Podcasts about texas southwestern

Real strength shows up when life knocks you down and you choose to rise with gratitude, faith, and community. Dr. Douglas Burton shares how a life-altering diagnosis transformed not just his health journey, but his entire perspective on what it means to truly live well. From the operating room to the other side of the patient experience, he opens his heart about the emotional weight of caregiving, the spiritual awakening that came through illness, and the small, intentional shifts that have brought him greater peace than ever before. His story is a powerful reminder that joy is not found in doing more—it's found in slowing down, showing up, and surrounding yourself with love. Key Takeaways: Slowing down and creating space for joy can be more healing than constant striving. Practicing daily gratitude builds emotional resilience and a deeper sense of peace. Community support is a critical part of mental, emotional, and spiritual well-being. Faith and surrender can bring clarity and calm when facing uncertainty or illness. True healing isn't just physical—it's also spiritual, relational, and deeply personal.   About Dr. Douglas Burton: Douglas Burton, M.D. is the Marc and Elinor Asher Spine Professor and Chair of the Department of Orthopedic Surgery at the University of Kansas Medical Center. He received his undergraduate degree from Kansas State University in Manhattan, KS and his MD from the University of Texas Southwestern in Dallas, TX. He completed his residency at the University of Kansas Medical Center and completed spine fellowships at The Texas Back Institute in Plano, TX and at Thomas Jefferson University in Philadelphia, PA. In 2003 he was awarded the Marc and Elinor Asher Spine Professorship. Dr. Burton's clinical practice is focused on the diagnosis and treatment of complex spinal disorders in both pediatric and adult patients. In addition to his primary practice location at the University of Kansas Hospital, he also travels to both Hutchinson and Salina, KS for a monthly outreach clinic to provide health care to patients in rural parts of Kansas. He is a member of the American Academy of Orthopaedic Surgeons, the American Orthopaedic Association, the Interurban Orthopaedic Society, the North American Spine Society and the Scoliosis Research Society, where he is the incoming Chair-Elect of the Research Council and member of the Board of Directors. He served as President of the Federation of Spine Associations from 2018 to 2019. In 2019, The American Association of Neurological Surgeons and the American Academy of Orthopaedic Surgeons announced a new partnership, the American Spine Registry (ASR), which will be jointly owned and developed by both organizations. Dr. Burton currently serves as co-chair of the Data Use Committee for the ASR. His research interests include the development of disease specific health related quality of life instruments and the study of complications and outcomes associated with spinal deformity surgery. He has authored or co-authored over 236 peer reviewed publications and serves as a Deputy Editor of Spine Deformity, the official journal of the Scoliosis Research Society. In 2006 he helped found and remains on the Executive Council of the International Spine Study Group. This is a consortium of spinal deformity surgeons and researchers at over 15 top academic centers in the United States and Canada with collaborators in Europe and Japan. They have been performing prospective and retrospective studies on surgical and non-surgical Adult Spinal Deformity patients since their inception.   Connect with Dr. Michelle and Bayleigh at: https://smallchangesbigshifts.com hello@smallchangesbigshifts.com https://www.linkedin.com/company/smallchangesbigshifts https://www.facebook.com/SmallChangesBigShifts https://www.instagram.com/smallchangesbigshiftsco   Thanks for listening! Thanks so much for listening to our podcast! If you enjoyed this episode and think that others could benefit from listening, please share it using the social media buttons on this page. Do you have some feedback or questions about this episode? Leave a comment in the section below! Subscribe to the podcast If you would like to get automatic updates of new podcast episodes, you can subscribe to the podcast on Apple Podcasts or Stitcher. You can also subscribe in your favorite podcast app. Leave us an Apple Podcasts review Ratings and reviews from our listeners are extremely valuable to us and greatly appreciated. They help our podcast rank higher on Apple Podcasts, which exposes our show to more awesome listeners like you. If you have a minute, please leave an honest review on Apple Podcasts.

CardioNerds co-founders Dr. Daniel Ambinder and Dr. Amit Goyal are joined by Dr. Spencer Weintraub, Chief Resident of Internal Medicine at Northwell Health, Dr. Michael Albosta, third-year Internal Medicine resident at the University of Miami, and Anna Biggins, Registered Dietitian Nutritionist at the Georgia Heart Institute. Expert commentary is provided by Dr. Zahid Ahmad, Associate Professor in the Division of Endocrinology at the University of Texas Southwestern. Together, they discuss a fascinating case involving a patient with a new diagnosis of hypertriglyceridemia. Episode audio was edited by CardioNerds Intern Student Dr. Pacey Wetstein. A woman in her 30s with type 2 diabetes, HIV, and polycystic ovarian syndrome presented with one day of sharp epigastric pain, non-bloody vomiting, and a new lower extremity rash. She was diagnosed with hypertriglyceridemia-induced pancreatitis, necessitating insulin infusion and plasmapheresis.   The CardioNerds discuss the pathophysiology of hypertriglyceridemia-induced pancreatitis, potential organic and iatrogenic causes, and the cardiovascular implications of triglyceride disorders. We explore differential diagnoses for cardiac and non-cardiac causes of epigastric pain, review acute and long-term management of hypertriglyceridemia, and discuss strategies for the management of the chylomicronemia syndrome, focusing on lifestyle changes and pharmacotherapy.  This episode is part of a case reports series developed in collaboration with the National Lipid Association and their Lipid Scholarship Program, with mentorship from Dr. Daniel Soffer and Dr. Eugenia Gianos. US Cardiology Review is now the official journal of CardioNerds! Submit your manuscript here. CardioNerds Case Reports PageCardioNerds Episode PageCardioNerds AcademyCardionerds Healy Honor Roll CardioNerds Journal ClubSubscribe to The Heartbeat Newsletter!Check out CardioNerds SWAG!Become a CardioNerds Patron! Pearls - Hypertriglyceridemia Cardiac sarcoidosis can present with a variety of symptoms, including arrhythmias, heart block, heart failure, or sudden cardiac death. The acute management of hypertriglyceridemia-induced pancreatitis involves prompt recognition and initiation of therapy to lower triglyceride levels using either plasmapheresis or intravenous insulin infusion +/- heparin infusion. Insulin infusion is used more commonly, while plasmapheresis is preferred in pregnancy.   Medications such as fibrates and omega-3 fatty acids can be used to maintain long-term triglyceride reduction to prevent the recurrence of pancreatitis, especially in patients with persistent triglyceride elevation despite lifestyle modifications. Statins can be used in patients for ASCVD reduction in patients with a 10-year ASCVD risk > 5%, age > 40 years old, and diabetes or diabetes with end-organ damage or known atherosclerosis. Consider preferential use of icosapent ethyl as an omega-3 fatty acid for triglyceride lowering if the patients fit the populations that appeared to benefit in the REDUCE IT trial.   Apply targeted dietary interventions within the context of an overall healthy dietary pattern, such as a Mediterranean or DASH diet. Limit full-fat dairy, fatty meats, refined starches, added sugars, and alcohol. Encourage high-fiber vegetables, whole fruits, low-fat or fat-free dairy, plant proteins, lean poultry, and fish. Pay special attention to the cooking oils to ensure the patient is not using palm oil, coconut oil, or butter when cooking. Instead, use liquid non-tropical plant oils. Initiate a very low-fat diet (< 5% of total daily calories from fat) for 1-4 weeks when TG levels are > 750 mg/dL.  Recommend and encourage patients to exercise regularly, with a minimum goal of 150 minutes/week of moderate-intensity aerobic activity. If weight loss is required, aim for more than >225 - 250 minutes/week.   Develop patient-centered and multidisciplinary stra...

In this episode of SurgOnc Today®, Dr. Patricio Polanco, from the University of Texas Southwestern and Vice-chair of the SSO HPB disease site working group, and Dr. Sandra DiBrito, from Albany Medical College and member of the HPB disease site working group, are joined by Dr. Marc Besselink, of Amsterdam University Medical Center, and Dr. Amer Zureikat, of University of Pittsburgh. This is the second episode in our Minimally Invasive Techniques in Hepatobiliary Surgery Series. We will focus today on minimally invasive pancreas surgery.

In this episode of SurgOnc Today®, Dr. Patricio Polanco from the University of Texas Southwestern and Vice-chair of the SSO HPB disease site working group and Dr. Sandra DiBrito from Albany Medical College and member of the HPB disease site working group are joined by Dr. Asmund Fretland of the University of Oslo and Dr. Laleh Melstrom of City of Hope. This is the first episode in our Minimally Invasive Techniques in Hepatobiliary Surgery Series. We will focus on the minimally invasive surgery techniques on the liver, discussing patient selection, benefits of the MIS approach, potential drawbacks, and the impact of this approach on patient outcomes.

In this episode of Girls with Grafts, we sit down with Dr. Victoria Miles to explore the fascinating and complex world of hypermetabolism—the body's heightened metabolic response after a burn injury.

This podcast discussed the topic of "Improving consistency and reducing human bias for physicians' target contouring using AI auto-segmentation." Experts joining the discussion include Steve Jiang, PhD, Professor and Vice Chair in Department of Radiation Oncology at University of Texas Southwestern and Director of Medical Artificial Intelligence and Automation Lab, Nathan Yu, MD, Assistant Professor in Department of Radiation Oncology, Mayo Clinic Arizona, and Yi Rong, PhD, Professor and Lead photon physicist in Department of Radiation Oncology at Mayo Clinic Arizona. This podcast focused on the utility of AI in automatic segmentation of medical imaging and the challenges related to physician variability in clinical practice. We discussed various strategies for addressing these challenges, including developing physician-style aware AI models and balancing standardization with personalization in AI tool development and deployment. The emphasis is on the feasibility and clinical utility of using AI to improve the accuracy and efficiency of medical image segmentation while respecting the art and personalization inherent in clinical medicine.

This podcast discussed the topic of "Improving consistency and reducing human bias for physicians' target contouring using AI auto-segmentation." Experts joining the discussion include Steve Jiang, PhD, Professor and Vice Chair in Department of Radiation Oncology at University of Texas Southwestern and Director of Medical Artificial Intelligence and Automation Lab, Nathan Yu, MD, Assistant Professor in Department of Radiation Oncology, Mayo Clinic Arizona, and Yi Rong, PhD, Professor and Lead photon physicist in Department of Radiation Oncology at Mayo Clinic Arizona. This podcast focused on the utility of AI in automatic segmentation of medical imaging and the challenges related to physician variability in clinical practice. We discussed various strategies for addressing these challenges, including developing physician-style aware AI models and balancing standardization with personalization in AI tool development and deployment. The emphasis is on the feasibility and clinical utility of using AI to improve the accuracy and efficiency of medical image segmentation while respecting the art and personalization inherent in clinical medicine.

Deans chat welcomes Dr. George Tye Liu, current president of the American College of Foot and Ankle surgeons! Dr. Liu is a remarkable leader of the profession, currently working in Dallas TX as an Associate Professor in the Department of Orthopedic Surgery at University of Texas Southwestern. Dr. Liu specializes in Foot and Ankle Trauma and Reconstruction surgery. He completed his undergraduate degree from Trinity University in San Antonio TX with a double major in Biochemistry and Biology. Join us, as we get the inside scoop into what sparked his interests in podiatric medicine. He went on to complete his 4 yr podiatric medical degree with Temple University followed by his 3 year surgical residency program with University of Texas Health Science Center. As a lifelong learner, Dr. Liu completed additional Fellowship training with 2 international fellowships focused on Orthopedic Trauma, one in Dresden, Germany with AO and the other in Catania, Italy. Tune in, as he describes how Fellowship training influenced and impacted his career.  Dr. Liu is also a prolific educator. He has authored over 50 peer-reviewed articles, delivered a plethora of invited lectures both nationally and internationally as well authored many textbook chapters in the topics of foot and ankle surgery. Listen, as he shares some of his experiences education during multi-disciplinary grand rounds with orthopedic, internal medicine, radiology and podiatric residents at University of Texas Southwestern.  As a section editor for the Journal of Foot and Ankle surgery, Dr. Liu shares his insights about publishing and conducting research. He recently obtained his Masters degree in Biostatistics from the University of Nebraska Medical Center. Listen, as he shares why high quality research is important to advance the future of foot and ankle surgery and the podiatric profession in general.  Dr. Liu has been a tremendous leader in the profession both nationally and locally. He has received many awards in his career and describes how the call of leadership drives us forward. He has served in many roles (chair, board member and committee member for various task forces) with the Texas Podiatric Medical Association. He is current faculty for the AO North America, prior chair of Planning committee for the American Diabetes Association and part of the Advisory board for the American Academy of Foot and Ankle Osteosynthesis. We hope you enjoy this opportunity to get to know Dr. George Tye Liu!  https://www.acfas.org/ https://www.abfas.org/residents https://www.aofoundation.org/aona https://utswmed.org/doctors/george-liu/  

In this must-listen episode of The Problem With Perfect, we're joined by Dr. Stephanie Womack, a seasoned obstetric gynecologist with 25 years of experience, to demystify the options available for managing menopause symptoms.Hormone replacement therapy (HRT) is often at the center of the conversation about menopause, but how do you know if it's right for you? What are the risks, and are there alternatives? Dr. Wommack breaks it all down, offering expert insights into the benefits and potential drawbacks of HRT, as well as other remedies that can help women navigate this natural but often challenging stage of life.Tune in to learn:•What hormone replacement therapy is and who can benefit from it.•The risks associated with HRT and how to weigh your options.•Alternative remedies for managing symptoms like hot flashes, mood swings, and sleep issues.•Practical advice for approaching menopause with confidence and clarity.Whether you're living through menopause, preparing for it, or supporting someone who is, this episode is packed with valuable information you don't want to miss!Special Guest: Dr. Stephanie WomackDr. Womack is an OB/Gynecologist with more than 25 years of experience. She graduated from the University of Missouri Medical School and then went to the University of Texas Southwestern in Dallas for residency. Afterward, Dr. Womack returned to Columbia and launched her private practice. In addition to being a busy physician, she is also the mother of four children and an avid tennis player.

Menopause is a universal female experience, yet it remains one of the least discussed and most misunderstood phases of life. In this episode of The Problem With Perfect, we take a deep dive into why menopause has been ignored by medical research and society, leaving countless women unprepared and unsupported.We'll explore the common—and not so common—symptoms that women face and discuss the cultural and systemic reasons behind the silence. Whether you're experiencing menopause, preparing for it, or want to better understand the challenges faced by the women in your life, this episode is for youIt's time to break the silence, challenge the stigma, and start the conversations that women everywhere deserve.Tune in to discover:•Why menopause research and awareness are so limited.•The range of symptoms women endure, from hot flashes to emotional changes.•How we can begin to advocate for more open conversations and better resources.Listen now and join the movement to ensure menopause is no longer a mystery.Special Guest: Dr. Stephanie WomackDr. Womack is an OB/Gynecologist with more than 25 years of experience. She graduated from the University of Missouri Medical School and then went to the University of Texas Southwestern in Dallas for residency. Afterward, Dr. Womack returned to Columbia and launched her private practice. In addition to being a busy physician, she is also the mother of four children and an avid tennis player. 

Matthew A. Borgman, M.D. is a Professor of Pediatrics in the Division of Pediatric Critical Care at the University of Texas Southwestern.  Dr. Borgman graduated from Uniformed Services University (USU), he completed Pediatric Residency at Brooke Army Medical Center in 2007, followed by a fellowship in Critical Care at Boston Children's Hospital.  He is a prolific author in pediatric trauma management which has helped redefine the care of injured children. He is also the former national chair of the Pediatric Trauma Society Research Committee and has co-authored the 2022 Pediatric Traumatic Hemorrhagic Shock Consensus Conference Recommendations. Learning Objectives:By the end of this podcast, listeners should be able to:Define pediatric hemorrhagic shock and massive transfusion.Develop a guideline-based clinical approach to managing a child with hemorrhagic shock.Explore an expert's approach to managing a child with hemorrhagic shock where the evidence might not be clear. References:Russell et al. Pediatric traumatic hemorrhagic shock consensus conference recommendations. J Trauma Acute Care Surg. 2023 Jan 1;94(1S Suppl 1):S2-S10. Spinella et al. Transfusion Ratios and Deficits in Injured Children With Life-Threatening Bleeding. Pediatr Crit Care Med. 2022 Apr 1;23(4):235-244. Gaines et al. Low Titer Group O Whole Blood In Injured Children Requiring Massive Transfusion. Ann Surg. 2023 Apr 1;277(4):e919-e924. Moore et al. Fibrinolysis Shutdown in Trauma: Historical Review and Clinical Implications. Anesth Analg. 2019 Sep;129(3):762-773.Roberts et al. The CRASH-2 trial: a randomised controlled trial and economic evaluation of the effects of tranexamic acid on death, vascular occlusive events and transfusion requirement in bleeding trauma patients. Health Technol Assess. 2013 Mar;17(10):1-79. Dewan et al. CRASH-3 - tranexamic acid for the treatment of significant traumatic brain injury: study protocol for an international randomized, double-blind, placebo-controlled trial. Trials. 2012 Jun 21;13:87.Spinella et al. Survey of transfusion policies at US and Canadian children's hospitals in 2008 and 2009. Transfusion. 2010 Nov;50(11):2328-35.Whitton TP, Healy WJ. Clinical Use and Interpretation of Thromboelastography. ATS Sch. 2023 Jan 9;4(1):96-97. MATIC-2: Questions, comments or feedback? Please send us a message at this link (leave email address if you would like us to relpy) Thanks! -Alice & ZacSupport the showHow to support PedsCrit:Please complete our Listener Feedback SurveyPlease rate and review on Spotify and Apple Podcasts!Donations are appreciated @PedsCrit on Venmo , you can also support us by becoming a patron on Patreon. 100% of funds go to supporting the show. Thank you for listening to this episode of PedsCrit. Please remember that all content during this episode is intended for educational and entertainment purposes only. It should not be used as medical advice. The views expressed during this episode by hosts and our guests are their own and do not reflect the official position of their institutions. If you have any comments, suggestions, or feedback-you can email us at pedscritpodcast@gmail.com. Check out http://www.pedscrit.com for detailed show notes. And visit @critpeds on twitter and @pedscrit on instagram for real time show updates.

Welcome back to Voices of Your Village, and today I got to hang out with Dr. Mary Ann Little. She's a PhD and is a clinical psychologist who's been in private practice for over four decades. We got to dive into a juicy topic talking about childhood narcissism. Her latest book is Childhood Narcissism: Strategies to Raise Unselfish, Unentitled and Empathetic Children. She is currently an adjunct professor at the University of Texas Southwestern medical center at Dallas, and has served as an adjunct professor in the departments of psychology and special education at the University of Texas at Dallas. It was a fun conversation. I feel like the word narcissism is such a triggering one. And I was excited to dive in with her on what does this really look like? What does it even mean? And what can we as parents be doing to support children so that we aren't looking at narcissistic adults down the road? How do we help them see outside themselves? In the second half, Rach and I dive into our fears around narcissism, how it relates to the need for external validation, and how our need for validation of our enough-ness shows up in real life. (Hint- we're still working on it) If this podcast has been helpful for you, please take a minute to rate and review. This helps us reach more folks who are looking for tools to raise emotionally intelligent humans. I'm so deeply grateful to get to do this work alongside you and to bring free resources like this podcast to you. Thank you so much for sharing. You're the bomb. Couldn't do this without you and wouldn't want to. All right, folks, let's dive in.  Connect with Dr. Little: Website: https://www.drmaryannlittle.com Order the book: Childhood Narcissism: Strategies to Raise Unselfish, Unentitled, and Empathetic Children Connect with us: Instagram: @seed.and.sew  Podcast page: Voices of Your Village Seed and Sew's Regulation Quiz: Take the Quiz Order Tiny Humans, Big Emotions now!  Website: seedandsew.org Music by: Ruby Adams and Bensound Learn more about your ad choices. Visit megaphone.fm/adchoices

Thomas Conlon, MD is a pediatric intensivist at the Children's Hospital of Philadelphia, where he also serves as the Director of Pediatric Critical Care Ultrasound. His professional/research interests include clinical and educational outcomes in diagnostic and procedural ultrasound as well as programmatic ultrasound implementation.Sarah Ginsburg, MD is an Assistant Professor of Pediatrics at the University of Texas Southwestern and pediatric intensivist at Children's Medical Center Dallas. Her professional & research interests include clinical applications of POCUS in the PICU. She is very active both locally and nationally in improving POCUS skills for pediatric intensivists, including participating in Pediatric Research Collaborative on Critical Ultrasound, a subgroup of PALISI.Learning Objectives:By the end of this podcast, listeners should be able to:Identify the limitations of the physical exam and lab-based data in evaluating shock at the bedside of critically ill children.Describe how point-of-care ultrasound might provide greater accuracy in our evaluation of complex shock physiology.Discuss limitations to our ability as critical care physicians to use point-of-care ultrasound in our clinical practice and suggest solutions to overcome commonly encountered barriers.References:Lu et al. Recommendations for Cardiac Point-of-Care Ultrasound in Children: A Report from the American Society of Echocardiography. J Am Soc Echocardiogr. 2023 Mar;36(3):265-277. doi: 10.1016/j.echo.2022.11.010. Epub 2023 Jan 23. PMID: 36697294.Walker et al. Clinical Signs to Categorize Shock and Target Vasoactive Medications in Warm Versus Cold Pediatric Septic Shock. Pediatr Crit Care Med. 2020 Dec;21(12):1051-1058. Conlon et al. Diagnostic Bedside Ultrasound Program Development in Pediatric Critical Care Medicine: Results of a National Survey. Pediatr Crit Care Med. 2018 Nov;19(11):e561-e568.Ultrasound Guidelines: Emergency, Point-of-Care, and Clinical Ultrasound Guidelines in Medicine. Ann Emerg Med. 2023 Sep;82(3):e115-e155. Conlon et al. Establishing a risk assessment framework for point-of-care ultrasound. Eur J Pediatr. 2022 Apr;181(4):1449-1457. https://coreultrasound.com/ https://coreultrasound.com/5ms/ https://www.youtube.com/@perccus How to support PedsCrit:Please rate and review on Spotify and Apple Podcasts!Donations are appreciated @PedsCrit on Venmo , you can also support us by becoming a patron on Patreon. 100% of funds go to supporting the show.Thank you for listening to this episode of PedsCrit. Please remember that all content during this episode is intended for educational and entertainment purposes only. It should not be used as medical advice. The views expressed during this episode by hosts and our guests are their own and do not reflect the official position of their institutions. If you have any comments, suggestions, or feedback-you can email us at pedscritpodcast@gmail.com. Check out http://www.pedscrit.com for detailed show notes. And visit @critpeds on twitter and @pedscrit on instagram for real time show updates.Support the show

Thomas Conlon, MD is a pediatric intensivist at the Children's Hospital of Philadelphia, where he also serves as the Director of Pediatric Critical Care Ultrasound. His professional/research interests include clinical and educational outcomes in diagnostic and procedural ultrasound as well as programmatic ultrasound implementation.Sarah Ginsburg, MD is an Assistant Professor of Pediatrics at the University of Texas Southwestern and pediatric intensivist at Children's Medical Center Dallas. Her professional & research interests include clinical applications of POCUS in the PICU. She is very active both locally and nationally in improving POCUS skills for pediatric intensivists, including participating in Pediatric Research Collaborative on Critical Ultrasound, a subgroup of PALISI.Learning Objectives:By the end of this podcast, listeners should be able to:Identify the limitations of the physical exam and lab-based data in evaluating shock at the bedside of critically ill children.Describe how point-of-care ultrasound might provide greater accuracy in our evaluation of complex shock physiology.Discuss limitations to our ability as critical care physicians to use point-of-care ultrasound in our clinical practice and suggest solutions to overcome commonly encountered barriers.References:Lu et al. Recommendations for Cardiac Point-of-Care Ultrasound in Children: A Report from the American Society of Echocardiography. J Am Soc Echocardiogr. 2023 Mar;36(3):265-277. doi: 10.1016/j.echo.2022.11.010. Epub 2023 Jan 23. PMID: 36697294.Walker et al. Clinical Signs to Categorize Shock and Target Vasoactive Medications in Warm Versus Cold Pediatric Septic Shock. Pediatr Crit Care Med. 2020 Dec;21(12):1051-1058. Conlon et al. Diagnostic Bedside Ultrasound Program Development in Pediatric Critical Care Medicine: Results of a National Survey. Pediatr Crit Care Med. 2018 Nov;19(11):e561-e568.Ultrasound Guidelines: Emergency, Point-of-Care, and Clinical Ultrasound Guidelines in Medicine. Ann Emerg Med. 2023 Sep;82(3):e115-e155. Conlon et al. Establishing a risk assessment framework for point-of-care ultrasound. Eur J Pediatr. 2022 Apr;181(4):1449-1457. https://coreultrasound.com/ https://coreultrasound.com/5ms/ https://www.youtube.com/@perccus How to support PedsCrit:Please rate and review on Spotify and Apple Podcasts!Donations are appreciated @PedsCrit on Venmo , you can also support us by becoming a patron on Patreon. 100% of funds go to supporting the show.Thank you for listening to this episode of PedsCrit. Please remember that all content during this episode is intended for educational and entertainment purposes only. It should not be used as medical advice. The views expressed during this episode by hosts and our guests are their own and do not reflect the official position of their institutions. If you have any comments, suggestions, or feedback-you can email us at pedscritpodcast@gmail.com. Check out http://www.pedscrit.com for detailed show notes. And visit @critpeds on twitter and @pedscrit on instagram for real time show updates.Support the show

Description: Co-host Ryan Piansky, a graduate student and patient advocate living with eosinophilic esophagitis (EoE) and eosinophilic asthma, and co-host Mary Jo Strobel, APFED's Executive Director, speak with Dr. Kathryn Peterson, MD, MSCI, a Professor of Gastroenterology at the University of Utah Health. In this episode, Ryan and Mary Jo interview Dr. Peterson about the family risk of eosinophilic gastrointestinal diseases, discussing the studies she has done, future work she is planning, and other studies of related topics. She shares that she is a parent to a patient living with an eosinophilic disorder. She hints at future research that may lead to easier diagnosis of EGIDs.   Listen in for more information on Dr. Peterson's work. Disclaimer: The information provided in this podcast is designed to support, not replace the relationship that exists between listeners and their healthcare providers. Opinions, information, and recommendations shared in this podcast are not a substitute for medical advice. Decisions related to medical care should be made with your healthcare provider. Opinions and views of guests and co-hosts are their own.   Key Takeaways: [:49] Ryan Piansky welcomes co-host Mary Jo Strobel. Mary Jo introduces Dr. Kathryn Peterson, a Professor of Gastroenterology at the University of Utah Health. Dr. Peterson specializes in diagnosing and treating diseases of the digestive system including eosinophilic esophagitis (EoE), Barrett's esophagus, and inflammatory bowel disease.   [2:00] Dr. Peterson works at the University of Utah in Salt Lake City. She co-directs an eosinophilic gastrointestinal disease clinic with Dr. Amiko Uchida. They also work closely with allergy, nutrition, and pharmacy in the clinic and are looking for additional ancillary services to come into the clinic.   [2:27] Dr. Peterson takes care of all sorts of eosinophilic gastrointestinal diseases. She works closely with Dr. Gerald Gleich, as well. Dr. Peterson is a mother of a boy living with eosinophilic disease for 10 years, so she experiences both sides of eosinophilic diseases. She loves her job.   [3:23] Familial risk refers to the risk of the disease in a patient when a family member is affected, compared to the general population. Looking at a proband (patient), is a first-degree family member (parent, sibling, or child) also affected with eosinophilic disease? Is a second-degree family member (grandparent) affected? Are cousins?   [3:58] Dr. Peterson's is trying to see if and how far out the risk for the disease goes within a family. Based on that, you can get an idea if some shared genes are involved, vs. shared environmental influence of the disease within family members. That's the idea of doing family risk studies in complex diseases; eosinophilic diseases are very complex.   [4:44] Dr. Peterson explains how she conducts a family risk study in Utah. The Utah Population Database is very helpful. The University of Utah has partnered with The Church of Jesus Christ of Latter-day Saints for large genealogical pedigrees that allow tracking disease through expanded pedigrees, with privacy and security limitations.   [5:24] It's necessary to clarify physician coding to make sure it's realistic and coded appropriately so that results are believable. It's very hard to recruit family members. Dr. Peterson feels extremely blessed to live in that area. The families are generous and giving. She also believes all eosinophilic families are generous.   [6:34] The farther out you can identify the risk for disease, the more likely you will find a common gene that could be implicated in disease risk or onset. If the disease is tracked in extended relatives, it implies a shared gene more than a shared environmental risk. If the disease is isolated within nuclear families, it may indicate an environmental risk.   [7:39] In doing familial research, Dr. Peterson is trying to develop a risk score. People are getting pretty good at diagnosing EoE, but Dr. Peterson would not say that the non-EoE EGIDs are well-established or well-diagnosed. They are missed commonly and often. To have a risk score from the extent of the disease in a family is helpful.    [8:12] Dr. Peterson notes that studies of cancer risk in extended families have established cancer risk scores and related screening that is needed.   [8:43] Dr. Peterson coauthored a paper in November 2020 about the familial risk of EoE, published in the Clinical Gastroenterology and Hepatology Journal. She and her colleagues looked at nuclear families. They were looking for how many members of the nuclear family of an EoE patient have esophageal eosinophilia. [9:28] They used a questionnaire on allergies, food allergies, and symptoms. They pulled in around 70 first-degree family members and scoped them for eosinophilia, pulled the records on the rest of the family members if they had been scoped, and assessed the risk for eosinophilia.   [9:51] Including the records, and assuming that everyone who hadn't had an endoscopy was negative, they found the risk for esophageal eosinophilia in first-degree family members was 14%, bordering on the familial risk for celiac disease. It's probably higher since they assumed anyone who hadn't been scoped didn't have eosinophilia.   [10:19] They called it esophageal eosinophilia, because the guidelines for diagnosing EoE suggest that the patient must complain of symptoms, and these family members did not have symptoms. It was interesting to find this high prevalence of eosinophilia in the nuclear family members of EoE patients. They had a higher risk of allergy, as well.   [11:14] Dr. Peterson explains the differences between esophageal eosinophilia and eosinophilic esophagitis (EoE). Esophageal eosinophilia means eosinophils are in the esophagus, >15 per high-power field in a biopsy. That could qualify as EoE when you go through the criteria of symptoms.   [12:19] We call it esophageal eosinophilia while we rule out everything else that could cause that cell to get recruited into the esophagus. It could be an allergic reaction to a medication, larger eosinophilic disorders, or parasitic infections. Esophageal eosinophilia means you had that initial biopsy that puts you at risk for EoE.   [13:06] You have to go down the diagnostic steps: Do I have symptoms? Do I have anything else that explains it? If you have nothing else that explains the eosinophils, and you have esophageal dysfunction, then you can call it EoE.   [13:33] Dr. Peterson, speaking personally, believes that educating doctors to ask patients about EoE symptoms would be useful in diagnosing EoE. People cope. You don't want to focus on your symptoms because you want to be able to focus on your life. If symptoms aren't brought to a doctor's attention, a diagnosis can get missed.   [16:47] Dr. Peterson discusses risks for EoE in families where allergies are present. Dr. Peterson is involved currently in another familial study to find more information about the risk of EoE where there are allergies in a family. In the preliminary data, it looks like there is a link with asthma. Asthma and EoE in a family seem to track together.   [17:31] The risk of EoE seems to be higher with additional allergies within a family. Dr. Peterson says they are cleaning up the data to get a better answer. It appears that allergies in general go along with some of the genes that have been identified in EoE. Watch for Dr. Peterson's papers going forward!   [19:05] They looked at around 300 eosinophilic gastroenteritis (EGE) patients and about 170 eosinophilic colitis (EoC) patients. If you have a proband with EoE, is there a higher family risk of having EGE or EoC? It looks like EoE puts you at higher risk of these other conditions. But with such low numbers in the study, the jury is still out.   [20:37] They looked at EGE codes because there is a subset of patients who have eosinophilic disease in their stomach and small bowel who don't have EoE. They found that in patients who have eosinophilic disease in the stomach or the small bowel, EoE is still commonly seen throughout families. EoE seems to be a common theme.   [21:54] Down the road, Dr. Peterson hopes to be able to identify enough families that they might be able to start looking at genes that might put people at risk for more extensive disease.   [23:07] Dr. Peterson discusses the difficulty in diagnosing eosinophilic colitis, inflammatory bowel disorder, and other disorders. Having eosinophils does not categorize you as an EGID patient. There are other disorders where eosinophils are present. We need a better understanding of eosinophilic colitis.   [25:21] Eosinophilic asthma and eosinophilic fasciitis are disorders that Dr. Peterson has not studied but are in the Institutional Review Board approved documentation for future study.   [26:18] Dr. Peterson addresses whether your degree of risk for an EGID increases if you have an immediate family member with an EGID, vs. a second cousin with an EGID. She would say yes, based on the hazard ratios in the data and knowing that eosinophilic disorders are complex and twin studies show an environmental influence.   [27:28] Dr. Peterson asks patients about their family history, especially when they have other symptoms besides EoE. It makes her more aware of what to test.   [29:10] A paper Dr. Peterson is about to submit studied family members who weren't affected, who were siblings of probands. Their mucosa wasn't entirely normal. They may be pre-diagnostic. These are patients who need to be followed. There may be things that set people up for the development of this disease, in the right environment.   [31:04] Something fascinating from the familial study is the challenge of diagnosing EGIDs. Fifty percent of the people they brought in hadn't had an endoscopy. We need to be proactive in identifying diseases in patients. In the study, there are a lot of general GI symptoms coded that Dr. Peterson wonders if they may be missed EGIDs.   [32:34] The NIH gave Dr. Peterson's team funding and they were able to do linkage analysis on several de-identified families that were at high risk for EGIDs. It looks like multiple genes have the potential to be involved. Personalizing medicine would be applicable if there were just one specific gene involved.   [33:23] Down the road, we may find some genes that portend higher risk and other genes that portend risk where we can do preventative environmental care. We can develop risk scores to identify risks and point to interventions.   [34:10] Mary Jo thanks Dr. Peterson for joining us today to share her expertise and help us learn and understand.   [34:36] Future research needs to be done where we are able to recruit patients and do more work looking at genetic linkage and get to the point where we can diagnose and identify non-EoE EGIDs well enough to explore them more, including eosinophilic colitis. Defining those diseases is necessary and needed.   [35:16] A lot of what Dr. Peterson is trying to do is to look further into combined diseases and hypereosinophilic states to determine if there is some gene within families that may help her to develop other therapies not focusing only on the GI tract but on a global approach to health for these patients.   [35:48] There is current research being done to find less invasive ways of identifying disease, such as imaging, so people don't have to undergo endoscopy. That research is being done on the commercial side.   [36:44] Dr. Peterson has been looking at food-specific antibodies. Also, research by other doctors is being done to identify other markers of the foods that often trigger the disease. There has been some interesting preliminary data. This can help patients to eliminate fewer foods.   [37:27] Dr. Peterson has been looking at less invasive ways to identify non-EoE EGIDs in ways that can avoid biopsy.   [38:04] What's being done to study Barrett's esophagus? Dr. Peterson speaks of past and planned research, using the Utah population database. They looked at the risk for Barrett's esophagus in patients with EoE and it was eight times higher than the normal population. Dr. Peterson correlates risks with reflux for Barrett's and EoE.   [39:26] There are still questions about which comes first, EoE, Barret's esophagus, or reflux. She also talks about the relationship between achalasia, allergic diseases, and EoE.   [41:05] To learn more about Dr. Peterson's research, please see the links in the show notes. To learn more about eosinophilic gastrointestinal disorders, please visit apfed.org/egids.   [41:29] To find a specialist, visit apfed.org/specialists. To connect with others impacted by eosinophilic diseases, please join APFED's online community on the Inspire Network at apfed.org/connections.   [41:48] Ryan and Mary Jo thank Dr. Kathryn Peterson again for joining them. Mary Jo thanks APFED's education partners, linked below, for supporting this episode.   Mentioned in This Episode: Kathryn A. Peterson, M.D. Pubmed.ncbi.nlm.nih.gov/36148824/ (to release February 2024) Pubmed.ncbi.nlm.nih.gov/33221551/ (published November 2020) University of Utah Health American Partnership for Eosinophilic Disorders (APFED) APFED on YouTube, Twitter, Facebook, Pinterest, Instagram Real Talk: Eosinophilic Diseases Podcast   Education Partners: This episode of APFED's podcast is brought to you thanks to the support of AstraZeneca, Bristol Myers Squibb, Sanofi, and Regeneron.   Tweetables:   “When we study familial risk, we're looking at the risk of the disease in a patient when a family member is affected, compared to the general population.” — Dr. Kathryn Peterson   “I think allergies, in general, kind of go along with some of the genes that have been identified in EoE.” — Dr. Kathryn Peterson   “Fifty percent of the people we brought in [to this familial risk study] hadn't had an endoscopy. We need to be proactive in identifying diseases in patients.” — Dr. Kathryn Peterson   About Dr. Kathryn Peterson Kathryn Peterson, MD is a Professor of Gastroenterology at the University of Utah Health. She is certified by the American Board of Internal Medicine.   Dr. Peterson specializes in diagnosing and treating diseases of the digestive system including eosinophilic esophagitis, Barrett's esophagus, and inflammatory bowel disease. She completed her medical degree at the University of Texas Southwestern, followed by residency and a fellowship at the University of Utah and a master's program in Epidemiology at Harvard University.   Bio: Healthcare.utah.edu/find-a-doctor/kathryn-peterson    .  

For this episode of “Ask the Expert: Research Edition,” "Increased Intracranial Pressure in Pediatric MOG Antibody Disease," Krissy Dilger of SRNA was joined by Dr. Cynthia Wang and Dr. Linda Nguyen. They discussed MOG antibody disease and the significance of MOG antibodies in diagnosis (00:00:02-00:03:36). Dr. Nguyen highlighted the background of the study and how this research focused on determining the impact of elevated intracranial pressure on patient outcomes (00:03:52-00:06:56). She reviewed the implications of the findings for patient management, emphasizing the importance of early recognition and intervention to mitigate disability (00:10:34-00:14:02). Dr. Wang and Dr. Nguyen anticipated future studies and stressed the collaborative effort required for better patient outcomes and the need for ongoing research in this field (00:17:16-00:20:30). Dr. Linda Nguyen completed her MD, PhD training at West Virgina University in 2017, and then pediatric neurology residency at University of California San Diego in 2022. Currently, she is a neuroimmunology fellow at University of Texas Southwestern. Dr. Cynthia Wang received her medical degree from University of Texas Southwestern Medical Center in Dallas, Texas and completed a pediatrics and pediatric neurology residency at Mott Children's Hospital, University of Michigan Health System in Ann Arbor, Michigan. Dr. Wang completed her James T. Lubin Fellowship under the mentorship of Dr. Benjamin Greenberg at The University of Texas Southwestern and Children's Health. Her research study was a prospective, longitudinal study on acute disseminated encephalomyelitis (ADEM) to identify the clinical characteristics, treatment methods, and follow-up interventions that are associated with better and worse patient-centered outcomes.

Ethan Sanford, MD is an Assistant Professor of Anesthesia and Pediatrics at the University of Texas Southwestern in Dallas. He completed his MD at Harvard University followed by Anesthesiology residency at Brigham and Women's Hospital and pediatric anesthesia fellowship at Boston Children's Hospital. He then completed a pediatric critical care fellowship here at UTSW. He is board certified in both pediatric anesthesia and pediatric critical care medicine. He works both as a pediatric anesthesiologist and intensivist at UTSW/CMC Dallas.Learning Objective:By the end of this podcast, listeners should have an improved understanding of the grief experienced by parents at the end of their child's life and be better equipped to care for them in the pediatric intensive care unit. How to support PedsCrit:Please rate and review on Spotify and Apple Podcasts!Donations are appreciated @PedsCrit on Venmo , you can also support us by becoming a patron on Patreon. 100% of funds go to supporting the show.Thank you for listening to this episode of PedsCrit. Please remember that all content during this episode is intended for educational and entertainment purposes only. It should not be used as medical advice. The views expressed during this episode by hosts and our guests are their own and do not reflect the official position of their institutions. If you have any comments, suggestions, or feedback-you can email us at pedscritpodcast@gmail.com. Check out http://www.pedscrit.com for detailed show notes. And visit @critpeds on twitter and @pedscrit on instagram for real time show updates.Reference:Sanford EL. Losing Ceci. JAMA. 2023 May 2;329(17):1451-1452. doi: 10.1001/jama.2023.4747. PMID: 37022705.Support the show

Low testosterone is a burning issue. It remains a widely debated topic and is a common dilemma for men, especially as they age. We are thrilled to get the ball rolling for the 2024 Prostate Health Podcast season with two fantastic guests to discuss strategies for hormonal optimization. Doctors Amy and Michelle Pearlman are sisters. Dr. Amy Pearlman is a board-certified urologist specializing in male sexual and hormonal health and genital reconstruction. She did her urology residency at the University of Pennsylvania and her fellowship training in urologic reconstruction, prosthetic urology, and infertility at Wake Forest University. Even though she trained as a surgeon, her primary mission lies in educating individuals about fundamental aspects of their bodies to foster health-conscious behaviors, optimize their health, and support them in living their most authentic lives. Dr. Michelle Pearlman is a board-certified gastroenterologist and obesity medicine specialist. She did her residency training at the University of California San Diego and a gastroenterology fellowship at the University of Texas Southwestern in Dallas. As a board-certified gastroenterologist, she understands the significance of maintaining gut health concerning dietary habits and sustaining a healthy weight.  This dynamic sibling duo brings a wealth of knowledge to our podcast, shedding light on both urology and gastroenterology perspectives for a holistic approach to well-being and offering valuable insights into hormonal optimization. Whether you are navigating the challenges of low testosterone or simply seeking ways to live your best life in 2024 and beyond, this episode is a must-listen. Stay tuned for valuable insights to enhance your health in the new year! Disclaimer: The Prostate Health Podcast is for informational purposes only. Nothing in this podcast should be construed as medical advice. By listening to the podcast, no physician-patient relationship has been formed. For more information and counseling, you must contact your personal physician or urologist with questions about your unique situation. Show Highlights: How the urology and gastroenterology fields complement each other How obesity impacts testosterone levels The active and extremely inflammatory role fat cells play in the body How does exercise affect testosterone levels in men? Foods that support testosterone production and weight loss How weight loss and stress management impact hormonal health, including testosterone levels How the microbiome influences the brain What are the available options for testosterone therapy? How investing in your health today will help you avoid sickness later  The wisdom Dr. Amy Pearlman and Dr. Michelle Pearlman share today provides a foundation for informed decisions and a holistic approach to your health journey.  Thank you for joining us! We look forward to bringing you more enriching discussions in upcoming episodes. Links:  Follow Dr. Pohlman on Twitter and Instagram - @gpohlmanmd  Get your free What To Expect Guide (or find the link on our podcast website)   Join our Facebook group  Follow Dr. Pohlman on Twitter and Instagram  Go to the Prostate Health Academy to sign up.  You can access Dr. Pohlman's free mini webinar, where he discusses his top three tips to promote men's prostate health, longevity, and quality of life here. Connect with Dr. Michelle Pearlman and Dr. Amy Pearlman  Prime Institute   https://www.rethinktestosterone.com/ https://www.kyzatrex.com/ https://pearlmanmds.com/amy-pearlman-md/ https://www.primeinstitute.us/

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

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

Megan & Ross Maenius are parents to Mila and patient advocates at Children's Medical Center Dallas. They have an incredible story to tell about their child's journey that may help the next time you are caring for a patient with chronic medical complexity in the pediatric ICU.Erin Gordon, D.O. is an Associate Professor of Pediatrics at University of Texas Southwestern and an intensivist in the pediatric cardiac intensive care unit. Dr. Gordon is the medical director of the inpatient developmental care program and directly involved in creating an environment that fosters the growth and development of the congenital heart disease population, including parental mental health and resilience. Her passion for patient and family advocacy has led to her desire to bring a louder voice to the concept of a “primary” intensivist.Learning objectives:After listening to this episode, learners should be able to:Recognize the parental consequences of children with complex chronic conditions and those requiring a prolonged ICU stay.Recognize aspects of ICU care that limit effective communication between parents/caregivers and clinicians.Discuss strategies to improve communication between parents/caregivers and clinicians including the role of a primary intensivist program.Discuss ways that parents/caregivers and clinicians can partner together to improve the care provided to children in the ICU.How to support PedsCrit:Please rate and review on Spotify and Apple Podcasts!Donations are appreciated @PedsCrit on Venmo , you can also support us by becoming a patron on Patreon. 100% of funds go to supporting the show.To help improve the podcast, please complete our Listener Feedback Survey (< 5 minutes)!Thank you for listening to this episode of PedsCrit. Please remember that all content during this episode is intended for educational and entertainment purposes only. It should not be used as medical advice. The views expressed during this episode by hosts and our guests are their own and do not reflect the official position of their institutions. If you have any comments, suggestions, or feedback-you can email us at pedscritpodcast@gmail.com. Check out http://www.pedscrit.com for detailed show notes. And visit @critpeds on twitter and @pedscrit on instagram for real time show updates.Support the show

About our guests:Jeffrey Edwards, M.D is an Associate Professor of Pediatrics at Columbia University and a pediatric intensivist at Morgan Stanley Children's Hospital in New York. He is an active physician-investigator with clinical and research interests in children with complex chronic conditions and technology-dependence. Erin Gordon, D.O. is an Assistant Professor of Pediatrics at University of Texas Southwestern and an intensivist in the pediatric cardiac intensive care unit. Dr. Gordon is the medical director of the inpatient developmental care program and directly involved in creating an environment that fosters the growth and development of the congenital heart disease population, including parental mental health and resilience. Her passion for patient and family advocacy has led to her desire to bring a louder voice to the concept of a “primary” intensivist.Learning objectives:After listening to this series of episodes, learners should be able to discuss:The discrepant health-related outcomes of long-stay patients (LSP) and those with complex chronic conditions (CCC) in the PICU.Barriers to delivering effective care to LSPs and those with CCC in the PICU.Strategies to improve continuity of care to LSPs and to those with CCC in the PICU.The rationale and evidence supporting the use of a primary intensivist program in the PICU.Patient eligibility criteria and best practices of a primary intensivist program with an emphasis on equity and minimizing the risk of bias. Physician specific and healthcare system related strategies to maintaining a successful primary intensivist program.The role of a PICU fellow in providing care similar to a primary intensivist.Next steps in implementation and research of primary intensivists in PICUs.How to support PedsCrit:Please rate and review on Spotify and Apple Podcasts!Donations are appreciated @PedsCrit on Venmo , you can also support us by becoming a patron on Patreon. 100% of funds go to supporting the show.To help improve the podcast, please complete our Listener Feedback Survey (< 5 minutes)!Thank you for listening to this episode of PedsCrit. Please remember that all content during this episode is intended for educational and entertainment purposes only. It should not be used as medical advice. The views expressed during this episode by hosts and our guests are their own and do not reflect the official position of their institutions. If you have any comments, suggestions, or feedback-you can email us at pedscritpodcast@gmail.com. Check out http://www.pedscrit.com for detailed show notes. And visit @critpeds on twitter and @pedscrit on instagram for real time show updates.Support the show

About our guests:Jeffrey Edwards, M.D is an Associate Professor of Pediatrics at Columbia University and a pediatric intensivist at Morgan Stanley Children's Hospital in New York. He is an active physician-investigator with clinical and research interests in children with complex chronic conditions and technology-dependence. Erin Gordon, D.O. is an Assistant Professor of Pediatrics at University of Texas Southwestern and an intensivist in the pediatric cardiac intensive care unit. Dr. Gordon is the medical director of the inpatient developmental care program and directly involved in creating an environment that fosters the growth and development of the congenital heart disease population, including parental mental health and resilience. Her passion for patient and family advocacy has led to her desire to bring a louder voice to the concept of a “primary” intensivist.Learning objectives:After listening to this series of episodes, learners should be able to discuss:The discrepant health-related outcomes of long-stay patients (LSP) and those with complex chronic conditions (CCC) in the PICU.Barriers to delivering effective care to LSPs and those with CCC in the PICU.Strategies to improve continuity of care to LSPs and to those with CCC in the PICU.The rationale and evidence supporting the use of a primary intensivist program in the PICU.Patient eligibility criteria and best practices of a primary intensivist program with an emphasis on equity and minimizing the risk of bias. Physician specific and healthcare system related strategies to maintaining a successful primary intensivist program.The role of a PICU fellow in providing care similar to a primary intensivist.Next steps in implementation and research of primary intensivists in PICUs.How to support PedsCrit:Please rate and review on Spotify and Apple Podcasts!Donations are appreciated @PedsCrit on Venmo , you can also support us by becoming a patron on Patreon. 100% of funds go to supporting the show.To help improve the podcast, please complete our Listener Feedback Survey (< 5 minutes)!Thank you for listening to this episode of PedsCrit. Please remember that all content during this episode is intended for educational and entertainment purposes only. It should not be used as medical advice. The views expressed during this episode by hosts and our guests are their own and do not reflect the official position of their institutions. If you have any comments, suggestions, or feedback-you can email us at pedscritpodcast@gmail.com. Check out http://www.pedscrit.com for detailed show notes. And visit @critpeds on twitter and @pedscrit on instagram for real time show updates.Support the show

Tidal Volume is a podcast from ATS Assembly on Pediatrics focusing on core concepts of pediatric pulmonology. The goal is to bring in depth focus on these core concepts for residents, fellows, early career pulmonologists or even senior faculty looking for a refresher.In episode 8, Drs. Kubra Melike Bozkanat and Yadira Rivera-Sanchez from University of Texas Southwestern discuss pathophysiology, diagnosis and treatment of Primary Ciliary Dyskinesia. ReviewersRyan Thomas, MDMichigan State University College of Human MedicineChristina Barreda, MDUniversity of Wisconsin School of Medicine and Public HealthReferences Hannah, W., et al. "Frequency of CFTR Mutations in Individuals Evaluated for Primary Ciliary Dyskinesia." B25. CHRONIC SUPPURATIVE LUNG DISEASE IN CHILDREN. American Thoracic Society, 2018. A2843-A2843. Leigh, Margaret W., et al. "Clinical features and associated likelihood of primary ciliary dyskinesia in children and adolescents." Annals of the American Thoracic Society 13.8 (2016): 1305-1313. Shapiro, Adam J., et al. "Diagnosis, monitoring, and treatment of primary ciliary dyskinesia: PCD foundation consensus recommendations based on state of the art review." Pediatric pulmonology 51.2 (2016): 115-132. Shoemark, Amelia, et al. "ERS and ATS diagnostic guidelines for primary ciliary dyskinesia: similarities and differences in approach to diagnosis." European Respiratory Journal 54.3 (2019). Shapiro, Adam J., et al. "The prevalence of clinical features associated with primary ciliary dyskinesia in a heterotaxy population: results of a web-based survey." Cardiology in the Young 25.4 (2015): 752-759. Collins, Samuel A., et al. "Nasal nitric oxide screening for primary ciliary dyskinesia: systematic review and meta-analysis." European Respiratory Journal 44.6 (2014): 1589-1599. Shapiro, Adam J., et al. "Nasal nitric oxide measurement in primary ciliary dyskinesia. A technical paper on standardized testing protocols." Annals of the American Thoracic Society17.2 (2020): e1-e12. Davis, Stephanie D., et al. "Primary ciliary dyskinesia: longitudinal study of lung disease by ultrastructure defect and genotype." American journal of respiratory and critical care medicine 199.2 (2019): 190-198. Horani, Amjad, and Thomas W. Ferkol. "Understanding primary ciliary dyskinesia and other ciliopathies." The Journal of pediatrics 230 (2021): 15-22. Zariwala, Maimoona A., Michael R. Knowles, and Margaret W. Leigh. "Primary ciliary dyskinesia." GeneReviews®[Internet](2019). Contact InformationTidalVolumeATSPeds@gmail.comTwitter@ATSPeds

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

A 1978 UMKC School of Medicine graduate, Dr. Jackson completed a pediatric residency at Cincinnati Children's and an infectious diseases fellowship at the University of Texas Southwestern before joining Children's Mercy Kansas City faculty in 1984. Acknowledged locally, regionally, and nationally as an educator on pediatrics and pediatric infectious diseases topics, she is recognized for developing one of the most robust pediatric infectious diseases programs in the country and for educating thousands of students, residents, fellows, and faculty in pediatrics throughout her nearly 40-year career. In 2019, she was recognized with the American Academy of Pediatrics award for Lifetime Contribution to Infectious Diseases Education. A fellow of the American Academy of Pediatrics, the Infectious Diseases Society of America, and the Pediatric Infectious Disease Society, she served as a National Vaccine Advisory Committee member from 2017-2021. She has also been elected to the Alpha Omega Alpha Honor Society, the American Pediatric Society, the Society of Pediatric Research, and the Academic Pediatric Association.  She is a national thought leader in pediatric infectious disease topics. In 2014 with her colleagues at Children's Mercy, she identified the first cases of enterovirus D68 infection, leading to a CDC investigation that alerted pediatric providers around the country to the largest outbreak ever of this unique virus that led to respiratory failure and a polio-like syndrome that followed infection. Her research efforts have focused on the characterization of Kawasaki disease, prevention of antibiotic resistance, judicious use of antibiotics, emerging viruses, and optimal use of vaccines. During the COVID-19 pandemic, she has served on University, state, and national advisory committees. For the last five years, Dr. Jackson has been the Dean of the UMKC School of Medicine, working to promote recruitment and retention of a diverse student body and faculty, inspire changes in an already innovative curriculum, and promote a vibrant discovery enterprise for their MD degree programs, the Masters in Science Physician Assistant, the Masters in Science Anesthesia Assistant and Graduate Health Education programs.This show was made possible by a generous corporate contribution from PBG. Physician Buying Group, helping pediatricians vaccinate children. Support the showPlease subscribe to our podcast on Apple or Amazon and give us a 5-star review. The Pediatric Lounge - A Podcast taking you behind the door of the Physician's Lounge to get a deeper insight into what docs are talking about today, from the clinically profound to the wonderfully routine...and everything in between. The conversations are not intended as medical advice, and the opinions expressed are solely those of the host and guest.

A 1978 UMKC School of Medicine graduate, Dr. Jackson completed a pediatric residency at Cincinnati Children's and an infectious diseases fellowship at the University of Texas Southwestern before joining Children's Mercy Kansas City faculty in 1984. Acknowledged locally, regionally, and nationally as an educator on pediatrics and pediatric infectious diseases topics, she is recognized for developing one of the most robust pediatric infectious diseases programs in the country and for educating thousands of students, residents, fellows, and faculty in pediatrics throughout her nearly 40-year career. In 2019, she was recognized with the American Academy of Pediatrics award for Lifetime Contribution to Infectious Diseases Education. A fellow of the American Academy of Pediatrics, the Infectious Diseases Society of America, and the Pediatric Infectious Disease Society, she served as a National Vaccine Advisory Committee member from 2017-2021. She has also been elected to the Alpha Omega Alpha Honor Society, the American Pediatric Society, the Society of Pediatric Research, and the Academic Pediatric Association.  She is a national thought leader in pediatric infectious disease topics. In 2014 with her colleagues at Children's Mercy, she identified the first cases of enterovirus D68 infection, leading to a CDC investigation that alerted pediatric providers around the country to the largest outbreak ever of this unique virus that led to respiratory failure and a polio-like syndrome that followed infection. Her research efforts have focused on the characterization of Kawasaki disease, prevention of antibiotic resistance, judicious use of antibiotics, emerging viruses, and optimal use of vaccines. During the COVID-19 pandemic, she has served on University, state, and national advisory committees. For the last five years, Dr. Jackson has been the Dean of the UMKC School of Medicine, working to promote recruitment and retention of a diverse student body and faculty, inspire changes in an already innovative curriculum, and promote a vibrant discovery enterprise for their MD degree programs, the Masters in Science Physician Assistant, the Masters in Science Anesthesia Assistant and Graduate Health Education programs.This show was made possible by a generous corporate contribution from Canid.  They do everything: from buying the vaccines, to managing all the paperwork, to making sure you get paid fairly for both private and VFC vaccines. You simply scan the vaccine and you're done!We partnered with them to offer you a free lunch where they'll help you understand the financials of your vaccine program in more depth. Just go to: Canid.io/lounge to learn more. Support the showPlease subscribe to our podcast on Apple or Amazon and give us a 5-star review. The Pediatric Lounge - A Podcast taking you behind the door of the Physician's Lounge to get a deeper insight into what docs are talking about today, from the clinically profound to the wonderfully routine...and everything in between. The conversations are not intended as medical advice, and the opinions expressed are solely those of the host and guest.

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

On today's episode we are chatting with Dr. Sarah Bedell. Dr, Bedell currently practices Gynecology with her sisters and mother at New Age Women's Health in Miami FL since 2017.. She does general gynecology but also sees patients with vulvar skin conditions and conditions that can cause pain with intercourse. She went to Medical School at New York University where she met her mentor, Dr. Andrew Goldstein, who introduced her to this subspecialty. Dr. Bedell trained with him after she completed her residency at the University of Texas-Southwestern in Dallas, and worked part-time in his office in New York while primarily practicing in Miami (yes, she would commute to NYC once a month for about 1.5 years). It is through him that she actually learned about pelvic floor physical therapy. Visit me at: My Website: https://www.pelvicorerehab.com/ Instagram : https://www.instagram.com/pelvicorerehab Facebook:https://www.facebook.com/pelvicorerehab/ Facebook Group: https://www.facebook.com/groups/pelvichealthplus YouTube:  https://www.youtube.com/channel/UCCiEl1ZFlA5SzN44MhUwzgA?view_as=subscribe Ebook Books links Pregnancy Ebook:  https://www.pelvicorerehab.com/pain-free-pregnancy-guide Bladder Leaking Ebook https://www.pelvicorerehab.com/leaking 8 steps to achieving pelvic healing  https://www.pelvicorerehab.com/ Pelvic Pain, Bladder leaking, and 8 steps to achieve pelvic healing https://www.pelvicorerehab.com/pelvicfloorguides Pelvic Pain  https://www.pelvicorerehab.com/pelvicpain Menopause Guide https://www.pelvicorerehab.com/menopauseguide Postpartum ebook https://www.pelvicorerehab.com/headtotoewellnessformommyandbaby Disclaimer: Susan Winograd, PT offers health and fitness information intended to assist you in improving your general health and well-being. These videos and written text are designed for entertainment and educational purposes only. Please consult your physician before beginning or implementing this or any other technique or exercise program.  Do not rely on the information presented as a substitute for professional medical advice, diagnosis, or treatment. If you have any concerns or questions about your health, consult with a physician or other healthcare professional. Do not disregard, avoid or delay obtaining medical or health-related advice because of something you may have read, heard, or viewed on this site or channel. The use of any information provided on this (or any associated) video or website is solely at your own risk.

"The best way to fix mistakes is to avoid them." Of course, the problem is how does one avoid the mistakes in the first place? Dr. Sam Rhee @bergencosmetic, Dr. Salvatore Pacella @sandiegoplasticsurgeon and Dr. Sam Jejurikar @samjejurikar discuss liposuction, mommy makeovers and tummy tucks with special guest Dr. Reza Kordestani, @drreza.k, expert plastic surgeon, regarding aesthetic body contouring and how to achieve spectacular results while avoiding potential pitfalls.Dr. Reza Kordestani is a plastic surgeon in the Washington D.C. area. He earned his medical degree from the Dartmouth Geisel School of Medicine. He went on to complete his plastic surgery training at the University of Texas Southwestern. After completing his last year as Chief Resident, Dr. Kordestani was awarded the Chief Resident Teaching Award by the faculty and junior residents. Dr. Reza Kordestani now provides cosmetic procedures for patients from his private practice locations in McLean and Woodbridge, VA and Chevy Chase, MD.#podcast #plasticsurgery #cosmeticsurgery #plasticsurgeon #beauty #boardcertified #aesthetic #3plasticsurgeonsandamicrophone ⁠#bergencosmetic ⁠#bestplasticsurgeon #beforeafter #aesthetics #realpatientrealresult #boardcertifiedplasticsurgeon #njplasticsurgeon #njplasticsurgery #nyplasticsurgeon #nyplasticsurgery  

The CardioNerds Academy welcomes Dr. Melanie Sulistio to give the 2nd Annual Sanjay V. Desai Lecture in Medical Education to mark the graduation of the 2022 CardioNerds Academy Class. Join us as Dr. Sulistio and CardioNerds Academy Program Director Dr. Tommy Das discuss the humanity deficiency in medicine, and how the practice of compassionate assumption can lead us to be better physicians for our patients, our colleagues, our learners, and ourselves. Credit to rising CardioNerds Academy chiefs Dr. Rawan Amir, Dr. Kate Wilcox, Dr. Alaa Diab, and Dr. Gurleen Kaur for their terrific acting in this episode. Audio editing by CardioNerds academy intern, Pace Wetstein. Dr. Sanjay V Desai serves as the Chief Academic Officer, The American Medical Association and is the former Program Director of the Osler Medical Residency at The Johns Hopkins Hospital. Dr. Melanie Sulistio is an Associate Professor of Medicine in the Division of Cardiology at the University of Texas Southwestern. Additionally, she is an Associate Dean for Student Affairs and Distinguished Teaching Professor at the University of Texas Southwestern Medical School and co-chairs the ACC Internal Medicine Residency Program. She has a passion for medical education and promoting humanity in medicine, and is actively involved in the work of teaching communication skills that encompass meaningful care, discussions with patients, and difficult conversations with colleagues. Relevant disclosures: None CardioNerds Episode PageCardioNerds AcademyCardionerds Healy Honor Roll CardioNerds Journal ClubSubscribe to The Heartbeat Newsletter!Check out CardioNerds SWAG!Become a CardioNerds Patron!

"How I Do It: Celiac Plexus Block," by Kevin Neal, MD, Assistant Professor, Department of Anesthesiology and Pain Management, University of Texas Southwestern, Dallas, Texas. From ASRA Pain Medicine News, February 2023. See original article at www.asra.com/feb23news for figures and references. This material is copyrighted.     

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

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

Project Veritas got an apparent Pfizer executive on video admitting the company does “directed evolution” of viruses, including Corona viruses. It's a great piece of work, but why is anyone shocked? We have covered Pfizer's many crimes and their lies; we have made clear they run the CDC and FDA and most of the Mockingbird Media.https://thetoddhermanshow.substack.com/p/the-united-states-of-pfizer#details. . . we just watched again how much control Pfizer has over media and tech. The MailOnline disappeared their story on the Project Veritas scoop. YouTube has deleted the video. Google played this game: The Mockingbirds aren't covering it. Then, there is Pfizer's response. I break it down in the show. Know this: Pfizer didn't want their response seen by anyone. How do I know? The same way anyone who works in the media knows. Look when they released it. What does God say?The Lord warned us about “times such as these …” Does this not describe everything The Party is pushing in our society? 2 Timothy 3:1-53 But mark this: There will be terrible times in the last days. 2 People will be lovers of themselves, lovers of money, boastful, proud, abusive, disobedient to their parents, ungrateful, unholy, 3 without love, unforgiving, slanderous, without self-control, brutal, not lovers of the good, 4 treacherous, rash, conceited, lovers of pleasure rather than lovers of God— 5 having a form of godliness but denying its power. Have nothing to do with such people.God will render His judgment 2 Thessalonians 1:9These will pay the penalty of eternal destruction, away from the presence of the Lord and from the glory of His power,The Lord wants people to repent, He wants to save us. He sent His only son for that purpose! How long have I said Pfizer is a criminal organization? BREAKING: @Pfizer Exploring "Mutating" COVID-19 Virus For New Vaccines. "Don't tell anyone this...There is a risk...have to be very controlled to make sure this virus you mutate doesn't create something...the way that the virus started in Wuhan, to be honest."Who is "Jordon Trishton Walker"?; Project Veritas recently released a video featuring "Jordon Trishton Walker," Pfizer executive who revealed shocking new info. But finding anything about him is tough. Here is what I've found so far.O'Keefe: We've obtained internal Pfizer docs verifying Jordan Walker as Pfizer Director, Research & Development Strategic Operations. Graduated Yale 2013. Doctor Med at U of Texas Southwestern medical school.. His supervisor reports to Mikael Dolsten who reports to Albert Bourla, CEO. Pfizer's response Malone: “OK, this is an interesting tidbit. Pfizer is basically acknowledging that they are doing the same type of gain of function research that Boston University was caught doing, but they are denying that it is gain of function or directed evolution.” CDC Official: “Just get rid of all the ‘whites . . . ‘“Language Warning: CRAZY: Justin Trudeau swarmed by angry protesters outside the Bread Bar in Hamilton.MailOnline deleted the story about Pfizer doing GOF on Corona VirusesAustralian Senator Malcolm Roberts drops truth bombs: "Billionaire, globalist corporations will own everything: Homes, factories, farms, cars, furniture, and everyday citizens will rent what they need - if their social credit score allows."Love or hate her, Ayn Rand was a piercing voice on moral questions that continue to haunt the 21st century. Watch this 1959 clip with Mike Wallace and ask yourself: was she wrong?EmailsCathiHey Todd, I just sat down to listen to your episode of Speak now or forever be held in silence. You had mentioned going on record with feeling like you're in a hostile work environment…YES!I did that with my company, a Major Bank. I've been there 21 years. After January 6th, 2021, The Bank and other woke corporations hopped on the narrative about insurrectionists and no PAC dollars to any elected member who questioned the election…blah blah.Anyway, I professionally and calmly escalated concerns until one The Head of Govt Relation direct reports contacted me and I calmly told them explicitly that The Bank was creating a hostile work environment. The Bank certainly didn't stop with wokeness but going on record like that is the only way to hold them accountable if one needs to take legal action - including if one gets fired for escalating concerns. We have to put that in there for protection - plus it's the truth.In addition, in December 2021 when The Bank and other organizations were pushing the injection or you couldn't take your mask off at work and new people couldn't be hired without proof of the injection, I escalated a letter to all of the Board of Directors, Operating Committee and most Senior Leaders. I told them I would hold them accountable to several things: since the injection does not prevent infection, they're completely ignorant on covid facts; given that the injection doesn't stop infection yet they're still pushing it, it seems entirely possible that some of them may have an unhealthy weighting of stock in pharmaceutical companies and should be audited for a conflict of interest; BUT the kicker of the feedback I gave was that THEY'RE the ones creating systemic racism given that black people and people of Mexican/Hispanic descent have the lowest injection rates and therefore are the ones who are disproportionately impacted by wearing masks and not being eligible for hire without the injection. By Feb they dropped in the injection requirement for new hires. By the end of March they very abruptly stopped their covid testing. I'm not saying it had anything to do with my letter. But it could have helped. If we go on record using their own rules, we can actually say a lot to senior leaders without compromising ourselves. And of course, we must always stay calm in written word and voice.God be with you, Todd.

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

Dr. Jacob Hunter is currently the Dedman Family Scholar in Clinical Care and an Associate Professor in the Department of Otolaryngology-Head and Neck Surgery at the University of Texas Southwestern. He has worked as an Assistant Professor for the UT Southwestern Medical Center. Dr. Hunter started his medical career as an Otolaryngology Resident at Montefiore Medical Center. He completed his Neurotology Surgery Fellowship at Vanderbilt, where he specialized in acoustic neuroma surgery, cochlear implants, skull base surgery and chronic ear disease. In this episode… Epidemics are associated with infectious, quick-spreading diseases. However, the same principle applies to any medical issue that expands quicker than treatment can cover. The need for cochlear implants falls into this perfectly — the patients who could benefit from the technology greatly outnumber those receiving treatment. As a result, thousands upon thousands of people are living with deteriorating hearing loss and have made little effort to change their situation. So what can be done to provide more hearing care? On this episode of the ListenUp! Podcast, Dr. Mark Syms talks with Dr. Jacob Hunter, an Associate Professor at The University of Texas Southwestern Medical School, about the state of cochlear implants. They discuss raising awareness, utilizing data to make informed decisions, and building infrastructure. Lastly, they touch on the personal element of hearing counseling and how it plays into education.

Vaccine development is a tremendous scientific breakthrough. In Part Two of this ASCO Education Podcast episode, Dr. Doug Lowy, Principal Deputy Director of the National Cancer Institute describes overcoming the hesitancy of taking vaccines in the era of Covid (:57), the scientific impacts of other nations like China (3:54), the importance and the standing of the NCI (5:10) and the future of oncology (10:36). If you liked this episode, please subscribe. Learn more at https://education.asco.org, or email us at education@asco.org. TRANSCRIPT Pat Loehrer: Hi, I'm Pat Loehrer, Director of Global Oncology and Health Equity, at Indiana University. I'm here with Dave Johnson, a colleague and friend, and Medical Oncologist at the University of Texas Southwestern in Dallas, Texas. This is the second half of our Oncology, Etc., conversation with Principal Deputy Director of the NCI, and Chief of the Intramural Laboratory of Cellular Oncology in the Center for Cancer Research, Dr. Doug Lowy. In part one, we chatted with Dr. Lowy about his interest in cancer, which was developed through his personal academic experiences, including that of his parents, as well as his groundbreaking work on the HPV vaccine with Dr. John Schiller. Today, we're going to continue our conversation with Dr. Lowy by asking him about overcoming the hesitancy of taking vaccines in the era of COVID.   Dr. Doug Lowy: Pat, it's very difficult. There was some vaccine hesitancy when the HPV vaccine was introduced initially. My view is that the people you want to speak to and with, are the people whose minds can be changed. So, I don't try to change the minds of people who are opposed to vaccination for one reason or another, but instead, try to talk with people about evidence, but directing it towards those people whose minds potentially can be changed. A big advantage with the HPV vaccine is that this has been going on over a number of years. With COVID, everything happened in a greatly truncated way. So, the vaccine was introduced less than a year after the pandemic. But concomitant with that was a lot of vaccine hesitancy, and I think that that's going to be difficult to overcome. What I have really worried about is whether the vaccine hesitancy associated with COVID might extend to other vaccines and not just to the HPV vaccine, but to childhood vaccines, et cetera. The national data for 2020 and 2021 for HPV vaccination is almost counterintuitive and provisionally reassuring, both. Compared to 2019, the last full year without the pandemic, the number of people being vaccinated with the HPV vaccine went up between '19 and '20, and between '20 and '21, went up again. So, at least by that metric and through that time, it doesn't look as though the vaccine hesitancy associated with Covid is extending to the HPV vaccine, at least in the short term. So, what we've seen between 2019 and 2021 is that HPV vaccine uptake among teenagers actually has gone up each year. So, at least in the short term, the vaccine hesitancy associated with the Covid vaccine does not seem to have extended to the HPV vaccine. Dave Johnson: So, Doug, I'm going to shift gears just a little bit. I read recently, in Science, that China had overtaken the United States in terms of scientific publication and impact; and I'm wondering what you think about that, and what we need to do to retain our longstanding leadership in that role. Or does it really matter? Dr. Doug Lowy: If China's research, if their quality is outstanding-- I mean, there's nothing wrong with another country making important contributions to biomedical research. I don't see this, per se, as a competition. Perhaps, it's because I'm just looking at it through the lens of cancer research, and we think that cancer research is much too big to be done exclusively through support of NCI, exclusively in the United States, et cetera. So, to me, if other countries are doing high-quality research that can help people all over the world with regard to cancer- Pat Loehrer: -Let me ask you this, Doug, you've been at the NCI for 50 years. And I calculated that you've served under nine presidents, and of the NCI's 16 directors, you've served with 10 of them- Dr. Doug Lowy: Really ancient. Thank you. Pat Loehrer: -so, with all that, what do you think; one, about the importance of the NCI, and then also, we'll ask you a little bit about the reflections of the directors, and lessons learned from them, and maybe, some good stories. So, where do you think the NCI stands, and why is it important for the world, and for the country? Dr. Doug Lowy: What's really important is the funding from Congress. It is long-term and sustained. Cancer research can't be done in two or three years. It just takes a while to do really high-quality cancer research. And what really counts, from my perspective, is you can rely on the government to be strongly supporting cancer research through the NCI. In other words, private philanthropy is very important, but private philanthropy can decide, "Tomorrow we don't want to be doing what we have been doing." It's very much like pharmaceutical companies - they can decide that they're not going to be doing it. But it's almost impossible for us to say, "We are no longer going to support basic science research. Okay? We're not interested in investigator-initiated research," because, of course, we are. And that's the bedrock of development. We can't say, "We're no longer interested in doing clinical trials," because, of course, we are, because we can't make the progress that we need to make without clinical trials. We can't say, "We're not interested in doing implementation research," because it's one thing to have a new approval, it's something else to have it widely and equitably disseminated, and doing some kind of research with implementation. Science is critically important, and this applies for prevention, screening, diagnosis, treatment, survivorship, all of these areas that NCI supports, and will continue to support. The proportion may vary from one year to another, from one director to another, but all of those areas are going to continue to be supported. Dave Johnson: So, Doug, during your various tenures as the interim director, what program or programs are you most proud about? Dr. Doug Lowy: Instead of programs that I'm most proud of, I would say that working with NCI staff is what enables the achievement. The mission of the NCI is just incredible, and virtually everyone on the staff buys into the mission; which is, to help people live longer and healthier lives through research-related advances in cancer. That's what people do. And the first time when I was Acting Director, was the first Cancer Moonshot, so I was involved in that. But tremendous amount of credit needs to go to the Obama administration for wanting to do it, to the Congress for its strong bipartisan support for the initial Cancer Moonshot, and to my NCI colleagues, and then extramurally, for everybody who really got on board and tried to do things. So, this is very much a team effort, and it's not limited to NCI, you know, extramural colleagues are critically important to everything that we do. Pat Loehrer: Doug, you've alluded to the fact that you've served under so many different presidents and directors, and they all have different leadership styles. If you were gonna be a mentor on leadership, what advice would you give to the listeners as to what makes a good leader, and perhaps, what makes a not-so-good leader too? Dr. Doug Lowy: I think that there is a spectrum - there are some people who lead by intimidation, and some people who lead by example; and all of them can be effective leaders. My own view is that I like to lead by example because I really feel that that leads to very high morale. People who lead by intimidation may get a lot of work out of people, but it is nowhere near as satisfying as knowing that you are an extraordinarily, highly-valued member of a team and that the whole is greater than the sum of its parts. So, I think that having tremendous admiration and respect for the people that you work with, is absolutely number one, and number two, is listening to them. You don't always need to do what they advise, but people really thrive on being listened to, and everybody wants to make a difference. And so, help them to achieve that goal. When they look good, you'll look good. Dave Johnson: So, Doug, I'm attending on the general medical wards right now. Just got asked today by the medical students to give them some advice about the future of Oncology, and where did I think it was going. Before I go back and meet with them, I'd love to get your thoughts. Dr. Doug Lowy: Well, the future of oncology is extraordinarily bright. On the one hand, we've made tremendous progress. On the other hand, there are still 600,000 people dying every year in the United States from cancer, and worldwide, the problem is even greater. But what's going to happen in the future is, we will understand the causes of cancer better, and so, that will enable us to prevent more cancers. I think there's going to be an enormous increase in the opportunities for screening, and to reduce either the incidence of cancer or increase the outlook for people with cancer, because asymptomatic cancer will be diagnosed at a substantially earlier time point. And then when it comes to treatment, my view is, we've barely scratched the surface. With the opportunities for making drugs, immuno-oncology, and who knows what other areas lie in front of us, are almost limitless. The Biden administration has a goal for the reignited Cancer Moonshot of decreasing the mortality rate over the next 25 years by 50%. What I think we need to do is to decrease mortality over the next 25 years by even more than that, and in addition, to make progress against those cancers where progress thus far has been limited. Take pancreatic cancer as a specific example; 10 years ago, the RAS oncoproteins were thought to be undruggable targets. But last year, we had the first approval from the FDA of a RAS-specific inhibitor. The good news is, that can target about half of lung cancer that has mutant RAS. The bad news is, it targets very few people with pancreatic cancer who have mutant RAS. On the other hand, there now are G12D inhibitors where there's excellent preclinical data and hopefully, sometime next year, be starting clinical trials. G12D mutations account for about half of people with pancreatic cancer. If the success there mirrors the success that we've seen thus far with lung cancer, it means that we are potentially on the way to actually making a difference in outlook for people with pancreatic cancer. But I just see this as one of many opportunities as time goes forward. Pat Loehrer: You did, this week, something that no one has done, and that is, to turn the reins of the directorship of the Cancer Center, over to the first woman director, Monica Bertagnolli. What was in your letter that you left on the desk that you gave her? What kind of advice did you give her? Dr. Doug Lowy: My advice that I gave her was really, "How can I help you the best and the most?" Dave Johnson: That's awesome advice. No doubt about it. It's a really historical moment, and of course, we, who are members of ASCO, are particularly proud that Monica has taken the reins, as a former ASCO president. And Doug, we really appreciate you taking the time to spend with us. It's been incredibly interesting, and congratulations on an amazing career. Pat Loehrer: Absolutely. Dave Johnson: And also, thanks to our listeners for tuning in to Oncology, Etc. As you know, this is an ASCO Educational podcast, where Pat and I will talk about just about anything. If you have an idea for a topic or a guest you'd like us to interview, please by all means email us at: education@asco.org      Thank you for listening to the ASCO Education Podcast. To stay up to date with the latest episodes, please click, "subscribe". Let us know what you think by leaving a review. For more information, visit the Comprehensive Education Center, at: education.asco.org.  The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. 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.     

Have you ever wondered how someone graduating from medical school becomes a plastic surgeon? Today we talk to special guest Dr. Amanda Gosman @aagosman, who trains plastic surgeons for a living. Dr. Amanda Gosman is a board certified plastic surgeon who is chief of the Division of Plastic Surgery at UC San Diego School of Medicine and Director of the Plastic Surgery Residency Program and the Craniofacial Fellowship Program. She is also the director of the Fresh Start Clinic for Craniofacial Anomalies at Rady Children's Hospital-San Diego.Dr. Salvatore Pacella @sandiegoplasticsurgeon,  Dr. Sam Jejurikar @samjejurikar, and Dr. Sam Rhee @bergencosmetic discuss how plastic surgery training has changed over the years, how to safely incorporate aesthetic surgery in residency training, and the challenges facing newly trained plastic surgeons.Dr. Gosman completed her fellowship in craniofacial and pediatric plastic surgery and her residency training at the University of Texas Southwestern. She also completed a one-year fellowship in international plastic surgery with ReSurge International (formerly Interplast). She earned her medical degree from Case Western Reserve University.As a board-certified plastic surgeon, Dr. Gosman's clinical interests include cleft lip and palate surgery, pediatric and adult craniofacial surgery, microsurgical facial reanimation, breast reconstruction and aesthetic surgery. Her research is focused on cleft lip and palate surgeries, plastic surgery outcomes, telemedicine and international health.#podcast #plasticsurgery #cosmeticsurgery #plasticsurgeon #beauty #boardcertified #aesthetic #3plasticsurgeonsandamicrophone ⁠#bergencosmetic ⁠#bestplasticsurgeon #beforeafter #aesthetics #realpatientrealresult #boardcertifiedplasticsurgeon #njplasticsurgeon #njplasticsurgery #nyplasticsurgeon #nyplasticsurgery #ucsdplasticsurgery #diversifyplasticsurgery #globalsurgery #craniofacial

This week, please join authors Kevin Roedl and Sebastian Wolfrum, as well as Associate Editor Mark Link as they discuss the article "Temperature Control After In-Hospital Cardiac Arrest: A Randomized Clinical Trial." Dr. Carolyn Lam: Welcome to Circulation on the Run, your weekly podcast summary, and backstage pass to the Journal and its editors. We are your cohosts. I'm Dr. Carolyn Lam, Associate Editor from the National Heart Center, and Duke National University of Singapore. Dr. Greg Hundley: And I'm Dr. Greg Hundley, Associate Editor and Director of the Pauley Heart Center at VCU Health in Richmond, Virginia. Well, Carolyn, this week's feature, very interesting, a randomized clinical trial of temperature control after in-hospital cardiac arrest. But before we get to that exciting study, let's grab a cup of coffee, and jump in and discuss some of the other articles in the issue. Carolyn, would you like to go first? Dr. Carolyn Lam: Yes. Starting with a great quiz. So Greg, which is better? How about this? It's multiple choice. Is it A; transradial, or B; transfemoral access, in terms of post-procedural mortality? Dr. Greg Hundley: I'm going to go with transradial. It has been, hopefully, I'm okay on this. It just seems so many fewer complications. Dr. Carolyn Lam: But that's exactly that we need to meta-analyze the studies that have been done. Exactly what this paper did, led by Professor Valgimigli, from USI in Lugano, Switzerland. So what they did is, they performed an individual patient data meta-analysis of 21,600 patients, enrolled in seven multi-center randomized control trials, comparing the transradial with transfemoral access, among patients undergoing coronary angiography with or without PCI. And they found that transradial access was associated with a lower incidence of the primary outcome of all-cause mortality, and the co-primary outcome of major bleeding at 30 days, compared to transfemoral access. There was also evidence for reductions in major adverse cardiac and cerebral vascular events, net adverse clinical events, vascular complications, excess site bleeding, and blood transfusion. MI, stroke, and stent thrombosis, did not differ. And crossover was higher in the transradial access group. At predefined subgroup analysis, the authors confirmed that the benefit observed the transradial group was generally consistent across the majority of pre-specified subgroups, except for those with significant baseline anemia. Patients with baseline anemia appear to derive a substantial mortality benefit with transradial access rather than transoral access, compared to those with mild or no anemia. So, the authors concluded, that the meta-analysis provides evidence that transradial access should be considered the preferable access site for PCI, in patients with acute coronary syndrome, supporting most recent recommendations on the preferential use of this radial approach. So you were right, Greg. Dr. Greg Hundley: Very nice, Carolyn. A really important piece of science to disclose to our listeners, in that hurried state, and moving quickly door to balloon times, et cetera. And here we find another positive outcome in study result for transradial approaches. Well Carolyn, as we know, my next paper, it's really going to come to us from the world of preclinical science. And it pertains to hypertension, which is a common cardiovascular disease, and is related to both genetic and environmental factors. But the mechanisms linking the interplay between the domains of genetics and the environment have not been well studied. Now, DNA methylation, a classical epigenetic modification, not only regulates gene expression, but is also quite susceptible to environmental factors. Thereby, linking environmental factors to genetic modifications. So therefore, Carolyn, these authors, including Professor Jingzhou Chen, from Fuwai Hospital, National Center for Cardiovascular Diseases, and the Chinese Academy of Medical Sciences, and the Peking Union Medical College, and their colleagues, felt that screening differential genomic DNA methylation, in subjects with hypertension, would be important for investigating this genetic environment interplay in hypertension. So this study, Carolyn, like many from the world of preclinical science and circulation, incorporated both human and animal model subjects. Methodologically differential genomic DNA methylation in hypertensive, pre-hypertensive, and healthy control individuals, was screened using the Illumina 450K BeadChip, and then verified by pyrosequencing. Plasma oviduct glycoprotein 1, or OVGP1 levels, were determined using an enzyme-linked immunosorbent assay. And OVGP1 transgenic and knockout mice were generated to analyze the function of OVGP1. Dr. Carolyn Lam: Wow. Nice approach, Greg. And what did the authors find? Dr. Greg Hundley: Right, Carolyn. These authors found a hypomethylated site at cg20823859 in the promoter region of OVGP1, and the plasma OVGP1 levels were significantly increased in hypertensive patients. This finding indicates that OVGP1 is associated with hypertension. Now Carolyn, in OVGP1 transgenic mice, OVGP1 over expression caused an increase in blood pressure. Also, dysfunctional vasoconstriction, and vasodilation, remodeling of the arterial walls, and increased vascular superoxide stress and inflammation. And these phenomenon were exacerbated by angiotensin II infusion. In contrast, OVGP1 deficiency, attenuated angiotensin II induced vascular oxidase, stress, inflammation, and collagen deposition. Now pull down, and co-immunoprecipitation assays showed that myosin heavy chain 2A, or MYH9, interacted with OVGP1. Whereas, inhibition of MYH9 attenuated OVGP1 induced hypertension and vascular remodeling. Dr. Carolyn Lam: So Greg, let me try to summarize, is that okay? So hypomethylation, at that specific site in the promoter region of the OVGP1 gene, is associated with hypertension, and induces its upregulation. The interaction of this OVGP1 with myosin heavy chain 2A contributes to vascular remodeling and dysfunction. And so, OVGP1 is a pro hypertensive factor, that promotes vascular remodeling by binding to this myosin heavy chain. So, really cool stuff. Thanks for teaching us. Dr. Greg Hundley: Very good. Dr. Carolyn Lam: Well thanks so much, Greg. And we go back to the clinical world now, and ask the question, what is the efficacy and safety of prophylactic full dose anticoagulation and antiplatelet therapy, in critically ill COVID-19 patients? So I'm going to tell you the results of the COVID-PACT trial. And this was a multi-center, two-by-two factorial, open label, randomized controlled trial, with blinded endpoint adjudication in 390 ICU level patients. So, severely ill patients with COVID-19, from 34 US centers. Patients were randomized to a strategy of full dose anticoagulation, or standard dose prophylactic anticoagulation. And in the absence of an indication for antiplatelet therapy, patients were additionally randomized to either clopidogrel or no antiplatelet therapy. Dr. Greg Hundley: Ah, Carolyn. So what did they find? Dr. Carolyn Lam: Full dose anticoagulation substantially reduced the proportion of patients experiencing a venous or arterial thrombotic event, and there was no benefit from treatment with clopidogrel. Severe bleeding events were rare, but numerically increased in patients on full dose versus standard dose prophylactic anticoagulation, without any fatal bleeding events, GUSTO moderate or severe bleeding was so significantly increased with full dose anticoagulation, but with no difference in all-cause mortality. So in summary, in a population of critically ill patients with COVID-19, a strategy of prophylaxis with full dose, versus standard dose prophylactic anticoagulation, but not the addition of clopidogrel, reduced thrombotic complications, with an increased risk of bleeding, driven primarily by transfusions in hemodynamically stable patients, with no apparent excess in mortality. Dr. Greg Hundley: Very nice, Carolyn. What a important piece of information, as many of us around the world are taking care of critically ill patients with COVID-19. Well, how about we see what is in the mail bag this week? So first, Carolyn, there's a Frontiers piece by Dr. Packer, entitled, “Critical Reanalysis of the Mechanisms Underlying the Cardiorenal Benefits of SGLT2 inhibitors, and Reaffirmation of the Nutrient Deprivation Signaling Autophagy Hypothesis.” Next, there's a Research Letter, from Professor Airaksinen entitled, “Novel Troponin Fragmentation Assay to Discriminate Between Troponin Elevations in Acute Myocardial Infarction and End-stage Renal Disease.” Carolyn, there's another Research Letter, from Professor Solomon, entitled, “Aptamer Proteomics for Biomarker Discovery in Heart Failure with Reduced Ejection Fraction.” Also, Carolyn, [a] wonderful Cardiovascular News summary from Tracy Hampton, reviewing three articles. First, “Mechanisms Behind Cannabis Effects on Heart Health.” The second, “Exercise Inducible Metabolite Suppresses Hunger.” And then lastly, “Piezo1 Initiates the Cardiomyocyte Hypertrophic Response to Pressure Overload.” Dr. Carolyn Lam: Cool. There's also an exchange of letters between Doctors Jha and Borlaug on latent pulmonary vascular disease in therapeutic atrial shunt. And finally, an On My Mind, by Dr. David Kass entitled, “What's EF Got To Do, Got To Do With It.” I love it. You must read it. It's so, so cool. All right. But now, let's go on to our feature discussion, shall we? Dr. Greg Hundley: You bet, Carolyn.   Welcome listeners, to our feature discussion today, and really delving into the world of in-hospital cardiac arrest, and how we manage those patients. And we have with us today, Dr. Kevin Roedl from Hamburg, Germany, Dr. Sebastian Wolfrum from Lubeck, Germany, and our own associate editor, Dr. Mark Link from University of Texas Southwestern in Dallas, Texas. Welcome gentlemen. Kevin, we're going to start with you. Can you describe for us, some of the background information that went into the construct of your study, and what was the hypothesis that you wanted to address? Dr. Kevin Roedl: Thank you, Greg. We thank you for the kind invitation to this podcast. We're very likened to do this podcast with you. And so, talking about the background of hypothermia in-hospital cardiac arrest, we have to go back like two decades almost, because there were two studies in New England Journal of Medicine published 2002, who introduced mild therapeutic hyperthermia to the treatment in post cardiac arrest. Primary, these two studies show the benefit of the therapy in this kind of patients. And then, 2003, it was introduced in also the international guidelines. However, these studies only addressed out-of-hospital cardiac arrest patients, and also, only shockable rhythms. And so, the question arised over the years, what about other patients like non shockable rhythms, or also in-hospital cardiac arrest? And so, that's basically was the primary aim of our study to address this special population. Because when you see the states, the numbers, there are 290,000 in-hospital cardiac arrests a year. So it's actually, a very large population. And there's no randomized control trial to show any benefit, or maybe harm, in this group. There were some observational studies, 2016 in China published. From China, in this group, they looked at the Get With The Guidelines registry, and actually, they saw that there was probably a negative influence of hypothermia in the study. However, it was only observational. So actually, there were no randomized control trials. And that primary hypothesis was, that we wanted to know actually, does thus mild therapeutic hyperthermia work in this group of patients in the in-hospital cardiac arrest setting? And what is the outcome? Is it like in the out-of-hospital cardiac arrest setting, or not? Dr. Greg Hundley: Wonderful, Kevin. And so, can you describe for us then, your study population and your study design? Dr. Kevin Roedl: Yes, of course. We did a randomized control trial. There were over 1000 people screened, and overall, we included 242. So you see how hard it is to get people in there. And actually, in terms of hypothermic temperature control, we are 120 about, and long term at 118, and the final others of the endpoints. And when we look at the baseline characters of these patients, they were well balanced actually, about 72 years. When we look at the initial cardiac arrest rhythm, that's interesting because about 70% non-shockable rhythms, and 25% shockable rhythms. And probably also interesting, the location of the cardiac arrest. Medical boards about 50%, and ICU or ED was 22%. So that's probably summed up the baseline characteristics of our study. Dr. Greg Hundley: Perfect. And so Kevin, can you describe for us what was the hypothermic target for the group that was going to have their temperature recused? Dr. Kevin Roedl: Yes, hypodermic target was 32 degrees to 44. And so two degrees Celsius, basically the same target like in earlier trials. Dr. Greg Hundley: Very nice. Well listeners, now we're going to turn to our second co-author, Dr. Sebastian Wolfrum. And Sebastian, can you share with us the study results? Dr. Sebastian Wolfrum: Yes, Greg. Thank you very much for the opportunity to participate in this podcast. Only wanted to include unconscious patients, and therefore, we took a time and took 45 minutes after their cardiac arrest, to let the patients get away if they did so. We also excluded patients that had severe functional deficit before the cardiac arrest; since we could not really define the neurological outcome if we would've included those. And we didn't see any differences. Neither in mortality, not in the functional outcome, either when they're treated with 33 degrees Celsius, or whether normothermia was used. The death rate after six month was in a range which is comparable to other in-hospital cardiac arrest studies, and higher than those performed in the out-of-hospital cardiac arrest studies. It was about slightly over 70% in both groups. And the number of patients with the good functional recovery after six months was 23% of the patients in the hypothermia group, and 24% of the patients in the normothermia group. And if we look at only the survivors, we see that the ones which are worse functional outcome, were most of them dead after six months. We then also focused on the temperature curves in our patients, and to see whether we have achieved our goal. And we saw that we have reached the target temperature within four and a half hours after cardiac arrest in our hypothermia group. Which is not as fast that we had expected, but still in the range, which is comparable to other studies on this field. And we also saw that our control group was about 37 degrees, within the first 12 and 48 hours. So we truly avoided fever, which has not been done in every previous study on cardiac arrests. Dr. Greg Hundley: Very nice. And any differences between the hypothermia and normothermia groups, related to the age of the patient? Or, whether or not they had a shockable rhythm at the time of presentation? Dr. Sebastian Wolfrum: We saw as a result of our study, that age is a predictive factor for mortality. But age did not differ between our treatment groups, and therefore, did not interfere with our results. And we didn't see differences in the shockable or non-shockable rate in our patients in the different treatment groups.   Dr. Greg Hundley: Thank you. Well listeners, now we're going to turn to our associate editor, Dr. Mark Link, one of our expert electrophysiologists at Circulation. And Mark, you have many papers come across your desk, and what attracted you to this particular paper? Dr. Mark Link: There were a number of things. One, it's hard to do RCTs in resuscitation, and I thought they did a very nice job with this RCT. Two, the subject of hypothermia, or therapeutic temperature management, is a very hot one in resuscitation. It's one of the few treatments in the past that have been shown to make a difference in outcome. And so, all of those trials were done in out-of-hospital arrest. So to have a trial done in in-hospital arrest was very intriguing also. And I think we're all disappointed that it wasn't a positive trial, but we have to take the negative trials also. And I think, part of the reason it may have been a negative trial is because the normal thermic group avoided hyperthermia. And I think that's something that's coming out of a lot of these trials is avoid fever. It may not be so important to get hypothermic targets, actually, looks like it's probably not, but it looks like it's very important to avoid fever. Dr. Greg Hundley: Very nice. Well listeners, we're going to turn back to our expert panel here really, and start with you Kevin. Kevin, what do you think is the next study that needs to be performed in this sphere of research? Dr. Kevin Roedl: Thank you for this interesting question. Yeah, a bunch of studies could be performed, especially maybe in the out-of-hospital cardiac arrest study, because we don't know. This fever harmful, we have to find certain subgroups in which this treatment works. So maybe in this subgroups there is data on this and it could be a benefit. So these are, I think, the two main topics that should be done in the future. Dr. Greg Hundley: Thank you. Sebastian, what are your thoughts? Dr. Sebastian Wolfrum: As Mark said, the hypothermic treatment was, for decades, maybe the only treatment which we could give to cardiac arrest patients, which has been proven to reduce mortality. And all other studies following didn't see any be benefit of hypothermia, not even in a subgroup. Also, the TTM trials did not. So I'm questioning myself, where is the original HACA study group that benefits? Where did this hide in the other studies? So I would think, to do another study in out-of-hospital cardiac arrest patients, whether in ventricular fibrillation that had shown in the HACA trial to reduce mortality. This should be done in a similar way to the original study, to see whether there is this subgroup. People who support the idea of hypothermia also focus very much on the fast onset of their hypothermic treatment. And they say we saw a difference in mortality in the HACA trial, and we could very fast. And I think the other studies have to show that they cool as fast as the HACA study. So the main focus should be on the time calls of hypothermia after cardiac arrest, cooling very fast to a target temperature of 33 degrees, maybe holding on for 24, maybe 48 hours. Dr. Greg Hundley: Very nice, Sebastian. So focusing on the speed and the timing of that cooling. And Mark, anything to add? Dr. Mark Link: Yeah, so if I sit here with my writing group hat on for the HA and say, "What are we going to do for the resuscitation guidelines in 2025?" I think you look at the totality of the data for targeted temperature management. And I think, the main thing you say, walking away from this, is avoid fever. Don't let your patients get hot. I'm not sure you can say much more than that right now, until we get more data. Dr. Greg Hundley: Very nice. Well listeners, a really interesting provocative discussion today. And we want to thank Dr. Kevin Roedl from Hamburg, Germany, Dr. Sebastian Wolfrum from Lubeck, Germany, and our own associate editor, Dr. Mark Link from Dallas, Texas, bringing us the results of this study highlighting that hypothermic temperature control is compared with normothermia did not improve survival, nor functional outcome, at 180 days in patients presenting with coma after in-hospital cardiac arrest. Well, on behalf of Carolyn and myself, we want to wish you a great week, and we will catch you next week On The Run. This program is copyright of the American Heart Association 2022. The opinions expressed by speakers in this podcast are their own, and not necessarily those of the editors, or of the American Heart Association. For more, please visit ahajournals.org.

Dr. Jun Wu is an Assistant Professor at the University of Texas Southwestern. The Wu lab uses interspecies chimeras to study fundamental biology: conserved and divergent developmental programs, determination of body and organ size, species barriers, and cancer resistance. They are also working to develop new applications for regenerative medicine. He talks about developmental compatibility between species, and the similarities and differences between blastoid models and blastocyts. He also discusses the challenges of growing human cells in animals, and human-monkey chimeric embryos.

"In part two this ASCO Education Oncology, Etc. podcast, healthcare policy expert, pulmonary physician, epidemiologist, and writer Dr. Peter Bach shares what it was like to face his wife Ruth's cancer and eventual passing − as a husband and as a doctor. The episode also explores delivering difficult news to patients. If you liked this episode, please subscribe. Learn more at https://education.asco.org, or email us at education@asco.org. Resources: Cancer Topics - Delivering Serious News" The Day I Started Lying to Ruth by Peter Bach, MD After a Cancer Diagnosis, Wishing for a Magic Number - The New York Times   TRANSCRIPT Pat Loehrer: Hi, I'm Pat Loehrer, Director of Global Oncology and Health Equity at Indiana University. I'm here with Dave Johnson, a Medical Oncologist at The University of Texas Southwestern in Dallas, Texas. This is the second half of our Oncology, Etc. conversation with health policy and payment expert, pulmonary physician, epidemiologist, and writer, Peter Bach. In part one, we chatted with Dr. Bach about his upbringing, the trajectory of his career from English Literature to Medicine, and from academia to industry. We also explored his seminal work on drug pricing and improving health equity. Today, we're going to continue our conversation with Dr. Bach by asking about something deeply personal: his wife, Ruth, who sadly passed away from cancer at the age of 46. Probably about seven or eight years ago, you wrote a wonderful article in The New York Times, and there was another article you wrote, but the one that I liked reading was called, “The Day I Started Lying to Ruth”, and this is where cancer stabbed you very personally. Can you tell us a little bit about that, and tell us a little bit about your wife, Ruth? Peter Bach: So, it was in New York Magazine, just to give credit where it's due, I'm very grateful to them for running it. I wrote that after she died, and it followed on a series I had in The New York Times called, The Doctor's Wife, which I wrote while she was getting her initial treatment for breast cancer, and then I walked through the steps of adjuvant therapy that she received, in my experience. And then the piece in The New York Magazine talks about her last months basically, and my experiences then. The story goes that she was tragically taken from us and tragically taken from my son when he was very young, and my experience being at her side-- and I think I was a good husband, I was present -- was an alarmingly dissociative experience along every dimension. You know, I'd go to her appointment, I would swipe in with my badge. You know, this was my place, and the doctor who took care of her is and was a dear friend, and so were the other doctors in most cases. And the visits, you know, I had nurses and people in the hall would say "Hi" to me. And then I was going through this absolutely devastating experience, you know, tearing apart the sort of prevailing narrative and experience and structure of my life and our family. And so, for whatever reason, it was this out-of-body experience where I could see stuff very, very clearly. Not only clinical realities, like I knew what was happening, but also the mechanics of healthcare, the interactions, and I felt like I should journal it, if you will. And then when I journaled it, I thought I should publish it, and so I wrote about what it was like to stand there when my friend, Chip Cody, the surgeon said, "This is cancer, I can feel axillary lymph nodes, you've got cancer." And what that morning was like between the-- look, most people have a lump, what's the big deal? We'll go, we'll deal with it. She's young. She had just had a mammogram actually, to that. And then the experience of, you know, and I was in Biostat at MSK. So, I'd sat for a gazillion protocol reviews, I'd read a gazillion informed consent forms, and then there was one in front of her for a randomized trial for adjuvant therapy. I mean, it was Avastin versus placebo versus a longer period of Avastin, if I remember correctly, and ultimately a negative trial I saw at ASCO. But sitting there and actually thinking about like, "What is this like for somebody who doesn't know all of this stuff?" And my wife was way smarter than me, that you guys know me, that is the least surprising fact ever. But it was still dizzying for her. And so, I wrote about that, like, hawt was our conversation like that night after that whole, like, “Do you want to join this trial?" And her peppering me with questions, like, essentially, “What the hell is wrong with you guys? Why don't you know these answers?" And it was sort of like, "Okay, this is why we do randomized trials, this is why we have placebo. This is–” And she's smart, not irate. She was much more relaxed and philosophical through the whole thing up until the day she died, or a few days before, than I ever was. So, I wrote about that. Like, what was that conversation like? What was she being asked to do, and how important was it that she did it? And I remember sitting in the room when that trial was presented, and The Kaplan-Meier overall survival curves, and I was pretty sure I saw the step in that curve. I'm pretty sure I saw her on that graph. And it made me-- obviously, I'm desperately sad that she's gone - but it made me proud that she had contributed to it, even though, you know negative studies are important, too. So, I wrote about those things, and I wrote about prognosis and what it was like to have a conversation when she asked about prognosis, and in an article called ‘Waiting for a Magic Number', where I described her oncologist saying, "Fine, I'll tell you what are your chances of living five years, you tell me what's the cut point. Essentially, above or below, what number are you going to change things in your life? When you tell me that number, I'll tell you whether you're above it or below it." And it was like, "Wow, philosophy from an oncologist, fantastic." Really sunk in with both of us, and that was it. We never asked that question again, he never gave us a number. And I've been greatly rewarded over the years to run into people from here and there who say, "You know, I always hand my patients that article to put that in perspective." And then when she died, I wrote about the sheer horror of what was happening to me. And the title wasn't mine, but it was worked right on point. I found myself in a situation where I didn't want to reveal to her just how bad things were, and it was terribly weak of me. And ultimately, and I describe it in the article, got to a point where I just was ready for it to be over, before it was. And I think it's actually not that hard, to be honest, after you've gone through something like this like I don't really care what people think of me. I went through something really hard. And again, I'm someone with resources, I'm someone with knowledge, I could call her oncologist at two in the morning and he'd answer, that's not something normal people get. And you know, even for me, like this was completely disorienting. And so, that article was very rewarding to write because it allowed me to put it somewhere where I've gotten to revisit it. A couple of years ago, of course, he was young when I published it. He said he had read it; he liked the part about the dog. But I got a lot of notes afterwards from strangers saying that it provided them some comfort that even someone like me went through basically the same experience they went through. And look, this whole, like, "even something like me” seems odd, but I think to the external world, somehow, we're like, "You know, we get those white coats. Stuff is different for us," and of course, it isn't at all. Since that time, and we're all in the same world, so we have the same sets of friends. We probably have many of our overlapping friends who we know have lost spouses. In recent years, I routinely get phone calls from folks like, "I'm going through this, what's the first step?" You know, and it's about everything. "How do I deal with my kid? Should I go dating?" Stuff like that. Dave Johnson: You know, Peter, that article should be required reading for every Oncology fellow. I think it was beautifully written, clearly from the heart. I think your undergraduate degree shows in terms of your writing style, but to write that, I'm sure was emotionally challenging and difficult. In fact, Pat mentioned at the start of our podcast, Trillin's book, About Alice. In a book review that was written in The New York Times, About Alice, Trillin made a comment similar to the one you just made, where people that he didn't even know wrote letters in which they conveyed to him a sense of knowledge of Alice, even though he knew they had never met Alice. And I think your article about your wife conveyed that same sense to anyone who did not meet her. And I think you memorialized her in ways that are really fantastic. But I want to just read something from an article in The New York Times, and this is quoting Trillin. He says, "They may not have known her, but they knew how I felt about her." And he went on to say, "Yes, I got a lot of letters, like the one from a young woman in New York who wrote that she sometimes looked to her boyfriend and thought, "But will he love me like Calvin loves Alice?" I think the same could be written about your relationship with Ruth. And thank you for sharing that. I can't imagine how challenging that must be even all these years later, and I'm glad your son had the opportunity to read that. He should be proud of both his mother and his father. Pat Loehrer: It was a gift to all of us and mankind. You know, again, as I saw that article, there's a photo of you and Ruth on your last vacation. I think it was from Versailles, and I think you were in the Hall of Mirrors. And I think there's a poignant metaphor there about the reflection of your lives and being with her at that time, and we really thank you. We have all experienced this and it's so powerful there. There's this time when you get a result of a test of someone that you know and love and there's this limbo between, they're so naive and life is good, and it really is a time between heaven and hell in which you're the only one there, in which you know that you're going to go in the room now and change their lives forever by sharing this news. And we've been there and we pause, and again, you talked about that - I think being in a car looking at the x-ray. And that's the essence of when you said, the day you started lying to them, which is understandable because you just don't want to shatter that moment there. You know, we pause and reflect on that enormity of the moment there and I thank you deeply for sharing that with us because it's something that we physicians find, and this uniqueness of being a physician, and having someone you care about and knowing something that they don't quite know yet. Thank you for all of that. Peter Bach: The important message is that to patients, it's very isolating. And part of what I think the article did, and this was the message I got at least, was, send a message to other people that you're not alone. That others are going through it, others have gone through it, and I don't know what "it" is in that context, but loss. And there's that wonderful article in The New Yorker called ‘The Aquarium', which is by man who had a sick child-- and I don't remember all the details, but the aquarium metaphor is, I can't remember if he's in the aquarium and the rest of the world's outside or the other way around, but it's that isolation that is particularly frightening. And when I talk with my friends who've gone through it, it's part of it. As I just said, you know, there's a lot of us out there. I don't know if it gives so much reassurance. You know, 40,000 women die a year of breast cancer, so there's a lot of people out there. Dave Johnson: Pat, you had, I think, a final question? Pat Loehrer: Briefly. You know, now I'm asking to be an academic person there, but if you had a young medical student and you were going to try to give them one lesson about communicating bad news to patients, what would that be? Peter Bach: I've obviously been in this situation many times. I'm a Pulmonary Critical Care doc, so I've watched bad news be delivered many, many times. And the first mistake I see people make is trying to fill the silence with words, and I think I made earlier reference to it. One of the key skills doctors need to develop is the ability to listen. And sometimes listening to silence is a version of listening, but it's delivering what you have to say without euphemism, with directness. Not everyone's enamored with it, I am. But then giving time to listen, even just space for people to feel safe, that that communication is part of a relationship, not a sort of text message. You know, in today's metaphor, right, that just arrives and the person moves on. That is really hard for people to do; not experienced doctors, for trainees because it's frightening for a lot of reasons. Over my career, I've certainly rehearsed it many times with people. I made the mistake myself too, of just sort of talking over the thing in the room to avoid, you know, just sort of as you said, the enormity of what you just communicated. Dave Johnson: So, Peter, I think you're right on. I think that's one of the most difficult things to do, is to allow that pause to take place. And so many, even highly experienced physicians attempt to fill that void when it doesn't need to be filled. Been there, done that, been on the receiving end as well as the delivery end of that. It's always challenging. You know, we're out of time, and I'm sad about that because we could go on, I'm sure for quite a long time. Want to end this by asking you, Peter, we talked about a book on the front end, both Pat and I love to read, and we share recommendations all the time. I wonder, is there a book or a podcast, or anything that you think we should read or you think our listeners should know about? And by the way, you can include anything that you wrote if you'd like. Peter Bach: Yeah, it'd be very au courant to pitch my own stuff here, I would never do that. I like to read as well. And so, I just finished Rules of Civility by Amor Towles. Of course, there's a few health events in it, but it's not to do with anything, but, you know, it's a book about New York. I live in New York, so I just enjoyed every single word of it. I'm newly married- Dave Johnson: Congratulations. Peter Bach: -thank you. I feel very lucky. And my wife has noted that I often like to read nonfiction at night. Typically, books about how the world is just going completely to hell. And she's noted that outrage is my happy place, that I sleep extremely well if I read something that's absolutely infuriating. So, the other thing I'll recommend is the book about the Department of Justice has essentially lost its mojo when dealing with corporate crime. If your best soporific is being absolutely furious, it's right up there with a full dose of Ambien. So anyway, those are my two recs. Pat Loehrer: I love it. Yeah, Dave and I both love non-fiction. We love that. So, it's great. Dave Johnson: We've come to an end of another podcast, and we want to thank our listeners for tuning in. We really appreciate your participation. Remember, Oncology, Etc. is an ASCO Educational podcast, where we'll talk about virtually anything and everything. So, if you have an idea for a topic or a guest you'd like for us to interview, please email us at: education@asco.org. Thanks again. You know, speaking of interesting nonfiction, Pat, if ‘pro' and ‘con' are opposite, what's the opposite of progress? Pat Loehrer: Oh, I love that - Congress. Dave Johnson: Yes, Congress. I knew you would get that. Peter Bach: That is a ‘Dad joke' if I ever heard one. Dave Johnson: We don't have good jokes on this show. Pat Loehrer: We're going to have to redo the ending to this because, Dave, you said this was an ASCO Education Podcast. I'm not sure we've taught anybody anything on this one. Dave Johnson: Now, Peter has taught us a lot. Pat Loehrer: That's for sure. Thank you so much, Peter, for a wonderful interview. Dave Johnson: Absolutely perfect. Wonderful. Peter Bach: Thanks for the privilege. It's wonderful seeing you both.   Thank you for listening to the ASCO Education podcast. To stay up to date with the latest episodes, please click, "Subscribe." Let us know what you think by leaving a review. For more information, visit the Comprehensive Education Center at: education.asco.org.   The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. 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.

Christy Huff, MD, is a cardiologist and director of Benzodiazepine Information Coalition, a nonprofit that educates about the adverse effects of prescribed benzodiazepines. Dr. Huff attended medical school at the University of Texas Southwestern where she graduated Alpha Omega Alpha. She completed an internal medicine residency at Washington University in St. Louis and a cardiology fellowship at U.T. Southwestern, with a focus in advanced cardiovascular imaging and noninvasive cardiology. Dr. Huff is a Fellow of the American College of Cardiology, and was a private practice cardiologist in Fort Worth,Texas until 2011, when she became a stay-at-home mom after the birth of her daughter. Dr. Huff speaks and writes frequently about her lived experience with benzodiazepines. In 2015, she experienced adverse effects after three weeks of prescribed Xanax for insomnia. Over a three-year period, she slowly tapered off benzodiazepines utilizing Valium, and suffered protracted and disabling symptoms. Her personal experience led her to realize the serious risks of these medications and the potential severity of benzodiazepine withdrawal syndrome, neither of which were emphasized during her medical training. Dr. Huff specifically advocates for better education of physicians regarding the adverse effects of benzodiazepines and how to safely taper patients off these medications. Her research interests include patient-centered benzodiazepine deprescribing and benzodiazepine-induced neurological dysfunction (BIND). In addition to her work at BIC, Dr. Huff is a member of the Colorado Consortium for Prescription Drug Abuse's Benzodiazepine Action Work Group.

This week, please join authors Mikhail Kosiborod and Christian Schulze and Editorialist Stefan Anker as they discuss the original articles "Effects of Empagliflozin on Symptoms, Physical Limitations and Quality of Life in Patients Hospitalized for Acute Heart Failure: Results From the EMPULSE Trial" and "Effects of Early Empagliflozin Initiation on Diuresis and Kidney Function in Patients With Acute Decompensated Heart Failure (EMPAG-HF)" and the editorial "SGLT2 Inhibitors: From Antihyperglycemic Agents to All-Around Heart Failure Therapy." Dr. Carolyn Lam:             Welcome to Circulation on the Run, your weekly podcast summary and backstage pass to the journal and its editors. We're your co-hosts. I'm Dr. Carolyn Lam, Associate Editor from the National Heart Center and Duke National University of Singapore. Dr. Greg Hundley:           And I'm Dr. Greg Hundley, associate editor, director of the Pauley Heart Center at VCU Health in Richmond, Virginia. Dr. Carolyn Lam:             I'm so excited about the feature discussion this week. It is a paired feature along with their editorial and it's all focused on SGLT2 inhibitors. The first, results from the EMPULSE trial, Effects of Empagliflozin on Symptoms, Physical Limitations and Quality of Life in Patients Hospitalized for Acute Heart Failure; and the second, the EMPAG-heart failure trial, The Effects of Early Empagliflozin Initiation on Diuresis and Kidney Function in Patients with Acute Heart Failure. Incredibly important topics, incredibly important discussion. Wait up for it. We're just going to tell you a little bit more about two other original papers in today's issue, and I'm going to go first, Greg. Is that okay? Dr. Greg Hundley:           You bet. Dr. Carolyn Lam:             Now, really interesting topic here. We have strong evidence supporting the effective blood pressure and cardiovascular disease risk lowering properties of healthy diet such as the DASH diet, Mediterranean diet, and so on and so on. But what about the diet consumed by a fifth of the entire world's population? The Chinese cuisine. Interestingly, today's paper addresses just that. This is from authors, Dr. Wu, from Peking University Clinical Research Institute and colleagues who performed a multicenter patient and outcome assessor blind randomized feeding trial among 265 participants with baseline systolic blood pressure of 130 to 159 in four major Chinese cuisines. And these are the Shandong, Huaiyang, Cantonese, and Szechuan cuisines, and here's how they did it. After a seven day run in period on a control diet matching the usual local diets, participants were randomized to continue with the control diet or the cuisine based Chinese heart healthy diet for another 28 days. The primary outcome was systolic blood pressure. The study developed the first heart healthy Chinese diet that fits Chinese food culture and emphasizes its palatability by involving master shifts in developing the recipes. Dr. Greg Hundley:           Oh wow. Carolyn, this is really interesting, especially one fifth of the world's population in studying a heart healthy diet. So did it work? I can't wait to hear the results. Dr. Carolyn Lam:             Well, the change in systolic and diastolic blood pressure from baseline to the end of the study in the control group was five millimeters mercury and 2.8 millimeters mercury reduction, respectively. The net difference of change between the two groups in systolic and diastolic blood pressure were a reduction of 10 and almost four millimeters mercury, respectively. The effect size did not differ among cuisines, and so in summary, with a patient and assessor blind randomized feeding trial, this study really demonstrated that the blood pressure lowering effect of the Chinese heart health diet could indeed be substantial, and importantly, be compatible with medications while palatable and affordable in Chinese adults with high blood pressure, and so these results support the idea that food is medicine and will give many patients with high blood pressure the confidence to adopt heart healthy diets in their lifestyle treatment. Dr. Greg Hundley:           Wow, Carolyn, that is really an interesting article. So many of these articles today could all be features in and of themselves. That was just outstanding. Well, my next paper comes to us from the world of preclinical science, and it's from Dr. Sean Wu from Stanford University School of Medicine. So Carolyn, immune checkpoint inhibitors are monoclonal antibodies that are used to activate the immune system against tumor cells. Now, despite their therapeutic benefits, immune checkpoint inhibitors have the potential to cause immune mediated adverse events such as myocarditis, a rare but serious side effect with up to 50% mortality in affected patients. Now histologically, patients with immune checkpoint inhibitor of myocarditis have lymphocytic infiltrates in the heart implicating T-cell mediated mechanisms. However, the precise pathologic immune subsets and molecular changes in immune checkpoint inhibitor myocarditis are unknown. Dr. Carolyn Lam:             Wow. So insights into the etiology of these immune checkpoint associated myocarditis cases must be very important. So what did they find? Dr. Greg Hundley:           Right, Carolyn? So clonal cytotoxic, TEMRA CD8+ cells were found to be significantly increased in the blood of patients with immune checkpoint inhibitor myocarditis corresponding with an analogous increase in effector cytotoxic CD8+ cells in the blood and hearts of PD-1 deficient mice with myocarditis. These expanded effector CD8+ cells had unique transcriptional changes, including upregulation of the chemokines CCL5, CCL4, and CCL4L2, and they may serve as attractive diagnostic therapeutic targets for reducing life threatening cardiac immune related adverse events in immune checkpoint inhibitor treated cancer patients, and Carolyn, just like so many of our articles, there's a very nice accompanying editorial by Professor Gianluigi Condorelli that also offers an update on current research pertaining to non-systemic steroid therapy to treat immune mediated myocarditis. Well, Carolyn, how about we jump to some of the other articles in the issue? Dr. Carolyn Lam:             Oh, you bet, Greg. There's an exchange of letters between Drs. Madias and Knops regarding the article “Efficacy and Safety of Appropriate Shocks and Antitachycardia Pacing in Transvenous and Subcutaneous Implantable Defibrillators: The Analysis of All Appropriate Therapy in the PRAETORIAN Trial.” Dr. Greg Hundley:           And also in the mail bag, Professor Mark has a Research Letter entitled “Effect of Empagliflozin on Kidney Biochemical and Imaging Outcomes in Patients with Type 2 Diabetes, or Prediabetes, and Heart Failure with Reduced Ejection Fraction, The SUGAR-DM-HF Study,” and our own Tracy Hampton has several synopses from articles published elsewhere in our piece on cardiovascular news. Well, how about we get onto that feature forum discussion, two papers, two editorialists. I can't wait. Dr. Carolyn Lam:             Me too. Let's go, Greg. Dr. Greg Hundley:           Welcome, listeners to this July 26th feature forum discussion. So remember, listeners, for forum discussions, we have several manuscripts that focus on a singular topic and we bring together the authors, our associate editors, and also an editorialist, and today, I want to introduce, we have with us Dr. Mikhail Kosiborod from Mid America Heart Institute in Kansas City, Missouri, Dr. Christian Shults from University Hospital Jena in Germany, Stefan Anker from Charité in Berlin, Germany, and our Associate Editors, Brendan Everett from Brigham and Women's Hospital in Boston, Massachusetts, and Justin Grodin from University of Texas Southwestern Medical Center in Dallas, Texas. Welcome, gentleman, and we'll start with you, Mikhail. Could you describe for us the background information that went into the preparation of your study and what was the hypothesis that you wanted to address? Dr. Mikhail Kosiborod:   Well, thanks very much, Greg. The background for the study, which was the secondary analysis of the EMPULSE trial was patients that are hospitalized with acute decompensated heart failure represent a very high risk group. We know that they have high risk of death and hospitalizations, and we also know that they have very poor health status that's very high burden of symptoms, physical limitations, and poor quality of life, and so addressing those treatment goals, trying to reduce the risk of clinical events like death and hospitalizations and improve the symptoms and physical limitations in this patient population are very important treatment goals. Now we previously demonstrated in the main results of the EMPULSE trials that using empagliflozin initiating empagliflozin SGLT2 inhibitor in this patient population as compared with placebo provided a significant total clinical benefit, which was a composite of total death, repeat hospitalizations for heart failure, or a change in a Kansas City cardiomyopathy questionnaire, which is a kind of a gold standard measure of patient's health status. What we tried to do in a much more granular fashion in this study is to understand the effects of empagliflozin as compared with placebo on this very important outcome, the Kansas City cardiomyopathy questionnaire, and we actually evaluate all of the key domains and composite symptoms, physical limitations, as well as quality of life. Dr. Greg Hundley:           Very nice, and Mikhail, can you describe for us what study population specifically, and then what was your study design? Dr. Mikhail Kosiborod:   Well, this was a population of patients that were hospitalized with heart failure and that EMPULSE was unique in its design because first of all, previous SGLT2 inhibitor trials mostly focused on patients with chronic heart failures that were in an outpatient setting, including prior trials of empagliflozin, and EMPULSE really focused on acutely hospitalized patient population, but it included patients regardless of ejection fraction. So as they were hospitalized with decompensated heart failure and reduced or preserved ejection fraction. They were enrolled regardless of if they had type 2 diabetes, they were enrolled essentially, regardless of kidney function, only patients with EGFR of less than 20 were excluded, and also importantly, was this study and a unique feature of the study in particular was that we enrolled patients whether they had acute de novo heart failure. That means that was a new diagnosis of heart failure that was bad enough for them to be hospitalized or worsening chronic heart failure requiring hospitalization. So it was really an all-comer trial for patients acutely hospitalized for heart failure. So we had just over 500 patients and they were randomized in the hospital. After a brief period of stabilization, we use empagliflozin, 10 milligrams daily or placebo and treated for 90 days, and the primary outcome at 90 days was a total clinical benefit that I described that was a composite, hierarchical composite of total death hospitalizations, repeat hospitalizations for heart failure and changing KCCQ. In this study, again, we focused predominantly on KCCQ, trying to understand the effects on health status, again, symptoms, physical limitations, and quality of life. Dr. Greg Hundley:           Excellent. And Mikhail, what were your study results? Dr. Mikhail Kosiborod:   Well, what we observed, a couple of things. One is we first examined the effects of empagliflozin on the primary endpoint across the range of KCCQ and baseline, and what we found was that regardless of the degree of symptomatic impairment and baseline, empagliflozin was consistent in providing them total clinical benefits that I described previously, and then kind of shifting to what I think is the most interesting findings, the effects of empagliflozin versus placebo on KCCQ, what we found was that as you would imagine in this population of patients that were acutely hospitalized with heart failures, that had very poor health status, very low KCCQ at baseline, and within the first 90 days, which was observation period, both groups of patients had substantial improvements in KCCQs. As one would expect after acutely decompensated episode of heart failure and treatment in a hospital, everyone got better. But patients treated with empagliflozin had significantly greater improvement in KCCQs than those that were treated with placebo, and that was first of all, a very substantial difference between the two groups. It was more than five points in favor of empagliflozin already at 15 days and was highly statistically significant, and it was maintained throughout the 90 day treatment period. So the fact that we saw both a clinical meaningful and statistically significant improvement in just 15 days, I think is a very important clinical message, and then finally, I guess what I will mention is these benefits of empagliflozin while main outcome we looked at was KCCQ total symptoms, we're focusing on the symptoms, but it was consistent when we looked at physical limitations as well as quality of life. So really, all key domains of KCCQ were impacted in a similar way. Dr. Greg Hundley:           Very nice. So in acute heart failure, marked symptomatic improvement after the administration of the SGLT2 inhibitor empagliflozin at 10 milligrams per day. Well, now listeners, we're going to turn to our associate editor, Dr. Brendan Everett, and Brendan, again, you have many papers come across your desk. What attracted you to this particular manuscript? Dr. Brendan Everett:      Well, thanks, Greg, and I think this manuscript caught my eye because of the importance of the clinical question, and Mikhail outlined why I think that was really relevant. So we understand that this class of medications or SGLT2 inhibitors have important effects on outcomes like re-hospitalization in patients with heart failure, and what was particularly striking about this paper is that it took patients rather than those with chronic heart failure, but as Mikhail mentioned, enrolled a patient population that was actually in the hospital, and I think this was an important frontier for this particular question about when to start the SGLT2 inhibitor and what kind of benefits there might be. Furthermore, I think the fact that they did not select the population based on ejection fraction was particularly striking, and of course, I think is remarkable, but now old news, they did not select on the presence or absence of diabetes as well. And so those three components really attracted me to the paper. I also think the outcome is one that really is valuable and worth exploring, and specifically, I'm talking about how patients feel on the medication after a hospitalization for heart failure. Appropriately, we focused on re-hospitalization for heart failure and cardiovascular death in prior trials in this space, and I think we need to embellish those findings or further deepen those findings with a perspective on how patients actually feel when they get the medication, and of course, it goes without saying that what's particularly important here also is that it was a randomized placebo controlled trial, and so the results have some element of internal validity that I think is really important. So those were the things, Greg, that really attracted my attention as I read the paper for the first time. Dr. Greg Hundley:           Thank you so much, Brendan. Well, listeners, we've got a second paper today and we're next going to hear from Dr. Christian Shults, and he also is focusing on really another aspect of the administration of empagliflozin in patients with acute heart failure and that pertains to the renal function of the patients. So Christian, could you describe for us the background pertaining to your study and what was the hypothesis that you were intending to address? Dr. Christian Schulze:     Thanks, Greg. Well, it's great to introduce all study here in this running. So our study impacted those in acute decompensated heart failure. The impact HF trial was a study based on the hypothesis that we wanted to test, whether empagliflozin has effects in acute decompensated heart failure, and we focused on the patient population that was not addressed in EMPULSE, patients that came to the ER and needed to be treated right away, and we wanted to know and this was our main hypothesis, but are the diuretic and [inaudible 00:17:11] effects of the SGLT2 inhibitor on this case, empagliflozin, actually had an impact on diuretic regimens and kidney functions since this is one of the main end points that limits treatment, and also is one of the outcomes of patients with acute decompensated heart failure in the hospital. Dr. Greg Hundley:           Very nice. And so Christian, what study design did you implement and who was included in your study population? Dr. Christian Schulze:     So we also used the randomized two arm study design. We included patients with acute decompensated heart failure independent of left ventricular ejection fraction. Patients needed to have an NT-proBNP of more than 500. The average NT-proBNP in fact was 4,300 in our entire patient population, and we included patients within 12 hours of presentation. So many of these patients have been recruited in the ER, they presented two hour cardiology heart failure service, and then were immediately randomized to the trial in the two arms, and we tested not 10 milligrams of empagliflozin. We actually tested 25 milligrams of empagliflozin based on in-house data that 25 milligrams potentially had a stronger diuretic effect compared to 10 milligrams. Dr. Greg Hundley:           And what did you find? Dr. Christian Schulze:     So we followed patients for five days. It was a relatively short period of time. It was designed to address the in-house phase of patients with acute decompensated heart failure. The mean duration of stay was 6.3 days in the hospital so this was exactly the time that we wanted to test. We had a 30 day endpoint for safety issues, and what we could see is that patients on 25 milligrams on empagliflozin on top of standard diuretic regimens and medical care had 25% higher diuretic outputs compared to patients in the placebo group. We also found no differences in markers of renal injury dysfunction, and could in fact confirm that after 30 days, patients in the empagliflozin group had a better EGFR compared to patients in the placebo group. On top, we saw a more rapid decrease in body weight and also a more profound decrease in NT-proBNT values. Dr. Greg Hundley:           And Christian, just for our listeners to put a little bit of this in perspective, what was the range of serum creatinine for the patients that were enrolled in your study? Dr. Christian Schulze:     So the main EGFR in the entire population was around 60 and the creatinine values were around 107 on average in the entire cohort. So this is a very typical population. We had around 30% of the population with de Novo heart failure, around 20 to 30% of the population was pre-treated for preexisting heart failure. So very typical population of patients with heart failure presenting to the emergency room. Dr. Greg Hundley:           And did you have any kind of lower level EGFR cutoff, I mean, for enrollment into this study? Dr. Christian Schulze:     So when we designed the trial, we actually still had the sub classification of diabetes or impaired glucose or homeostasis as an inclusion criteria. We dropped it before we started the trial because the data came out that this is actually, in fact, not a critical issue for patients with heart failure. So diabetes was not a subgroup in our trial and the lower limit of EGFR was actually a thoroughly defined protocol. Dr. Greg Hundley:           Very nice. Well, listeners, now we're going to turn to our second associate editor, Dr. Justin Grodin from University of Texas Southwestern Medical Center in Dallas, Texas, and Justin, similar to Brendan, and you see many papers come across your desk and so what attracted you to this particular paper by Christian and his colleagues? Dr. Justin Grodin:            Well, Greg, I think first and foremost, and I think very similar to Brendan, but I think what's always striking is if I may just take a step back, decompensated heart failure in the United States is the number one cause for hospitalization among Medicare beneficiaries. So I think really, the brunt and really the truly public health message of the disease is very important in the applicability, and even though that decompensated heart failures is one of the most common things that we ever encounter when we practice, internists, cardiologists, et cetera, we have very, very little clinical trial guidance that tells us how to decongest individuals when they're hospitalized with swelling and heart failure and a lot of these individuals can be quite ill, and we have some clinical trial data, but largely, we have a lot of negative studies or inconclusive studies in this space. So certainly, what drew me to this trial was definitely that context, and obviously, based on the mechanistic data with SGLT2 inhibitors, I think one of the natural questions, which Christian addresses, is that we know that up front, they do augment natriuresis. So I think it's very compelling to marry those two together because this is what many of us that use these medications regularly have been asking is whether or not they would have some efficacy in that regard, and then another thing that caught my eye and me as a cardiorenal investigator was, just as Christian highlighted, was we have a clinical trial that randomly assigned individuals, really that were ill and many of whom were not stabilized within 12 hours of presentation, and we're talking about patients that are coming into the hospital at all times during the day in and I think that's very remarkable that we have something with standard... We have a study with standardized assessments where we're really trying to ask a very practical, pragmatic question, which is do these therapies lower the sodium balance in individuals with decompensated heart failure, and I think what's important is largely, we've got a lot of medications that supplement loop diuretics, which are the class of drugs that the majority of us use, and we have a lot of other therapies that we use that really have very little data or poor data that guide us such as thiazide diuretics, carbonic and hydrase inhibitors, mineralocorticoid receptor antagonists, and so here, we have a clinical trial that asks a question that's on many people's minds. And then we do have very compelling, at least short term pragmatic and mechanistic data that does tell us that these individuals do have a greater natriuretic effect when empagliflozin is used as an adjunct to standardized loop diuretic therapy. So it's a very practical clinical question, and I think what's very important, and we could debate probably all day about the implications of GFR change and kidney function change while we're decongesting somebody with diuretics, but I think what's reassuring to all the clinicians is we really didn't see an effect on kidney function despite a greater natriuretic effect or enhanced diuretic effect, if you will, with the use of empagliflozin. Dr. Greg Hundley:           Very nice. Well, thank you, Justin. Listeners, now we have an editorialist and as you know, editorialists really help us put the scientific presentation of an original manuscript into the perspective of really the global theme of a topic, and we have Stefan Anker from Berlin, and Stefan, can you describe for us how do we put these two manuscripts and results that we've heard about really in the context now of moving forward with the use of SGLT2 inhibitors in the management of patients with acute decompensated heart failure? Dr. Stefan Anker:            Thank you so much. Really, I think these two papers, on the one hand, enhance our certainty about early use, and on the other hand, possibly show us that there might be even more to achieve by, on the one hand, moving even earlier with the application of SGLT2 inhibitors or possibly consider the higher dose. Now let's take one step back. These drugs were developed in type two diabetes and the first successful trial was the [inaudible 00:25:42] outcome trial. Many people have forgotten that this trial tested two doses and not only one, the 10 and the 25 milligram dose, and of course, with the success for improving kidney outcomes and heart failure hospitalization outcomes, we move forward into these two specialist areas, on the one hand, broadening it to the non-diabetic communities, but on the other end, narrowing it by focusing on the 10 milligram dose regardless of whether there is [inaudible 00:26:12]. And we basically now learn A, to use these drugs even earlier than we did in the big trials and we can now be sure to start their use in the hospital, and if you take the average change in quality of life results seen, you actually get a better result for the patient on quality of life when you start earlier than when you start late in the ambulatory studies where basically, in the chronic setting, maybe you have one and a half to two points difference. Here, you now have four and a half points in the study shown by Mikhail, and of course, it's also good to know that you can start this in any type of patient, regardless of their quality of life. The impact study from Christian, they basically moved it now even earlier, moving into the hospital space is possible based on EMPULSE. Moving it into the acute admission space is at least a consideration now based on what Christian here has shown. And he is actually addressing the one question I hear very often in my presentations about SGLT2 inhibitors, what about this 25 milligram dose? Is there a place for this in cardiology as well, and a possible place is shown here, not only that this is a safe thing to do, but also you get urinary output. Of course, we may in the future, want to see this compared, directly compared to the 10 milligram dose, but of course, the world is not created in one day, but needs more than one and so really, I think these two studies, on the one hand, address an important issue, when to start using them. On the other hand, show us a little bit of a glimpse to the future. Dr. Greg Hundley:           Very nice, Stefan, and listeners, we get to take advantage of having these authors, editors, and editorialists together and ask them what they see as the next study to be performed in this sort of sphere of research. So Mikhail, we'll start with you. In 30 seconds or less, what do you see as the next study to be performed in this arena of research? Dr. Mikhail Kosiborod:   I think, Greg, what we've learned recently, including from the EMPULSE trial, we have this population of patients in a hospital with heart failure's a huge issue as Justin mentioned, and until recently, we had very little [inaudible 00:28:31] for them beyond the usual kind of decongestion with loop diuretics and trying to make them feel better, but you look at outcome data. It really was a dearth of effective therapies that have meaningful impact on important outcomes. Now that's changing, SGLT2 inhibitors is one example. There are some other recent examples in this patient population, like a firm HF and iron deficient patients with heart failure. But the bottom line is it's no longer kind of a desert, if you will, of positive trials. We now have something we can do and I think what this proves is that we need to actually invest more, both in terms of resources and time to really do what we we're being able to do in other areas of heart failure and those patients with chronic, half and half where we can start developing pillars of therapy that can actually truly improve outcomes with this patient population and there is a lot going on that makes me optimistic that's going to be the case in the coming years. Dr. Greg Hundley:           Very nice. And Brendan? Dr. Brendan Everett:      Well, I think both trials mentioned today really pushed our understanding of this population forward. I think the biggest clinical question that I face when I'm caring for these patients is that we have four, at least, guideline directed therapies, right? We have beta blockers, we have ARBs, ACE inhibitors and ARNIs. We have mineral receptor antagonists and we have SGLT2 inhibitors. So which do we use in what order and how do we start them, and what kind of parameters do we use to guide us if we're limited either by renal function or by blood pressure or by some other factor. And we often, if not always, have one of those constraints that we're dealing with and so I would say the next step for me is trying to sort out which of these therapies and what order ought to be our highest priority for patients with acute decompensated heart failure as we move quickly from the acute decongestion stage towards discharge and a chronic therapy that will then be followed as an outpatient over the ensuing days and months. Dr. Greg Hundley:           Very nice. And Christian. Dr. Christian Schulze:     Thank you again, and Brandon pointed out very nicely. I mean, we have good evidence now for chronic heart failure treatment. We have the four columns of heart failure medical therapy. Questions that remain open is what do we do with all these patients that are now guideline medicated, come to the hospital with an acute decompensation? Should we carry on with the medication? Should we terminate and in particular, should be carry on with full dose, 50% dose of SGLT2 inhibitors, and the next question is, what dose should we use, in fact, for SGLT2 inhibitors? Is it in group effects or is sotagliflozin comparable to empagliflozin, and then is there a role for a step by scheme that we initially have in high dose therapy that we then downgrade to 10 milligrams on the chronic heart failure treatments, and then of course, quality of life is very important. We should ask this question also in this patient population that is early on treated, do we see benefits that carry on in the outpatient setting and do we see an effect of early treatment on long term benefits? Dr. Greg Hundley:           Justin? Dr. Justin Grodin:            Well, I would have to agree with all of my colleagues here on this call. I think all have raised really good points, but I think one very simple, and I'll echo some of Brendan's statements, but one very simple question is we know that when we decongest people and initiate a negative salt balance in the hospital for decompensated heart failure, we cause neurohormonal activation and there are a lot of downstream untoward effects from chronic decongestive therapies, and I think one of the more compelling things is we still yet have defined what is the best way to decongest individuals with swelling or volume overload in the hospital. Here, we have compelling studies with SGLT2 inhibitors for quality of life and really, the way patients feel. And this is really what's important to them, and then something very pragmatic to clinicians and let's make people pee more, but I think one of the compelling questions, and I don't know if it will be answered, is we have a lot of choices for supplemental therapies and different diuretic strategies when patients come in the hospital for decompensated heart failure, and I do think that these studies do move the needle with SGLT2 inhibitors. I think that's abundantly clear, but we still don't know what is the best way to dry out my patient or make my patient pee so that they feel better, but I do think that these studies do at least set the stage that there's some compelling advantages to SGLT2 inhibitors. Dr. Greg Hundley:           And then lastly, Stefan. Dr. Stefan Anker:            Thank you. Besides the detailed points mentioned by many, and Christian, totally support 25 versus 10 milligram, how long 25 milligram, if at all in the future. Besides this, I'm interested in the big picture question. So what about the post myocardial infarct congestion/heart failure situation, and there will be two trials in the next 18 to 24 months that report on this, and my pet kind of area is actually to treat heart failure where nobody thinks it is heart failure, and what I mean is for instance, advanced cancer patients, cardiac wasting cardiomyopathy. So the heart failure in sick cancer patients, and indeed, we are planning to do exactly that now in a study focusing on hospice care patients to really improve the quality of life, the very thing focus here on the EMPULSE trial. Dr. Greg Hundley:           Well, listeners, we want to thank our authors, Dr. Mikhail Kosiborod from Mid America Heart Institute in University of Missouri, and Christian Shults from the University Hospital in Jena, Germany. Also, our associate editors, Dr. Brendan Everett from Brigham and Women's Hospital in Boston, and Dr. Justin Grodin from University of Texas Southwestern in Dallas, Texas, and also, our editorialist, Dr. Stefan Anker from Charité in Berlin, Germany for bringing us these two manuscripts pertaining to two randomized clinical trials regarding the administration of the SGLT2 inhibitor, empagliflozin in acute heart failure, demonstrating first, marked improvement in heart failure symptoms and health related quality of life. And second, in those with estimated GFRs greater than 30 mls per minute, an augmentation of natriuresis in the setting of the co-administration of diuretics without deterioration in renal function. Well, on behalf of Carolyn and myself, we want to wish you a great week and we will catch you next week on the run. This program is copyright of the American Heart Association, 2022. The opinions expressed by speakers in this podcast are their own and not necessarily those of the editors or of the American Heart Association. For more, please visit ahajournals.org.

The utilization of point-of-care ultrasound and other non-invasive cardiac output monitoring technologies varies because of knowledge, resource availability and cultural practices. In this  Clinical Challenge in Surgery episode from the Surgical Critical Care team at Behind the Knife, we provide a brief history of the use of cardiac-output monitoring in the ICU, introduce a few clinical scenarios in the context of point of care ultra-sound and other less-invasive cardiac-output monitoring technologies. Learning Objectives:  In this episode, we review the historical uses of central venous pressure monitoring, pulmonary-artery catheters and the more frequently utilized point-of-care-ultrasound (or POCUS) in managing complex ICU patients. We review the outcomes behind these technologies, describe the views and utility of POCUS, and introduce less-invasive or completely non-invasive ways to measure cardiac-output monitoring.  Hosts: Brittany Bankhead, MD, MS (@BBankheadMD) is an Assistant Professor of Surgery at Texas Tech University Health Sciences Center. Ryan Dumas, MD, FACS (@PMH_Trauma_RPD) is an Assistant Professor of Surgery at the University of Southwestern Medical Center and Parkland Memorial Hospital. Caroline Park, MD, MPH, FACS (@CPark_MD) is an Assistant Professor of Surgery at the University of Southwestern Medical Center and Parkland Memorial Hospital. Links to Papers Referenced in this Episode: National Heart, Lung, and Blood Institute Acute Respiratory Distress Syndrome (ARDS) Clinical Trials Network, Wheeler AP, Bernard GR, Thompson BT, Schoenfeld D, Wiedemann HP, deBoisblanc B, Connors AF Jr, Hite RD, Harabin AL. Pulmonary-artery versus central venous catheter to guide treatment of acute lung injury. N Engl J Med. 2006 May 25;354(21):2213-24. doi: 10.1056/NEJMoa061895. Epub 2006 May 21. PMID: 16714768. Yildizdas D, Aslan N. Ultrasonographic inferior vena cava collapsibility and distensibility indices for detecting the volume status of critically ill pediatric patients. J Ultrason. 2020 Nov;20(82):e205-e209. doi: 10.15557/JoU.2020.0034. Epub 2020 Sep 28. PMID: 33365158; PMCID: PMC7705480. Kircher BJ, Himelman RB, Schiller NB. Noninvasive estimation of right atrial pressure from the inspiratory collapse of the inferior vena cava. Am J Cardiol. 1990 Aug 15;66(4):493-6. doi: 10.1016/0002-9149(90)90711-9. PMID: 2386120. Marik PE, Cavallazzi R. Does the central venous pressure predict fluid responsiveness? An updated meta-analysis and a plea for some common sense. Crit Care Med. 2013 Jul;41(7):1774-81. doi: 10.1097/CCM.0b013e31828a25fd. PMID: 23774337. Acknowledgements:  We would like to acknowledge Dr. Hassan Mashbari and the Department of Surgical Critical Care and Anesthesia at the Massachusetts General Hospital and Dr. Christopher Choi and the Department of Anesthesiology at the University of Texas Southwestern for their ultra-sound video contributions. Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more.  

Holly Neville, MD, FAAP, FACS is the Division Chief of Pediatric Surgery at Joe Di Maggio Children's Hospital and Associate Program Director for the Memorial Healthcare System Department of General Surgery.  Holly attended Emory University (92) where she received a BS in Biology and served as Co-Captain of the varsity swim team, followed by the University of Florida College of Medicine (96).  She completed her surgical residency at the University of Texas at Houston and Pediatric Surgery at the University of Texas Southwestern. She became a certified coach in wellness and well-being in 2021.  Holly serves nationally on various committees, including the Educational Committee and wellness committee for APSA, and is Lead Coach and co-director of the APSA coaching program.  Holly currently serves on the Board for the University of Florida College of Medicine and the Foundation for Joe Di Maggio Children's Hospital. Outside of work, Holly is the mom to 3 children: Zack (20), Camille (17) and Chloe (13). She is an avid sport enthusiast, enjoying paddle boarding, yoga, jogging, swimming, and Otillo racing.  She also is a home chef, and due to Celiac disease, specializes in gluten free and vegetarian cooking. Find out more about Holly and this episode at: www.nicupodcast.com______________________________________________________________________________________As always, feel free to send us questions, comments or suggestions to our email: nicupodcast@gmail.com. You can also contact the show through instagram or twitter, @nicupodcast. Or contact Ben and Daphna directly via their twitter profiles: @drnicu and @doctordaphnamd. enjoy!This podcast is proudly sponsored by Chiesi.

We all need more energy. Without it, we can't use our unique gifts to positively impact the lives of those we lead. Our guest today, Jill Roberts, promotes a unique form of self-care that can help us have that energy...a focus on nutrition. Through her simple, yet powerful approach, she helps leaders sift through the noise of fads and create accessible habits that lead to sustainable and substantial change.We also discuss:-Jill's journey from being a picky eater to being a dietitian nutritionist -The best places to start with nutrition habits for busy moms-How your nutrition affects every part of your leadership-Simple, gradual processes to improve your health and to get your whole family on boardAbout JillJill Roberts is a dietitian nutritionist and owner of Living Up Wellness  where she focuses on health for the whole family.  She has a whole body approach to wellness that incorporates diet, movement and mindset. Her programs transform her clients' habits without a sense of overwhelm or stress by making small changes over time that add up to huge results. She prides herself on building personal relationships with her clients to meet  their unique wellness needs.She also enjoys teaching cooking classes where everyone learns a little, laughs a little and has fun creating tasty food that is good for us. Jill received her degree in biology from The University of Texas in Austin, which led her to a 9 year career in gastroenterology research at Michael E. DeBakey VA Medical Center. There, she recognized a huge need for nutrition education in preventing and managing chronic diseases which led her to pursue a master's degree in nutrition at the University of Texas Southwestern so she could help others live a happy healthy life at any age. In her free time, she enjoys spending time with her family, being outside; preferably the country, where she can take care of her animals, run and grow her garden.Links SharedLiving Up WellnessJill's InstagramIf you want to join this movement of women seeking to thrive in leadership and life be sure to subscribe and connect with us!LinkedInIG: @wearemomsthatleadFB: @momsthatlead

In this week's episode, I chat with Monica Chung, M.D., on her 11 year journey to soon becoming an attending! Dr. Chung is a board-certified OB/GYN. She completed her residency training at University of Texas Southwestern in Dallas, Texas in 2020. She moved to Houston, Texas, where she is currently training as a Reproductive Endocrinology and Infertility (REI) specialist to gain experience in the diagnosis and treatment of infertility. Monica takes pride in being a second generation Korean American and is extremely close with her family. She is the third of four daughters and considers her sisters her closest friends. During her free time, Monica enjoys traveling, exercising, exploring restaurants and different cuisines, and spending time with her family and friends. Monica is an Enneagram 3 and her MBTI is ESTP - The Entrepreneur! Instagram: @monicaschung If you loved this episode as much as I did, head on over to rate and subscribe so you never miss an episode! I would love to hear more from you on the topics you want to hear. Go to @kollercommentary to comment your key takeaways and join the email list to share what you want to hear about next! Eunjoy ~ --- This episode is sponsored by · Anchor: The easiest way to make a podcast. https://anchor.fm/app --- Send in a voice message: https://anchor.fm/kollercommentary/message Support this podcast: https://anchor.fm/kollercommentary/support

Yep, you read that right. Do you know anyone who has an inflated sense of self-importance, needs admiration and has a sense of entitlement? If you do, then don't miss this episode with Dr. Stephanie Byerly. Dr. Byerly is an anesthesiologist and life coach. She helps women physicians who are exhausted, exhausted, overextended, and feel like they are failing at everything, take back control of their lives so they can get the joy back in their personal and professional lives, and don't have to leave medicine. She completed Medical School, Anesthesiology Residency, and Neuroanesthesiology Fellowship at the University of Florida and has spent her career at The University of Texas Southwestern in Dallas. CONNECT with Dr. Byerly IG: @thephysicianhealer FB: @thephysicianhealer www.linkedin.com/in/thephysicianhealer https://www.youtube.com/channel/UCJcXXE57NYUr6Z4chOFnpJA --- Send in a voice message: https://anchor.fm/urcaringdocs/message

Join the Drs. Washington as they speak with Dr. Maryann Osayande, a Gastroenterology Fellow at the University of Texas Southwestern in Dallas, as she discusses her life, career, and future goals!Music is from single “Alright” by Mississippi-native, Mike Burton on his album Soulful. All rights reserved.  Available on iTunes. Our views are our own and do not represent those of our employers. The  content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. If you think you may have a medical emergency, call your doctor, go to the emergency department, or call 911 immediately. Follow us on social media!Facebook @thedrswashingtonpodcastInstagram @thedrswashingtonTwitter       @drs_washingtonContact us for booking and inquiries at drswashingtonpodcast@gmail.com