Podcasts about prognostic

Angenommen, Dein Personalausweis sagt, Du bist 46. Dann erzählt Dein Körper vielleicht die Geschichte einer 55-Jährigen – oder die eines 37-Jährigen. Der Unterschied? Dein biologisches Alter. Und das kannst Du beeinflussen.Am Ende dieser Folge weißt Du, was biologisches Alter wirklich bedeutet, wie Du es messen kannst – von DNA-Tests bis Wearables – und welche drei Hebel auf Basis aktueller Forschung am effektivsten sind. Mark teilt seine eigenen WHOOP-Daten aus 2025: vom Bestwert im Sommer über Bundeswehrübung und USA-Jetlag bis zum Buchlaunch-Stress. Das Ergebnis? Trotz allem netto jünger geworden.Du lernst, warum VO₂max der stärkste Prädiktor für Deine Lebenserwartung ist, warum Schlafkonsistenz wichtiger ist als Schlafdauer – und warum 90 Minuten Krafttraining pro Woche Dich um fast 4 Jahre verjüngen können.____________*WERBUNG: Infos zum Werbepartner dieser Folge und allen weiteren Werbepartnern findest Du hier.Nur diese Woche: Sichere Dir Dein #DRNBLBR Gym Towell – solange vorrätig: drnblbr.de.____________Erwähnte Tools und Ressourcen:Fitnesstracker:WHOOP (Fitness-Tracker mit umfassendem Healthspan-Feature) – 1 Monat gratis über diesen Link.Cerascreen Genetic Age Test (epigenetischer Test, Horvath-Uhr)Polar Loop (kein Abo, weniger Funktionen)Amazfit Helio Strap (kein Abo, Basisfunktionen)Waage:Withings Body ScanBücher:„Looking Good Naked – Die Gesamtausgabe“ von Mark Maslow (2025)Podcast und Artikel:Folge 466: Die neue Wissenschaft vom Schlaf – mit Dr. Peter SporkArtikel: Genetic Age Test: Die Wahrheit über Dein biologisches Alter?Testbericht:c't Fitnessarmband-Vergleichstest (Helio Strap, Polar Loop, WHOOP)Forschungseinrichtung:Buck Institute for Research on Aging (Whoop-Forschungspartner)Literatur:Horvath, S. (2013). DNA methylation age of human tissues and cell types. Genome Biology, 14(10), R115.Fitzgerald, K.N. et al. (2021). Potential reversal of epigenetic age using a diet and lifestyle intervention: a pilot randomized clinical trial. Aging, 13(7), 9419–9432.Mandsager, K. et al. (2018). Association of Cardiorespiratory Fitness With Long-term Mortality Among Adults Undergoing Exercise Treadmill Testing. JAMA Network Open, 1(6), e183605.Windred, D.P. et al. (2024). Sleep regularity is a stronger predictor of mortality risk than sleep duration. SLEEP, 47(1), zsad253.Leong, D.P. et al. (2015). Prognostic value of grip strength: findings from the Prospective Urban Rural Epidemiology (PURE) study. The Lancet, 386(9990), 266–273.Tucker, L.A. (2024). Telomere Length and Biological Aging: The Role of Strength Training in 4814 US Men and Women. Biology, 13(11), 883.c't Magazin (2025). Fitnessarmbänder ohne Display im Test: Helio Strap, Polar Loop, WHOOP MG. Ausgabe 25, S.102.Produktlinks sind Affiliate-Links.____________Shownotes und Übersicht aller Folgen.Trag Dich in Marks Dranbleiber Newsletter ein.Entdecke Marks Bücher.Folge Mark auf Instagram, Facebook, Strava, LinkedIn. Hosted on Acast. See acast.com/privacy for more information.

Clinicians and patients are in a state of prognostic uncertainty when they are unsure about the future course of an illness. By embracing uncertainty while cultivating prognostic awareness, neurologists can serve the critical role of supporting patients and families through the living and dying process. In this episode, Casey Albin, MD, speaks with Robert G. Holloway, MD, MPH, FAAN, author of the article "Managing Prognostic Uncertainty in Neurologic Disease" in the Continuum® December 2025 Neuropalliative Care issue. Dr. Albin is a Continuum® Audio interviewer, associate editor of media engagement, and an assistant professor of neurology and neurosurgery at Emory University School of Medicine in Atlanta, Georgia. Dr. Holloway is the Edward and Alma Vollertsen Rykenboer Chair and a professor of neurology in the department of neurology at the University of Rochester School of Medicine and Dentistry in Rochester, New York. Additional Resources Read the article: Managing Prognostic Uncertainty in Neurologic Disease Subscribe to Continuum®: shop.lww.com/Continuum Earn CME (available only to AAN members): continpub.com/AudioCME Continuum® Aloud (verbatim audio-book style recordings of articles available only to Continuum® subscribers): continpub.com/Aloud More about the American Academy of Neurology: aan.com Social Media facebook.com/continuumcme @ContinuumAAN Host: @caseyalbin Full episode transcript available here Dr Jones: This is Dr Lyell Jones, Editor-in-Chief of Continuum. Thank you for listening to Continuum Audio. Be sure to visit the links in the episode notes for information about earning CME, subscribing to the journal, and exclusive access to interviews not featured on the podcast. Dr Albin: Hello, this is Dr Casey Albin. Today I'm interviewing Dr Bob Holloway about his article on managing prognostic uncertainty in neurologic disease, which appears in the December 2025 Continuum issue on neuropalliative care. Welcome to the podcast, and please introduce yourself to our audience. Dr Holloway: Hi, Casey, and thank you. Again, my name is Bob Holloway. I'm a clinician and neurologist up in Rochester, New York, and I've been doing both neurology and palliative care for many years. Dr Albin: Well, that's fantastic. And I really wanted to emphasize how much I really enjoyed reading this article. I know that we're going to get into some of the pearls that you offer, but I really want to tell the listeners, like, this is a great one to read because not only does it have sort of a philosophical take, but you also really provide some pragmatic tips of how we can help our patients manage this prognostic uncertainty. But maybe just tell us a little bit, what is prognostic uncertainty? Dr Holloway: Yes, thank you. Well, I think everyone has a sense of what prognostic uncertainty is. And it's just the uncertain futures that we as clinicians and our patients face. And I would just say that a way to summarize it is just, how do we manage the "not yet" of neurologic illness? Dr Albin: I love that. In neurologic illness, there is so much "not yet" and there are so many unknowns. And what I thought was really helpful about your article is you kind of give us three buckets in which we can think about the different types of uncertainty our patients are facing. What are those? Dr Holloway: This is, I think, an area that really is of interest to me, thinking about how to organize the prognostic "not yet" or that landscape. And one way I've tried to simplify it is to think about it as data-centered. And that's the world that we mostly live in as neurologists. That's the probability distributions. We also have kind of system-level uncertainties, and that's the uncertainties that our health system affords for our patients. And then we have, also, the patient-centered uncertainties and the uncertainties that those two prior categories cause for our patients. And that's a big uncertainty that we often don't address. Dr Albin: In reading the article, I was really struck by, we spend a lot of time thinking about data uncertainty. Can we get population-based research? Can we sort of look at prognostication scoring? I live in the ICU, and so we think a lot about these, like, scoring metrics and putting patients into buckets and helping us derive their care based on where their severity index is. And I'm sure that is true in many of the divisions of neurology. But what I did not really appreciate---and I thought you did a really fantastic job of kind of drawing our attention to---is there's a lot of system-centered uncertainty. Can you give us a little bit of examples, like, what is system-based uncertainty? Dr Holloway: I think system-level uncertainties just encompass the practical information gaps that may arise during our healthcare encounter. And a lot of, I think, the uncertainty that our patients face and families, they actually describe it as they feel captive by the uncertainty. And it's just the unknowns, not just what affords from the actual information about the disease and its prognosis in the future, but actually the level of the system, like, who's going to take care of them? How do you manage arranging for nurses to come into the home or all those practical-level uncertainties that the system provides that sometimes we don't do a good job of road-mapping for patients. Dr Albin: Absolutely. Because I feel like we have a little bit of a gap in that often as physicians. Like, the family asks, what will hospice at home look like? Well, you know, that's a question for case management. I think they'll come in and they'll tell you. But it strikes me that that's a real gap of my being able to walk patients through. Will they get home health care? Will they have transportation set up? Will there be a nurse who comes in to check? How often are they available? What's the cost going to be? All of these practical aspects of dealing with an illness that are beyond sort of our scope of knowledge, but probably have a huge practical impact to the patient. Dr Holloway: Without question, every encounter patients wonder about, that kind of future wish landscape that we- all our future-oriented desires and hopes. And so much of that is the practical aspects of our health system, which is often fragmented, kind of unknown, uncertain. And that's a huge source of uncertainty for our patients and families. And then that leads to many other uncertainties that we need to address. Dr Albin: Absolutely. I think another one that we, again, maybe don't spend quite as much time thinking about is this patient-level uncertainty. What's going on there? Dr Holloway: Yeah. So, I think patient-level uncertainty is that uncertainty that they experience when confronted with the two other types of uncertainty: the actual data-centered uncertainty and the system-level uncertainty. And that's that, kind of, very huge kind of uncertainty about what it means for them and their family and their future futures. And that's a source of huge stress and anxiety, and often frankly bordering on dread and fear for our patients and families. That actually gets into very levels of uncertainty that I would call maybe over even in the existential realm. Patient-level uncertainty in the actual existential questions or the fear and the dread or the kind of just unnerving aspect of it is actually even more important to patients than the scientific or data-centered uncertainty that we focus most of our attention on. Dr Albin: Yeah, I think this is, to me, was getting towards that, like, what does the patient care about and how are they coping with what is in many times a really dramatic shift in their life expectancy or morbidity expectations and this sort of radical renegotiation about what it means to have a neurologic illness? And how does that shift their thinking about who they are and their priorities in the world? Is that right? Dr Holloway: One thousand percent, and in fact, I will say---and I think is one of the main take home messages is that, you know, managing prognostic certainty is not an end in itself. It really is to help patients and families adaptively cope to their new and often harsh new reality, that we could help them adapt to their new normal. I think that is one of our main tasks as neurologists in our care teams is to help patients find and ultimately maybe achieve existential or spiritual or well-being even in their new health states. You know, that you certainly often see in the intensive care unit, but we often always see in the outpatient realm as well, and all our other diseases. Dr Albin: I think that's really hard to do. I think those conversations are incredibly difficult and trying to navigate where patients want to be, what would bring meaning, what would bring value. I think many of us struggle to have these pretty real and intense conversations with families about what really is important. And one of the things I really liked about this article is you kind of walk us through some steps that we as clinicians can take to get a little bit more comfortable. Maybe just walk us through, what are some of the things that you have found most helpful in trying to get families and patients to open up about what brings them meaning? How are they navigating this new, really uncertain time in their life? Dr Holloway: Yeah, so I do kind of have a ten-point recommendations of how to help cultivate a more integrated awareness of an uncertain future. I mean, I think the most important thing is actually just recognizing that embracing uncertainty as an amazingly remarkable cognitive tool. I mean, let's face it, uncertainty, when it happens with neurologic illness and disease, is often fearful. It's scary. It kind of changes our world. But on the flip side of it, it's a remarkable cognitive tool that actually can help us find new ways and new paths and new creativity. And I think we can use that kind of opposites to help our patients find new meaning in very difficult situations. So, thinking about uncertainty, kind of being courageous, leaning into it and recognizing that it does create anxieties and fear, but it also can kind of help create new solutions and new ideas to help people navigate. Dr Albin: I was hoping that maybe you could give us an example of, like, how would you do that? If a patient comes in and they're dealing with, you know, a new diagnosis and they're navigating this new uncertainty, what are some of the things that you ask to help them reframe that, to kind of take some of the good about that uncertainty? How do you navigate that? Dr Holloway: One of the other recommendations is actually just resetting the timeline and expectations for these conversations. That it shouldn't be expected that patients should accept their harsh new reality immediately, that it takes time in a trusted environment. And that there's this, like, oscillating nature of hopes and fears and dread, and you've just got to work with them over time. And with time, and once you understand who the patient and family are and understand where they find meaning and where they find, actually, joy in their life, or what actually brings them meaning, you can start recasting their futures into credible narratives in their kind of future landscape in ways that I think can help them enter into their new realities within the, you know, framework of disease management that you can offer them within your healthcare team or your healthcare system or wherever you are in the world and the available resources that you have to offer patients and families. Dr Albin: So, this sounds like a lot to me like active listening and really trying to get to know what is important to the family, what is important to the patient. And I guess probably just creating that space even in that busy clinical environment. Do I have that right? Dr Holloway: You can absolutely do that, right. You know, and honestly, active listening, we are challenged in our busy healthcare system to do this, but I think with the right listening skills and the appropriate ways of paying attention, you can definitely illuminate these possible, kind of future-oriented worlds for patients and help them navigate those new terrains with them. Frankly, I think that's a real new space for us in neurology. We don't think about and train how to create credible narratives for patients and families. We do it on the fly, but I think there's so much more work to do. How do you actually keep, you know, that best-case, worst-case, most likely credible narratives for patients that can help them adapt to their new realities and support them on their new journeys? Dr Albin: I love that best-case, worst-case, most likely case. I find that framework really helpful. But you talk in your article, it's not just about using that best case or worst case or most likely, but it's actually building some forecasting into that and having some real data to kind of support what you're saying. And there's a lot of growth towards actually becoming good as a medical forecaster. Can you describe a little bit, what did you mean by that? Dr Holloway: You're absolutely right. I think, actually, one of the skillsets of becoming and managing prognostic uncertainty is actually becoming a skilled medical forecaster. And it's a really tall order. So, we've got to be both good medical forecasters as well as helping patients adaptively cope to their new reality. But the good medical forecasting is actually now going more quantitative in thinking about the data that's available to help think about the important outcomes for patients and families and then predicting what their probabilities are so you can shape those futures around. So, yes, we do have to have an open mindset. We do have to actually look at the data that's available and actually think about, what are those long-term probabilities and outcomes? And we can be honest about those and even communicate them with families. But it's a really good skill set to have. Dr Albin: Yeah. This to me was a little bit about, how do you bring in the data knowledge that we try to get over time as we develop our expertise? You're developing not just a reliance on population-based data, but in my experience, I have seen this. And that sort of ability to kind of look at the patient in front of you, think about the big picture, but also a little bit about their unique medical comorbidities or prior life experiences. So, some of that database knowledge, and then bringing in and getting to know what is important to the patient. And so, sort of marrying that data-centric/patient-centric mindset. Dr Holloway: I love it. I guess the other way of saying that, too, is we need to think with precision, but communicate in narratives. And it's okay to gently put more precise estimates on our probability predictions with patients and families, what we think is the most likely case, best and worst case. Because patients and families want us to be more precise. We often shy away from it, but- so, it's okay to think in precisions, but we've got to put those in narratives in the most likely, best-, and worst-case scenarios. And don't be afraid if you think in terms of ninety percents, ten percents, fifty percents; most patients and families don't mind that. And what they're telling us is they actually want to hear that, if you are comfortable talking in those terms. Dr Albin: Yeah, absolutely. And giving a sense of the humility to say, like, this is my best guess based on medical data and my experience, I would say, but again, none of us have a crystal ball. And I do think families, as long as you're sort of couching your expectations into the sort of imperfect, but I'm doing my best, really appreciate that. Dr Holloway: They totally do all the time. Just say, I simply don't know for certain, but these are my best estimates. That's a good way of just phrasing that. Dr Albin: Yeah. So powerful. I don't know for certain. And then I wanted to just kind of close out, because there's this one term that you use that I thought was so interesting. And I wanted you to kind of tell our listeners a little bit about what you mean here, which is that, when you're actively open-minded, you're using this, quote, "dragonfly eyes." What do you mean by that? Dr Holloway: So, the dragonfly eyes, as you know, they can look at three sixty around them and they just, they move in all directions. Being actively open minded, I guess the biggest example I would say is, I don't like the term prognostic discordance, which means that there's a difference of subjective estimates of prognosis between patients and families. Being openly minded is actually embracing the potential information that the family has about prognosis and incorporating that into your estimates. So, I wouldn't say it's discordances, per se; I think being really actively open-minded is taking that all in and utilizing that as, you know what, they know more than you do about the patient and their loved ones, and they may have insights that can inform your best estimates of prognosis. So, the true dragonfly prognosticator actually is one who embraces and doesn't consider it discord, but considers it kind of new, useful information that I just need to weigh in so I can help the family in my best professional way in terms of developing a prognosis, whatever the condition may be. Dr Albin: I can imagine this is just so challenging and something that takes a long time to sort of perfect all of this. I think you say right below that, you need a growth mindset to do this because it is hard, and it's going to take an active participation and an active desire to get better at these conversations with our families. Dr Holloway: One thousand percent. You are so right that it takes time, effort, and not feeling like you're being challenged, but that actually you are including them in your entire body of knowledge, that you're just- it's part of all you're collecting. And even, I was on service last week, and I talked to residents and students about that very issue. It's like take their prognosis. And someone who came in, we thought CJB, very sad, tragic case, but we were thinking about what the future may look like and how do we actually work with the family who had very what we thought was unrealistic expectations. I said, well, no, this is not discordance. This is just useful information that we can take understand where they're coming from and incorporate that into the ways we want to build relationships, build trust, and over time we'll get to a point where we hopefully can work with them and have them have that fully integrated awareness of their future. Dr Albin: Yeah, that's beautiful. It really is this ongoing negotiation that really requires so much listening, understanding, and then obviously information and expertise about the data that we're presenting and the likelihood outcome, recognizing that there's a lot of uncertainty in all of this. Which, you know, again, this is kind of a 360 talk. At every level there is uncertainty, and that's what makes it so hard. Dr Holloway: Yeah, you're absolutely right. And actually, even in the article I kind of used the term radical uncertainty as that, no matter how resolvable all this uncertainty is, there will always still remain that radical element of our existence which we have to actually incorporate and be prepared for. And actually, not only of ourselves, but actually for patients and families and helping manage that. Using narratives and credible narratives and kind of ranges of possibilities is the best way to do that in a personalized way. Dr Albin: Well, this has been a fantastic conversation, and I know that we are running a bit short on time. So, as we wrap up and you think about this topic, are there any key take-home messages that you hope our listeners will walk away with? Dr Holloway: I think one main emphasis is that despite all the successes we feel we have in neurology, is that we all have to recognize that prognostic uncertainty is just going to increase in the future. But this is going to be for several reasons. One is that, just, the illness uncertainty of all of our great therapies are just going to be creating more uncertainty for the future. And precision medicine is paradoxical, and that actually it creates more uncertainty. So, I think we need to be prepared that we have to manage prognostic uncertainty better, because it's definitely going to increase. And two, it's what I said earlier, is that actually managing prognostic uncertainty is not an end to itself. It's actually helping patients and families adapt to their new and sometimes harsh new reality and actually help them to ultimately get to a place where maybe either their condition is neither dreaded, but actually they can accept it as their new reality and actually achieve some sort of existential well-being and existential health. I think that we have a lot more to emphasize in this area. And for far too long, we've focused on the certainty aspect of our field and not enough on the uncertainty in the world of medicine to help our patients and families. Dr Albin: And gosh, isn't there just so much uncertainty? And I think this has been beautiful. So, thank you again for coming and sharing your expertise. Dr Holloway: Thank you very much. It's been a pleasure. Dr Albin: For all of our listeners out there, this is a truly fantastic article, and I would just like to direct you to going to read the cases because not only do the cases offer a little bit of practical advice, but there's one that's actually sort of a philosophical discussion about, what does it mean to be alive and confront death? There's some beautiful artwork that's featured as well. So this is just a really unique article, and I'm excited for our listeners to have a chance to check it out. So again, today I've been interviewing Dr Bob Holloway about his article on managing prognostic uncertainty in neurologic disease, which appears in the December 2025 Continuum issue on neuropalliative care. Be sure to check out Continuum Audio episodes from this and other issues. Dr Monteith: This is Dr Teshamae Monteith, Associate Editor of Continuum Audio. If you've enjoyed this episode, you'll love the journal, which is full of in-depth and clinically relevant information important for neurology practitioners. Use the link in the episode notes to learn more and subscribe. AAN members, you can get CME for listening to this interview by completing the evaluation at continpub.com/audioCME. Thank you for listening to Continuum Audio.

Commentary by Dr.  Jian'an Wang.

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In this week's episode, Blood editor Dr. Laurie Sehn interviews three of the latest Blood authors: Drs. Vijay Sankaran, Ruud Delwel, Françoise Kraeber-Bodere. Two studies on the MECOM gene have been paired in this episode, analyzing new groundwork for potential novel myeloid differentiation therapies via repression of MECOM restoring enhancer mediated CEBPA expression. We'll also hear about the results of CASSIOPET, imaging companion study of the CASSIOPEIA trial, and how achieving negativity in PET before starting maintenance therapy is significant even in patients who still show residual disease in the bone marrow.Featured ArticlesCEBPA repression by MECOM blocks differentiation to drive aggressive leukemiasMECOM is a master repressor of myeloid differentiation through dose control of CEBPA in acute myeloid leukemia Prognostic value of premaintenance FDG PET/CT response in patients with newly diagnosed from the CASSIOPEIA trial

Commentary by Dr. Jian'an Wang.

In today's VETgirl online veterinary continuing education podcast, we dig into the latest evidence on prognostic indicators during Cardiopulmonary Resuscitation (CPR) in dogs and cats. Using data from the RECOVER registry, this 2025 JVECC study sheds light on which factors can help predict return of spontaneous circulation (ROSC) and survival to discharge, giving us practical tools to guide our decision-making in the heat of resuscitation. Tune in to hear how this data can help set realistic expectations for veterinary staff and for pet owners, and shape how we approach veterinary CPR!

In today's VETgirl online veterinary continuing education podcast, we dig into the latest evidence on prognostic indicators during Cardiopulmonary Resuscitation (CPR) in dogs and cats. Using data from the RECOVER registry, this 2025 JVECC study sheds light on which factors can help predict return of spontaneous circulation (ROSC) and survival to discharge, giving us practical tools to guide our decision-making in the heat of resuscitation. Tune in to hear how this data can help set realistic expectations for veterinary staff and for pet owners, and shape how we approach veterinary CPR!

Darshan H. Brahmbhatt, Podcast Editor of JACC: Advances, discusses a recently published original research paper on Prognostic Implications of Preoperative hs-cTnT in Elective Coronary Artery Bypass Grafting.

Dr Neil Greening and Dr Hnin Aung join Diana Stanley to discuss a new multidimensional prognostic risk stratification model for COPD exacerbations.click here to read the full article: https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(25)00362-5/fulltextContinue this conversation on social!Follow us today at...https://thelancet.bsky.social/https://instagram.com/thelancetgrouphttps://facebook.com/thelancetmedicaljournalhttps://linkedIn.com/company/the-lancethttps://youtube.com/thelancettv

Commentary by Dr. Jian'an Wang.

Dr. Kenneth Ellenbogen, Deputy Editor of JACC: Clinical Electrophysiology, discusses Mental Disorders Following Implantable Cardioverter-Defibrillator Therapy: Incidence and Prognostic Implications in a Nationwide Cohort Study.

Commentary by Dr. Anastasios Apostolos.

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In this week's episode we'll learn about targeting the tissue factor pathway inhibitor with a monoclonal antibody to rebalance HEMOSTASIS in hemophilia A and B. In the phase 3 BASIS trial, the monoclonal antibody marstacimab reduced bleeding events, and was generally well tolerated, with no unanticipated side effects. After that: matched-donor allogeneic CD19 CAR-T for adult B-ALL. Given after allogeneic transplantation, CAR-donor lymphocyte infusion after lymphodepleting chemotherapy was associated with favorable efficacy and a tolerable safety profile. Finally: a new prognostic index for mycosis fungoides and Sézary syndrome. Comprised of four prognostic factors, the “CLIPI” could enable more personalized treatment of cutaneous lymphomas, identifying patients who may benefit from intensified treatment.Featured ArticlesMarstacimab prophylaxis in hemophilia A/B without inhibitors: results from the phase 3 BASIS trialMatched donor allogeneic CAR-T for adult B-ALL: toxicity, efficacy, repeat dosing, and the importance of lymphodepletionA new prognostic index (CLIPI) for advanced cutaneous lymphoma enables precise patient risk stratification

This content has been developed for healthcare professionals only. Patients who seek health information should consult with their physician or relevant patient advocacy groups.For the full presentation, downloadable Practice Aids, slides, and complete CME/MOC/NCPD/AAPA/IPCE information, and to apply for credit, please visit us at PeerView.com/DPB865. CME/MOC/NCPD/AAPA/IPCE credit will be available until September 7, 2026.Mapping Therapeutic Directions in DLBCL: Team Strategies for Prognostic Assessment and Implications for Targeted Therapy and Other Innovative Options In support of improving patient care, PVI, PeerView Institute for Medical Education, is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.SupportThis activity is supported by an independent educational grant from AstraZeneca.Disclosure information is available at the beginning of the video presentation.

This content has been developed for healthcare professionals only. Patients who seek health information should consult with their physician or relevant patient advocacy groups.For the full presentation, downloadable Practice Aids, slides, and complete CME/MOC/NCPD/AAPA/IPCE information, and to apply for credit, please visit us at PeerView.com/DPB865. CME/MOC/NCPD/AAPA/IPCE credit will be available until September 7, 2026.Mapping Therapeutic Directions in DLBCL: Team Strategies for Prognostic Assessment and Implications for Targeted Therapy and Other Innovative Options In support of improving patient care, PVI, PeerView Institute for Medical Education, is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.SupportThis activity is supported by an independent educational grant from AstraZeneca.Disclosure information is available at the beginning of the video presentation.

This content has been developed for healthcare professionals only. Patients who seek health information should consult with their physician or relevant patient advocacy groups.For the full presentation, downloadable Practice Aids, slides, and complete CME/MOC/NCPD/AAPA/IPCE information, and to apply for credit, please visit us at PeerView.com/DPB865. CME/MOC/NCPD/AAPA/IPCE credit will be available until September 7, 2026.Mapping Therapeutic Directions in DLBCL: Team Strategies for Prognostic Assessment and Implications for Targeted Therapy and Other Innovative Options In support of improving patient care, PVI, PeerView Institute for Medical Education, is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.SupportThis activity is supported by an independent educational grant from AstraZeneca.Disclosure information is available at the beginning of the video presentation.

This content has been developed for healthcare professionals only. Patients who seek health information should consult with their physician or relevant patient advocacy groups.For the full presentation, downloadable Practice Aids, slides, and complete CME/MOC/NCPD/AAPA/IPCE information, and to apply for credit, please visit us at PeerView.com/DPB865. CME/MOC/NCPD/AAPA/IPCE credit will be available until September 7, 2026.Mapping Therapeutic Directions in DLBCL: Team Strategies for Prognostic Assessment and Implications for Targeted Therapy and Other Innovative Options In support of improving patient care, PVI, PeerView Institute for Medical Education, is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.SupportThis activity is supported by an independent educational grant from AstraZeneca.Disclosure information is available at the beginning of the video presentation.

This content has been developed for healthcare professionals only. Patients who seek health information should consult with their physician or relevant patient advocacy groups.For the full presentation, downloadable Practice Aids, slides, and complete CME/MOC/NCPD/AAPA/IPCE information, and to apply for credit, please visit us at PeerView.com/DPB865. CME/MOC/NCPD/AAPA/IPCE credit will be available until September 7, 2026.Mapping Therapeutic Directions in DLBCL: Team Strategies for Prognostic Assessment and Implications for Targeted Therapy and Other Innovative Options In support of improving patient care, PVI, PeerView Institute for Medical Education, is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.SupportThis activity is supported by an independent educational grant from AstraZeneca.Disclosure information is available at the beginning of the video presentation.

This content has been developed for healthcare professionals only. Patients who seek health information should consult with their physician or relevant patient advocacy groups.For the full presentation, downloadable Practice Aids, slides, and complete CME/MOC/NCPD/AAPA/IPCE information, and to apply for credit, please visit us at PeerView.com/DPB865. CME/MOC/NCPD/AAPA/IPCE credit will be available until September 7, 2026.Mapping Therapeutic Directions in DLBCL: Team Strategies for Prognostic Assessment and Implications for Targeted Therapy and Other Innovative Options In support of improving patient care, PVI, PeerView Institute for Medical Education, is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.SupportThis activity is supported by an independent educational grant from AstraZeneca.Disclosure information is available at the beginning of the video presentation.

Darshan H. Brahmbhatt, Podcast Editor of JACC: Advances, discusses a recently published original research paper on Prognostic Implications of Preoperative N-Terminal Pro-B-Type Natriuretic Peptide Dynamics in Patients Undergoing Cardiac Surgery.

Dr. John Fleetham chats with Dr. Chris Ryerson and Dr. Yet Khor about their article, "Epidemiology and Prognostic Significance of Cough in Fibrotic Interstitial Lung Disease."

Dr. John Fleetham chats with Dr. Chris Ryerson and Dr. Yet Khor about their article, "Epidemiology and Prognostic Significance of Cough in Fibrotic Interstitial Lung Disease."

In this JCO Precision Oncology Article Insights episode, Natalie DelRocco summarizes "Prognostic Value of the G2 Expression Signature and MYC Overexpression in Childhood High-Grade Osteosarcoma" by Roelof van Ewijk et al. published on May 29, 2025. TRANSCRIPT Natalie Del Rocco: Hello, and welcome to JCO Precision Oncology Article Insights. I'm your host, Natalie DelRocco, and today we will be discussing the original report, "Prognostic Value of the G2 Expression Signature and MYC Overexpression in Childhood High-Grade Osteosarcoma." This original report by van Ewijk et al. describes a study of the association between 2 biomarkers and survival outcomes among patients with high-grade osteosarcoma. Osteosarcoma is a disease where not much progress has been made in risk stratification factors that could potentially help patients target lower-risk therapies, less toxic therapies, or therapies that might be more toxic but could help their high-risk osteosarcoma. So, it's important to identify risk factors that can help target therapies. The G1/G2 gene expression signature is a prognostic risk score developed by a French osteosarcoma group in 2022. They showed in a cohort of 79 osteosarcoma patients that risk score was associated with poorer event-free survival and overall survival. This considers expression of 15 individual genes. MYC amplification was shown in 2023 by a North American osteosarcoma group to be associated with poor overall survival in a cohort of 92 osteosarcoma patients, and this group validated that finding in a localized cohort in the same publication.  The goal of this particular original report was to assess the prognostic significance of each of these biomarkers in a population independent to those prior publications and, hence, to serve as an external validation of prior findings and to assess these 2 biomarkers in the same study. The investigators considered MYC amplification, defined as having greater than 7 copies; MYC expression as a continuous rather than the previously categorized variable; and G2 expression defined as a continuous variable; and then G2 expression defined as a dichotomous variable with the cut point at the median, as done in the original paper.  What the investigators found in their primary multivariable Cox proportional hazards regression model, which controlled for additional clinical risk factors such as age, tumor site, tumor size, is that G2 expression and MYC expression as continuous variables were associated with increased hazard of EFS and OS event. MYC amplification was not found to be prognostic. This is not surprising. When we have continuous variables, we have greater statistical power, we decrease the likelihood that an identified cut point in a previous study does not generalize well to either our genetic assay or our patient population. So, we don't have to worry about finding the optimal cut point in our particular patient sample. Thank you for listening to our JCO Precision Oncology Article Insights. Don't forget to give us a rating or review, and be sure to like and subscribe so that you never miss an episode. You can find all ASCO shows at asco.orgpodcasts. 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.  

In this JCO Precision Oncology Article Insights episode, Natalie DelRocco summarizes "Prognostic Value of the G2 Expression Signature and MYC Overexpression in Childhood High-Grade Osteosarcoma" by Roelof van Ewijk et al. published on May 29, 2025. TRANSCRIPT Natalie Del Rocco: Hello, and welcome to JCO Precision Oncology Article Insights. I'm your host, Natalie DelRocco, and today we will be discussing the original report, "Prognostic Value of the G2 Expression Signature and MYC Overexpression in Childhood High-Grade Osteosarcoma." This original report by van Ewijk et al. describes a study of the association between 2 biomarkers and survival outcomes among patients with high-grade osteosarcoma. Osteosarcoma is a disease where not much progress has been made in risk stratification factors that could potentially help patients target lower-risk therapies, less toxic therapies, or therapies that might be more toxic but could help their high-risk osteosarcoma. So, it's important to identify risk factors that can help target therapies. The G1/G2 gene expression signature is a prognostic risk score developed by a French osteosarcoma group in 2022. They showed in a cohort of 79 osteosarcoma patients that risk score was associated with poorer event-free survival and overall survival. This considers expression of 15 individual genes. MYC amplification was shown in 2023 by a North American osteosarcoma group to be associated with poor overall survival in a cohort of 92 osteosarcoma patients, and this group validated that finding in a localized cohort in the same publication.  The goal of this particular original report was to assess the prognostic significance of each of these biomarkers in a population independent to those prior publications and, hence, to serve as an external validation of prior findings and to assess these 2 biomarkers in the same study. The investigators considered MYC amplification, defined as having greater than 7 copies; MYC expression as a continuous rather than the previously categorized variable; and G2 expression defined as a continuous variable; and then G2 expression defined as a dichotomous variable with the cut point at the median, as done in the original paper.  What the investigators found in their primary multivariable Cox proportional hazards regression model, which controlled for additional clinical risk factors such as age, tumor site, tumor size, is that G2 expression and MYC expression as continuous variables were associated with increased hazard of EFS and OS event. MYC amplification was not found to be prognostic. This is not surprising. When we have continuous variables, we have greater statistical power, we decrease the likelihood that an identified cut point in a previous study does not generalize well to either our genetic assay or our patient population. So, we don't have to worry about finding the optimal cut point in our particular patient sample. Thank you for listening to our JCO Precision Oncology Article Insights. Don't forget to give us a rating or review, and be sure to like and subscribe so that you never miss an episode. You can find all ASCO shows at asco.orgpodcasts. 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.  

Darshan H. Brahmbhatt, Podcast Editor of JACC: Advances, discusses a recently published original research paper on Myocardial Work in Children With Hypertrophic Cardiomyopathy: Longitudinal Evaluation and Prognostic Implications.

Welcome to the Part Time Pilot Audio Ground School Podcast! This podcast takes our free podcast to a whole new level by providing students with every single lesson included in the Part Time Pilot Private Pilot & IFR Ground Schools without a single Ad! On top of that, VIP podcast students get BONUS episodes like Mock Checkrides, Checkride Prep, Expert Interviews and more!   The #1 reason student pilots never end up becoming a private pilot is NOT due to money. The real reason is actually deeper than that. Yes, flight training is expensive. But every student pilot knows this and budgets for it when they decide to do it.   The actual #1 reason a student pilot fails is because they do not have a good, fundamental understanding of the private pilot knowledge they are meant to learn in ground school.   You see when a student does not have a good grasp of this knowledge they get to a point in their flight training where their mind just can't keep up. They start making mistakes and having to redo lessons. And THAT is when it starts getting too expensive.   This audio ground school is meant for the modern day student pilot... aka the part time student pilot. Let's face it, the majority of us have full time responsibilities on top of flight training. Whether it is a job, kids, family, school, etc. we all keep ourselves busy with the things that are important to us. And with today's economy we have to maintain that job just to pay for the training. The modern day student pilot is busy, on the go and always trying to find time throughout his or her day to stay up on their studies. The audio ground school allows them to consume high quality content while walking, running, working out, sitting in traffic, traveling, or even just a break from the boring FAR/AIM or ground school lecture.   Did I meant high quality content? The audio ground school is taken straight out of the 5-star rated Part Time Pilot Online Ground School that has had over 2000 students take and pass their Private Pilot & IFR exams with only 2 total students failing the written. That's a 99.9% success rate! And the 2 that failed? We refunded their cost of ground school and helped them pass on their second attempt. We do this by keeping ground school engaging, fun, light and consumable. We have written lessons, videos, audio lessons, live video lessons, community chats, quizzes, practice tests, flash cards, study guides, eBooks and much more.   Part Time Pilot was created to be a breath of fresh air for student pilots. To be that flight training provider that looks out for them and their needs. So that is just what we are doing with this podcast.     IFR Section 4 Lesson 18: In this Free IFR Ground School lesson we talk about more helpful weather charts, and in particular significant weather prognostic charts such as surface, low-level and high-level which can give use significant weather event forecasts.   Links mentioned in the episode: Scholarships: https://parttimepilot.com/scholarships/  Private Pilot Online Ground School: PPL Ground School - Part Time Pilot Checkride Prep: PPL Checkride Prep - Part Time Pilot IFR Online Ground School: IFR Ground School – Part Time Pilot   PPL study group: https://www.facebook.com/groups/parttimepilot  IFR study group: https://www.facebook.com/groups/parttimepilotifr/   Recommended Products & Discounts:  https://parttimepilot.com/recommended-products-for-student-pilots/   

Dr. Diwakar Davar and Dr. Jason Luke discuss novel agents in melanoma and other promising new data in the field of immunotherapy that were presented at the 2025 ASCO Annual Meeting. TRANSCRIPT Dr. Diwakar Davar: Hello. My name is Diwakar Davar, and I am welcoming you to the ASCO Daily News Podcast. I'm an associate professor of medicine and the clinical director of the Melanoma and Skin Cancer Program at the University of Pittsburgh's Hillman Cancer Center. Today, I'm joined by my colleague and good friend, Dr. Jason Luke. Dr. Luke is a professor of medicine. He is also the associate director of clinical research and the director of the Phase 1 IDDC Program at the University of Pittsburgh's Hillman Cancer Center. He and I are going to be discussing some key advancements in melanoma and skin cancers that were presented at the 2025 ASCO Annual Meeting. Our full disclosures are available in the transcript of this episode.  Jason, it is great to have you back on the podcast. Dr. Jason Luke: Thanks again so much for the opportunity, and I'm really looking forward to it. Dr. Diwakar Davar: Perfect. So we will go ahead and start talking a little bit about a couple of key abstracts in both the drug development immunotherapy space and the melanoma space. The first couple of abstracts, the first two, will cover melanoma. So, the first is LBA9500, which was essentially the primary results of RELATIVITY-098. RELATIVITY-098 was a phase 3 trial that compared nivolumab plus relatlimab in a fixed-dose combination against nivolumab alone for the adjuvant treatment of resected high-risk disease. Jason, do you want to maybe give us a brief context of what this is? Dr. Jason Luke: Yeah, it's great, thanks. So as almost all listeners, of course, will be aware, the use of anti–PD-1 immunotherapies really revolutionized melanoma oncology over the last 10 to 15 years. And it has become a standard of care in the adjuvant setting as well. But to review, in patients with stage III melanoma, treatment can be targeted towards BRAF with BRAF and MEK combination therapy, where that's relevant, or anti–PD-1 with nivolumab or pembrolizumab are a standard of care. And more recently, we've had the development of neoadjuvant approaches for palpable stage III disease. And in that space, if patients present, based on two different studies, either pembrolizumab or nivolumab plus ipilimumab can be given prior to surgery for somewhere in the 6- to 9-week range. And so all of these therapies have improved time-to-event endpoints, such as relapse-free or event-free survival. It's worth noting, however, that despite those advances, we've had a couple different trials now that have actually failed in this adjuvant setting, most high profile being the CheckMate-915 study, which looked at nivolumab plus ipilimumab and unfortunately was a negative study. So, with RELATIVITY-047, which was the trial of nivolumab plus relatlimab that showed an improvement in progression-free survival for metastatic disease, there's a lot of interest, and we've been awaiting these data for a long time for RELATIVITY-098, which, of course, is this adjuvant trial of LAG-3 blockade with relatlimab plus nivolumab. Dr. Diwakar Davar: Great. So with that, let's briefly discuss the trial design and the results. So this was a randomized, phase 3, blinded study, so double-blinded, so neither the investigators knew what the patients were getting, nor did the patients know what they were getting. The treatment investigational arm was nivolumab plus relatlimab in the fixed-dose combination. So that's the nivolumab standard fixed dose with relatlimab that was FDA approved in RELATIVITY-047. And the control arm was nivolumab by itself. The duration of treatment was 1 year. The patient population consisted of resected high-risk stage III or IV patients. The primary endpoint was investigator-assessed RFS. Stage and geography were the standard stratifying factors, and they were included, and most of the criteria were balanced across both arms. What we know at this point is that the 2-year RFS rate was 64% and 62% in the nivolumab and nivolumab-combination arms, respectively. The 2-year DMFS rate was similarly equivalent: 76% with nivolumab monotherapy, 73% with the combination. And similar to what you had talked about with CheckMate 915, unfortunately, the addition of LAG-3 did not appear to improve the RFS or DMFS compared to control in this patient population. So, tell us a little bit about your take on this and what do you think might be the reasons why this trial was negative? Dr. Jason Luke: It's really unfortunate that we have this negative phase 3 trial. There had been a lot of hope that the combination of nivolumab with relatlimab would be a better tolerated combination that increased the efficacy. So in the metastatic setting, we do have 047, the study that demonstrated nivolumab plus relatlimab, but now we have this negative trial in the adjuvant setting. And so as to why exactly, I think is a complicated scenario. You know, when we look at the hazard ratios for relapse-free survival, the primary endpoint, as well as the secondary endpoints for distant metastasis-free survival, we see that the hazard ratio is approximately 1. So there's basically no difference. And that really suggests that relatlimab in this setting had no impact whatsoever on therapeutic outcomes in terms of efficacy. Now, it's worth noting that there was a biomarker subanalysis that was presented in conjunction with these data that looked at some immunophenotyping, both from circulating T cells, CD8 T cells, as well as from the tumor microenvironment from patients who were treated, both in the previous metastatic trial, the RELATIVITY-047 study, and now in this adjuvant study in the RELATIVITY-098 study. And to briefly summarize those, what was identified was that T cells in advanced melanoma seemed to have higher expression levels of LAG-3 relative to T cells that are circulating in patients that are in the adjuvant setting. In addition to that, there was a suggestion that the magnitude of increase is greater in the advanced setting versus adjuvant. And the overall summary of this is that the suggested rationale for why this was a negative trial may have been that the target of LAG-3 is not expressed as highly in the adjuvant setting as it is in the metastatic setting. And so while the data that were presented, I think, support this kind of an idea, I am a little bit cautious that this is actually the reason for why the trial was negative, however. I would say we're not really sure yet as to why the trial was negative, but the fact that the hazard ratios for the major endpoints were essentially 1 suggests that there was no impact whatsoever from relatlimab. And this really makes one wonder whether or not building on anti–PD-1 in the adjuvant setting is feasible because anti–PD-1 works so well. You would think that even if the levels of LAG-3 expression were slightly different, you would have seen a trend in one direction or another by adding a second drug, relatlimab, in this scenario. So overall, I think it's an unfortunate circumstance that the trial is negative. Clearly there's going to be no role for relatlimab in the adjuvant setting. I think this really makes one wonder about the utility of LAG-3 blockade and how powerful it really can be. I think it's probably worth pointing out there's another adjuvant trial ongoing now of a different PD-1 and LAG-3 combination, and that's cemiplimab plus fianlimab, a LAG-3 antibody that's being dosed from another trial sponsor at a much higher dose, and perhaps that may make some level of difference. But certainly, these are unfortunate results that will not advance the field beyond where we were at already. Dr. Diwakar Davar: And to your point about third-generation checkpoint factors that were negative, I guess it's probably worth noting that a trial that you were involved with, KeyVibe-010, that evaluated the PD-1 TIGIT co-formulation of vibostolimab, MK-4280A, was also, unfortunately, similarly negative. So, to your point, it's not clear that all these third-generation receptors are necessarily going to have the same impact in the adjuvant setting, even if they, you know, for example, like TIGIT, and they sometimes may not even have an effect at all in the advanced cancer setting. So, we'll see what the HARMONY phase 3 trial, that's the Regeneron cemiplimab/fianlimab versus pembrolizumab control with cemiplimab with fianlimab at two different doses, we'll see how that reads out. But certainly, as you've said, LAG-3 does not, unfortunately, appear to have an impact in the adjuvant setting. So let's move on to LBA9501. This is the primary analysis of EORTC-2139-MG or the Columbus-AD trial. This was a randomized trial of encorafenib and binimetinib, which we will abbreviate as enco-bini going forward, compared to placebo in high-risk stage II setting in melanoma in patients with BRAF V600E or K mutant disease. So Jason, you know, you happen to know one or two things about the resected stage II setting, so maybe contextualize the stage II setting for us based on the trials that you've led, KEYNOTE-716, as well as CheckMate-76K, set us up to talk about Columbus-AD. Dr. Jason Luke: Thanks for that introduction, and certainly stage II disease has been something I've worked a lot on. The rationale for that has been that building off of the activity of anti–PD-1 in metastatic melanoma and then seeing the activity in stage III, like we just talked about, it was a curious circumstance that dating back about 7 to 8 years ago, there was no availability to use anti–PD-1 for high-risk stage II patients, even though the risk of recurrence and death from melanoma in the context of stage IIB and IIC melanoma is in fact similar or actually higher than in stage IIIA or IIIB, where anti–PD-1 was approved. And in that context, a couple of different trials that you alluded to, the Keynote-716 study that I led, as well as the CheckMate 76K trial, evaluated pembrolizumab and nivolumab, respectively, showing an improvement in relapse-free and distant metastasis-free survival, and both of those agents have subsequently been approved for use in the adjuvant setting by the US FDA as well as the European Medicines Agency.  So bringing then to this abstract, throughout melanoma oncology, we've seen that the impact of anti–PD-1 immunotherapy versus BRAF and MEK-targeted therapy have had very similar outcomes on a sort of comparison basis, both in frontline metastatic and then in adjuvant setting. So it was a totally reasonable question to ask: Could we use adjuvant BRAF and MEK inhibitor therapy? And I think all of us expected the answer would be yes. As we get into the discussion of the trial, I think the unfortunate circumstance was that the timing of this clinical trial being delayed somewhat, unfortunately, made it very difficult to accrue the trial, and so we're going to have to try to read through the tea leaves sort of, based on only a partially complete data set. Dr. Diwakar Davar: So, in terms of the results, they wanted to enroll 815 patients, they only enrolled 110. The RFS and DMFS were marginally improved in the treatment arm but certainly not significantly, which is not surprising because the trial had only accrued 16% to 18% of its complete accrual. As such, we really can't abstract from the stage III COMBI-AD data to stage II patients. And certainly in this setting, one would argue that the primary treatment options certainly remain either anti–PD-1 monotherapy, either with pembrolizumab or nivolumab, based on 716 or 76K, or potentially active surveillance for the patients who are not inclined to get treated.  Can you tell us a little bit about how you foresee drug development going forward in this space because, you know, for example, with HARMONY, certainly IIC disease is a part of HARMONY. We will know at least a little bit about that in this space. So what do you think about the stage IIB/C patient population? Is this a patient population in which future combinations are going to be helpful, and how would you think about where we can go forward from here? Dr. Jason Luke: It is an unfortunate circumstance that this trial could not be accrued at the pace that was necessary. I think all of us believe that the results would have been positive if they'd been able to accrue the trial. In the preliminary data set that they did disclose of that 110 patients, you know, it's clear there is a difference at a, you know, a landmark at a year. They showed a 16% difference, and that would be in line with what has been seen in stage III. And so, you know, I think it's really kind of too bad. There's really going to be no regulatory approach for this consideration. So using BRAF and MEK inhibition in stage II is not going to be part of standard practice moving into the future. To your point, though, about where will the field go? I think what we're already realizing is that in the adjuvant setting, we're really overtreating the total population. And so beyond merely staging by AJCC criteria, we need to move to biomarker selection to help inform which patients truly need the treatment. And in that regard, I don't think we've crystallized together as a field as yet, but the kinds of things that people are thinking about are the integration of molecular biomarkers like ctDNA. When it's positive, it can be very helpful, but in melanoma, we found that, unfortunately, the rates are quite low, you know, in the 10% to 15% range in the adjuvant setting. So then another consideration would be factors in the primary tumor, such as gene expression profiling or other considerations.  And so I think the future of adjuvant clinical trials will be an integration of both the standard AJCC staging system as well as some kind of overlaid molecular biomarker that helps to enrich for a higher-risk population of patients because on a high level, when you abstract out, it's just clearly the case that we're rather substantially overtreating the totality of the population, especially given that in all of our adjuvant studies to date for anti–PD-1, we have not yet shown that there's an overall survival advantage. And so some are even arguing perhaps we should even reserve treatment until patients progress. I think that's a complicated subject, and standard of care at this point is to offer adjuvant therapy, but certainly a lot more to do because many patients, you know, unfortunately, still do progress and move on to metastatic disease. Dr. Diwakar Davar: Let's transition to Abstract 2508. So we're moving on from the melanoma to the novel immunotherapy abstracts. And this is a very, very, very fascinating drug. It's IMA203. So Abstract 2508 is a phase 1 clinical update of IMA203. IMA203 is an autologous TCR-T construct targeting PRAME in patients with heavily pretreated PD-1-refractory metastatic melanoma. So Jason, in the PD-1 and CTLA-4-refractory settings, treatment options are either autologous TIL, response rate, you know, ballpark 29% to 31%, oncolytic viral therapy, RP1 with nivolumab, ORR about 30-ish percent. So new options are needed. Can you tell us a little bit about IMA203? Perhaps tell us for the audience, what is the difference between a TCR-T and traditional autologous TIL? And a little bit about this drug, IMA203, and how it distinguishes itself from the competing TIL products in the landscape. Dr. Jason Luke: I'm extremely enthusiastic about IMA203. I think that it really has transformative potential based on these results and hopefully from the phase 3 trial that's open to accrual now. So, what is IMA203? We said it's a TCR-T cell product. So what that means is that T cells are removed from a patient, and then they can be transduced through various technologies, but inserted into those T cells, we can then add a T-cell receptor that's very specific to a single antigen, and in this case, it's PRAME. So that then is contrasted quite a bit from the TIL process, which includes a surgical resection of a tumor where T cells are removed, but they're not specific necessarily to the cancer, and they're grown up in the lab and then given to the patient. They're both adoptive cell transfer products, but they're very different. One is genetically modified, and the other one is not. And so the process for generating a TCR-T cell is that patients are required to have a new biomarker that some may not be familiar with, which is HLA profiling. So the T-cell receptor requires matching to the concomitant HLA for which the peptide is bound in. And so the classic one that is used in most oncology practices is A*02:01 because approximately 48% of Caucasians have A*02:01, and the frequency of HLA in other ethnicities starts to become highly variable. But in patients who are identified to have A*02:01 genotype, we can then remove blood via leukapheresis or an apheresis product, and then insert via lentiviral transduction this T-cell receptor targeting PRAME. Patients are then brought back to the hospital where they can receive lymphodepleting chemotherapy and then receive the reinfusion of the TCR-T cells. Again, in contrast with the TIL process, however, these T cells are extremely potent, and we do not need to give high-dose interleukin-2, which is administered in the context of TIL. Given that process, we have this clinical trial in front of us now, and at ASCO, the update was from the phase 1 study, which was looking at IMA203 in an efficacy population of melanoma patients who were refractory at checkpoint blockade and actually multiple lines of therapy. So here, there were 33 patients and a response rate of approximately 50% was observed in this population of patients, notably with a duration of response approximately a year in that treatment group. And I realize that these were heavily pretreated patients who had a range of very high-risk features. And approximately half the population had uveal melanoma, which people may be aware is a generally speaking more difficult-to-treat subtype of melanoma that metastasizes to the liver, which again has been a site of resistance to cancer immunotherapy. So these results are extremely promising. To summarize them from what I said, it's easier to make TCR-T cells because we can remove blood from the patient to transduce the T cells, and we don't have to put them through surgery. We can then infuse them, and based on these results, it looks like the response rate to IMA203 is a little bit more than double what we expect from lifileucel. And then, whereas with lifileucel or TILs, we have to give high-dose IL-2, here we do not have to give high-dose IL-2. And so that's pretty promising. And a clinical trial is ongoing now called the SUPREME phase 3 clinical trial, which is hoping to validate these results in a randomized global study. Dr. Diwakar Davar: Now, one thing that I wanted to go over with you, because you know this trial particularly well, is what you think of the likelihood of success, and then we'll talk a little bit about the trial design. But in your mind, do you think that this is a trial that has got a reasonable likelihood of success, maybe even a high likelihood of success? And maybe let's contextualize that to say an alternative trial, such as, for example, the TebeAM trial, which is essentially a T-cell bispecific targeting GP100. It's being compared against SOC, investigator's choice control, also in a similarly heavily pretreated patient population. Dr. Jason Luke: So both trials, I think, have a strong chance of success. They are very different kinds of agents. And so the CD3 bispecific that you referred to, tebentafusp, likely has an effect of delaying progression, which in patients with advanced disease could have a value that might manifest as overall survival. With TCR-T cells, by contrast, we see a very high response rate with some of the patients going into very durable long-term benefit. And so I do think that the SUPREME clinical trial has a very high chance of success. It will be the first clinical trial in solid tumor oncology randomizing patients to receive a cell therapy as compared with a standard of care. And within that standard of care control arm, TILs are allowed as a treatment. And so it will also be the first study that will compare TCR-T cells against TILs in a randomized phase 3. But going back to the data that we've seen in the phase 1 trial, what we observe is that the duration of response is really connected to the quality of the response, meaning if you have more than a 50% tumor shrinkage, those patients do very, very well. But even in patients who have less than 50% tumor shrinkage, the median progression-free survival right now is about 4.5 months. And again, as we think about trial design, standard of care options for patients who are in this situation are unfortunately very bad. And the progression-free survival in that population is probably more like 2 months. So this is a trial that has a very high likelihood of being positive because the possibility of long-term response is there, but even for patients who don't get a durable response, they're likely going to benefit more than they would have based on standard chemotherapy or retreatment with an anti–PD-1 agent. Dr. Diwakar Davar: Really, a very important trial to enroll, a trial that is first in many ways. First of a new generation of TCR-T agents, first trial to look at cell therapy in the control arm, a new standard of efficacy, but potentially also if this trial is successful, it will also be a new standard of trial conduct, a new kind of trial, of a set of trials that will be done in the second-line immunotherapy-refractory space. So let's pivot to the last trial that we were going to discuss, which was Abstract 2501. Abstract 2501 is a first-in-human phase 1/2 trial evaluating BNT142, which is the first-in-class mRNA-encoded bispecific targeting Claudin-6 and CD3 in patients with Claudin-positive tumors. We'll talk a little bit about this, but maybe let's start by talking a little bit about Claudin-6. So Claudin-6 is a very interesting new target. It's a target that's highly expressed in GI and ovarian tumors. There are a whole plethora of Claudin-6-targeting agents, including T-cell bispecifics and Claudin-6-directed CAR-Ts that are being developed. But BNT142 is novel. It's a novel lipid nanoparticle LNP-encapsulated mRNA. The mRNA encodes an anti–Claudin-6 CD3 bispecific termed RiboMAB-021. And it then is administered to the patient. The BNT142-encoding mRNA LNPs are taken up by the liver and translated into the active drug. So Jason, tell us a little bit about this agent. Why you think it's novel, if you think it's novel, and let's talk a little bit then about the results. Dr. Jason Luke: So I certainly think this is a novel agent, and I think this is just the first of what will probably become a new paradigm in oncology drug development. And so you alluded to this, but just to rehash it quickly, the drug is encoded as genetic information that's placed in the lipid nanoparticle and then is infused into the patient. And after the lipid nanoparticles are taken up by the liver, which is the most common place that LNPs are usually taken up, that genetic material in the mRNA starts to be translated into the actual protein, and that protein is the drug. So this is in vivo generation, so the patient is making their own drug inside their body. I think it's a really, really interesting approach. So for any drug that could be encoded as a genetic sequence, and in this case, it's a bispecific, as you mentioned, CD3-Claudin-6 engager, this could have a tremendous impact on how we think about pharmacology and novel drug development moving into the future in oncology. So I think it's an extremely interesting drug, the like of which we'll probably see only more moving forward. Dr. Diwakar Davar: Let's maybe briefly talk about the results. You know, the patient population was heavily pretreated, 65 or so patients, mostly ovarian cancer. Two-thirds of the patients were ovarian cancer, the rest were germ cell and lung cancer patients. But let's talk a little bit about the efficacy. The disease control rate was about 58% in the phase 1 population as a whole, but 75% in the ovarian patient population. Now tell us a little bit about the interesting things about the drug in terms of the pharmacokinetics, and also then maybe we can pivot to the clinical activity by dose level. Dr. Jason Luke: Well, so they did present in their presentation at ASCO a proportionality showing that as higher doses were administered, that greater amounts of the drug were being made inside the patient. And so that's an interesting observation, and it's an important one, right? Suggesting that the pharmacology that we classically think of by administering drugs by IV, for example, would still be in play. And that did translate into some level of efficacy, particularly at the higher dose levels. Now, the caveat that I'll make a note of is that disease control rate is an endpoint that I think we have to be careful about because what that really means is sometimes a little bit unclear. Sometimes patients have slowly growing tumors and so on and so forth. And the clinical relevance of disease control, if it doesn't last at least 6 months, I think is probably pretty questionable. So I think these are extremely interesting data, and there's some preliminary sense that getting the dose up is going to matter because the treatment responses were mostly observed at the highest dose levels. There's also a caveat, however, that across the field of CD3 bispecific molecules like this, there's been quite a bit of heterogeneity in terms of the response rate, with some of them only really generating stable disease responses and other ones having more robust responses. And so I think this is a really interesting initial foray into this space. My best understanding is this molecule is not moving forward further after this, but I think that this really does set it up to be able to chase after multiple different drug targets on a CD3 bispecific backbone, both in ovarian cancer, but then basically across all of oncology. Dr. Diwakar Davar: Perfect. This is a very new sort of exciting arena where we're going to be looking at, in many ways, these programmable constructs, whether we're looking at in vivo-generated, in this case, a T-cell bispecific, but we've also got newer drugs where we are essentially giving drugs where people are generating in vivo CAR T, and also potentially even in vivo TCR-T. But certainly lots of new excitement around this entire class of drugs. And so, what we'd like to do at this point in time is switch to essentially the fact that we've got a very, very exciting set of data at ASCO 2025. You've heard from Dr. Luke regarding the advances in both early drug development but also in advanced cutaneous melanoma. And Jason, as always, thank you so much for sharing your very valuable and great, fantastic insights with us on the ASCO Daily News Podcast. Dr. Jason Luke: Well, thanks again for the opportunity. Dr. Diwakar Davar: And thank you to our listeners for taking your time to listen today. You will find the links to the abstracts that we discussed today in the transcript of this episode. And finally, if you value the insights that you hear on the ASCO Daily News Podcast, please take a moment to rate, review, and subscribe wherever you get your podcasts. Disclaimer: The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. Guest statements on the podcast do not express the opinions of ASCO. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement. Follow today's speakers:    Dr. Diwakar Davar    @diwakardavar    Dr. Jason Luke @jasonlukemd Follow ASCO on social media:     @ASCO on Twitter       ASCO on Bluesky   ASCO on Facebook       ASCO on LinkedIn   Disclosures:     Dr. Diwakar Davar:      Honoraria: Merck, Tesaro, Array BioPharma, Immunocore, Instil Bio, Vedanta Biosciences     Consulting or Advisory Role: Instil Bio, Vedanta Biosciences     Consulting or Advisory Role (Immediate family member): Shionogi     Research Funding: Merck, Checkmate Pharmaceuticals, CellSight Technologies, GSK, Merck, Arvus Biosciences, Arcus Biosciences     Research Funding (Inst.): Zucero Therapeutics     Patents, Royalties, Other Intellectual Property: Application No.: 63/124,231 Title: COMPOSITIONS AND METHODS FOR TREATING CANCER Applicant: University of Pittsburgh–Of the Commonwealth System of Higher Education Inventors: Diwakar Davar Filing Date: December 11, 2020 Country: United States MCC Reference: 10504-059PV1 Your Reference: 05545; and Application No.: 63/208,719 Enteric Microbiotype Signatures of Immune-related Adverse Events and Response in Relation to Anti-PD-1 Immunotherapy     Dr. Jason Luke:     Stock and Other Ownership Interests: Actym Therapeutics, Mavu Pharmaceutical, Pyxis, Alphamab Oncology, Tempest Therapeutics, Kanaph Therapeutics, Onc.AI, Arch Oncology, Stipe, NeoTX     Consulting or Advisory Role: Bristol-Myers Squibb, Merck, EMD Serono, Novartis, 7 Hills Pharma, Janssen, Reflexion Medical, Tempest Therapeutics, Alphamab Oncology, Spring Bank, Abbvie, Astellas Pharma, Bayer, Incyte, Mersana, Partner Therapeutics, Synlogic, Eisai, Werewolf, Ribon Therapeutics, Checkmate Pharmaceuticals, CStone Pharmaceuticals, Nektar, Regeneron, Rubius, Tesaro, Xilio, Xencor, Alnylam, Crown Bioscience, Flame Biosciences, Genentech, Kadmon, KSQ Therapeutics, Immunocore, Inzen, Pfizer, Silicon Therapeutics, TRex Bio, Bright Peak, Onc.AI, STipe, Codiak Biosciences, Day One Therapeutics, Endeavor, Gilead Sciences, Hotspot Therapeutics, SERVIER, STINGthera, Synthekine     Research Funding (Inst.): Merck , Bristol-Myers Squibb, Incyte, Corvus Pharmaceuticals, Abbvie, Macrogenics, Xencor, Array BioPharma, Agios, Astellas Pharma , EMD Serono, Immatics, Kadmon, Moderna Therapeutics, Nektar, Spring bank, Trishula, KAHR Medical, Fstar, Genmab, Ikena Oncology, Numab, Replimmune, Rubius Therapeutics, Synlogic, Takeda, Tizona Therapeutics, Inc., BioNTech AG, Scholar Rock, Next Cure     Patents, Royalties, Other Intellectual Property: Serial #15/612,657 (Cancer Immunotherapy), and Serial #PCT/US18/36052 (Microbiome Biomarkers for Anti-PD-1/PD-L1 Responsiveness: Diagnostic, Prognostic and Therapeutic Uses Thereof)     Travel, Accommodations, Expenses: Bristol-Myers Squibb, Array BioPharma, EMD Serono, Janssen, Merck, Novartis, Reflexion Medical, Mersana, Pyxis, Xilio

Please visit answersincme.com/URZ860 to participate, download slides and supporting materials, complete the post test, and obtain credit. In this activity, an expert in esophageal carcinoma (EAC) discusses novel tests to predict the risk of progression from Barrett's esophagus (BE) to EAC. Upon completion of this activity, participants should be better able to: Identify the clinical rationale for using novel prognostic stratification tests to predict the risk of progression from BE to EAC, Review the clinical support for prognostic tests that provide actionable information for identifying patients with BE who are at risk of progression to EAC; and Outline strategies to integrate novel prognostic tests into the surveillance algorithm for patients with BE who may be at risk of progression to EAC.

This week's episode dives into brand new research on prognostic factors for patients with nonspecific low back pain—one of the most common challenges chiropractors face every day in practice. Dr. Jeff breaks down a recent prospective study that tracked nearly 250 patients across multiple chiropractic practices, revealing what really predicts improvement, how long meaningful outcomes take, and which strategies can set your patients up for lasting success.You'll learn not only about the numbers—like the remarkable drop in pain and disability over just four weeks—but also about the power of mindset, patient expectations, and your own confidence as a provider.Episode Notes: Prognostic factors associated with improvement in patients with an episode of non-specific low back pain without radicular syndrome: a prospective observational exploratory studyThe Best Objective Assessment of the Cervical Spine- Provide reliable assessments and exercises for Neuromuscular Control, Proprioception, Range of Motion, and Sensorimotor-Integration. Learn more at NeckCare.comTurncloud EHR- Minimalist design, without being sparse. Practical, yet elegant. Turncloud's design was to find the most efficient path in a day in the life of a chiropractic office. Connect with their team at www.turncloud.com Patient Pilot by The Smart Chiropractor is the fastest, easiest to generate weekly patient reactivations on autopilot…without spending any money on advertising. Click here to schedule a call with our team.Our members use research to GROW their practice. Are you interested in increasing your referrals? Discover the best chiropractic marketing you aren't currently using right here!

Interview with Manuel Comabella, MD, author of Prognostic Factors for Multiple Sclerosis Symptoms in Radiologically Isolated Syndrome. Hosted by Cynthia E. Armand, MD. Related Content: Prognostic Factors for Multiple Sclerosis Symptoms in Radiologically Isolated Syndrome

Interview with Manuel Comabella, MD, author of Prognostic Factors for Multiple Sclerosis Symptoms in Radiologically Isolated Syndrome. Hosted by Cynthia E. Armand, MD. Related Content: Prognostic Factors for Multiple Sclerosis Symptoms in Radiologically Isolated Syndrome

Commentary by Dr. Jian'an Wang.

JCO PO author Dr. Timothy Showalter at Artera and University of Virginia shares insights into his JCO PO article, “Digital Pathology–Based Multimodal Artificial Intelligence Scores and Outcomes in a Randomized Phase III Trial in Men With Nonmetastatic Castration-Resistant Prostate Cancer” . Host Dr. Rafeh Naqash and Dr. Showalter discuss how multimodal AI as a prognostic marker in nonmetastatic castration-resistant prostate cancer may serve as a predictive biomarker with high-risk patients deriving the greatest benefit from treatment with apalutamide. TRANSCRIPT  Dr. Rafeh Naqash: Hello and welcome to JCO Precision Oncology Conversations where we'll bring you engaging conversations with authors of clinically relevant and highly significant JCO PO articles. I'm your host, Dr. Rafeh Naqash, podcast Editor for JCO Precision Oncology and assistant professor at the OU Health Stephenson Cancer Center at the University of Oklahoma. Today, we are excited to be joined by Dr. Timothy Showalter, Chief Medical Officer at Artera and professor of Radiation Oncology at the University of Virginia and author of the JCO Precision Oncology article entitled, “Digital Pathology Based Multimodal Artificial Intelligence Scores and Outcomes in a Randomized Phase 3 Trial in Men with Non-Metastatic Castration Resistant Prostate Cancer.” At the time of this recording, our guest's disclosures will be linked in the transcript. Dr. Showalter, it's a pleasure to have you here today. Dr. Timothy Showalter: It's a pleasure to be here. Thanks for having me. Dr. Rafeh Naqash: I think this is going to be a very interesting discussion, not just from a biomarker perspective, but also in terms of how technologies have evolved and how we are trying to stratify patients, trying to escalate or deescalate treatments based on biomarkers. And this article is a good example of that. One of the things I do want to highlight as part of this article is that Dr. Felix Feng is the first author for this article. Unfortunately, Dr. Felix Feng passed away in December of 2024. He was a luminary in this field of prostate cancer research. He was also the Chair of the NRG GU Committee as well as Board of Directors for RTOG Foundation and has mentored a lot of individuals from what I have heard. I didn't know Dr. Feng but heard a lot about him from my GU colleagues. It's a huge loss for the community, but it was an interesting surprise for me when I saw his name on this article as I was reviewing it. Could you briefly talk about Dr. Feng for a minute and how you knew him and how he's been an asset to the field? Dr. Timothy Showalter: Yeah. I'm always happy to talk about Felix whenever there's an opportunity. You know, I was fortunate to know Felix Feng for about 20 years as we met during our residency programs through a career development workshop that we both attended and stayed close ever since. And you know, he's someone who made an impact on hundreds of lives of cancer researchers and other radiation oncologists and physicians in addition to the cancer patients he helped, either through direct clinical care or through his innovation. For this project in particular, I first became involved soon after Felix had co-founded Artera, which is, you know the company that developed this. And because Felix was such a prolific researcher, he was actually involved in this and this research project from all different angles, both from the multimodal digital pathology tool to the trial itself and being part of moving the field forward in that way. It's really great to be able to sort of celebrate a great example of Felix's legacy, which is team science, and really moving the field forward in terms of translational projects based on clinical trials. So, it's a great opportunity to highlight some of his work and I'm really happy to talk about it with you. Dr. Rafeh Naqash: Thanks, Tim. Definitely a huge loss for the scientific community. And I did see a while back that there was an international symposium organized, showcasing his work for him to talk about his journey last year where more than 200, 250 people from around the globe actually attended that. That speaks volumes to the kind of impact he's had as an individual and impact he's had on the scientific side of things as well. Dr. Timothy Showalter: Yes. And we just had the second annual Feng Symposium the day before ASCO GU this year with, again, a great turnout and some great science highlighted, as well as a real focus on mentorship and team science and collaboration. Dr. Rafeh Naqash: Thank you so much for telling us all about that. Now going to what you guys published in JCO Precision Oncology, which is this article on using a biomarker approach to stratify non-metastatic prostate cancer using this artificial intelligence based H&E score. Could you tell us the background for what started off this project? And I see there is a clinical trial data set that you guys have used, but there's probably some background to how this score or how this technology came into being. So, could you superficially give us an idea of how that started? Dr. Timothy Showalter: Sure. So, the multimodal AI score was first published in a peer reviewed journal back in 2022 and the test was originally developed through a collaboration with the Radiation Therapy Oncology Group or Energy Oncology Prostate Cancer Research Team. The original publication describes development and validation of a risk stratification tool designed to predict distant metastasis and prostate cancer specific mortality for men with localized prostate cancer. And the first validation was in men who were treated with definitive radiation therapy. There have been subsequent publications in that context and there's a set of algorithms that have been validated in localized prostate cancer and there's a test that's listed on NCCN guidelines based on that technology. The genesis for this paper was really looking at extending that risk stratification tool that was developed in localized prostate cancer to see if it could one, validate in a non-metastatic castrate refractory prostate cancer population for patients enrolled on the SPARTAN trial. And two, whether there was a potential role for the test output in terms of predicting benefit from apalutamide for patients with non-metastatic prostate cancer. For patients who are enrolled on the SPARTAN study, almost 40% of them had H&E stain biopsy slide material available and were eligible to be included in this study. Dr. Rafeh Naqash: Going a step back to how prostate cancer, perhaps on the diagnostic side using the pathology images is different as you guys have Gleason scoring, which to the best of my knowledge is not necessarily something that most other tumor types use. Maybe Ki-67 is somewhat of a comparison in some of the neuroendocrine cancers where high Ki-67 correlates with aggressive biology for prognosis. And similarly high Gleason scores, as we know for some of the trainees, correlates with poor prognosis. So, was the idea behind this based on trying to stratify or sub-stratify Gleason scoring further, where you may not necessarily know what to do with the intermediate high Gleason score individual tumor tissues? Dr. Timothy Showalter: Well, yeah. I mean, Gleason score is a really powerful risk stratification tool. As you know, our clinical risk groupings are really anchored to Gleason scores as an important driver for that. And while that's a powerful tool, I think, you know, some of the original recognition for applying computer vision AI into this context is that there are likely many other features located in the morphology that can be used to build a prognostic model. Going back to the genesis of the discovery project for the multimodal AI model, I think Felix Feng would have described it as doing with digital pathology and computer vision AI what can otherwise be done with gene expression testing. You know, he would have approached it from a genomic perspective. That's what the idea was. So, it's along the line of what you're saying, which is to think about assigning a stronger Gleason score. But I think really more broadly, the motivation was to come up with an advanced complementary risk stratification tool that can be used in conjunction with clinical risk factors to help make better therapy recommendations potentially. So that was the motivation behind it. Dr. Rafeh Naqash: Sure. And one of the, I think, other important teaching points we try to think about, trainees of course, who are listening to this podcast, is trying to differentiate between prognostic and predictive scores. So, highlighting the results that you guys show in relation to the MMAI score, the digital pathology score, and outcomes as far as survival as well as outcomes in general, could you try to help the listeners understand the difference between the prognostic aspect of this test and the predictive aspect of this test? Dr. Timothy Showalter: So let me recap for the listeners what we found in the study and how it kind of fits into the prognostic and the predictive insights. So, one, you know, as I mentioned before, this is ultimately a model that was developed and validated for localized prostate cancer for risk stratification. So, first, the team looked at whether that same tool developed in localized prostate cancer serves as a prognostic tool in non-metastatic castrate-refractory prostate cancer. So, we applied the tool as it was previously developed and identified that about 2/3 of patients on the SPARTAN trial that had specimens available for analysis qualified as high risk and 1/3 of patients as either intermediate or low risk, which we called in the paper ‘non-high risk'. And we're able to show that the multimodal AI score, which ranges from 0 to 1, and risk group, was associated with metastasis free survival time to second progression or PFS 2 and overall survival. And so that shows that it performs as a prognostic tool in this setting. And this paper was the first validation of this tool in non-metastatic castrate-refractory prostate cancer. So, what that means to trainees is basically it helps you understand how aggressive that cancer is or better stratify the risk of progression over time. So that's the prognostic performance. Dr. Rafeh Naqash: Thank you for trying to explain that. It's always useful to get an example and understand the difference between prognostic and predictive. Now again, going back to the technology, which obviously is way more complicated than the four letter word MMAI, I per se haven't necessarily done research in this space, but I've collaborated with some individuals who've done digital pathology assessments, and one of the projects we worked on was TIL estimation and immune checkpoint related adverse events using some correlation and something that one of my collaborators had sent to me when we were working on this project as part of this H&E slide digitalization, you need color deconvolution, you need segmentation cell profiling. Superficially, is that something that was done as part of development of this MMAI score as well? Dr. Timothy Showalter You need a ground truth, right? So, you need to train your model to predict whatever the outcome is. You know, if you're designing an AI algorithm for Ki-67 or something I think you mentioned before, you would need to have a set of Ki-67 scores and train your models to create those scores. In this case, the clinical annotation for how we develop the multimodal AI algorithm is the clinical endpoints. So going back to how this tool was developed, the computer vision AI model is interpreting a set of features on the scan and what it's trying to do is identify high risk features and make a map that would ultimately predict clinical outcomes. So, it's a little bit different than the many digital pathology algorithms where the AI is being trained to predict a particular morphological finding. In this case, the ground truth that the model is trained to predict is the clinical outcome. Dr. Rafeh Naqash: Sure. And from what you explained earlier, obviously, tumors that had a high MMAI score were the ones that were benefiting the most from the ADT plus the applausive. Is this specific for this androgen receptor inhibitor or is it interchangeable with other inhibitors that are currently approved? Dr. Timothy Showalter: That's a great question and we don't know yet. So, as you're alluding to, we did find that the MMAI risk score was predictive for benefit from apalutamide and so it met the statistical definition of having a significant interaction p value so we can call it a predictive performance. And so far, we've only looked in this population for apalutamide. I think you're raising a really interesting point, which is the next question is, is this generalizable to other androgen receptor inhibitors? There will be future research looking at that, but I think it's too early to say. Just for summary, I think I mentioned before, there are about 40% of patients enrolled on the SPARTAN study had specimens available for inclusion in this analysis. So, the SPARTAN study did show in the entire clinical trial set that patients with non-metastatic castrate-refractory prostate cancer benefited from apalutamide. The current study did show that there seems to be a larger magnitude of benefit for those patients who are multimodal AI high risk scores. And I think that's very interesting research and suggests that there's some interaction there. But I certainly would want to emphasize that we have not shown that patients with intermediate or low risk don't benefit from apalutamide. I think we can say that the original study showed that that trial showed a benefit and that we've got this interesting story with multimodal AI as well. Dr. Rafeh Naqash: Sure. And I think from a similar comparison, ctDNA where ctDNA shows prognostic aspects, I treat people with lung cancer especially, and if you're ctDNA positive at a 3 to 4-month period, likely chances of you having a shorter disease-free interval is higher. Same thing I think for colorectal cancers. And now there are studies that are using ctDNA as an integral biomarker to stratify patients positive/negative and then decide on escalation/de-escalation of treatment. So, using a similar approach, is there something that is being done in the context of the H&E based stratification to de-intensify or intensify treatments based on this approach? Dr. Timothy Showalter: You're hitting right on the point in the most promising direction. You know, as we pointed out in the manuscript, one of the most exciting areas as a next step for this is to use a tool like this for stratification for prospective trials. The multimodal AI test is not being used currently in clinical trials of non-metastatic castrate-refractory prostate cancer, which is a disease setting for this paper. There are other trials that are in development or currently accruing where multimodal AI stratification approach is being taken, where you see among the high-risk scores, at least in the postoperative setting for a clinical trial that's open right now, high risk score patients are being randomized to basically a treatment intensification question. And then the multimodal AI low risk patients are being randomized to a de-intensification experimental arm where less androgen deprivation therapy is being given. So, I think it's a really promising area to see, and I think what has been shown is that this tool has been validated really across the disease continuum. And so, I think there are opportunities to do that in multiple clinical scenarios. Dr. Rafeh Naqash: Then moving on to the technological advancements, very fascinating how we've kind of evolved over the last 10 years perhaps, from DNA based biomarkers to RNA expression and now H&E. And when you look at cost savings, if you were to think of H&E as a simpler, easier methodology, perhaps, with the limitations that centers need to digitalize their slides, probably will have more cost savings. But in your experience, as you've tried to navigate this H&E aspect of trying to either develop the model or validate the model, what are some of the logistics that you've experienced can be a challenge? As we evolve in this biomarker space, how can centers try to tackle those challenges early on in terms of digitalizing data, whether it's simple data or slides for that matter? Dr. Timothy Showalter: I think there's two main areas to cover. One, I think that the push towards digitalization is going to be, I think, really driven by increasing availability and access to augmentative technologies like this multimodal AI technology where it's really adding some sort of a clinical insight beyond what is going to be generated through routine human diagnostic pathology. I think that when you can get these sorts of algorithms for patient care and have them so readily accessible with a fast turnaround time, I think that's really going to drive the field forward. Right now, in the United States, the latest data I've seen is that less than 10% of pathology labs have gone digital. So, we're still at an early stage in that. I hope that this test and similar ones are part of that push to go more digital. The other, I think, more interesting challenge that's a technical challenge but isn't about necessarily how you collect the data, but it certainly creates data volume challenges, is how do you deal with image robustness and sort of translating these tools into routine real-world settings. And as you can imagine, there's a lot of variation for staining protocols, intensity scanner variations, all these things that can affect the reliability of your test. And at least for this research group that I'm a part of that has developed this multimodal AI tool can tell you that the development is sophisticated, but very data and energy intensive in terms of how to deal with making a tool that can be consistent across a whole range of image parameters. And so that presents its own challenges for dealing with a large amount of compute time and AI cycles to make robust algorithms like that. And practically speaking, I think moving into other diseases and making this widely available, the size of data required and the amount of cloud compute time will be a real challenge. Dr. Rafeh Naqash: Thank you for summarizing. I can say that definitely, you know, this is maybe a small step in prostate cancer biomarker research, but perhaps a big step in the overall landscape of biomarker research in general. So definitely very interesting. Now, moving on to the next part of the discussion is more about you as a researcher, as an individual, your career path, if you can summarize that for us. And more interestingly, this intersection between being part of industry as well as academia for perhaps some of the listeners, trainees who might be thinking about what path they want to choose. Dr. Timothy Showalter: Sure. So, as you may know, I'm a professor at the University of Virginia and I climbed the academic ladder and had a full research grant program and thought I'd be in academia forever. And my story is that along the way, I kind of by accident ended up founding a medical device company that was called Advaray and that was related to NCI SBIR funding. And I found myself as a company founder and ultimately in that process, I started to learn about the opportunity to make an impact by being an innovator within the industry space. And that was really the starting point for me. About four years ago, soon after Felix Feng co-founded Artera, he called me and told me that he needed me to join the company. For those who were lucky to know Felix well, at that very moment, it was inevitable that I was going to join Artera and be a part of this. He was just so persuasive. So, I will say, you know, from my experience of being sort of in between the academic and industry area, it's been a really great opportunity for me to enter a space where there's another way of making an impact within cancer care. I've gotten to work with top notch collaborators, work on great science, and be part of a team that's growing a company that can make technology like this available. Dr. Rafeh Naqash: Thank you so much, Tim, for sharing some of those thoughts and insights. We really appreciate you discussing this very interesting work with us and also appreciate you submitting this to JCO Precision Oncology and hopefully we'll see more of this as this space evolves and maybe perhaps bigger more better validation studies in the context of this test. Thank you for listening to JCO Precision Oncology Conversations. Don't forget to give us a rating or review and be sure to subscribe so you never miss an episode. You can find all ASCO shows at asco.org/podcast.   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.  

Study compared the prognostic impact of differing high-risk inclusion criteria used in the monarchE and NATALEE trials among patients with hormone receptor-positive/HER2-negative early #BreastCancer , using data from the MIG1, GIM2, and GIM3 trials. Patients were stratified into high- and low-risk cohorts per each trial's criteria, and further grouped into concordant low-risk, discordant risk, and concordant high-risk categories.Link to Articlehttps://academic.oup.com/jnci/advance-article/doi/10.1093/jnci/djaf031/8002826?login=false#google_vignette

Commentary by Dr. Justin Grodin.

Join us in this insightful episode of the Oncology Brothers podcast as we dive deep into the current treatment landscape of pancreatic cancer. Drs. Rohit and Rahul Gosain are joined by Dr. Emil Lou, a medical and neuro-oncologist from the University of Minnesota, to discuss the challenges and advancements in managing this complex disease. In this episode, we covered: •⁠  ⁠The importance of a multidisciplinary approach in treating early-stage pancreatic cancer. •⁠  ⁠The role of neoadjuvant and adjuvant therapies, including the latest insights on chemotherapy regimens like FOLFIRINOX, nal-IRI and gemcitabine. •⁠  ⁠The significance of germline and next-generation sequencing (NGS) testing in personalizing treatment plans. •⁠  ⁠The current state of clinical trials and emerging therapies, including PARP inhibitors for BRCA mutations and the implications of ctDNA testing. •⁠  ⁠Prognostic discussions around metastatic pancreatic cancer and the importance of managing side effects to improve patient quality of life. Key takeaways include the necessity of balancing treatment efficacy with adverse events, the critical role of genetic testing, and the need for vigilance regarding venous thromboembolism (VTE) in pancreatic cancer patients. Don't miss this comprehensive discussion that aims to shed light on the ongoing efforts to improve outcomes for patients battling pancreatic cancer.   YouTube: https://youtu.be/HCKQxmOqRTI   Follow us on social media: •⁠  ⁠X/Twitter: https://twitter.com/oncbrothers •⁠  ⁠Instagram: https://www.instagram.com/oncbrothers •⁠  Website: https://oncbrothers.com/ Subscribe to our channel for more discussions on oncology and stay updated on the latest in cancer treatment!

Full article: Prognostic Implications of the Volume Doubling Time of the Solid Component in Lung Adenocarcinomas Manifesting as Part-Solid Lesions on Chest CT Aisha Alam, DO, discusses the AJR article by Ahn et al. exploring the importance of the volume doubling time of the solid component in lung cancers appearing as part-solid nodules.

In this JCO Precision Oncology Article Insights episode, Natalie DelRocco summarizes "Digital Pathology–Based Multimodal Artificial Intelligence Scores and Outcomes in a Randomized Phase III Trial in Men With Nonmetastatic Castration-Resistant Prostate Cancer" by Felix Y. Feng, et al published January 31, 2025. Come back for the next episode where JCO Precision Oncology Conversations host, Dr. Rafeh Naqash interviews the author of the JCO PO article discussed, Dr. Tim Showalter. TRANSCRIPT Natalie DelRocco: Hello and welcome to JCO Precision Oncology Article Insights. I'm your host Natalie Del Rocco. Today, we'll be discussing the article, “Digital Pathology-Based Multimodal Artificial Intelligence Scores and Outcomes in a Randomized Phase III Trial in Men With Nonmetastatic Castration-Resistant Prostate Cancer.” We will also be discussing the accompanying editorial, “Leveraging Artificial Intelligence to Improve Risk Stratification in Nonmetastatic Castration-Resistant Prostate Cancer.” So, we're going to start by summarizing the original report and then we'll jump into a few of the high-level interpretations that were supplied by the editorial.   The original report by Feng et. al. describes the application of multimodal artificial intelligence to data collected on a nonmetastatic castration-resistant prostate cancer. We will call this disease moving forward NMCRPC, a Clinical Trial. So, we're looking at data from an NMCRPC clinical trial. The SPARTAN trial was a randomized phase three trial and this study compared metastasis-free survival as the primary endpoint for those treated with traditional androgen deprivation therapy or ADT to those treated with androgen deprivation therapy plus apalutamide. Other secondary endpoints included progression-free survival and overall survival, but the primary endpoint there was metastasis-free survival or MFS. This study found that the addition of apalutamide resulted in a significantly longer median metastasis-free survival compared to androgen deprivation therapy alone. And we should note that this is a double-blind placebo-controlled trial. In the overall study, 1,207 patients participated and over the course of this study histopathology slides were collected and they were digitized for future use. And that future use is what we are going to be discussing today.  The authors do note that there are currently no good biomarkers for use in NMCRPC. The authors seem to be inspired by the ArteraAI prostate test, which was a recent application of multimodal artificial intelligence models. But in localized prostate cancer as opposed to NMCRPC, the authors constructed a multimodal artificial intelligence model or an MMAI model. They applied this to the SPARTAN trial with the intention of developing a risk score that could be used for risk stratification in NMCRPC. And we should note here that multimodal artificial intelligence or MMAI is a broad class of artificial intelligence models, and they can analyze different types of data at one time, hence the term multimodal. So in this example, the author's primary data source of interest were those digitized histopathology images because histopathology tells you a lot about NMCRPC. The authors though also wanted their model to consider traditional clinical factors that are known to be prognostic such as Gleason score, tumor stage, PSA level, and age. So those two different types of data, those histopathology images and that traditional clinical data are the two different types of data that make this model multimodal. So we should note here importantly, after dropping missing data, 420 patients contribute to this model, the MMAI model.  The authors generate a risk score from this MMAI model and they categorize that risk score into low, intermediate, and high risk groups using clinical knowledge. The authors found in their results that an increase in this MMAI risk score was associated with an increased hazard of metastasis-free survival event with a hazard ratio from a Cox proportional hazards model of 1.72. To summarize how the authors arrived here, they derived a risk score from this MMAI model which incorporates both imaging and regular data. They plugged this risk score into a Cox proportional hazards mode,l modeling metastasis-free survival and they found that an increase in that MMAI based risk score is associated with increased hazard of metastasis-free event with a hazard ratio of 1.72, which is quite large. Additionally, the risk score seemed to be associated with PFS2 and OS, which were two of the secondary endpoints from the SPARTAN clinical trial, though the effect sizes were more modest. Those are the highlights from the original report, the methods and the results.  The accompanying editorial notes that both histopathology and Gleason score specifically are very critical to understanding prostate cancer, and Gleason score alone is not sufficient to summarize the complexity of the disease, although it is a well validated prognostic factor for prostate cancer. So this makes MMAI an excellent tool in the setting described by the authors. We have an existing prognostic factor that doesn't describe the entire picture of the disease by itself and so we can use those digitized histopathology slides to help bolster our understanding and provide the model more information. MMAI allows you to do this because it can take in different types of data. So that was the main conclusion of the editorial.  They also summarize a number of recent validations of MMAI models in prostate cancer research, noting that it will be an important tool for risk stratification and has already been shown to outperform classical techniques. The editorial though does highlight a number of weaknesses of this paper, limitations and I think the most important one to highlight, and we touched on this earlier, is that 420 patients from the SPARTAN clinical trial contributed to the development of this MMAI score. That is a small proportion of the roughly 1200 patients that did participate in the SPARTAN clinical trial. So we have a small subgroup analysis that can be limiting and this model will need to be validated in a broader population in the future.   Thank you for listening to JCO Precision Oncology Article Insights. Don't forget to give us a rating or a review and be sure to subscribe so that you never miss an episode. You can find all ASCO shows at asco.org/podcasts.    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.      

Chuck and Chris discuss a radial nerve palsy associated with a humerus fracture.  We discuss diagnosis, examination, and preliminary treatment options.  Part 2 will follow after the IFSSH meeting.  We also discuss upcoming, IFSSH- related episodes.Some citations1: Lieberdorfer A, Shivakumar N, Stonner MM, Brogan DM, Ray WZ, Mackinnon SE, DyCJ. Expectant Management, Tendon Transfer, or Nerve Transfer Surgery for RadialNerve Injury: A Qualitative Study Exploring Patient Expectations, Goals, andTreatment Experiences. J Bone Joint Surg Am. 2023 Apr 19;105(8):600-606. doi:10.2106/JBJS.22.01201. Epub 2023 Feb 16. PMID: 36795855. 2: Malikowski T, Micklesen PJ, Robinson LR. Prognostic values ofelectrodiagnostic studies in traumatic radial neuropathy. Muscle Nerve. 2007Sep;36(3):364-7. doi: 10.1002/mus.20848. PMID: 17587226. 3: Steenbeek ED, Pondaag W, Tannemaat MR, Van Zwet EW, Malessy MJA, Groen JL.Optimal timing of needle electromyography to diagnose lesion severity intraumatic radial nerve injury. Muscle Nerve. 2023 Apr;67(4):314-319. doi:10.1002/mus.27787. Epub 2023 Jan 22. PMID: 36625338.4.  PMID: 31714418Radial Nerve Palsy Recovery With Fractures of the Humerus: An Updated Systematic Review.Ilyas AM, Mangan JJ, Graham J.J Am Acad Orthop Surg. 2020 Mar 15;28(6):e263-e269. doi: 10.5435/JAAOS-D-18-00142.5. PMID: 32285189Radial nerve palsy associated with closed humeral shaft fractures: a systematic review of 1758 patients.Hendrickx LAM, Hilgersom NFJ, Alkaduhimi H, Doornberg JN, van den Bekerom MPJ.Arch Orthop Trauma Surg. 2021 Apr;141(4):561-568. doi: 10.1007/s00402-020-03446-y. Epub 2020 Apr 13.6.  PMID: 33335819Incidence and Management of Radial Nerve Palsies in Humeral Shaft Fractures: A Systematic Review.Hegeman EM, Polmear M, Scanaliato JP, Nesti L, Dunn JC.Cureus. 2020 Nov 15;12(11):e11490. doi: 10.7759/cureus.11490.PMID: 33335819 Free PMC article. Review.Please complete our survey:  https://bit.ly/3iHGFpDSee www.practicelink.com/theupperhand for more information from our partner on job search and career opportunities.The Upper Hand Podcast is sponsored by Checkpoint Surgical, a provider of innovative solutions for peripheral serve surgery. To learn more, visit https://checkpointsurgical.com/. Subscribe to our newsletter: bit.ly/3X0Gq89As always, thanks to @iampetermartin for the amazing introduction and concluding music.For additional links, the catalog.  Please see https://www.ortho.wustl.edu/content/Podcast-Listings/8280/The-Upper-Hand-Podcast.aspx

This content has been developed for healthcare professionals only. Patients who seek health information should consult with their physician or relevant patient advocacy groups.For the full presentation, downloadable Practice Aids, slides, and complete CME information, and to apply for credit, please visit us at PeerView.com/EKV865. CME credit will be available until February 27, 2026.Addressing Unmet Needs for Better Outcomes in DLBCL: Leveraging Prognostic Assessment and Off-the-Shelf Immunotherapy Strategies In support of improving patient care, PVI, PeerView Institute for Medical Education, is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.SupportThis activity is supported by an educational grant from Pfizer.Disclosure information is available at the beginning of the video presentation.

This content has been developed for healthcare professionals only. Patients who seek health information should consult with their physician or relevant patient advocacy groups.For the full presentation, downloadable Practice Aids, slides, and complete CME information, and to apply for credit, please visit us at PeerView.com/EKV865. CME credit will be available until February 27, 2026.Addressing Unmet Needs for Better Outcomes in DLBCL: Leveraging Prognostic Assessment and Off-the-Shelf Immunotherapy Strategies In support of improving patient care, PVI, PeerView Institute for Medical Education, is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.SupportThis activity is supported by an educational grant from Pfizer.Disclosure information is available at the beginning of the video presentation.

This content has been developed for healthcare professionals only. Patients who seek health information should consult with their physician or relevant patient advocacy groups.For the full presentation, downloadable Practice Aids, slides, and complete CME information, and to apply for credit, please visit us at PeerView.com/EKV865. CME credit will be available until February 27, 2026.Addressing Unmet Needs for Better Outcomes in DLBCL: Leveraging Prognostic Assessment and Off-the-Shelf Immunotherapy Strategies In support of improving patient care, PVI, PeerView Institute for Medical Education, is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.SupportThis activity is supported by an educational grant from Pfizer.Disclosure information is available at the beginning of the video presentation.

This content has been developed for healthcare professionals only. Patients who seek health information should consult with their physician or relevant patient advocacy groups.For the full presentation, downloadable Practice Aids, slides, and complete CME information, and to apply for credit, please visit us at PeerView.com/EKV865. CME credit will be available until February 27, 2026.Addressing Unmet Needs for Better Outcomes in DLBCL: Leveraging Prognostic Assessment and Off-the-Shelf Immunotherapy Strategies In support of improving patient care, PVI, PeerView Institute for Medical Education, is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.SupportThis activity is supported by an educational grant from Pfizer.Disclosure information is available at the beginning of the video presentation.

Dr. Michael Benatar is a Professor of Neurology and Chief of the Neuromuscular Division and Executive Director of the ALS Center at the University of Miami.  Here he discusses the recent publication “Prognostic clinical and biological markers for amyotrophic lateral sclerosis disease progression: validation and implications for clinical trial design and analysis”.

Before getting into this new podcast, have you checked out the recent newsletter editions of Ground Truths?—how are gut microbiome drives sugar cravings—the influence of sleep on brain waste clearance and aging—the new findings of microplastics in the brain—the surprise finding about doctors and A.I.In this podcast with Dr. Emily Silverman, an internist and founder of The Nocturnists, an award winning podcast and live show, we discuss what inspired her in medicine, what led to her disillusionment, the essentiality of storytelling, of recognizing uncertainty, the limits of A.I., and promoting humanity in medicine. The audio is available on iTunes and Spotify. The full video is linked here, at the top, and also can be found on YouTube.“Storytelling is medicine's currency. Storytelling is not just an act of self-healing; it may actually create better physicians.”—Emily SilvermanTranscript with links to audio and relevant publications, websitesEric Topol (00:07):Well, hello. This is Eric Topol with Ground Truths, and with me, I am delighted to welcome Dr. Emily Silverman, who is Assistant Volunteer Professor of Medicine at UCSF, an old training grounds for me. And we're going to talk about some of the experience she's had there and she is the Founder of the remarkably recognized podcast, The Nocturnists. It's more than a podcast folks. We'll talk about that too. So Emily, welcome.Emily Silverman (00:40):Thank you for having me.Inspiration by Kate McKinnonEric Topol (00:42):Yeah. Well, I thought I would go back to perhaps when we first synapsed, and it goes back to a piece you wrote in JAMA about going to the Saturday Night Live (SNL) with Kate McKinnon. And it was one of my favorite columns, of course, it brought us together kind of simpatico because you were telling a story that was very personal, and a surprise factor added to it. We'll link to it. But it said, ‘Sometime in 2016, I fell in love with SNL comedian Kate McKinnon.' You wrote, ‘It was something about her slow-mo swagger; her unilateral dimple, flickering in and out of existence; the way she drinks up her characters and sweats them from her pores.' I mean, you're an incredible writer, no less podcast interviewer, organizer, doctor. And you talked about my sterile clinical life, which was kind of maybe a warning of things to come and about the fact that there's two very different career paths, comedy and medicine. One could argue they are in essence the same. So maybe you could tell us about that experience and about Kate McKinnon who, I mean, she's amazing.Emily Silverman (02:09):You're making me blush. Thank you for the kind words about the piece and about the writing, and I'm happy to give you a bit of background on that piece and where it came from. So I was in my internal medicine residency at UCSF and about halfway through residency really found myself hitting a wall. And that is actually what gave birth to The Nocturnists, which is the medical storytelling program that I run. But I think another symptom of my hitting that wall, so to speak, and we can talk more about what exactly that is and what that means, was me really looking outside of medicine and also outside of my typical day-to-day routine to try to find things that were a part of me that I had lost or I had lost touch with those aspects of myself. And one aspect of myself that I felt like I had lost touch to was my humorous side, my sense of humor, my silly side even you could say.Emily Silverman (03:17):And throughout my life I have this pattern where when I'm trying to get back in touch with a side of myself, I usually find somebody who represents that and sort of study it, I guess you could say. So in this case, for whatever reason that landed on Kate McKinnon, I just loved the surrealism of her comedy. I loved how absurd she is and loved her personality and so many things. Everything that you just read and really found her and her comedy as an escape, as a way to escape the seriousness of what I was doing on a day-to-day basis in the hospital and reconnect with those humorous sides of myself. So that's the understory. And then the story of the article is, I happened to be traveling to New York for a different reason and found myself standing in line outside of 30 Rock, hoping to get into Saturday Night Live. And there was basically a zero chance that we were going to get in. And part of the reason why is the musical guest that week was a K-pop band called BTS, which is one of the most famous bands in the world. And there were BTS fans like camped out in three circles around 30 Rock. So that week in particular, it was especially difficult to get in. There was just too many people in line. And we were at the very end of the line.Eric Topol (04:43):And it was in the pouring rain, too.Emily Silverman (04:45):And it was pouring rain. And my husband, God bless him, was there with me and he was like, what are we doing? And I was like, I don't know. I just have a feeling that we should stay in line, just go with it. So we did stay in line and then in the morning we got a number, and the way it works is you get your number and then that evening you show up with your number and our number was some crazy number that we weren't going to get in. But then that evening when we went back with our number to wait in line again to get in, what ended up happening is a young woman in the NBC gift shop, she passed out in the middle of the gift shop and I was right there. And so, I went over to her and was asking her questions and trying to help her out.Emily Silverman (05:27):And fortunately, she was fine. I think she just was dehydrated or something, and the security guards were so appreciative. And the next thing I knew, they were sweeping me backstage and up a staircase and in an elevator and they said, thank you so much for your service, welcome to Saturday Night Live. So it became this interesting moment where the very thing that I had been escaping from like medicine and serving and helping people ended up being the thing that gave me access, back to that side of myself, the humorous side. So it was just felt kind of cosmic, one of those moments, like those butterfly wing flapping moments that I decided to write about it and JAMA was kindly willing to publish it.Eric Topol (06:15):Well, it drew me to you and recognize you as quite an extraordinary talent. I don't know if you get recognized enough for the writing because it's quite extraordinary, as we'll talk about in some of your other pieces in the New York Times and in other JAMA journals and on and on. But one thing I just would note is that I resort to comedy a lot to deal with hard times, like the dark times we're in right now, so instead of watching the news, I watch Jimmy Kimmel's monologue or Colbert's monologue or the Comedy Show, anything to relieve some of the darkness that we're dealing with right at the moment. And we're going to get back to comedy because now I want to go back, that was in 2019 when you wrote that, but it was in 2016 when you formed The Nocturnists. Now, before you get to that critical path in your career of this new podcast and how it blossomed, how it grew is just beyond belief. But maybe you could tell us about your residency, what was going on while you were a medical resident at UCSF, because I can identify with that. Well, like any medical residency, it's pretty grueling experience and what that was like for you.Medical ResidencyEmily Silverman (07:45):There were so many wonderful positive aspects of residency and there were so many challenges and difficult aspects of residency. It's all mixed up into this sticky, complicated web of what residency was. On the positive side, some of the most amazing clinicians I've ever met are at UCSF and whether that was seasoned attendings or chief residents who they just seemed to have so many skills, the clinical, the research, the teaching, just amazing, amazing high caliber people to learn from. And of course, the patient population. And at UCSF, we rotate at three different hospitals, the UCSF hospital, the SF General Hospital, which is the public county hospital and the VA hospital. So having the opportunity to see these different patient populations was just such a rich clinical and storytelling opportunity. So there was a lot there that was good, but I really struggled with a few things.Emily Silverman (08:48):So one was the fact that I spent so much of my sitting in front of a computer, and that was not something that I expected when I went into medicine when I was young. And I started to learn more about that and how that happened and when that changed. And then it wasn't just the computer, it was the computer and other types of paperwork or bureaucratic hurdles or administrative creep and just all the different ways that the day-to-day work of physicians was being overtaken by nonclinical work. And that doesn't just mean thinking about our patients, but that also means going to the bedside, sitting with our patients, getting to know them, getting to know their families. And so, I started to think a lot about clinical medicine and what it really means to practice and how that's different from how it was 10, 20, 40 years ago.Emily Silverman (09:43):And then the other part of it that I was really struggling with was aspects of medical culture. The fact that we were working 80 hour weeks, I was working 28 hour shifts every fourth night, every other month. And the toll that took on my body, and I developed some health issues as a result of that and just felt in a way, here I am a doctor in the business of protecting and preserving health and my own health is kind of being run into the ground. And that didn't make sense to me. And so, I started asking questions about that. So there was a lot there. And at first I thought, maybe this is a me thing or maybe this is a California thing. And eventually I realized this was a national thing and I started to notice headlines, op-eds, articles, even pre-Covid about the epidemic of clinician burnout in this country.Emily Silverman (10:40):And there are so many different facets to that. There's the moral injury aspect of it, there's the working conditions and understaffing aspect of it. I learned about how physicians were starting to think about unionizing, which was something that had not really been in the physician, I think consciousness 20, 40 years ago. So just started learning a lot about how medicine had evolved and was continuing to evolve and felt myself wanting to create a space where people could come together and tell stories about what that was like and what their experience was. And that was the birth of The Nocturnists. But I guess that wasn't really your question. Your question was about residency.Birth of The NocturnistsEric Topol (11:20):That's a good answer actually. It kind of gives the background, lays the foundation of how you took a fork in the road here, which we're going to get into now. We're going to link to The Nocturnists website of course, but you have an intro there about, ‘shatter the myth of the “physician God” reveal the truth: that healthcare workers are human, just like everyone else, and that our humanity is our strength, not our weakness.' And that's a very deep and important point that you make to get people interested in The Nocturnists. But now you finished your residency, you're now on the faculty, assistant professor at UCSF, and then you have this gathering that you hadn't already named it the Nocturnists yet had you?Emily Silverman (12:15):I named it in residency.Eric Topol (12:17):Oh, okay in residency. So this was even before you had finished, you started the podcast before you finished?Emily Silverman (12:25):Correct. Before we were a podcast, we were a live show. So the very first live show was in 2016, so I consider that the birth year of the program. And then I graduated residency in 2017, so I started it about halfway through residency.Eric Topol (12:39):Got it. So tell us about that first live show. I mean, that's pretty amazing. Yeah.Emily Silverman (12:46):Yeah. I went to a live taping of The Moth in San Francisco, which some of your listeners may know. The Moth is a live storytelling show in the US, it's often on the radio on NPR. You may have heard it. It's a very ancient way of telling stories. It's more like monologues, people standing up on stage and just spontaneously telling a story the way you would around a campfire or something like that. It's not hyper scripted or anything like that. So I came out of that event feeling really inspired, and I had always loved live performance and live theater. I grew up going to the theater and ended up deciding that I would try that with my community, with the clinicians in my community. So the very first show that we did was in 2016, it was about 40 people in this living room of this Victorian mansion in San Francisco.Emily Silverman (13:42):It was a co-op where different people lived. In the living space, they occasionally rented out for meetings and presentations and gatherings, and it was like $90. So I rented that out and people came and residents, physician residents told stories, but a couple of faculty came and told stories as well. And I think that was a really nice way to set the stage that this wasn't just a med student thing or a resident thing, this was for everybody. And there was definitely an electricity in the air at the show. I think a lot of people were experiencing the same thing I was experiencing, which was having questions about the medical system, having questions about medical culture, trying to figure out how they fit into all of that, and in my case, missing my creative side, missing my humorous side. And so, I think that's the reason people came and showed up was that it wasn't just a night out of entertainment and coming was really more out of a hunger to reconnect with some aspect of ourselves that maybe gets lost as we go through our training. So that was the first show, and people kept asking, when are you going to do another one? When are you going to do another one? The rest is history. We have done many shows since then. So that was the beginning.Eric Topol (14:58):Well, you've been to many cities for live shows, you sold out hundreds and hundreds of seats, and it's a big thing now. I mean, it's been widely recognized by all sorts of awards, and the podcast and the shows. It's quite incredible. So a derivative of The Moth to medicine, is it always medical people telling stories? Does it also include patients and non-medical people?Emily Silverman (15:28):So we're nine years in, and for the first several years, this question came up a lot. What about the patient voice? What about the patient perspective? And the way that I would respond to that question was two ways. First, I would say the line between doctor and patient isn't as bright as you would think. Doctors are also patients. We also have bodies. We also have our own medical and psychiatric conditions and our own doctors and providers who take care of us. So we're all human, we're all patients. That said, I recognize that the doctor, the clinician has its own unique place in society and its own unique perspective. And that's really what I was trying to focus on. I think when you're making art or when you're making a community, people ask a lot about audience. And for me, for those first several years, I was thinking of The Nocturnists as a love letter by healthcare to healthcare. It was something that I was making for and with my community. And in recent months and years, I have been wondering about, okay, what would a new project look like that pulls in the patient voice a bit more? Because we did the clinician thing for several years, and I think there's been a lot of wonderful stories and material that's come out of that. But I'm always itching for the next thing. And it was actually an interview on the podcast I just did with this wonderful person, Susannah Fox.Eric Topol (17:04):Oh yeah, I know Susannah. Sure.Emily Silverman (17:04):Yeah. She was the chief technology officer at the Department of Health and Human Services from 2015 to 2017, I want to say. And she wrote a book called Rebel Health, which is all about patients who weren't getting what they needed from doctors and researchers and scientists. And so, they ended up building things on their own, whether it was building medical devices on their own, on the fringes or building disease registries and communities, online disease communities on their own. And it was a fabulous book and it was a fabulous interview. And ever since then I've been thinking about what might a project look like through The Nocturnists storytelling ethos that centers and focuses on the patient voice, but that's a new thought. For the first several years, it was much more focused on frontline clinicians as our audience.Why is Storytelling in Medicine so Important?Eric Topol (17:55):And then I mean the storytelling people that come to the shows or listen to the podcast, many of them are not physicians, they're patients, all sorts of people that are not part of the initial focus of who's telling stories. Now, I want to get into storytelling. This is, as you point out in another JAMA piece that kind of was introducing The Nocturnists to the medical community. We'll link to that, but a few classic lines, ‘Storytelling is medicine's currency. Storytelling is not just an act of self-healing; it may actually create better physicians.' And then also toward the end of the piece, “Some people also believe that it is unprofessional for physicians to be emotionally vulnerable in front of colleagues. The greater risk, however, is for the healthcare professional to appear superhuman by pretending to not feel grief, suffer from moral distress, laugh at work, or need rest.” And finally, ‘storytelling may actually help to humanize the physician.' So tell us about storytelling because obviously it's one of the most important, if not the most important form of communication between humans. You nailed it, how important it is in medicine, so how do you conceive it? What makes it storytelling for you?Emily Silverman (19:25):It's so surreal to hear you read those words because I haven't read them myself in several years, and I was like, oh, what piece is he talking about? But I remember now. Look, you on your program have had a lot of guests on to talk about the massive changes in medicine that have occurred, including the consolidation of it, the corporatization of it, the ways in which the individual community practice is becoming more and more endangered. And instead what's happening is practices are getting gobbled up and consolidated into these mega corporations and so on and so forth. And I just had on the podcast, the writer Dhruv Khullar, who wrote a piece in the New Yorker recently called the Gilded Age of Medicine is here. And he talks a lot about this and about how there are some benefits to this. For example, if you group practices together, you can have economies of scale and efficiencies that you can't when you have all these scattered individual self-owned practices.Emily Silverman (20:26):But I do think there are risks associated with the corporatization of healthcare. The more that healthcare starts to feel like a conveyor belt or a factory or fast food like the McDonald's of healthcare, MinuteClinic, 15 minutes in and out, the more that we risk losing the heart and soul of medicine and what it is; which is it's not as simple as bringing in your car and getting an oil change. I mean, sometimes it is. Sometimes you just need a strep swab and some antibiotics and call it a day. But I think medicine at its best is more grounded in relationships. And so, what is the modern era of medicine doing to those relationships? Those longitudinal relationships, those deeper relationships where you're not just intimately familiar with a patient's creatinine trend or their kidney biopsy results, but you know your patient and their family, and you know their life story a little bit.Emily Silverman (21:26):And you can understand how the context of their renal disease, for example, fits into the larger story of their life. I think that context is so important. And so, medicine in a way is, it is a science, but it's also an art. And in some ways it's actually kind of an applied science where you're taking science and applying it to the messy, chaotic truth of human beings and their families and their communities. So I think storytelling is a really important way to think of medicine. And then a step beyond that, not just with the doctor patient interaction, but just with the medical community and medical culture at large. I think helping to make the culture healthier and get people out of this clamped down place where they feel like they have to be a superhuman robot. Let's crack that open a little bit and remind ourselves that just like our patients are human beings, so are we. And so, if we can leverage that, and this is also part of the AI conversation that we're having is like, is AI ever going to fully substitute for a physician? Like, well, what does a physician have that AI doesn't? What does a human being have that a machine doesn't? And I think these are really deep questions. And so, I think storytelling is definitely related to that. And so, there's just a lot of rich conversation there in those spaces, and I think storytelling is a great way into those conversations.Eric Topol (22:57):Yeah. We'll talk about AI too, because that's a fascinating future challenge to this. But while you're talking about it, it reminds me that I'm in clinic every week. My fellow and I have really worked on him to talk to the patients about their social history. They seem to omit that and often times to crack the case of what's really going on and what gets the patient excited or what their concerns are really indexed to is learning about what do they do and what makes them tick and all that sort of thing. So it goes every which way in medicine. And the one that you've really brought out is the one where clinicians are telling their stories to others. Now you've had hundreds and hundreds of these physician related stories. What are some of the ones that you think are most memorable? Either for vulnerability or comedy or something that grabbed you because you've seen so many, and heard so many now.A Memorable StoryEmily Silverman (24:02):It's true. There have been hundreds of physician stories that have come through the podcast and some non-physician. I mean, we are, because I'm a doctor, I find that the work tends to be more focused around doctors. But we have brought in nurses and other types of clinicians to tell their stories as well, particularly around Covid. We had a lot of diversity of healthcare professionals who contributed their stories. One that stands out is dialogue that we featured in our live show. So most of our live shows up until that point had featured monologues. So people would stand on stage, tell their story one by one, but for this story, we had two people standing on stage and they alternated telling their story. There was a little bit more scripting and massaging involved. There was still some level of improvisation and spontaneity, but it added a really interesting texture to the story.Emily Silverman (24:58):And basically, it was a story of these two physicians who during Covid, one of them came out of retirement and the other one I think switched fields and was going to be doing different work during Covid as so many of us did. And they were called to New York as volunteers and ended up meeting in the JFK airport in 2020 and it was like an empty airport. And they meet there and they start talking and they realize that they have all these strange things in common, and they sit next to each other on the plane and they're kind of bonding and connecting about what they're about to do, which is go volunteer at the peak of Covid in New York City, and they end up staying in hotels in New York and doing the work. A lot of it really, really just harrowing work. And they stay connected and they bond and they call each other up in the evenings, how was your day? How was your day? And they stay friends. And so, instead of framing it in my mind as a Covid story, I frame it more as a friendship story. And that one just was really special, I think because of the seriousness of the themes, because of the heartwarming aspect of the friendship and then also because of the format, it was just really unusual to have a dialogue over a monologue. So that was one that stood out. And I believe the title of it is Serendipity in Shutdown. So you can check that out.Eric Topol (26:23):That's great. Love it. And I should point out that a lot of these clinical audio diaries are in the US Library of Congress, so it isn't like these are just out there, they're actually archived and it's pretty impressive. While I have you on some of these themes, I mean you're now getting into some bigger topics. You mentioned the pandemic. Another one is Black Voices in Healthcare, and you also got deep into Shame in Medicine. And now I see that you've got a new one coming on Uncertainty in Medicine. Can you give us the skinny on what the Uncertainty in Medicine's going to be all about?Uncertainty in MedicineEmily Silverman (27:14):Yes. So the American Board of Internal Medicine put out a call for grant proposals related to the topic of uncertainty in medicine. And the reason they did that is they identified uncertainty as an area of growth, an area where maybe we don't talk about it enough or we're not really sure how to tolerate it or handle it or teach about it or work with it, work through it in our practice. And they saw that as an area of need. So they put out this call for grants and we put together a grant proposal to do a podcast series on uncertainty in medicine. And we're fortunate enough to be one of the three awardees of that grant. And we've been working on that for the last year. And it's been really interesting, really interesting because the place my mind went first with uncertainty is diagnostic uncertainty.Emily Silverman (28:07):And so, we cover that. We cover diagnostic odyssey and how we cope with the fact that we don't know and things like that. But then there's also so many other domains where uncertainty comes up. There's uncertainties around treatment. What do we do when we don't know if the treatment's working or how to assess whether it's working or it's not working and we don't know why. Or managing complex scenarios where it's not clear the best way to proceed, and how do we hold that uncertainty? Prognostic uncertainty is another area. And then all of the uncertainty that pops up related to the systems issues in healthcare. So for example, we spoke to somebody who was diagnosed with colon cancer, metastatic to the liver, ended up having a bunch of radiation of the mets in the liver and then got all this liver scarring and then got liver failure and then needed a liver transplant and saw this decorated transplant surgeon who recommended the transplant was already to have that done.Emily Silverman (29:06):And then the insurance denied the liver transplant. And so, dealing with the uncertainty of, I know that I need this organ transplant, but the coverage isn't going to happen, and the spoiler alert is that he ended up appealing several times and moving forward and getting his transplant. So that one has a happy ending, but some people don't. And so, thinking about uncertainty coming up in those ways as well for patients. So for the last year we've been trying to gather these stories and organize them by theme and figure out what are the most salient points. The other exciting thing we've done with the uncertainty series is we've looked to people outside of medicine who navigate high uncertainty environments to see if they have any wisdom or advice to share with the medical community. So for example, we recently interviewed an admiral in the Navy. And this person who was an admiral in the Navy for many years and had to navigate wartime scenarios and also had to navigate humanitarian relief scenarios and how does he think about being in command and dealing with people and resources and it is life or death and holding uncertainty and managing it.Emily Silverman (30:18):And he had a lot of interesting things to say about that. Similarly, we spoke to an improvisational dancer who his whole job is to get on stage and he doesn't know what's going to happen. And to me, that sounds terrifying. So it's like how do you deal with that and who would choose that? And so, that's been really fun too, to again, go outside the walls of medicine and see what we can glean and learn from people operating in these different contexts and how we might be able to apply some of those.Eric Topol (30:51):Yeah, I mean this is such a big topic because had the medical community been better in communicating uncertainties in medicine, the public trust during the pandemic could have been much higher. And this has led to some of the real challenges that we're seeing there. So I'm looking forward to that series of new additions in The Nocturnists. Now, when you get this group together to have the live show, I take it that they're not rehearsed. You don't really know much about what they're going to do. I mean, it's kind of like the opposite, the un-TED show. TED Talk, whereby those people, they have to practice in Vancouver wherever for a whole week. It's ridiculous. But here, do you just kind of let them go and tell their story or what?Emily Silverman (31:44):In the beginning it was more open mic, it was more let them go. And then as the years went on, we moved more toward a TED model where we would pair storytellers with a story coach, and they would work together pretty intensively in the six to eight weeks leading up to the event to craft the story. That said, it was very important to us that people not recite an essay that they memorized word for word, which surprise, surprise physicians really love that idea. We're like, we're so good at memorization and we love certainty. We love knowing word for word what's going to come. And so, it's really more of this hybrid approach where we would help people get in touch with, all right, what are the five main beats of your story? Where are we opening? Where are we closing? How do we get there?Emily Silverman (32:34):And so, we'd have a loose outline so that people knew roughly what was going to, but then it wasn't until the night of that we'd fill in the blanks and just kind of see what happens. And that was really exciting because a lot of unexpected things happened. Certain stories that we thought would be really comedic ended up landing with a much more serious and thoughtful tone and vice versa. Some of the stories that we thought were really heavy would unexpectedly get laughs in places that we didn't expect. So I think the magic of live audience is, I guess you could say uncertainty of not quite knowing what's going to happen, and sort of a one time night.Eric Topol (33:17):I'd like to have a storytelling coach. That'd be cool. I mean, we could always be better. I mean, it takes me back to the first story you told with the Saturday Night Live and Kate McKinnon, you told the story, it was so great. But to make telling your story, so it's even more interesting, captivating and expressing more emotion and vulnerability and what makes the human side. I mean, that's what I think we all could do, you never could do it perfectly. I mean, that's kind of interesting how you organize that. Alright, well now I want to go back to your career for a moment because you got into The Nocturnists and these shows and you were gradually, I guess here we are in the middle and still a global burnout, depression, suicide among clinicians, especially physicians, but across the board. And you're weaning your time as a faculty member at UCSF. So what was going through your mind in your life at that time? I guess that takes us to now, too.A Career MoveEmily Silverman (34:36):Yeah, when I was a little kid, I always wanted to doctor and fully intended when I went to med school and residency to find my way as a physician and didn't really think I would be doing much else. I mean, I'd always love reading and writing and the arts, but I never quite thought that that would become as big of a piece of my career as it has become. But what ended up happening is I finished residency. I took a job in the division of hospital medicine at SF General and worked as a hospitalist for about four years and was doing that and balancing with my medical storytelling nonprofit and eventually realized that it wasn't quite working, it wasn't the right fit. And ended up taking a step back and taking a little break from medicine for a while to try to figure out how am I going to balance this?Emily Silverman (35:26):Am I going to shift and go full medicine and retire The Nocturnists? Am I going to go full art, creative journalism, writing and leave clinical medicine behind? Or am I going to continue to proceed in this more hybrid way where I do a little bit of practicing, and I do a little bit of creative on the side? And thus far, I have continued to pursue that middle road. So I ended up starting a new outpatient job, a part-time job that's actually outside of UCSF. I'm still on faculty at UCSF, but my practice now is in private practice. And so, I do that two days a week and it feeds me in a lot of ways and I'm really glad that I've continued to keep that part of myself alive. And then the rest of the days of the week I work from home and some of that is charting and doing clinical work and some of that time is podcasting and working on these other creative projects. So that's where I've landed right now. And I don't know what it will look like in 5, 10, 20 years, but for now it seems to be working.Taking On EpicEric Topol (36:31):Yeah. Well, I think it's great that you've found the right kind of balance and also the channel for getting your exceptional talent, your niche if you will, in medicine to get it out there because people I think are really deriving a lot of benefit from that. Now, another piece you wrote in the New York Times, I just want to touch on because it is tied to the burnout story. This was a great op-ed, Our Hospital's New Software Frets About My ‘Deficiencies' and I want to just warn the listeners or readers or watchers that Epic, this company that you wrote about has non-disparaging agreements with hospitals, censors hospitals and doctors to say anything bad about Epic. So when anybody ever writes something, particularly if it's published in a widely read place, the Epic company doesn't like that and they squash it and whatnot. So what was in your mind when you were writing this op-ed about Epic?Emily Silverman (37:39):So this came out of personal experience that I had where, and maybe this is some of the reason why the hospital medicine work wore me down so much is the frequent messages and alerts and popups just having a lot of fatigue with that. But also what the popups were saying, the language that they used. So you'd open up your electronic chart and a message would pop up and it would say, you are deficient, or it would say you are a delinquent. And it was this scary red box with an upside down exclamation point or something. And it really started to get to me, and this was definitely in that phase of my life and career where I was peak burnout and just kind of raging into the machine a little bit, you could say, I think right now I'm somewhat past that. I think part of the reason why is, I've been able to get myself out into a more sustainable situation, but ended up, it actually came out of me, this piece poured out of me one night.Emily Silverman (38:37):It was like two, three in the morning and my laptop was open and I was laying in bed and my husband was like, go to sleep, go to sleep. And I said, no, this wants to come out, these moments where things just, you just want to give birth, I guess, to something that wants to come out. So I wrote this long piece about Epic and how tone deaf these messages are and how clinicians are, they're working really hard in a really difficult system and just the lack of sensitivity of that language and ended up pitching that to the New York Times. And I think there was something in there that they appreciated about that. There was some humor in there actually. Maybe my Kate McKinnon side came out a little bit. So yes, that piece came out and I think I did get a message or two from a couple folks who worked at Epic who weren't thrilled.Eric Topol (39:33):They didn't threaten to sue you or anything though, right?Emily Silverman (39:35):They didn't. NoEric Topol (39:37):Good.Emily Silverman (39:37):Fortunately, yeah.Medicine and A.I.Eric Topol (39:38):Yeah. Wow. Yeah, it was great. And we'll link to that, too. Now, as they say in comedy, we're going to have a callback. We're going to go to AI, which we talked about and touched on. And of course, one of the things AI is thought that it could help reduce the burden of data clerk work that you've talked about and certainly affected you and affects every person in working in medicine. But I wanted to get to this. For me, it was like a ChatGPT moment of November 2022. Recently, I don't know if you've ever delved into NotebookLM.Emily Silverman (40:18):I have.Eric Topol (40:19):Okay, so you'll recognize this. You put in a PDF and then you hit audio and it generates a podcast of two agents, a man and a woman who are lively, who accurately take, it could be the most complex science, it could be a book, and you can put 50 of these things in and they have a really engaging conversation that even gets away from some of the direct subject matter and it's humanoid. What do you think about that?Emily Silverman (40:57):Well, a lot of what I know about AI, I learned from your book, Eric. And from the subsequent conversation that we had when you came on my podcast to talk about your book. So I'm not sure what I could teach you about this topic that you don't already know, but I think it's a deeply existential question about what it means to be human and how machine intelligence augments that, replaces that, threatens that. I don't really know how to put it. I had Jamie Metzl on the podcast. He's this great historian and science policy expert, and he was saying, I don't like the phrase artificial intelligence because I don't think that's what we're making. I think we're making machine intelligence and that's different from human intelligence. And one of the differences is human beings have physical bodies. So being a human is an embodied experience.Emily Silverman (41:57):A machine can't enjoy, I was going to say a cheeseburger and I was like, wait, I'm talking to a cardiologist. So a machine intelligence being can't enjoy a cucumber salad, a machine intelligence can't feel the endorphins of exercise or have sex or just have all of these other experiences that human beings have because they have bodies. Now, does empathy and emotion and human connection and relationships also fall into that category? I don't know. What is the substrate of empathy? What is the substrate of human connection and relationships and experience? Can it be reduced to zeros and ones or whatever, quantum computing, half zeros and half ones existing simultaneously on a vibrating plane, or is there something uniquely human about that? And I actually don't know the answer or where the edges are. And I think in 5, 10, 20 years, we'll know a lot more about what that is and what that means.Emily Silverman (42:55):What does that mean for medicine? I don't know about the human piece of it, but I think just practically speaking, I believe it will transform the way that we do medicine on so many levels. And this is what your book is about. Some of it is image analysis and EKG analysis, X-ray analysis and MRI analysis. And some of it is cognition, like diagnostic reasoning, clinical reasoning, things like that. I already use OpenEvidence all the time. I don't know if you use it. It's this basically a search engine kind of GPT like search engine that's trained on high quality medical evidence. I'm always going to OpenEvidence with questions. And I actually saw a headline recently, oh gosh, I'll have to fish it out and email it to you and you can link it in the show notes. But it's a little bit about how medical education and also medical certification and testing is going to have to quickly bring itself up to speed on this.Emily Silverman (43:56):The USMLE Step 1 exam, which all physicians in the US have to pass in order to practice medicine. When I took it anyway, which was back in I think 2012, 2013, was very recall based. It was very much based on memorization and regurgitation. Not all, some of it was inference and analysis and problem solving, but a lot of it was memorization. And as you said, I think Eric on our interview on my podcast, that the era of the brainiac memorizing Doogie Howser physician is over. It's not about that anymore. We can outsource that to machines. That's actually one of the things that we can outsource. So I'm excited to see how it evolves. I hope that medical schools and hospitals and institutions find ways safely, of course, to embrace and use this technology because I think it can do a lot of good, which is also what your book is about, the optimistic lens of your book.Eric Topol (44:55):Well, what I like though is that what you're trying to do in your work that you're passionate about is bringing back and amplifying humanity. Enriching the humanity in medicine. Whether that's physicians understanding themselves better and realizing that they are not just to be expected to be superhuman or non-human or whatever, to how we communicate, how we feel, experience the care of patients, the privilege of care of patients. So that's what I love about your efforts to do that. And I also think that people keep talking about artificial general intelligence (AGI), but that's not what we are talking about here today. We're talking about human emotions. Machines don't cry, they don't laugh. They don't really bond with humans, although they try to. I don't know that you could ever, so this fixation on AGI is different than what we're talking about in medicine. And I know you're destined to be a leader in that you already are. But I hope you'll write a book about medical storytelling and the humanity and medicine, because a natural for this and you're writing it is just great. Have you thought about doing that?Emily Silverman (46:24):It's very kind of you to say. I have thought about if I were to embark on a book project, what would that look like? And I have a few different ideas and I'm not sure. I'm not sure. Maybe I'll consult with you offline about that.Eric Topol (46:42):Alright, well I'd like to encourage you because having read your pieces that some of them cited here you have it. You really are a communicator extraordinaire. So anyway, Emily, thank you for joining today. I really enjoyed our conversation and your mission not just to be a physician, which is obviously important, but also to try to enhance the humanity in medicine, in the medical community particularly. So thank you.Emily Silverman (47:14):Thank you. Thank you for having me.***************************************Thanks for listening, watching or reading Ground Truths. Your subscription is greatly appreciated.If you found this podcast interesting please share it!That makes the work involved in putting these together especially worthwhile.All content on Ground Truths—newsletters, analyses, and podcasts—is free, open-access.Paid subscriptions are voluntary and all proceeds from them go to support Scripps Research. They do allow for posting comments and questions, which I do my best to respond to. Many thanks to those who have contributed—they have greatly helped fund our summer internship programs for the past two years. And such support is becoming more vital In light of current changes of funding by US biomedical research at NIH and other governmental agencies. Get full access to Ground Truths at erictopol.substack.com/subscribe

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