"A New Deal for Cancer"

February 15, 2022

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Yale Cancer Center Grand Rounds | February 15, 2022

Hosted by: Eric P. Winer Presentations by: Dr. Charles Fuchs, Abbe Gluck, Dr. Melinda Irwin, Dr. Cary Gross, and Greg Simon

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00:00I wanna welcome everyone
00:02to to our Grand Rapids.
00:05I think this is the second or third
00:08that I've presided over in my very
00:10brief tenure at at Yale so far.
00:13And today we're doing
00:14something a little different,
00:16a little different from most of the
00:18presentations that that I've seen.
00:20And today's grand rounds grows out
00:23of or comes out of a book that
00:26that Abby Glock at the law school,
00:29and Charlie Fuchs,
00:30who you all know well as my predecessor.
00:35And who was here until just
00:36a matter of months ago?
00:40A book that that that they put
00:43together called a new deal for
00:45cancer lessons from a 50 year war.
00:48And this book. Thank you Melinda.
00:52There's this this book as described to me
00:55when I was first asked to write a chapter.
00:59Is a book that isn't necessarily meant purely
01:04for scientists or purely for clinicians,
01:07but as a book that's meant
01:09for students and for doctors,
01:12and for other health care professionals,
01:15and for the lay public,
01:16and for really everyone to review where we've
01:19come with cancer over the past 50 years?
01:22Not so much where we've come scientifically,
01:24describing scientific progress
01:26and exquisite detail,
01:28but more of a sociocultural.
01:30Look at the evolution of of of
01:33of cancer and our approach as a
01:35society to cancer and in truth some
01:38of the great progress we've made.
01:40So there are many chapters
01:43in this wonderful book,
01:45and we've we've put together a
01:48group of people today who have
01:51been involved with the book,
01:54mostly writing chapters and and,
01:58and we've asked each of them to come
02:01together and to speak for about 5 minutes
02:04about their piece of this project.
02:07And then we're going to have time
02:10for some questions at the end.
02:12So without further ado and I'm going
02:14to act as moderator and I will
02:16introduce each of the the speakers
02:19and our first speaker is well known
02:22to all of you Doctor Charles Fuchs,
02:24who was the former director of the
02:27Yale Cancer Center and Physician
02:29in Chief of Smilow Cancer Hospital.
02:32And is now the.
02:36Genentech's,
02:36head of oncology and hematology
02:39global product development.
02:40Charlie is an internationally
02:43recognized GI oncologist.
02:46Before coming to Yale,
02:49this is now probably five to six years ago.
02:54He was a professor at Harvard Medical
02:57School and the chief of the GI
02:59Oncology Division and the Robert E
03:01and Judith B Hill Chair in pancreatic cancer.
03:03At Dana Farber,
03:05where he and I were colleagues
03:08for approximately 19 years.
03:11So Charlie,
03:12without further ado,
03:15maybe you could start us
03:16off with some comments.
03:18Eric, thank you. And and it's so
03:20great to see you and everybody,
03:22and I'm really so honored to be back at
03:25this wonderful forum and and I guess
03:28virtually at this amazing center.
03:30You know, I I my years at Yale,
03:33were just such a privilege interacting
03:35and working with so many talented
03:38people and the experiences were
03:41really transformative. For me,
03:43but you know related to today's forum,
03:45I think 1 Red Letter day came in
03:49the summer of 2017 when I first met
03:52Abby Gluck in my office at Smilow,
03:55who approached me with the idea of
03:58let's do a conference between the law
04:01school smilow and the Cancer Center.
04:03And admittedly I it just didn't
04:07seem to click.
04:08It seemed inconceivable that we could
04:10come up with such a venue, but.
04:12You know, really all of this is
04:15the product of Abby's vision,
04:17her genius, and really,
04:19it's she is the architect
04:21of this and you know,
04:23she sort of led me along this path
04:26to launch this joint conference,
04:28which, as many of you know,
04:29was an extraordinary van bringing
04:32together leading figures in cancer care
04:36research regulation policymaking and was,
04:39as Abby can attest,
04:42one of the leading cancer conferences.
04:45In Connecticut, and I think, uh,
04:47an important event in terms of
04:49what we know about cancer.
04:51Following that,
04:53Abby,
04:53the innovator,
04:54really the the engine of all this
04:58suggested that we craft a book and
05:02and what I think the end result was a
05:06constellation of amazing thought leaders,
05:08innovators many of whom from Yale and Smilow,
05:12some of whom presenting today
05:15and one thing I think we wanted
05:17to do was to plan the book.
05:20To launch around the 50th
05:23anniversary of the National Cancer
05:25Act or as many of you know,
05:26the the war on Cancer Act that Richard
05:30Nixon signed into law in December 1971,
05:34which is really where the phrase moon
05:37shot as it relates to cancer care and
05:41research emanated from with the idea
05:44that they would launch a NASA like
05:47program and would conquer cancer.
05:49By the 200th anniversary of
05:52the United States,
05:54that is five years later in 1976 and
05:58ambitious perhaps unrealistic goal.
06:00But bottom line is a lot of
06:01great things happened, you know?
06:03And at the time the bill was signed,
06:05we spent $0.89 per person on
06:08Cancer Research in this country.
06:10Now we spend $20 per person,
06:14you know we launched the NCI
06:16Comprehensive Cancer Centers,
06:17of which Yale is a leading part of that.
06:21We saw a new opportunities for
06:23funding new programs for research,
06:26the revolution of therapies,
06:28targeted therapies, immuno oncology,
06:30new technologies and no less importantly
06:33the launching of careers of countless
06:36talented individuals across the
06:37spectrum of what we do in cancer.
06:40And you know,
06:41among the advances were the fact that
06:43cancer mortality rates declined 29%
06:45really over the past 20 or 30 years.
06:49But you know what?
06:51We also learned where the gaps?
06:53Right that that the war on
06:55cancer wasn't against a
06:56single enemy, and I don't mean just single
06:59cancer 'cause we obviously know the cancer,
07:02or hundreds potentially thousands of
07:04subtypes, but many other things about
07:07the complicated way we fund cancer care.
07:10You know how we use the payment
07:12on drugs and and procedures to
07:14cover the costs of payout of care,
07:16nutrition, social work,
07:18clinical research that are
07:20largely under reimbursed?
07:22The pressures of everyday practice
07:24in cancer medicine.
07:25The paucity of resources provided
07:27to public health and prevention.
07:30The challenges of supporting the next
07:32generation of researchers and providers.
07:35The issues of HealthEquity.
07:37The fact that R&D is extremely costly,
07:41redundant, and inefficient.
07:43The fact that the landscape of regulate
07:46regulation is fragmented and costly,
07:49that our approach in government
07:51is highly fragmented.
07:52And our approach to how we
07:54leverage the vast data we collect
07:57is fragmented and inefficient.
07:58And you know, really,
08:00with with Abby's vision what we did
08:03with the authors is challenging not
08:05only to reflect on the past 50 years,
08:08but to really offer a vision for the future.
08:10And that was really the idea of
08:12a new deal for cancer that is
08:15not only to address the science,
08:17but a truly comprehensive effort to
08:20tackle the full panoply of challenges.
08:23To eradicate radical cancer and
08:26you'll hear from the coauthors,
08:28my colleagues and of course,
08:30Abby.
08:31But you know,
08:32among the things that just I wanted to
08:34highlight was a really an extraordinary
08:37chapter from David Solid and colleagues
08:40about the advances in treatment,
08:42namely,
08:42targeted immune based therapies,
08:45but also the need going forward to come up
08:48with innovative clinical trial designs,
08:51regulatory flexibility,
08:52the ability to.
08:54Really understands sensing resistance and
08:57also to address diversity and bringing
09:00all these innovations to the underserved.
09:03At the same time,
09:04Charles Sawyers and colleagues talk
09:06about the the vast data we now collect
09:09in clinical care and tumor sequencing.
09:11We're sitting on a goldmine,
09:13but we're so fragmented in that
09:15collection of data that we don't
09:17have the ability to leverage that
09:19for true innovation and they offer.
09:21A lot of ideas and future reforms
09:24of how to reinvent data and privacy
09:27protections Tigard patients.
09:29But to leverage these great datasets
09:32collectively to generate insights you know,
09:36rich shulsky and colleagues talk about,
09:38you know we we created a lot of
09:41government infrastructure to build
09:43cancer care and research by virtue
09:45of the Act 50 years ago,
09:47but we now it's so fragmented we
09:50don't really harness all its power.
09:52So really is,
09:53as we say in the introduction
09:55what's needed now to to move to the
09:58next level is in all hands on deck
10:01approach a new deal that reinvests,
10:03and last week we saw that you know
10:05that is with the Biden moon shot,
10:07and I think the book is so you know
10:10is almost tailor made for what is
10:12needed in the future and what obviously
10:14Biden in the White House are trying to offer,
10:17you know,
10:18before I conclude I I want to,
10:20you know, thank you Gene Russon who.
10:22Worked with Abby and me and
10:24in in creating the book,
10:26and really was tireless in his efforts.
10:29I want to thank Abby,
10:30who's been an amazing partner and really
10:32the visionary and architect of all this.
10:35And then lastly,
10:36I get the privilege of introducing.
10:37I think the next speaker,
10:39who is a great friend and colleague
10:42and a great leader in cancer care and
10:47research who always has made himself
10:50available to me in times when I.
10:53I needed support for family members
10:56with cancer who was really an amazing
10:59mentor during my years at Harvard and
11:01who is now a great leader at Yale.
11:04I want to introduce the physician in
11:06chief of Smilow Cancer Hospital and the
11:08director of the Yale Cancer Center,
11:10Eric Weiner.
11:12Thanks Charlie. Then thanks thanks.
11:14Thanks for your your comments.
11:16There may be a little overlap
11:18between your comments and and mine.
11:19I'm I'm actually not the
11:21supposed to be the next speaker,
11:23so I'm going to move on.
11:24And introduce our next speaker who is Carrie
11:27Gross and Kerry is a professor of medicine,
11:31public health and director of the National
11:34Clinical Scholars Program at Yale.
11:36He's the founding director
11:37of Yale's Cancer Outcome,
11:39Public Policy and Effective Research
11:41Center Effectiveness Research Center,
11:43otherwise known as copper,
11:46and he has coauthored not one but two
11:50chapters in the book, a real hero from.
11:54Like Charlie and Abby's standpoint?
11:58And those chapters are are on pricing
12:00and also on the role play by state
12:03governments in shaping cancer policy.
12:05I called up Kerry before I took this
12:08job because I wanted to know what was
12:11going on in terms of in in terms of
12:15healthcare effectiveness research,
12:16and he very generously on his
12:19sabbatical spend time with me and
12:21reviewed all all that was taking place.
12:23And there were just really rich interactions
12:26between copper and the Cancer Center.
12:28So Kerry.
12:30All yours.
12:31Thank
12:32you and yeah again, thank you Charlie
12:34and Abby for the opportunity to.
12:37Participate in the book and
12:39by writing two chapters I I
12:41get 2 free copies of the book,
12:42so it's well worth it.
12:45So I'll yeah try to keep my comments brief,
12:48but I do want to touch on
12:50both chapters briefly first,
12:52the chapter looking at state
12:54policy had the pleasure of
12:56working with Doctor Deb Schrag,
12:58also with Harvard roots on that end.
13:03Well sorry, I'm having
13:04a cat attacked me here.
13:07Basically, if there was ever any doubt about
13:11the importance of states in public health,
13:13I think the last two years of the COVID
13:16epidemic has been raised that there's
13:18actually been a fourfold very variation.
13:21I just looked it up this morning and
13:23COVID mortality rates across states so
13:25that really underscores the importance of
13:28what states can do in the public health
13:30arena and that pertains to cancer as well.
13:32There's a 7070% variation across
13:35States and cancer mortality rate.
13:37So in Debs and my chapter we looked
13:40at some of the levers that states can
13:44employ to effect. Cancer incidence,
13:46cancer mortality and the patient experience,
13:49and we live in a federalist society
13:53which really does allow states great.
13:58Variation in how they use these
14:00these levers to address cancer care,
14:03cancer access, Cancer Research,
14:04but it's critical of to to look
14:07at how states are doing this,
14:08so Deb and I call for greater transparency,
14:12greater accountability on the behalf
14:14of the federal government to maybe
14:17have some more carrots and sticks with
14:20to address and improve how states
14:23are on our tackling cancer.
14:26The other chapter deals with the cost of
14:29cancer care and this I worked on with Zeke,
14:33Emanuel and Stacey Juice had seen a.
14:36It was a lot of fun bringing our diverse
14:40viewpoints and here we talked about what
14:43I think about is a cancer cost trifecta.
14:47You know, it's common question,
14:49how do we end up with a $200 billion
14:52system of cancer care in our country?
14:55And basically it's too many cancers,
14:58too many treatments,
15:00too many dollars per treatment.
15:02Too many cancers.
15:05First of all, we're an aging population.
15:07Cancer is largely aging related disease,
15:10so we're going to see more and
15:12more cancer as time goes by,
15:14but also to many cancers.
15:16You know,
15:17tobacco still accounts for about
15:19a third of all new cancers.
15:21We've made tremendous progress
15:23in decreasing tobacco use,
15:25but we have a lot of people still
15:27developing preventable tumors
15:29from the tobacco front.
15:31We've also made tremendous progress
15:33on developing new modalities.
15:35To prevent cancer or detect or prevent
15:38cancer death over the past 50 years,
15:40I mean HPV vaccine.
15:42A variety of screening tests called naskapi,
15:44etc.
15:45Those are underutilized,
15:46so too many cancers also gets at
15:50this issue of we're not optimally
15:52using our screening,
15:54but also too many cancers deals with this
15:57issue of over screening and overdiagnosis,
16:01particularly for the older population.
16:03Getting screening tests when.
16:05People have very short life expectancy,
16:07for example,
16:08or overuse of screening that doesn't
16:12have a really solid evidence base
16:14can lead to over to detection of
16:17cancer that may not have caused
16:18a problem in the 1st place,
16:20so too many cancers, too many treatments.
16:23We're in a very.
16:24We're very aggressive society
16:26when it comes to treatment,
16:28so you know our.
16:31System of reimbursement and
16:34finance at every step of the way
16:37is aligned in favor of maximizing
16:40the amount and intensity of
16:43treatment. So we if we reimburse very
16:46heavily on a fee for service basis,
16:49and that substantially contributes
16:51to in some cases over use of
16:55a variety of cancer screening
16:57and treatment modalities.
16:59And if that's over.
17:03As far as over treatment are too many
17:06treatments and as far as too many dollars
17:09to how expensive are our treatments?
17:12Again, it's not just our health
17:16system reimbursement that.
17:17Incentivizes the use of expensive treatments,
17:20but also our system of research.
17:23We are in our regulatory framework.
17:26The FDA has been lowering its bar for
17:30approval of new drugs over the past decade.
17:33In particular,
17:34where now the majority of drugs that are
17:38approved for clinical use by the FDA are
17:41approved by these alternate pathways
17:44such as the accelerated approval process.
17:47This doesn't have as rigorous of a
17:50bar for approval usually does not
17:53have things such as overall survival.
17:56And the challenges that we in
17:59the US increase.
18:01For many years have linked
18:04reimbursement with FDA approval,
18:05so it is usually just a reflex decision.
18:09By and by CMS to pay for.
18:13I'll pay for drugs that are FDA
18:15approved even when it's through
18:17one of these alternative pathways,
18:19so we have a lot of opportunity to
18:23make changes to decrease costs by
18:26hitting each angle of this trifecta
18:29by improving the regulatory process,
18:31improving our screening and cancer
18:33prevention approach,
18:34and redesigning our health care
18:36system to decrease overuse in in, in,
18:38improve, patient centeredness and equity.
18:41I look forward to discussing further.
18:44Thanks Gary. The the matter of
18:47redesigning the whole healthcare
18:49system is of course a simple one.
18:51But you know, we all we all wish that we
18:54could be the individual desire to do it,
18:57but it is really.
19:00It is really something that we have
19:02to tackle it at some point soon.
19:05So our next speaker is someone who I
19:09have known for many years collaborating
19:12between my former institution and and Yale.
19:16And that is Melinda Irwin,
19:18who is the Susan Dwight Bliss
19:21professor of epidemiology and
19:22associate Dean of research at the
19:25Yale School of Public Health.
19:27She is also, thankfully,
19:29the associate director of Population
19:32Sciences in the Yale Cancer Center
19:34and in the core Grant and deputy
19:37Director for Public Health and the Yale
19:40Center for Clinical Investigation.
19:42And together with her Co author,
19:45she's written an important chapter
19:47on the place of public health and
19:49prevention in addressing cancer and
19:51area that I think our health care
19:54system has been somewhat lacking it.
19:58Melinda, please,
20:00thank you. Yes, I'd like to share
20:03with you a bit about our chapter,
20:05and I'd like to acknowledge my
20:07Co authors from the Yale School
20:08of Public Health, Abby Freedman,
20:10Nicole Diesel and Linden Nicolai.
20:13So our chapter focuses on four areas with
20:16really a focus on policy implication,
20:20so tobacco control, obesity,
20:23environmental carcinogens,
20:24and HPV vaccination.
20:25So I'm just going to share
20:26a couple points with you.
20:28That we think are critical because
20:30many of these issues have been
20:33discussed and debated for decades
20:35yet how can we we make further
20:38progress so we know that a third of
20:41all cancer cases are preventable
20:42and public health approaches to
20:44cancer prevention represent the most
20:46cost effective long term strategies
20:48for reducing the cancer burden.
20:50Yet, interestingly,
20:52the United States only directs
20:54less than 3% of its health care
20:58expenditures towards prevention.
20:59Even though the return on investment
21:01from public health interventions is
21:03incredibly high, about 15 to one.
21:06So specifically regarding tobacco.
21:08For decades,
21:09tobacco use has been the leading cause
21:12of preventable mortality worldwide
21:13and is associated with 13 cancers
21:16and is responsible about a half a
21:18million deaths per year and about
21:2050% of all cancer deaths in the US
21:23are attributable to smoking 50% of deaths.
21:28What's concerning?
21:28Those at higher burdens and lower
21:31socioeconomic status groups are driving
21:34substantial health disparities.
21:35The good news?
21:36So is that over the past 20 years
21:38smoking rates have fallen from about 25%
21:41in the 1990s to currently around 14%.
21:45In much of this is due to
21:47tobacco control policies,
21:49so advertising restrictions,
21:51anti smoking campaigns,
21:53cigarette taxes,
21:55smoke free indoor air laws which was
21:57critical and then now most recently
22:00minimum tobacco sales age of 21.
22:03So these policy changes point to
22:06substantive reductions in tobacco.
22:08Overtime,
22:08but they have been uneven across populations.
22:12Fortunately,
22:13the Biden Moon shot initiative
22:16addresses cancer inequities
22:17and improving access to care
22:19including tobacco treatment,
22:21so that hopefully we'll
22:22see continued improvements.
22:25Our chapter also focuses on obesity.
22:27Recent reports estimate that obesity
22:30could overtake smoking as the primary
22:33modifiable cause of cancer mortality
22:36and what's most concerning is as cancer
22:39mortality rates have dropped to by
22:41about 30% since the peak in the 1990s.
22:43During that time,
22:44we've seen an increase in obesity rates,
22:47so there's concern as whether the the
22:50decrease in mortality will be attenuated
22:52because of the increase in obesity.
22:54Rates at present,
22:5640% of US adults are defined as obese,
23:00a BMI of 30 or greater,
23:02and this is a sixfold increase in
23:05obesity prevalence since the 1970s.
23:07We know obesity is associated with
23:1013 cancers and the incidence of 13
23:13cancers in mortality from cancer for
23:1614 different cancers and obesity
23:19also might be associated with worse
23:22adherence to adjuvant treatments.
23:25As well as reduced cancer treatment efficacy,
23:28there are a number of lifestyle
23:30interventions that have been completed
23:32that have shown benefit of these on
23:34various cancer outcomes and currently
23:36there are a number of large scale
23:38trials of lifestyle interventions
23:40on disease free survival and when
23:42those findings are made public
23:43in the next three or so years,
23:46it's hopeful that this will.
23:49Hopefully they'll be positive and
23:51it will cause a shift in how we
23:54deliver lifestyle interventions.
23:55In the clinic of note though,
23:58what is really concerning is
23:59Medicare currently reimburses
24:01for weight management services,
24:03not specific to cancer,
24:05but only 3% of patients who are
24:08eligible are referred for these
24:11weight management services.
24:13So I think the research that we need
24:15to do going forward is really the
24:17dissemination and implementation of
24:18these evidence based findings into the
24:21clinic and community so that we can
24:24improve referral rates as well as treatment.
24:27I'm switching to environmental carcinogens.
24:31These have been identified for more
24:33than two centuries over 200 years and
24:36about 10% of instant cancer cases are
24:40caused by occupational chemical exposures.
24:44However,
24:44certain racial and ethnic groups
24:47in lower socioeconomic populations
24:49experience higher exposures to
24:51known and suspected carcinogens,
24:53so we we must improve and
24:55expand the monitoring.
24:56Infrastructure for chemicals in our
24:59environment and harness the tremendous
25:01potential that we have with laboratory and
25:05informatics based tools and technologies.
25:07Thankfully, the Buydens infrastructure
25:10law will help in improving.
25:13Delivering clean water and
25:16cleaning up polluted sites.
25:19Lastly,
25:19our chapter focuses on HPV vaccination.
25:22Much of this work done by Linda
25:24Niccolai here at the School of Public
25:26Health and as many of you know,
25:28this vaccine helps to prevent six
25:30types of cancer in women and men.
25:32How and there's three vaccines available,
25:36but our HPV vaccination coverage is
25:39a suboptimal in our population and
25:42there's numerous reasons for this.
25:45The primary one might be vaccine hesitancy,
25:48which we're learning a lot about
25:49now with COVID-19.
25:50A key factor might be related to
25:53the lack of middle school entry
25:57requirements for HPV vaccination,
25:59yet schools the schools have had
26:02vaccine requirements in the US
26:05since the 1800s and currently,
26:07even though this this has been made
26:11for other vaccines for children,
26:14only three jurisdictions in the
26:17United States require HPV vaccination
26:20for school entry in contrast to.
26:2251 jurisdictions for T DAP,
26:25so there's a lot of debate over how to
26:29do these school entry requirements as
26:32it infringes on individual freedoms and
26:34parents ability to choose for their children.
26:37But I think there is significant room
26:40for improvement here, so the last
26:43inclosing the point I want to make is I.
26:47I was so incredibly impressed how colleagues,
26:49scientists and clinicians
26:51here at Yale pivoted.
26:53With COVID-19,
26:53with their research efforts and whatnot,
26:56and I believe that as a scientific community,
26:59we need to pivot and double down
27:01on efforts towards improving
27:03access to cancer care and fixing
27:05the structural and systems levels.
27:07Factors impeding equitable care.
27:08And if every one of us prioritizes
27:11HealthEquity and cancer care,
27:14it's likely I think that we could
27:16reach Biden's goal of seeing a
27:1850% reduction in cancer mortality
27:20rates over the next 25 years.
27:23Thank
27:24you. Thank you Melinda.
27:26So I'm next and I wrote this chapter
27:31with Neil Merola colleague of many
27:33years who used to be the chief of
27:36hematology oncology at Case Western,
27:39and now works at Flatiron.
27:42And Neil and I have had some
27:44shared interests over the years,
27:46and we primarily focused on
27:49how cancer has changed for both
27:52the doctor and the patient,
27:54mostly thinking about the patient.
27:56But but since the patient is affected
27:58by the doctor and other clinicians,
28:00that was part of this as well.
28:03When we both started our
28:04careers in the 1990s,
28:06indicating that we are both somewhat old,
28:10cancer was a little
28:11different than it is today.
28:13It tended to be diagnosed in later stages.
28:16There was much more secrecy
28:18around the diagnosis of cancer.
28:21We still see occasionally patients who
28:23don't want to talk about having cancer
28:26and who conceal diagnosis or simply
28:29can't come forward with with with.
28:32Seeking medical treatments,
28:33but that was much more common back
28:3630 years ago and not surprisingly,
28:38both because of later diagnosis and
28:41because of less effective treatment,
28:44the outcome was worse.
28:46Today there are 17 million cancer survivors,
28:50a pretty impressive number,
28:51both in terms of all those
28:53people who have survived cancer,
28:55but the fact that there's
28:56just been so much cancer,
28:58and I think Kerry raised a very
29:00important point that there is in many
29:03situations the over diagnosis of cancer,
29:06particularly in older individuals,
29:08and that has certainly increased that number
29:11and is another problem we need to address.
29:14But as Charlie pointed out,
29:16mortality has has clearly decreased.
29:18Cancer hasn't gone away,
29:20but I think that most of us in the
29:24field see a time when it'll be possible
29:27to say to a man or woman with cancer.
29:31That if they are able to access
29:33medical treatment and if they
29:36consent to medical treatment,
29:37that death is not something that
29:39should be part of a cancer diagnosis.
29:42And the closer we get to making a
29:45cancer diagnosis like the diagnosis
29:47of a strep throat where you take
29:49an antibiotic and it gets better.
29:52Of course the better it will be in,
29:54the less it will be so greatly feared.
29:59Treatments have changed.
30:01They're more targeted.
30:02Sometimes we think targeted
30:04means no toxicity.
30:05That's certainly not the case.
30:06We still deal with very real
30:09toxicities and and immunotherapy,
30:10which of course has been the rave
30:14for the past five plus years,
30:16and which is clearly very effective
30:19and is very appealing because it
30:21harnesses one's own immune system to
30:24kill the cancer can also be very toxic,
30:28and we have.
30:29As we develop,
30:30new treatments need to pay close
30:32attention to the fact that we want
30:34treatments that are both effective and
30:37do not require patients to sacrifice a
30:40great deal to receive that treatment.
30:44The other day I focused a lot on
30:46the doctor patient relationship,
30:48but I'm going to expand that
30:50to talk about the clinician
30:51patient relationship because in
30:532022 ruling not talking about just doctors,
30:57we're talking about doctors and nurse
30:59practitioners and nurses and social
31:01workers and pharmacists, and it's really
31:03a team approach that's so critical.
31:06I do think that there is
31:08something very special about the
31:10clinician patient relationship,
31:11and I don't think that that has
31:14necessarily changed so very much.
31:16And when a person has cancer,
31:18there is the opportunity for a
31:20clinician to walk in through a door into
31:23someone's life and their families life.
31:26And it's a very special moment,
31:29and I've always been.
31:30I've always been moved by the
31:32fact that this is a time when
31:35you can have a huge impact,
31:37and if you choose to walk through that door,
31:39it's a rich experience both
31:41for you and for the patient.
31:42And I don't think that's changed.
31:45That said,
31:46there are things that have changed.
31:50Shared decision making is much
31:52more common than it once was.
31:54I even think about decision making as
31:57similar to eating at a restaurant in a
31:59country where I don't speak the language.
32:02So imagine that I don't speak
32:04a word of French and Frances,
32:06like perhaps a particularly good
32:08example because they they won't probably
32:10try to explain anything to you,
32:12but if I go to that restaurant in France.
32:17I can just take whatever they give me,
32:20which is in my mind the paternalistic
32:22approach to cancer care.
32:24The doctor makes all the decisions.
32:27Alternatively I can I can say, well,
32:32give me whatever you would take yourself,
32:34which is perhaps a little bit better
32:39than than than some other situations.
32:41But if I say that it's not
32:44necessarily individualized for me,
32:46but what I really need is for the
32:49for the person serving me to say,
32:52what do you like to eat at home?
32:54And I'll fix your menu appropriately
32:58to work here.
33:00And in my mind,
33:02that's where that's shared decision
33:04making and it's matching my
33:06preferences with what's available
33:08and that has become ever more common.
33:11But that takes more time for clinicians
33:15and it in many ways can add more
33:18stress to the clinicians life.
33:21Patients are more knowledgeable
33:23than ever before.
33:24The Internet is both a wonderful and
33:26a hopelessly dangerous place to go.
33:28When you have cancer,
33:30particularly if you have a little
33:32knowledge and physicians and
33:35other clinicians.
33:36Have these new stresses in dealing
33:39with patients coming in with many,
33:41many questions,
33:42sometimes with questions that that
33:45they don't feel that they can answer,
33:48and this I think is one of the
33:50factors that has led to the
33:52concern about burnout burnout with
33:53doctors and nurses and others.
33:55But I think it's something that we've
33:57seen particularly in the oncology space,
34:00and it's worrisome.
34:01And we have to think about how
34:04we're going to get past this.
34:06I think one way is to make sure that
34:08we're working with teams of people and
34:11not trying to do everything ourselves.
34:14And then I just want to touch on
34:15very quickly on 2 themes that have
34:17been brought up and one is cost and
34:20one is health care, disparities.
34:22And of course, they're related.
34:24The cost issue is huge and it is
34:27just crazy what some of these new
34:31therapies and new procedures cost.
34:34And as Charlie was saying,
34:36it makes no sense to maximize
34:39reimbursement from a drug so that
34:42you can provide palliative care.
34:44There needs to be appropriate
34:47reimbursement for each and
34:50every one of these therapies.
34:53And finally.
34:54I think health care disparities
34:56is going to become the biggest
34:59challenge we face because as our
35:01therapies get better and better,
35:03it becomes more and more of a travesty
35:06that people can't get those therapies.
35:09And that's true around the world
35:11and it's true in New Haven,
35:13CT and it's something that that
35:16desperately needs to be addressed.
35:18So I think there's a lot that
35:20needs to change in the future,
35:22but I think that we can make progress
35:25if we keep remembering that the
35:28patient needs to be the center of
35:30clinical care the patient needs to
35:32be the center of research questions
35:35and at the same time we have to pay
35:37attention to the well being of those
35:39who are who are taking care of this patients.
35:42So with that I'll end.
35:45Alright,
35:46thank you and fine.
35:48We have two more speakers and next is
35:52Abby who has been briefly introduced,
35:54but I'm going to do a somewhat longer
35:56introduction because unlike the rest of us,
35:58you don't know her as well.
36:00I think so.
36:01Professor Glock is the Alfred M Rankin
36:04professor of law and founding faculty
36:07director of the Solomon Center for
36:09Health Law and Policy at Yale Law School.
36:12She's also a professor of
36:14internal medicine at our.
36:15Medical school and a professor
36:17in the Institution for social
36:19and Policy Studies at Yale.
36:21From November of 2020 to 2021,
36:24she served in the Biden administration
36:26as the lead lawyer for the White House.
36:28COVID-19 response.
36:29I would have been loved,
36:31loved to be there, watching her,
36:33that must have been incredible.
36:35But first for the Biden Harris
36:37transition and then in the White House,
36:39special counsel for the White House
36:41COVID-19 response and that capacity.
36:43Professor Gwac also served as a member
36:46of the White House Counsel's office,
36:48where she was additionally
36:49responsible for health care issues
36:51across the administration,
36:52including the Affordable Care Act.
36:54She's a member of the affiliated faculty
36:57of the Yale Program on Addiction Medicine,
37:00Executive Committee member of Yale's
37:02ISP S Health program and founded
37:05and directs the Yale Law School
37:07Medical Legal Partnership Program.
37:09She joined Yale Law School in 2020 if I
37:13remember from looking her up on Google.
37:15She also went to Yale College and and
37:18and was educated at Yale Law School.
37:23And before coming here was
37:26on the faculty at Columbia,
37:28so I'm I'm going to ask Abby to just
37:31sort of fill in some of the gaps in
37:35the in terms of the chapters that
37:37that we don't have representation for.
37:39And Abby, it's it's really a
37:41pleasure to meet you and to have
37:42you on the panel. Doctor
37:44Weiner, thank you and it's my pleasure,
37:46Richard, welcome you back and I look
37:49forward to many more collaborations.
37:52I I joined the law school in
37:542012 at Doctor Weiner is,
37:56I think juxtaposed the numbers.
37:57So I'm sorry. What did I say?
37:59I want everybody to think I was
38:00hanging around for the last year
38:02as an interloper when I wasn't
38:03actually part of the faculty.
38:04So I've been around for a decade.
38:07But I did just come back last month,
38:09and where I had the privilege of
38:11working with my wonderful friend
38:13and colleague Marcelo Nunez,
38:14Smith worked with all of you.
38:15As well and so thank you for
38:18the generous introduction.
38:19It's it's wonderful to be here.
38:21It is wonderful to be part of this
38:23project and to work with all of you.
38:24You might have heard me saying in the
38:26beginning that the Cancer Center and
38:28ysm in general is my favorite client.
38:29My favorite partner.
38:30I hope we have many more
38:32opportunities to collaborate,
38:33so please come find me if you
38:35ever need a lawyer for anything.
38:36We are here for you.
38:38Working with Charlie has been just a
38:40dream come true and I count my lucky
38:42stars every day to have made a friend
38:44in Charlie to have learn from Charlie.
38:46And part of this project.
38:47So thank you, Charlie for everything.
38:49So,
38:50as Eric noted,
38:51I am the cleanup batter before
38:52Greg and I am just gonna fill
38:54in from some of the chapters
38:55that we wanted to mention to you
38:57that haven't been talked about,
38:58but actually my wonderful Co authors
39:00did an incredible job hitting on a
39:02lot of the high points of the book,
39:04so I think I'll be able to be very
39:06brief 'cause I don't want to bore you.
39:08You know Charlie,
39:09emphasize this first that our approach,
39:12the title a new deal for cancer,
39:13is aimed to evoke an approach
39:15that is much more holistic.
39:16Adjust the science.
39:17The scientific advances in the last 50 years,
39:19so giving us the luxury of
39:21being able to think more broadly
39:23about these kinds of issues,
39:24like equity like financing,
39:26structure or like insurance
39:27and now is the time.
39:29And that is a role for lawyers and non
39:32scientists to play in this cancer space.
39:34Once you take a 360 degree approach,
39:37there's room for more people to
39:39be involved in the progress.
39:41So that's where our book comes in.
39:42And as I noted, a lot of you have
39:44already talked about this broader land,
39:46so I'll just head on a few.
39:47One thing I did when I hit
39:49on was health insurance.
39:50We have a great chapter from Robin.
39:51Yeah, brown at ASCO and the.
39:55Her chapter is about the fact that
39:57health insurance is a significant
39:59predictor of cancer outcomes,
40:01and you know,
40:02while the Affordable Care Act
40:03did a great job on this front,
40:05including eliminating copays for many
40:07kinds of preventative screenings,
40:08including getting more than 20
40:10million people newly insured,
40:11including on eliminating discrimination
40:13based on pre-existing conditions
40:15for more than 100 million Americans,
40:18we still have 12 states that
40:19haven't expanded Medicaid, right?
40:20And that is incredibly low
40:22hanging fruit for cancer progress
40:24that we have to do better on.
40:26The Biden plan has a plan to
40:28try to close that Medicaid gap,
40:30but it has to get through Congress
40:31and we really need to focus on
40:33that when we're thinking about
40:35disparities and things that we can
40:36do quickly in the name of progress.
40:38Second equity.
40:39I'm so glad my colleagues have
40:41already talked about equity.
40:43It's obviously incredibly important,
40:45just as universal health insurance wasn't
40:47front and center on the radar in 1971,
40:49and those conversations you know,
40:51surprisingly,
40:51equity wasn't either a well known
40:53report came out six months after
40:56the National Cancer Act passed.
40:58Highlighting egregious health
40:59disparities and obviously,
41:01COVID has shined a light on
41:02healthcare equity in a way it
41:04wasn't has ever been shined before,
41:06but that doesn't mean that it wasn't there.
41:07And of course it has been there
41:09in the cancer space all along,
41:10and I'm very,
41:11very proud that you know this
41:12project with the six years in the
41:14making was thinking about equity
41:15from the beginning and we have a
41:17couple of just fantastic chapters.
41:182 I want to highlight Otis Brawley,
41:21who had hoped to be here with us today,
41:23but it could not.
41:24What a wonderful chapter detailing
41:26disparity is not just across race.
41:28Put across genders, geography,
41:30and socioeconomics centers,
41:31he cites a statistic that 30% of
41:33Americans with college education
41:35have a lower death rate for cancer
41:37than those without an interesting
41:39fact that education such a predictor
41:41of cancer outcomes he knows
41:43connections to Melinda's chapter.
41:44The fact that cancers that we
41:46can prevent often hit low income
41:48populations and professions more
41:49than other professions,
41:51and he also points out a tragic
41:53irony of our progress,
41:54which is that take this example
41:56he offers which that in 1975.
41:58Black and white Americans had
42:00relatively equal death rates from
42:02breast and colorectal cancer,
42:03and why disparities have emerged
42:05and not been remedy.
42:06And he points out that this is almost
42:08a failure of our progress because
42:10advances in screening diagnostics
42:12and treatment haven't been made
42:14available to everybody equally.
42:15In a companion chapter by Blaise
42:17Polite and Lindsey Wiley,
42:18they talk about efforts in certain
42:20governments to actually address
42:22those very kinds of disparities.
42:23NYC and Delaware both had experiments and
42:27colorectal cancer aimed at increasing.
42:29Access to screening in a very aggressive way.
42:32Both of those cities states were
42:34able to close the gap in screening
42:37across race and in Delaware.
42:39They were actually able to close
42:40the gap and incidents,
42:41which is quite remarkable and
42:43shows what governments can do
42:44when they put their mind to it.
42:453rd Congress.
42:46My own chapter with Rosa De Lauro,
42:49our own congresswoman here in Connecticut.
42:51I've great supporter of the cancer space,
42:53so Doctor Reiner will no doubt get a lot of
42:56time with on his role details.
42:58We detail the role that
43:00Congress has in this space.
43:02Funding is obviously huge as a weapon,
43:04but also as a signifier of what's important.
43:06So I'm obsessed with the statistic
43:08that the entire budget of the
43:11CDC is basically the same.
43:13As NCIS budget for cancer therapeutics,
43:15but that includes everything the CDC does,
43:18COVID prevention, non cancer stuff.
43:20The cancer pieces $300 million
43:22of the $7 billion budget right?
43:24So that's a signal of how unimportant
43:27Congress thinks prevention is.
43:29It's also a signal how hard
43:30it is in the matter of budget
43:32scoring to enact prevention bills.
43:33I can talk about that more
43:35people are interested,
43:35but it's the way Congress scores
43:37bills or the matter of the budget.
43:39D incentivizes investments in prevention
43:41in ways that are very unhelpful.
43:44Congress also has a role to play
43:47in speeding innovation in areas
43:49of R&D where there are many
43:51market failures like rare cancers,
43:52pediatric cancers.
43:53We have several chapters on that,
43:56and just as Charlie mentioned,
43:58as cancers become more individualized
43:59as we start to think of more cancers,
44:02the population for each of those cancers
44:04is going to get to be fewer and fewer,
44:05and we're going to have to find a way to
44:07compensate for market failures or in drugs,
44:09or only go to effect a small amount of
44:12the population and not be as lucrative.
44:16Charles Sawyer chapter as Charlie mentioned,
44:18talks about need for hippo reform and the
44:21data privacy space to facilitate sharing
44:23of genomic data so we can actually make
44:25progress in the data that we collect.
44:27And finally economics.
44:28My colleagues have already talked about this,
44:30so I'll just briefly wind up with it
44:32to say that you know, the book talks
44:34about the landscape of cancer care,
44:36the shuttering of individual practices,
44:38the role that community hospitals
44:39play as both a local Cancer Center,
44:41but a network to a larger big
44:44cancer hospital like Yale.
44:45Some extra interventions are needed
44:47and Ed Vance is absolutely terrific
44:50chapter on cross subsidization in
44:52cancer care as both Doctor Weiner and
44:55Charlie both mentioned this idea that
44:57we subsidized research second opinions.
44:59Palliative care social supports with high
45:03priced therapeutics and diagnostics.
45:05And if Congress is going to insist
45:07on cutting drug prices, as it must,
45:09it absolutely has to be aware of these
45:11connections across the whole cancer space.
45:13We're going to have unintended
45:15ripple effects.
45:16That are going to hurt those least
45:18fortunate and connecting all the
45:19dots this way is exactly what we
45:21hope to do with the book,
45:23and it's been just a privilege
45:24to be part of it.
45:25So with that,
45:25let me just say thanks to Charlie.
45:27Again,
45:27express my enduring affection and
45:29to 2nd his thanks to Eugene Rusyn,
45:31who's just been a phenomenal
45:32support on the book.
45:33OK,
45:34all right back to
45:35you. Thanks thanks thanks that was great.
45:40So our last speaker is Greg Simon
45:43and he has held senior positions in
45:45both Chambers of Congress served in
45:482 presidential administrations was
45:50a senior strategy consultant to a
45:52variety of international technology
45:54CEOs co-founded with Michael Milliken
45:56and LED Fastercures co-founded and LED
45:59the Melanoma Melanoma Research Alliance
46:01and was the senior vice president,
46:04advisor for worldwide policy and
46:06patient engagement and the CEO Holy
46:09Wauka Financial Services company.
46:11Creating unique capital market
46:13opportunities and and and indices
46:15in healthcare and life sciences,
46:17he's developed a reputation as
46:20a visionary strategist.
46:21A dynamic public speaker and writer,
46:24and as an expert analyst of
46:26emerging trends in healthcare
46:28information technology technology,
46:30innovative drug research and
46:32development and patient advocacy
46:34most recently and importantly,
46:36Greg was the President of the
46:38Biden Cancer Initiative and
46:39served as the executive director.
46:41Of the White House cancer Munshaw taskforce,
46:44Greg. Black, glad to have you here thanks.
46:47Thanks for joining us.
46:51Thank you so much, Eric.
46:52And thank you Abby for asking me
46:55to do this many years ago now.
46:59It's a it's a real pleasure.
47:03I want to talk just briefly
47:04about the chapter in the book,
47:06and I've been asked to talk more about
47:08what's coming potentially in the
47:10cancer moonshots recently announced.
47:13The take away from what we did in the
47:15cancer Moon shot may surprise you,
47:17but I think we got more done in
47:19nine months than many people
47:21expected because we weren't doing
47:23it all inside the government.
47:25The reason we were able to get so much done,
47:27in my opinion, is because of the
47:31patient communities engagement.
47:32If you I don't know if I can share my screen.
47:34Am I able to share my screen?
47:37Let me try if you wonder why it's
47:39difficult to track in the government.
47:41Let me give you an example.
47:44Nope, didn't come up. Never mind,
47:46I'll do it later if you want to have
47:48a good time go to the NCI website,
47:50look on the implementation of
47:52the Moon shot link and you will
47:55find the most overwhelming chart.
47:58Of dots and arrows and squiggly
48:00lines that you will ever see.
48:02I have no idea how well the NCI did
48:04in implementing the original cancer.
48:07Mention it is a little hard to tell
48:10if this is new or if this is just
48:13moving the boxes from traditional
48:15R 01 grants and relabeling them.
48:18Cancer Moon shot grants.
48:19That is the first challenge for the
48:22current moon shot is what did the
48:24government actually get done in a
48:26number of these technical programs?
48:28Overseen by literally 100 subcommittees,
48:32that's the first challenge.
48:34How well did we actually do in
48:36the government?
48:37Because I can tell you from the
48:39standpoint of the patient community
48:40whether it's financial toxicity,
48:42caregiver support, transportation,
48:44and help with the day-to-day
48:46expenses of being treated for cancer.
48:48All of those things were bubbled
48:50up from the patient community.
48:53Those efforts,
48:53including the first Cancer Center on an
48:56Indian Reservation and make the Navajo.
48:59Nation Cancer Center staffed by an
49:03oncologist couple from here in Maryland,
49:06those efforts that were that
49:09were engaged in cooperation,
49:11collaboration with the local
49:13communities where the greatest success
49:16stories of the Cancer Moon shot.
49:18And yes, we got $1.8 billion.
49:20And yes,
49:21there were 100 subcommittees at the NCI.
49:24And yes,
49:24the VA and the DOE all had wonderful
49:27programs that they did implement.
49:29But progress is never over and
49:33progress is never permanent.
49:35There is a real challenge today
49:37to move all of this forward.
49:39So where is the next moon shot going?
49:41Well,
49:42I have to say if you're talking
49:44to the patient communities,
49:45you get a very different story than if
49:48you're talking to the cancer community.
49:50The traditional institutional
49:52cancer community asks one question,
49:55where's the money?
49:57That's the least important
49:59question in the future of cancer.
50:01It is not.
50:02Where's the money, it's where's the ideas.
50:04And where are the people?
50:06And I'd like to make a bold
50:08prediction about this.
50:09I have been working for the last year,
50:11focused on AI based drug discovery
50:13companies in the economy,
50:15and trying to bring some of them public.
50:17I think we will have more progress
50:20in cancer treatment and outcomes
50:22from private entrepreneurial
50:24startups then we will from NCI
50:27investment over the next 10 years.
50:29You can come back in 10
50:31years if I'm still here.
50:32God willing and tell me I was wrong,
50:35but from what I see the questions
50:38that need to be asked the
50:39barriers that need to be broken,
50:41the inequities that need to be
50:43destroyed are happening faster in
50:45the private sector and the public.
50:48And as a public servant for
50:49many of my years on this planet,
50:51and someone who believes deeply in
50:53public service that is troubling to me.
50:55So what should we do?
50:56Well, Biden starting off on the right foot,
50:59we we can reduce age adjusted death rate.
51:02That's the critical phrase I
51:05have leukemia since I was 64.
51:07If I'd had leukemia 20 years earlier,
51:09I wouldn't be here.
51:10So I've had a whole decade almost of
51:13bonus years from what I would have had
51:16if we hadn't developed the first FDA
51:19breakthrough accelerated drug in Brewton,
51:21which I've been on for two years,
51:23and I I picked it.
51:24And I say this with great
51:26humor because he's a friend.
51:27I'd made a decision a long time
51:29ago to always take the other
51:31side of the argument from Zeke.
51:32Emanuel, I don't think we need to
51:35put 75 year olds on an ice floe,
51:37and I don't think that just the
51:39price of the drugs is the problem.
51:41The problem is who pays it,
51:43and I was very happy to see in several
51:45chapters we need to take Co pay burdens
51:47off of patients for cancer treatments
51:49and other treatments that require
51:51you to be on a drug to save your life.
51:54We need to take the price of the
51:56drug outside of the people who can
51:58afford to pay and charging more
52:00for the people who can't afford
52:02to pay and reverse that scenario.
52:05And in terms of how we're going to do that
52:09and how the cancer Moon shot can do that.
52:11This is not necessarily a
52:13government solution I think,
52:14and I have been working on for many years,
52:16but private solution,
52:17you know,
52:18we spend $21 billion a year on migraines.
52:22That's the same amount we spend on wheat.
52:25There is a massive futures market
52:28and derivative market for wheat
52:30that stabilizes prices that
52:32keeps bread from costing $10.
52:34A loaf that keeps farmers from
52:35going out of business when there's
52:37a bad year or too good of a year.
52:39We don't have that in healthcare,
52:41but we will soon and I'm hoping
52:43that we'll we'll see an immediate
52:45change in the problems that drive
52:48prices higher and higher and higher.
52:50Now the RPH program,
52:52which has been much ballyhooed
52:54by people like me for 10 years.
52:57Is in grave danger because we have
52:59nobody who is currently leading the charge.
53:01The tragic resignation of Eric
53:03Lander after a series of bad
53:05incidents has left the movement in
53:07the White House somewhat leaderless,
53:09and I'm hoping that the Congress
53:11will take the reins,
53:12put it independently of the United H,
53:15and give it the mandate we
53:16all want it to have.
53:17Do wonderful hard things,
53:18and if you fail, it's OK.
53:21Don't do anything anybody else would do.
53:24That's the mission for a DARPA like agency.
53:27And as far as the moon shot goes,
53:29although everybody thought Eric
53:30Lander was going to run it,
53:31it's really always going to have
53:33been run by Daniel Carnival.
53:35My deputy in the first man shot
53:37and the challenge for the current
53:39moon shot is how do we get people
53:41to stop talking about money and
53:42what's going to go into the cancer
53:44centers and the NCI and start talking
53:46about how are we going to engage with
53:49the innovators in the private sector
53:51and the patient groups who are being
53:54very innovative today to build a new?
53:57Institution for Cancer Research
53:59that encompasses all of society,
54:01not just the campus here in Bethesda,
54:04that to me is the biggest challenge.
54:06It is time to rethink our institutions.
54:09We have had them the same way
54:12since Vannevar Bush's contract,
54:13and that is not right.
54:15It is time to rejuvenate to to redecorate
54:19and to bring younger people in.
54:22And it might as well say it.
54:24I wish we would give it an early
54:26out to everybody at NIH and NCI.
54:28Who's over the age of 70.
54:30It is time to bring the next
54:32generation into the building,
54:33but they can't get there for all
54:35the seats are taken so I know
54:37I've sort of expanded my time
54:39and maybe expanded my license,
54:41but I've I work with this everyday.
54:44One last point I found out yesterday
54:46two different people I know have cancer.
54:48One of them found out from a text.
54:52That was sent by an AI engine
54:54because his medical report showed
54:57he had metastatic colon cancer.
54:59He's a cancer doctor.
55:01He was shocked that he could
55:03get a text without a human being
55:05attached to it to tell him that.
55:07Another young woman in her 30s was diagnosed
55:11with CLL during a breast cancer exam.
55:13They didn't give her any
55:15information about what happens next.
55:17She called me and I had to do.
55:20Both of these are wrong.
55:21Both of these have to be fixed.
55:23We have got to provide people
55:25and environment to deal with the
55:27cancer diagnosis that does not put
55:29them on the on the on the spot
55:32to do everything themselves.
55:33Whether you're a cancer doctor
55:35or a mother in their 30s,
55:37we must do a better job.
55:39And in 2022 I would have hoped
55:41we would have done it by now.
55:43But with your help and all the people
55:45on who wrote chapters in the book,
55:46we can get there.
55:48But we have to be very honest
55:50about what the problems are today.
55:52Thank you.
55:56Thanks, thanks very much Greg.
56:00I think we might have time for one
56:03or two questions Max, so I guess
56:06I'm supposed to look in the chat,
56:09but I don't know that I see any Renee.
56:13There was one question Eric, about.
56:16Their fear about moving too fast on
56:18cancer progress because it will feel
56:20politicized like the COVID vaccine.
56:21I don't know if Greg you want
56:23to take that or somebody else.
56:24I already already responded to that
56:26text in the chat and said no and no.
56:29I don't think the public is
56:30generally aware of the time it
56:32takes to develop new cancer cures.
56:34And when things happen fast in cancer,
56:36it's still slow in the real world
56:39in terms of politicizing cancer,
56:42all I can tell you is that we
56:44helped during the cancer Moon shot.
56:46People ask for our help from
56:48both sides of the hill from both
56:50sides of the political parties.
56:52I have never in all my speeches
56:55where I'm pretty obviously
56:56my politics are pretty clear.
56:59I have never had anybody accused me
57:01of having a democratic view of cancer,
57:03so I think this is 1 Safe Harbor
57:07that we can all work on together.
57:10Yeah, I don't think people would accuse you
57:13of not being clear about your thoughts.
57:15We appreciate it. You know,
57:18I think that the the theme of disparities
57:21has come up over and over again.
57:23I think it's really an important take
57:26away from this and I'm just going to
57:28reiterate what I what I said before.
57:30I think that both in terms of clinical
57:33care and in terms of research,
57:35if you put the patient in the center and and
57:38reformulate everything around that concept,
57:42I think we would.
57:43We would do ever so much better.
57:46In terms of clinical care, Greg,
57:47you brought that up and you did.
57:49In terms of research as well,
57:51it's it's really key.
57:54I devoted the epilogue of my chapter
57:56in the book to exactly this point, and.
57:59I don't think as a liberal from the
58:0360s I thought we had made a lot
58:06more progress than we had in racial
58:08and equity and as a cancer patient,
58:11and I realize how fortunate I have been.
58:13I really understand now how
58:15little progress we've made.
58:17It is the most important thing we can do.
58:20One small example, the head of the
58:22national Minority Quality Forum,
58:23was told by CMS that he could not
58:26have access to all the Medicare
58:28data like other people can.
58:29Only 20% of it and he told them
58:32I can't do a study of racial
58:35inequities on 20% of Medicare.
58:37It won't show up because
58:39it's so small in that sample.
58:41So my friends and I raced into
58:43action to give him access to all
58:46of the Medicare data other ways,
58:48but this is an example of unthinking
58:51discrimination of unintended discrimination
58:53that has the effect of discrimination.
58:57Thanks Charlie, I just wanna give
58:59you a chance to sort of wrap up.
59:02Eric, I really appreciate you giving
59:05us the opportunity to share the
59:07book and thanks to the authors.
59:09I mean frankly, hearing from me should
59:12view is really inspiring and I frankly
59:14really appreciate the opportunity to
59:17reconnect with all my friends and
59:19colleagues at at Yale and Smilow several,
59:22or have been texting me during the session.
59:25I've been paying close attention, by the way,
59:27but it's still great to connect and Eric,
59:30I just want to say how fortunate.
59:32Yeah, and smile OR to have you as a leader.
59:36So looking forward to great things
59:38from you and all the amazing
59:41people at the institutions.
59:43We all just do our best well listen,
59:46thank you all.
59:48It was really great today.
59:50I think this was again as
59:51I said in the beginning,
59:52something a little different
59:53and I hope people enjoyed it.
59:55And thanks to the audience
59:57for spending the time with us.
59:59Bye bye.
01:00:05Eric, thanks so.