparently been exacerbated in recent years, particularly by climate events. But certainly ASCO has published some recommendations in terms of quality care delivery for patients with cancer. Can you tell us a little bit about how you think this will go in the coming year and what we can do to address some of the concerns that are there over drug shortages? Dr. Nathan Pennell: Yeah. This continues to be, I think, a surprising issue for many oncologists because it has been going on for a long time, but really hasn't been in the public eye. The general problem is that once drugs go off patent and become generic, they often have limited manufacturers that are often outside the U.S. sometimes even a single manufacturer, which leaves them extremely vulnerable to supply chain disruption issues or regulatory issues. So situations where the FDA inspects and decides that they're not manufacturing things up to snuff and suddenly the only manufacturer is temporarily shut down. And then as you mentioned, things like extreme weather events where we had Hurricane Maria hit Puerto Rico and suddenly we have no bags of saline for several months. And so these are major issues which I think have benefited from being in the public eye.  ASCO, on the one hand, has, I think, done an excellent job leading on what to do in scenarios where there are shortages. But I think more importantly, we need more attention on a national level to policy changes that would help prevent this in the future. Some suggestions have been to increase some of the oversight of the FDA into supply chain issues and generic drugs, perhaps forming more of an early warning system to anticipate shortages so that we can find workarounds, find alternative suppliers that perhaps aren't currently being widely utilized. We can advocate for our legislators to pass legislation to support drug production for vital agents through things like long term contracts or even guaranteed pricing that might also even encourage U.S. manufacturers to take back up generic drugs if they were able to make it profitable. And then finally, I think just more of a national coordinated approach rather than the piecemeal approach we've done in the past. I remember when we had a platinum [drug] shortage last year. Our institution, with massive resources in our pharmacy, really did an excellent job of making sure that we always had enough supply. We never actually saw that shortage in real time, but I know a lot of places did not have those resources and therefore were really struggling. And so I think more of a coordinated approach with communication and awareness so that we can try to prevent this from happening. Dr. John Sweetenham: Thanks, Nate. And you raised the issue of major weather events, and I'd like to pick up on that for just a moment to talk about climate change. We now know that there is a growing body of evidence showing that climate change impacts cancer care. And it does it in a lot of ways. I mean, the most obvious is disrupting care delivery during one of these major events. But there are also issues about increased exposure to carcinogens, reduced access to food, reduced access to cancer screenings during these major disasters. And the recent hurricanes, of course, have highlighted the need for cancer centers to have robust disaster preparedness plans. In addition to that, obviously there are questions about greenhouse gas emissions and how cancer centers and health care organizations handle that.  But what do you see for 2025 in this regard? And what's your thinking about how well we're prepared as deliverers of cancer care to deal with these climate change issues? Dr. Nathan Pennell: Yeah, that is sobering to look at some of the things that have happened with climate change in recent years. I would love to say that I think that from a national level, we will see these changes and proactively work to reduce greenhouse emissions so that we can reduce these issues in the future. I'm not sure what we're going to see from the incoming administration and current government in terms of national policy on changes for fossil fuel use and climate change. I worry that there's a chance that we may see less done on the national level. I know the NCI certainly has policies in place to try to study climate change impact on cancer. It's possible that even that policy could be impacted by the incoming administration. So we'll have to see.  So, unfortunately, I worry that we may be still dealing in a reactive way to the impacts of this. So, obviously, wildfires causing carcinogens, pollution leading to increased cancer incidence, obviously, major weather events leading to physical disruptions, where cancer centers definitely have to have plans in place to help people maintain their treatment during those periods. As an individual, we can certainly make our impact on climate change. There are certainly organizations like Oncologists United for Climate and Health, or so-called OUCH, led by Dr. Joan Schiller, a friend of mine in the lung cancer world, where oncologists are advocating for policies to reduce use of fossil fuels. But I don't know, John, I don't know if I'm hopeful that there's going to be major policy changes on this in the coming year. Dr. John Sweetenham: I suspect you're right about that, although I think on the positive side, I think the issue as a whole is getting a lot more attention than it was maybe even two or three years ago. So that has to be a good thing that there's more advocacy and more attention out there now.  Nate, before we go on to the last question, because I do want to finish on a positive note, I just wanted to mention briefly that there are a couple of ongoing issues which, when we do this podcast each year, we normally address, and they certainly haven't gone away. But we know that burnout and workforce issues in oncology will continue to be a big challenge. The workforce issues may or may not be exacerbated by whatever the new administration's approach to immigration is going to be, because that could easily significantly affect the workforce in oncology. So that's one issue around workforce and burnout that we are not addressing in detail this year. But I wanted to raise it just because it certainly hasn't gone away and is going to continue to challenge us in 2025.  And then the other one, which I kind of put in the same category, is that of disparities. We continue to see ethnic and racial disparities of care. We continue to see disparities in rural areas. And I certainly wouldn't want to minimize the challenges that these are likely to continue to present in 2025. I wonder if you just have any brief comments you'd like to make and whether you think we're headed in the right direction with those issues. Dr. Nathan Pennell: Well, I'm somewhat optimistic in some ways about burnout. And I think when we get to our final topic, I think some of that may help. There may be some technology changes that may help reduce some of the influences of burnout. Disparities in care, obviously, I think similarly to some of the other issues we talked about have really benefited from just a lot of attention being cast on that. But again, I actually am optimistic that there are some technology changes that are going to help reduce some disparities in care. Dr. John Sweetenham: It's always great to finish one of these conversations on a positive note, and I think there is a lot to be very positive about. As you mentioned right at the beginning of the podcast, we continue to see quite extraordinary advances, remarkable advances in all fields of oncology in the therapeutic area, with just a massive expansion in not only our understanding, but also resulting from that improved understanding of the biology of the disease, the treatment advances that have come along. And so I think undoubtedly, we're going to see continued progress during 2025. And I know that there are technology solutions that you've mentioned already that you're very excited about. So, I'd really like to finish today by asking you if you could tell us a little about those and in particular what you're excited about for 2025. Dr. Nathan Pennell: Yeah. It's always dangerous to ask me to nerd out a little bit about some of these technology things, but I don't think that we can end any conversation about technology and not discuss the potential for artificial intelligence (AI) in health care and oncology. AI is sort of everywhere in the media and sort of already worked its way into our lives in our phones and apps that we're using and whatnot. But some of what I am seeing in tools that are probably going to be here very soon and, in some cases, already arriving, are pretty remarkable.  So some of the advances in natural language processing, or NLP, which in the past has been a barrier to really mining the vast amounts of patient information in the electronic medical record, is so much better now. So now, we can actually use technology to read doctor's notes, to read through scanned PDFs in our EMRs. And we can imagine that it's going to become very soon, much harder to miss abnormal labs, going to be much harder to miss findings on scans such as pulmonary nodules that get picked up incidentally. It's going to be much easier to keep up with new developments as clinical guidelines get worked in and decision support tools start reminding patients and physicians about evidence-based, high-quality recommendations. Being able to identify patients who are eligible for clinical trials is going to become much more easy.  And that leads me to the second thing, which is, throughout the pandemic we have greatly increased our use of telehealth, and this really has the potential to reduce disparities in care by reaching patients basically wherever they are. This is going to disproportionately allow us to access rural patients, patients that are currently underrepresented in clinical trials and whatnot, being able to present patients for clinical trials. In the recent “State of Cancer Care in America” report from ASCO, more than 60% of patients in the U.S. did not have access to clinical trials. And now we have the technology to screen them, identify them and reach out to and potentially enroll them in trials through use of decentralized elements for clinical trials. And so I'm very optimistic that not just good quality standard cancer care, but also clinical research is going to be greatly expanded with the use of AI and telehealth. Dr. John Sweetenham: Really encouraging to hear that. Nate, it's been a real pleasure speaking with you today and I want to thank you for taking the time to share your insights with us on the ASCO Daily News Podcast.  Dr. Nathan Pennell: Thanks, John. Dr. John Sweetenham: I also want to say thank you to our listeners for your time today. If you value the insights that you hear on the ASCO Daily News Podcast, please take a moment to rate, review and subscribe wherever you get your podcasts. Disclaimer: The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience and conclusions. Guest statements on the podcast do not express the opinions of ASCO. The mention of any product, service, organization, activity or therapy should not be construed as an ASCO endorsement. Find out more about today's speakers: Dr. Nathan Pennell @n8pennell   Dr. John Sweetenham   Follow ASCO on social media:    @ASCO on Twitter    ASCO on Facebook    ASCO on LinkedIn      Disclosures:   Dr. John Sweetenham:   Consulting or Advisory Role: EMA Wellness   Dr. Nathan Pennell:     Consulting or Advisory Role: AstraZeneca, Lilly, Cota Healthcare, Merck, Bristol-Myers Squibb, Genentech, Amgen, G1 Therapeutics, Pfizer, Boehringer Ingelheim, Viosera, Xencor, Mirati Therapeutics, Janssen Oncology, Sanofi/Regeneron    Research Funding (Inst): Genentech, AstraZeneca, Merck, Loxo, Altor BioScience, Spectrum Pharmaceuticals, Bristol-Myers Squibb, Jounce Therapeutics, Mirati Therapeutics, Heat Biologics, WindMIL, Sanofi  

Aspiring honorary Irishman, Richard Pennell, joins us on this episode to reminisce about four golf trips he undertook to Ireland over the past 12 months. The North Coast & Donegal featured heavily and rightly so. The intrepid traveller also found time to schedule two whistle stop visits to County Mayo on the very Wild Atlantic Way, while also visiting a smattering of what the Dublin area has to offer from a golfing perspective. It amounted to a links overload which left Richard energised and plotting an imminent return. We hope the pod may give you some ideas as to where you might travel to in 2025, however, word of warning it might also make you a little envious that Richard passes these visits off as 'work'..... Either way, many thanks for tuning in, we hope you enjoy our chat! One of the last few copies of Richard's first book Grass Routes can be purchased by following this link (https://pitchmarks.bigcartel.com/product/grass-routes-by-richard-pennell) The Links Diary (https://www.thelinksdiary.com/no-10) Richard has written some great pieces on his @pitchmarks substack account and elsewhere. Please find a few links below to musings on some of his travels around Ireland: County Louth - currently a blank piece of paper.... he has promised us one, just as soon as inspiration arrives Royal Dublin - a work in progress, early 2025 methinks #71 - Portmarnock (https://pitchmarks.substack.com/p/pitchmarks-71-3rd-november-2024-very) #50 - Ballyliffin (https://pitchmarks.substack.com/p/pitchmarks-50-16th-june-2024-the) The North Coast (https://golftoday.co.uk/on-the-causeway-coast/) - an Article that appeared in Golf Today Episode music used under license from Epidemic Sound Special Guest: Richard Pennell.

Love the show? Have any thoughts? Click here to let us know!Step into the shadows of Delaware's haunted past in this chilling episode. First, Kenzie explores the Woodburn Mansion, a historic estate that serves as the governor's residence—and a hotspot for paranormal activity. From ghostly figures to unexplained phenomena, she'll uncover the eerie legends tied to this stately home. Then, Lauren delves into the disturbing case of Steven Brian Pennell, Delaware's only known serial killer. Known as the “Route 40 Killer,” Pennell's heinous crimes terrorized the state and left a legacy of fear. Join us as we weave together the supernatural and the sinister, unraveling Delaware's dark and mysterious tales.--Follow us on Social Media and find out how to support A Scary State by clicking on our Link Tree: https://instabio.cc/4050223uxWQAl--Have a scary tale or listener story of your own? Send us an email to ascarystatepodcast@gmail.com! We can't wait to read it!--Thinking of starting a podcast? Thinking about using Buzzsprout for that? Well use our link to let Buzzsprout know we sent you and get a $20 Amazon gift card if you sign up for a paid plan!https://www.buzzsprout.com/?referrer_id=1722892--Works cited!https://docs.google.com/document/d/1yta4QOa3v1nS3V-vOcYPNx3xSgv_GckdFcZj6FBt8zg/edit?usp=sharing --Intro and outro music thanks to Kevin MacLeod. You can visit his site here: http://incompetech.com/. Which is where we found our music!

Send us a textOn today's Zero Limits Podcast I chat with Jamie Pennell New Zealand Special Air Service and author of Serviceman J: The Untold Story of an NZSAS SoldierJamie Pennell spent 22 years in the New Zealand Defence Force, with 18 years in the NZ SAS.On 28 June 2011, a group of nine gunmen and suicide bombers attacked the Inter-Continental Hotel, Kabul. The attack and an ensuing five-hour siege left at least 21 people dead, including all nine attackers. Responsibility was claimed by the Taliban. Jamie's SAS patrol led the clearance of the hotel encountering many taliban fighters. Subsequently he was awarded New Zealand's second highest military honour by showing outstanding gallantry in the face of danger.During his time in the SAS, he also fought alongside Willie Apiata and was there when his actions led to him being awarded his Victoria Cross.After living the military Jamie's decision to write a book was sparked by encouragement from peers and family, as well as a personal tragedy. The death of our comrade, Steve Askin, motivated James to share his story. He began writing a tribute for Steve's family, which ultimately led him to expand his writing into a full book.Serviceman J: The Untold Story of an NZSAS Soldier

Chatting a top tip from a somatic vocal coach to use in daily life; why the voice is can be so under-rated; the voice & trauma; and fostering a new sense of resilience. Find Eleanor HERE Find the free Shamanic Reiki UK Community HERE Find the wait-list for the Shamanic Reiki Pathway Spring 25 HERE You'll find me most @shamanicreikiuk on IG

Former SAS commander Jamie Pennell recounts his experiences in Afghanistan in his memoir, Serviceman J, detailing life in one of the world's elite military forces and the transition to civilian life afterwards.

Join the Waste No Day! Facebook group: https://bit.ly/3xbqEj0 Follow Waste No Day on YouTube: https://bit.ly/3xlDLhD Lawrence Castillo is the President and Operating Partner of Brody Pennell Heating & Air Conditioning, Los Angeles' most successful HVAC company three years counting.  In this episode, we talked about technician training, service programs, client communication...

In this episode of MPR, we talk with Michael Pennell from Pythons in a Pear Tree about his approach to breeding Dwarf Burmese pythons.  Lucas Lee fills in for Owen on this one. Check out what Michael Pennell has going on: Pythons in a Pear TreeMPR Network SocialsFB: https://www.facebook.com/MoreliaPythonRadioIG: https://www.instagram.com/mpr_network/YouTube: https://www.youtube.com/channel/UCtrEaKcyN8KvC3pqaiYc0RQMORELIA CENTRAL Website: https://www.moreliapythonradio.netEmail: Info@moreliapythonradio.comMPR Support Cold-blooded CafeWe have an affiliate linkhttps://www.coldbloodedcafe.com/Cold Blooded CaffeineWe have an affiliate linkhttps://coldbloodedcaffeine.com/?ref=9wLRgXGdMerch store: https://teespring.com/stores/mprnetworkPatreon: https://www.patreon.com/moreliapythonradio ★ Support this podcast on Patreon ★

Recorded 5-16-2024 on OMEGAMAN "Tips from a Shepherd - Part Three" / Ralph Poupart and Larry Pennell / Omegaman Episode 10961  

Overtime With William Patteson HR 2 3.25.24: Max Pennell Joins! by Fanrun Radio

By early July 1988, he had already tortured, mutilated, and killed two women. Police were stumped until they sent in one of their own undercover. And while his wife and children slept, 30-year-old Steven Brian Pennell took the bait. Learn more about your ad choices. Visit podcastchoices.com/adchoices

With fear of confrontation and anxiety about disappointing loved ones, Steven Brian Pennell pent up his rage. He'd often drive along Highway 40 in Delaware to clear his head. After killing his first hitchhiker, he realized there was only one way to satisfy his desires. Learn more about your ad choices. Visit podcastchoices.com/adchoices