0:00

That turned out way better than I thought when I was

0:02

running last night. to go home yeah this place is ours

0:05

, going to be more kind of cancer thank

0:08

you jail that was no that was the it

0:10

is very nicely rescue eight is a team effort

0:12

so i get

0:15

Hi

0:21

everybody. Welcome to our show. Is it

0:23

serious? A conversational podcast?

0:25

We

0:26

share our doctor knowledge. Without all the complex

0:28

doctor talk. mark

0:30

lewis and i'm and medical oncologists be suitably

0:33

city retreat cancers the

0:35

game

0:36

i'm also a patient myself living with a

0:38

hereditary tumor syndrome so i

0:40

think about health care from both sides of the

0:42

exam table and i'm jean luc neptune

0:44

m d and my friends call me jail and

0:46

i'm in internal medicine physician based in new york

0:49

city why practice addiction medicine

0:51

at my company sent from modern recovery i'm

0:53

also health technology and started investing experts

0:56

and i'm passionate about making our healthcare system

0:58

better for everyone he also like to

1:00

thank you again my friend was gonna always

1:02

good to talk to mark ah it's going well

1:04

i'm excited were cranking out great

1:07

episodes and will be able to share with our

1:09

audience or we've been getting great

1:11

feedback gas from france i've been excited

1:13

about that and looking forward to more and more

1:15

audience participation in our podcast

1:18

nothing that i've done on twitter has ever

1:20

excited my children who are

1:22

fourteen and eleven but the fact that i have a

1:24

podcast now is finally early

1:26

me some dad point so that that feedback

1:28

alone has been worth but you know it's interesting

1:30

when your kids have access to the internet's so

1:33

apparently my son was showing my like my

1:35

company page to one of his friends at

1:37

school and that made me somehow famous

1:39

was as i was very interesting having having

1:41

best i think the podcast will make me extra

1:44

famous listen and there's a really cool

1:46

question today that i think our listeners who

1:48

i can the question is what is personalized

1:52

medicine now i'm in

1:54

some ways this almost seems like seen

1:56

the obvious like isn't all medicine

1:58

personal and i mean healthcare

2:01

in the business yeah

2:03

it's an industry that medicine

2:06

maybe i'm being too idealistic medicine is the interaction

2:08

between doctors and their patience and

2:11

that's why we went into this right is to help people and

2:13

, a my med school application that a certified

2:16

but us i meant that i really knows it's i

2:18

know to say basically safer is right so

2:21

when i'm getting at is i find that what we do

2:23

when you're sitting face to face with someone and exam

2:26

room that feels very personal

2:28

but words matter and the

2:30

key here is the whole world the whole

2:33

which is personalized right

2:35

so maybe this talk about that the way we're

2:37

going to talk about personalized medicine is a personalized

2:39

medicine is essentially using some

2:42

buddies genetic or bio marker

2:44

information to make a treatment

2:46

decision on their behalf peace could

2:48

include decisions about who gets what kind

2:51

of medicines or of what dose they get

2:53

or the interval at which they're treated or

2:55

it might be information about how carefully

2:57

somebody should be monitored because they are predisposed

3:00

to specific type of issue and is interesting

3:02

because this is actually very important milestone

3:05

in the history of medicine has not happened overnight

3:07

has been happening over appeared times by

3:09

this is a huge change how doctors

3:11

treat patients you know remember up until

3:14

about one hundred years ago we didn't even know what worked

3:16

as doctors you know doctors like would try

3:18

whatever they had learned from another doctor worked

3:21

on and you know the history of the last

3:23

let's a hundred years was trying to figure

3:25

out what was safe and what was effective

3:27

to see terms that we always use what's safe and

3:29

what's effective and we were doing that more

3:31

on a population bet basis we're saying

3:33

this medication works on this population

3:35

to achieve this results but now with

3:38

personalized medicine we're moving into an increasingly

3:40

interesting space where we can start to talk

3:42

about something that is safe and

3:44

effective at the patient levels which

3:47

is i think in many ways sort of a holy grail

3:49

for us particularly the way we were trained

3:51

in the time that we came up as doctors

3:53

the i hope for real is why we don't do bloodletting

3:56

anymore as a general curse because

3:58

it turns out and

4:00

the human how's this is part of my job i'm a blood

4:02

doctor to turns out there is a tiny

4:04

proportion of the population who actually

4:06

do have too much blood and they benefit

4:09

from bloodletting but the vast majority of people

4:11

don't so i know it's kinda silly example

4:13

these shows what you're saying is we've we've sir gone

4:15

from taking this potentially harmful

4:18

one size fits all approach and really

4:20

using genetics to customize

4:22

treatment better living through chemistry

4:25

know my god you just triggered me thats great

4:27

fat boy slim album from the late

4:29

nineteen nineties thats actually like when when m finishing

4:32

medical school starting residency

4:34

there whole bunch of like british bands you

4:36

know big bead e d m trip hop

4:38

i have i still have a lot of the cds you

4:40

i think i know whats on my playlist tonight electronica

4:43

i like added

4:46

for easier for his sister

4:49

, so believe that there and

4:51

a move on is so here's how i think about this yeah

4:53

i think about this is the difference between

4:56

the spokes tailoring tailoring

4:59

buying and off the rack suit

5:01

that's what we're talking about here is personalized medicine

5:03

second by the way as an aside requests

5:05

mycology training was at the mayo the

5:08

and quite famously in our community

5:10

every doctor at me or has to wear a

5:12

suit but actually sosa for

5:14

fellowship trainee thinking i'd be assigned to taylor

5:17

and airbus support it was like yeah

5:19

buddy better spare way for the next sales

5:21

joseph a pair of scissors there's no taylor here

5:24

said , i was a slight less dense but all

5:26

seriousness is this an approach jailed

5:28

it to you seem like in your practice

5:31

in your life who the question so you know i

5:33

think about my life in in two ways as

5:35

a provider of to

5:37

my own patients but also as a caregiver for

5:39

my family so i say he's been actually

5:41

more relevant in my experience

5:43

as a caregiver so you know my mother

5:46

was diagnosed with breast cancer in

5:48

twenty thirty and is doing well now

5:50

has had no recurrences doing great and

5:53

as you know breast cancers really at the cutting

5:55

edge of a lot of this personalized medicine

5:57

technology and knowledge or we

5:59

work with a really good dr woman a blend

6:01

of a dot at new york hospital and

6:03

what we discover where i came to learn i i i

6:05

guess i'd known this before with that their bunch

6:07

of different receptors that you can attest

6:09

for the out and as you test for those receptors

6:12

estrogen priests are progesterone

6:14

i heard to new depending

6:16

on how you test with those receptors will

6:18

determine how you're treated and

6:20

i remember doctor for dot like drawing these pretty

6:22

complicated slow diagrams to say

6:25

like if this then that if this than

6:27

that's and because of the way my mother

6:29

tested sues actually hurt too negative

6:31

sir she didn't actually get a treatment called

6:34

herceptin which is in effect of cancer treatment

6:36

but can cause cardiac our hearts toxicities

6:39

so with you know very interesting to see that

6:41

perspective into it as a doctor realize

6:43

they're all these different kinds of combinations

6:45

that you can treat in different ways as is

6:48

energetic and know oncologist

6:50

at all now jail would treat

6:52

breast cancer like your mother's and and thank you for sharing

6:54

that without knowing whether

6:56

or not these receptors or presence or

6:58

absence because you're right those estrogen

7:00

and progesterone receptors as or for female

7:03

hormones friends and you can block

7:05

those so it's really it's

7:07

really and again it's the standard

7:09

of care that we would apply

7:12

this level of personalized medicine

7:14

to breast cancer disappointed that misha that

7:16

was clear that school it's my personal

7:18

area practice in addiction medicine mental

7:20

health there is a lot of work

7:22

ongoing a lot of work that's been done so far

7:25

it's dad's trying to determine the efficacy

7:27

of various medications for depression

7:29

anxiety eighty eight the a lot of the middle

7:31

house indications and is actually

7:33

a whole specialty feel called pharmacogenomics

7:36

pharma the medicines you know mixed genetics

7:39

and basically how do variations in your genetics

7:41

impact the medications that she takes

7:43

certainly i've seen in my practice march probably

7:46

seen this year there's certain medications

7:48

that pieces respond very well to and then

7:50

other patients don't respond to it off and

7:52

it's clear that people metabolize

7:55

these medications differently respond to them

7:57

and receptor level difference or differently

7:59

and well as providers it's actually hard

8:01

to predict who's going to respond often

8:04

times so are you know there's a lot of work

8:06

going on their number of companies are that are

8:08

in the space and i'd say at

8:10

least when it comes to mental health this the

8:12

technology is interesting the testing is interesting

8:15

but is really not ready for prime time

8:17

yet you know it's it's interesting some of these companies produce

8:19

like hundred page reports that are

8:21

chock full of information chockfull the data

8:23

very interesting stuff but as a provider

8:26

it doesn't really help you make big decisions

8:28

maybe at the margins there's some information about dosing

8:30

that you can potentially used by digging through

8:32

one hundred page report is just not really something

8:34

that's helpful as a doctor at three of them am

8:36

in there's three billion

8:38

here is of letters in the human dna sequence

8:40

that's going to give you a lot of other data

8:43

the other read through especially i

8:45

went the if it's not entirely clear what to do with

8:47

it so how bout you mark i you know in your practice

8:50

obviously as i was alluding to before

8:52

of the oncology is really i think that

8:54

they're cutting edge area for the space and

8:56

how is it affecting your practice or the reason

8:58

we're at the cutting edge as we've been so terrible

9:01

historically has been discussed i'm

9:03

, i think this is actually making

9:05

my practice i'll be very careful of my words

9:07

here more precise so

9:10

let's address the elephant in the room you're very

9:13

kind person jail but i collins's

9:15

are not as well like

9:18

okay and and i guess people

9:20

hate chemo and

9:23

sometimes i'll hear sometimes i'll at a camp for conference

9:26

season the mice or this patient didn't want

9:28

him us nobody wants chemo

9:32

that the question is can you reasonably

9:34

convinced that pieces that they need

9:36

chemo and let's be honest there's

9:38

lots and lots of there's lots effects and

9:40

and the nastiness is that gets

9:43

conflated with the doctor who

9:45

prescribe

9:46

yeah and you know it to me it's like eighty

9:48

the weatherman for the bad weather you know

9:51

there's this movie may remember with nicholas cage

9:53

in two thousand and five i don't think one of his best performing

9:56

films but he's a character he plays a weatherman

9:58

and he has his to standing there waiting for the my

10:00

some people are throwing stuff atoms because they're unhappy

10:03

with what happened with the weather and that doughty

10:05

basic see that movies the main character

10:07

was actually diagnosed with cancer in the movie

10:09

these diagnosed with lymphoma in the movie serves

10:11

as a big part of his character arc in itself

10:14

wow layers and layers yes i can imagine

10:16

deathly really to the material mere hours as cassettes

10:18

says something you can't control but people don't

10:20

like you when you meet someone about it so

10:23

you know what is it makes chemo so

10:26

most them i think it is the

10:28

indiscriminate toxicity

10:31

and , sometimes a masters mean the my patients

10:33

i should explain to my patients your house chemo works

10:35

and try to break it down to the very

10:38

basics sort of explanation that

10:40

it kills cells that are

10:42

dividing the problem is

10:45

there are normal parts of you

10:47

that are dividing right now so quite

10:49

famously our hair grows the lining

10:52

of our mouth and our gut is the replay nurse

10:55

how can we fluffing our our blood cells

10:57

are being remade skew remake most

11:00

of your of blood circulation about

11:02

three or four times a year so there's constantly

11:05

this process of renewal and that's what chemo

11:07

is interrupting and you're my dad get

11:09

really the heavy duty chemo in the late

11:12

eighties early nineties and it's was his phrase

11:14

which means pretty movements me actually said

11:16

the chemo seems to be incinerating the bad

11:18

self at an only slightly

11:21

faster rate

11:22

the good ones and is

11:24

that you know and i hit me like iraq is as

11:26

nice as my father talking i see that even now

11:28

even though we've tried to refine it in my tastes

11:31

and again you know for for those of us went to medical

11:33

school and he of try to learn the

11:35

history of medicine you to understand

11:37

that the history of on college he comes out

11:39

of the history of war so you know that that

11:42

the terminology that your father's using is

11:44

almost the evocative of how

11:46

we develop see most air be in the first

11:48

place you know remember the first team o's

11:51

are developed because scientists

11:53

observe that mustard gas was capable

11:56

of killing and destroying lymphatic tissue

11:58

and bone marrow and they say maybe this

12:00

might have some benefit for cancer with you

12:02

know that prewar were to there were no drugs or

12:04

if we're we're once through early no drugs

12:06

to treat people with cancer so

12:08

often in the case with science we make an observation

12:11

and then what the doctors did is they went and they

12:13

did experiments on mice and they showed

12:15

by applying some nitrogen mustard

12:18

they were able to cause some tumors district so

12:20

it's a fascinating history you know to

12:22

think about cancer as a war within the body

12:24

but the treatments for cancer begin

12:26

in war you know so that's a fascinating observation

12:29

it's wild we might be able to put this in the show notes

12:31

what my favorite book about this is the

12:33

emperor of all maladies my

12:36

siddharth in mukerji and it's actually the subtitle

12:38

of the book is a a biography of cancer and he

12:40

draws that through line from that realization

12:43

that these weapons the literal weapon had

12:45

medical applications of creating yeah so

12:48

i am and as sound a little bit jail like a mad

12:50

scientist and a white coat which i realize there's another

12:52

stereotype of i couldn't care less but

12:55

, bear with me i like

12:57

i love actually to talk

12:59

patients tissues know that is either

13:01

a biopsy need all the has sampled

13:03

a massive cancers mass more

13:05

sometimes is drawn here through a needle

13:08

into a to from their bloodstream i like

13:10

to test it for mutations that

13:12

i can target and this is this is the precision

13:15

wise medicine part of oncology okay so

13:17

what other description of chemo and this actually

13:20

relates to your nitrogen mustard analogy

13:22

is it's like nape harming your lawn

13:25

the kill the we had sex and

13:28

what we'd like to do is plug

13:30

the weeds and leaves a good grasp

13:32

on frank just subsidy clear

13:34

we are nowhere near perfecting

13:36

this process but i have to tell you we're getting

13:39

closer and when the reasons we're getting closer

13:41

as we are more willing to look for these things

13:43

you're never going to find something you look for

13:46

you miss all the shots you don't take

13:48

and and sometimes i'll be honest just like the report

13:51

you're missing earlier hundreds of pages long and

13:53

there's a single a mutation in there that you can

13:55

do anything about by again

13:57

for getting better and we are finding more with hot

14:00

the actionable mutations mutations in the

14:02

cancer that can be matched to treatment

14:04

and then try to get that patient on the right medicine

14:07

that the writer so that's a lot

14:09

of information i just want to go to break and

14:11

with hum back we can tell i was knows how this

14:14

might come up hopefully not in the anthology

14:16

scenario but how am i come up and and a conversation

14:18

with the doctor says it

14:25

you are listening to this show on the

14:28

asked trip health radio network yes

14:30

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health south's sets off

15:04

script

15:14

come back we're talking about personalized

15:16

medicine or precision medicine

15:18

and we want to make this news you can

15:20

use how will this affect your own

15:23

healthcare in possibly conversations

15:25

you have in the future with , doctor share

15:27

what you think are i was this is a part

15:29

i love is making recommendations giving

15:31

information that people can you so i think

15:34

we wanted to think about personalized medicine

15:36

in for made a couple questions and i think

15:38

could drive the start process so i think

15:40

the first question that anybody should be

15:42

asking if they are diagnosed with a condition

15:45

whether it's us of cancer conditioner anything

15:47

else is does your condition

15:49

allow for precision based treatment

15:52

and that really should be a question that you're comfortable

15:54

with asking your provider and marked we have an

15:56

example something like that idea

15:58

, a personal example

16:00

so i mentioned earlier in the blood doctor but

16:02

i've also as a patient had blood clots

16:05

and , so many years jail

16:08

and you know this and that maybe mammals as

16:10

of this this done in blood

16:12

thinner with this medicine called

16:14

kuwait called and soon is

16:16

fascinating because it work really really

16:19

well but and and the by the

16:21

streets but it had to be monitored

16:23

so closely because the coonan

16:25

had to be kept in a very in

16:27

reach as you might imagine you don't

16:29

want things to sin he

16:31

don't want things to sake you want goldilocks

16:34

you want your straightens stand ordinarily

16:36

in an initial phases of prescribing

16:39

this tuna medicine your father peace and super super

16:41

closely and try to make sure that we weren't

16:43

exceeding either of those thresholds

16:45

the was fascinating was we learn more about

16:48

the pharmacogenomics you mentioned earlier in certain

16:50

people based on how the

16:52

butterflies become in really ought

16:54

to start at start different doses other people

16:56

under some fascinating assist on this

16:59

where it's coming goes the wrong way you

17:01

can have access

17:03

leading risk and if you're under goes down it

17:05

then you have the same clotting risk he started with

17:07

in either of those things actually can result in struck

17:10

serves him be hemorrhage or they can be

17:12

quite so there was an estimation that we

17:14

might avoid seventeen

17:16

effect

17:16

and strokes in the united states

17:19

while every year if we applied this

17:21

precision approach to the dosing

17:23

of what was then the most common blood thinner interesting

17:25

and important point i want to make before we go along

17:28

so is it there are a lot of people who use a marketing

17:30

term personalized medicine or precision

17:32

medicine score often just using it

17:34

in a marketing censor i'd like we pay

17:37

attention to you we know your name when you walked

17:39

in the door for the truth is real

17:41

precision medicine is understanding that

17:43

everybody's different and everybody's

17:45

different sometimes in ways that can be detected

17:48

in a laboratory tests or some other kind of

17:50

way and that we can then use

17:52

to treat you in a often

17:54

a better way of a way that's more effective has

17:56

fewer side effects to that's what we're talking but when

17:58

we say precision medicine more personalized

18:00

medicine just in case you hear something different on

18:02

the tv or on that on the radio that's right

18:05

any other phrase that it can be computer courses

18:07

concierge medicine this notion that

18:09

there's this doctor who's at your beck and call

18:11

who like you say no as you by name it

18:13

that different that's it as a piece

18:16

experience which frankly we would love

18:18

to offered all of our folks and

18:20

the what you're getting at and what we're getting at is the testing

18:22

aspect and know sometimes

18:24

genetics is kinda scary

18:26

subject people don't really understand

18:28

what's being tested in again the scenarios

18:31

that were allying and will get into some

18:33

the nuances here you kind of be testing to

18:35

tissues in your body or he he be testing

18:37

your own genetic makeup is

18:39

there a specific mutation sometimes called

18:41

the various that you can be testing for again

18:44

that's that it's me more oncology but i think will

18:46

tend to find that more and more as we go into

18:48

other are areas are marked

18:50

examples maybe have some specific mutations

18:52

are variants of people can test force yet

18:54

somehow make is very specific as to

18:56

how it affects patients in my practice and again

18:58

this is trying to make me a better and

19:00

more precise oncologist so

19:03

one freeze it we use sale with sandalow weird

19:05

at first his were trying to make

19:07

every cancer every cancer cancer

19:09

known for set means are trying to lower the

19:11

number of cases are but it also means

19:14

we're trying to take a really common added

19:16

he's like cooling cancer which affects tens

19:18

of thousands of americans have a year in

19:21

our trade realize that actually that

19:23

that large number is the sum

19:25

of a bunch little subsets and

19:27

that by splitting

19:29

the subset and are lumping them altogether

19:31

one diagnosis that's hard treatments can kind

19:33

get a more specific now again

19:36

there's a huge difference between testing

19:38

a tumor and testing a

19:40

person so this is the analogy of actually

19:42

use i got her from my son we were doing math here

19:44

recently and he said dad ma'am i learned geometry

19:47

every square is square rectangle

19:50

not every rectangle is a square what

19:52

that means is you can you can test

19:55

the tumor you find mutation that doesn't necessarily

19:57

mean that you'd find in the patient as

20:00

part of their genetic makeup and

20:02

this distinction really really matters shale it

20:04

comes up a lot and an encounter my patients

20:06

because of

20:07

there are more police departments sure

20:10

the specifics and you get better yeah i

20:13

mean what discussion of american healthcare

20:15

would be complete without worrying about the

20:17

insurance implications yeah and

20:19

look at me we me we are always trying

20:21

to keep it real trying to be a one

20:23

hundred percent there are said to cheers what

20:26

your insurance pays for really

20:28

drives the services you get so for

20:30

example free pandemic you know until

20:32

recently stations want to tell of is it's

20:34

but the insurance company

20:36

in general we're not willing to pay for it i think

20:38

the pandemic is change that but i think

20:40

it's a great example of something that people wanted

20:42

that they couldn't get because the insurance company was

20:45

paying for itself you know there are

20:47

so many different insurance companies it's it's so

20:49

long to make changes that's why it

20:52

sometimes takes a longer than you expect

20:54

for changes to happen in the healthcare system but

20:56

that is a reality that doctors live with and

20:58

a doctor a reality that the doctor suffer

21:01

with as much as patience to that's right

21:03

and attack is moving so fast it

21:05

you're right there's just lag of

21:07

, coverage car coming behind one

21:09

other thing has been really interesting and necessities

21:12

back in two thousand and eight it's something

21:14

called the genetic non

21:16

discrimination act urge gene act and

21:19

the it's try to do good thing is trying to say

21:21

that if you're tested for genetic disorder

21:23

and you yourself are found

21:25

to have any hereditary condition that

21:27

you cannot the discriminated

21:29

against in certain ways you can't lose your job

21:32

because of that discovery and actually

21:34

this actually this fascinating your health insurance

21:36

premiums shouldn't change stuff so

21:39

what's wrong with swelter what's wrong with it is

21:41

it's it's good but it's porous it's

21:43

incomplete cause i could

21:45

tell you this myself because this is not protect

21:47

me from some financial penalties i

21:49

encourage after i diagnose myself with

21:52

next syndrome so where you can still

21:54

have penalties levied against you his

21:56

life insurance disability

21:59

insurance the and long term

22:01

care insurance which obvious would you like being

22:04

able to pay for my nursing home didn't really occur

22:06

to me when i was thirty am

22:08

fascinated to know do i have zero condition

22:11

so i just want people to understand

22:13

that in a genetic testing typically

22:16

of themselves not necessarily a tissue

22:18

or cancer their body but their their own make

22:20

it comes to that caviar the you really

22:22

want to go into it with your eyes open the

22:25

yes it can yield a lot of information

22:27

it might not actually tell you anything that isn't

22:29

a change or carried out but it could

22:31

very meaningfully effect these

22:33

types of insurance and again

22:35

i'm not here scare anybody actually think it's part

22:38

of our duty jail to former listeners that

22:40

there's this this downside to do exact

22:42

testing if you're not prepared for that reason to and

22:44

and i was like to say you know it's sideways as

22:46

a superman movies with great power comes

22:49

great responsibility so he'd i think this

22:51

technology is amazing and is really

22:53

fundamentally changing the way we treat people

22:55

ah and us know at the same time there

22:57

are many many things that come out of that new

22:59

technology that we have to grapple with as a profession

23:02

as a side we we really don't want

23:04

a brave new world where we're stratified

23:06

by genetic risk and physiologic fitness on

23:09

the other hand i have to tell you in real time and

23:11

it's just happened this year okay a genetic

23:13

testing is making things better in very

23:15

very scary cancer cell one

23:17

of the worst cancers a tree his

23:19

pancreas cancer mean it's not like i have a favorite

23:22

cancer for this is probably my least

23:24

favorite player and for years

23:26

when he was sequenced we just get back to

23:28

seem cluster of what we call

23:31

in actionable mutations meaning we knew

23:33

the flaws where they are we knew what was causing

23:35

the pink or circumstances we just couldn't do

23:38

anything about it we couldn't find an

23:40

achilles' heel that we could strike with our

23:42

drugs and as you might imagine when you

23:44

do the same thing over and over and

23:46

over again and you don't get back anything

23:48

that you can treat we just stopped doing

23:51

it really brought what's the point that we're not gonna

23:53

sequence pincus cancer the way that we look at

23:55

other cancers so just this year

23:57

it was year huge deal there

24:00

are now finding a mutation in two percent

24:02

of our pancreatic cancer patients six be treated

24:04

with the highly effective highly

24:07

tolerable prevent gun i

24:09

know two percent sounds like a really really

24:11

low number but when you think

24:13

that we lose tens of thousands

24:15

of people to this illness every year every

24:18

year of a big number can

24:20

still be a big number real quick

24:22

and is is get out quickly devolved into a college

24:24

yeah that's you have any i won't assists our obviously

24:26

if you roll your eyes or fall asleep but

24:28

the mutation is called t ras t twelve

24:31

see and them as as hard as

24:33

it is called at aggressive in is actually uphill

24:35

okay so real quick aside lot of people

24:37

think they're all cancer team is intravenous

24:39

his gimmick and horribly oh this is an oral

24:42

therapy this designed to turkey to specific

24:44

sloths and again we're only going to find

24:46

it by watching the i gotta tell

24:48

you all oncologists at

24:50

their core or optimists and

24:52

i'm hopeful that even though this is a tiny

24:54

sliver of the pincers

24:57

it we treat if it works here that maybe we can

24:59

find similar mutations doing

25:01

testing and other patients other patients we're

25:03

on the blink

25:04

i have precision oncology cracking

25:07

open some of the traditionally hardest

25:09

to treat cancers i certainly hope so sure and

25:11

look i think that's the nature of really

25:13

any technology you know in the earliest days

25:15

you know technology might only be useful

25:18

in two percent of cases but at some

25:20

point you figure out another way to use that technology

25:22

now you're treating four percent of cases than

25:24

eight than sixteen and then eventually

25:26

everybody who's got the condition is getting

25:29

the same kind of testing and targeted chemotherapy

25:31

or whatever that technology may be so i am optimistic

25:34

as well and again i think you know somebody who

25:36

finish med school in two thousand you

25:38

know think about how far a the oncology

25:41

a space has come with monoclonal antibodies

25:43

small molecules genomic testing

25:46

i mean it's a world of difference from twenty years ago

25:48

and what's really cool is when progress

25:50

in one area bleeds over into another areas

25:53

for instance like some of our cohen management

25:55

actually comes from antibodies that we've been using

25:57

for a long time in oncology

25:59

so

26:00

you get this kind of beautiful i can

26:02

cross pollination going on settled in

26:04

iran genetic testing were still on the

26:06

infancy some of it is still very expensive

26:08

and not reimbursed by insurance need

26:10

to be super careful what

26:12

we do with information meaning we don't

26:15

want people to be labeled in a way

26:17

that's gonna forever changed their insurance or

26:19

frankly cheese the understanding of their own bodies

26:22

the one thing we have attacked or yeah gl that i want

26:24

to come and on his

26:25

you're so new in doing this

26:28

sit when you do say testing you can get back

26:30

to the smearing as you mentioned earlier but they're actually tagged

26:32

variants of uncertain

26:34

significance and what they

26:36

mean is right there in there name we don't know

26:39

yes rights as any good news is news

26:41

is very smart people and asking

26:43

these computer databases

26:45

and now i'm really nothing else but what happens

26:47

is information stored there and

26:50

the computer and and a people are

26:52

currently going back and looking mutations

26:54

we found before and saying ah sort

26:56

of eureka moment now we know that's

26:58

not of uncertain significance at all either

27:00

that's completely benign and we never

27:03

have to worry about it or actually

27:05

it's associate with this disease or this

27:07

is the best case scenario is associated

27:09

with the treatments that works and

27:12

i think together that we call

27:14

it or it is now it's a constant refinement

27:16

and adding to what we know that's how medicine

27:18

works as how it has worked for centuries

27:21

as exciting i'll be honest with you to hear

27:23

my voice to be practicing at this moment

27:26

and think that we're gonna be more

27:28

precise certain teams we are seen

27:30

as somebody whose job is an investor

27:33

in has invested in a lot of technology companies

27:35

you're starting to hear things like big data

27:37

artificial intelligence machine learning

27:40

and now with such as doctors as doctors working

27:42

with computer scientists working with supercomputers

27:45

crunching huge amounts of data and

27:47

really starting to discover things that you know

27:49

fifty years ago would have been impossible to discovers

27:52

but now is sort of jumping off the page so

27:54

it really is exciting and i think we may be

27:56

moving into a world

27:58

where everybody gets a customs

28:00

you'd rather than having to get an author

28:02

active process at some point

28:04

i say we should do like a part to forget

28:06

the updates for size methinks is

28:08

moving so fast actually really side the see where

28:10

it goes in other fields in your

28:12

field in other parts of medicine thirty

28:14

this is probably all we have time for to they aren't so

28:17

good

28:17

so before we go i don't have a mean

28:19

tweets so much as a mean google

28:22

search and this was my own

28:24

google search and all right so you know how your

28:26

type something into google and it'll auto complete

28:28

the sentence for e bay it's it's actually called google

28:31

auto suggest oh thank

28:33

you yeah

28:36

so what i typed in jail was like

28:38

what how can i figure out the public

28:40

perception

28:41

cancer doctor as i know as googles

28:43

i put in oncologists are and

28:46

honestly ice ice should have

28:48

been prepare for this but the results were

28:50

horrible are going into in order to okay oncologists

28:53

are murderers

28:56

the ice and colleges are evil

28:58

no voice on colleges

29:00

are confused anna colleges are

29:03

criminals so my go to be

29:05

as with you one of the many many many

29:07

reasons i wanna do this podcast of use i

29:09

want to put little bit of a human face on

29:11

like i say i really intimidating

29:13

profession no one ever wants to meet me i know

29:15

that i would rather not have people

29:18

in my clinic that need chemotherapy were just

29:20

doing the past we knew how to do

29:22

right now and i also know jail this is true this know that

29:24

history is going history judge this moment

29:26

partially because you know when things

29:29

progression you look back at like all those people

29:31

were so short sighted but this is how

29:33

we're going to get better it's personalized medicine

29:35

and is this precision approach to and and

29:37

remember where where fickle as a as a species

29:40

right you know i think i'd have got some point you

29:42

know when we care of chancery or at least

29:44

tern cancer into cancer not always

29:46

fatal condition you know the auto suggests will be

29:48

oncologists are geniuses oncologist

29:51

are angels oncologist are the best

29:53

people we know so maybe that'll maybe the google

29:55

auto suggest fifty years from now you

29:57

my friend or excellent mental health

30:00

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