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Welcome to Onco Daily, your go-to podcast for the latest in oncology news, research breakthroughs, and expert insights.
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Let's dive into today's episode.
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When I s think about global health, you are one of the first people come to my mind.
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Why you think is that?
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We've known each other for a very long time.
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Back when we first met in Armenia, um there weren't that many people doing global oncology, right?
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I mean, really, it was not a career pathway in the US, that's for sure, back when we first met.
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I think we both had global interests.
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We wanted to make cancer more effitable around the world.
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So we bomb it early on over a common cause, and we didn't have as many people working on it at that point in time.
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Do you agree?
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I think so, but also I think because you are one of the people in the field who is so open to help and support, genuinely.
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When I mean in general, in our field, there are many people, and it's kind of it's good to have this cooperation with many.
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But whenever I ask you anything You often even don't let me to finish, and you are already doing that.
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And I think many, many people around the world ex have this experience with you.
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Well, I am currently in a position where I can use my current title to influence a lot of people and to open doors.
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I can really open doors, and that's a privilege that I have, and I recognize it.
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And I need to use that privilege widely because it can really make a difference.
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Some of the introductions that I make, it is amazing to see where they go.
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It is indeed a privilege to have this job and to be in that position where I know so many people and I can connect to people to do better for our patients.
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Thank you.
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Thank you for all what you're doing.
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I want to go back from your early childhood.
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Please can you tell us how everything started?
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About your family, about your childhood, why did you choose medicine?
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Why did you choose oncology?
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I um am the daughter of a Navy test pilot and a nurse, my parents.
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I moved I've lived all around the US, any place you could get an aircraft carrier into.
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So I've looked up and down both coasts.
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And I'm the oldest child and got good grades and was a good student.
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And when people asked me when I was a little girl, what do you want to be when you grow up?
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I, when I was five years old, said, I either want to be a princess or an actress or a teacher, because her teachers are so influential at that age, right?
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And I continued to do well in school.
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Um, and then I got to be doctor or lawyer.
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That's kind of then that that comes up when you're when you're getting good grades.
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And um I was much more interested in the medicine side of things, with my mother being a nurse and and some other relatives that were in medicine.
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So I went that direction.
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But ultimately, I became a teacher, right?
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Uh professor emeritus now um at the University of Washington.
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The most important emeritus.
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Mentors.
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Oh, and mentorship.
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Okay.
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Well.
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And I'm I I mean, honestly, you also mentored me uh in a lot of things.
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But sorry to I would not have thought of that as a formal mentorship.
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But in some ways, you know, the I've I've learned a little bit the acting role because I'm being interviewed all the time.
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And then um, as we've seen time and time again, I get to interact with first ladies and princesses and all so who are very influential in their own way.
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So in a sense, I've achieved some combination uh of all those things I said I wanted when I was five years old.
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This point in my life, I'm I'm moving for the mentorship and the sponsorship and you know, generating those who will follow and lead and do all kinds of amazing things that I can't even imagine at this point in time.
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What keeps you up in the night?
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Inequality, the gaps.
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We know so much about how we can reduce the incidence and detect cancer early and treat cancer when it's formed and make life better, even if living with cancer.
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And most of the world is not accessing that.
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Unfairness, that inequity is very sad.
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We know we have so much available to a certain subset of the world, and most of the world doesn't have access to this.
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I mean, we could save hundreds of thousands of lives tomorrow if we could just implement what we already know.
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And I do recognize that patients who have access to everything are still dying of cancer.
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We need more research, absolutely.
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And we need to continue that because we're not preventing or curing all cancers.
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But it's the inequity, and that's what gives me the passion to do global oncology is to go out and to try to warp with others around the world.
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And how are we going to get access for everyone, no matter where they live, to prevention and early detection and treatment and survivorship and palliative care?
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I mean, if you are the decision maker for everyone and you can like make the change, what are the top things you you would change to make the world a more equal place or with less inequalities, I would say?
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If you have all the resources you think they're available right now, practically how you would make the world a place with less inequalities?
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Big level, and talking broader than just cancer and rather than just health care.
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I strongly believe that if we all traveled a bit more, reached out, met our neighbors in other countries, understood that for 99 plus percent of the world, we want the same base of things for our children and ourselves, right?
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We want health, we want education, we want food and shelter, right?
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I mean, 99 plus percent of the world wants the same thing and are good people.
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So I first I really think it's important that we meet people from other cultures and contexts and countries, et cetera, so that we can work together and not just be, I want it for me, I want it for my own country, I want it for my own family, that we will work together to find a solution.
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I think within cancer, I think even within a lower middle resource country, there are clearly the haves and the have-nots.
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I mean, I go to countries all over the world where the universal health coverage, you know, but it doesn't cover most things.
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And that's what the average patient gets.
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And yet they'll have a state-of-the-art, amazing cancer center in the main city that the wealthy can come to and get it.
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So it's not that you can't give that level of care in these countries.
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It's just that it costs too much.
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So we have to figure out ways of being able to deliver more broadly.
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We've already, if you've got that high-level, you know, state-of-the-art facility in the country, they know how to do it.
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And so we just have to figure out how to be able to spread it.
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Is it capacity building, that we train more people how to do it?
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Some of it's infrastructure, right?
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You need the building, some of it's the equipment, a lot of it's not the equipment.
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And then I think we can maximize the drugs.
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I'm an oncologist or a pediatric oncologist.
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If we could get all the drugs on the WHO's essential medicine list available to everybody, we would make a huge dent.
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And then we can start figuring out how to do the genomic profiling and testing and then getting the drugs that go along with that.
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I mean, we do need to add that piece of it to get the best results.
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And that's where we're going right now.
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But in many places, we don't even have the basics.
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We don't even have the generics and the biosimilars that are on the WHO's essential medicine list.
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And so that would be a goal would be let's get the basics and not let's not shoot too high.
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Let's get an infrastructure down, let's get it working, let's make sure that a patient who comes in with a symptom that could be cancer is referred appropriately, is diagnosed in a timely manner, is not just sent back home or lost to the system because the appointment's three months from now.
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You know, it's not just about the cost of the drugs, it's also about that health system's infrastructure.
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If you lose a patient who comes in with a breast mask because you're told, oh, a 35-year-old woman doesn't get breast cancer, you know, and you just send her out and you don't do any follow-up.
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And then she comes back with a locally advanced breast cancer a year or two later, you you you've done a lot of harm.
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We need the system in place to get referred in the system, get the diagnosis, positive or negative for cancer, you know, move along into surgery, radiation, treat chemo, whatever the treatment would be.
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And we're creating a lot of awareness.
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I've worked, as you know, with a lot of patient advocates around the world who are very inspirational, very vocal, willing to say I've had cancer and, you know, with the stigma in a lot of countries.
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But you can't just generate awareness.
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You have to have a system that if a woman therefore hears and is encouraged and says, I have a little breast slump, you know, that she can get through the system and get it found early before it's it's too late or much less curable.
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Is there one story?
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I mean, I'm sure there are many, but one story which stays you with you always, I mean, from the from your clinical work, I have a lot of stories for my clinical work, and I I love that I still get occasional emails with pictures of the child who's just graduated from college, and when I met the patient, he was just graduating from kindergarten, and you know, I I love all that.
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I just got one of those this week.
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Here's an interesting on a global scale story that I didn't even know about.
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And this gets to, you know, just talking and being open and traveling.
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I was invited exactly 10 years ago to give a talk in Lagos, Nigeria at a second girls' secondary school.
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Um, the first lady of Ando State was someone I knew from breast cancer work, and one of the alumni from the secondary girls' school was um had died of breast cancer.
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So the alumni at the school and the girls, and it was World Cancer Day.
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So I got invited on World Cancer Day to come and give a talk about breast health to the girls.
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Talk to your mother about this, to the alumni.
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They were doing it in honor, their colleague who had died.
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And so I went, it's my first trip to Nigeria, you know, and seriously, a month or two ago, I got an email from somebody who I am about to meet next week at the World Cancer Congress in Hong Kong.
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She told me that she had just been diagnosed with breast cancer and really didn't, was afraid of treatment, didn't want surgery, was burying her head in the sand.
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But she had a friend who kind of dragged her along to hear my talk in at the girls' school.
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And she said, she asked me a question at the end of my talk and said, Do all women with breast cancer need a masteptomy?
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And she said, my reply was, no, it depends.
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It depends on the cancer, it depends on the patient.
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Talk to your talk to your doctor about it.
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No, it's not inevitable.
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And she said that that answer prompted her to get treated.
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And now she has formed an NGO in Nigeria that is doing breast cancer and general cancer awareness and work.
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And she apparently, and I read it, wrote a chapter in a book she published about that whole interaction.
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And that that kind of I didn't even know for 10 years that I had had that impact.
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But look at not only did she get treatment based on just getting access to somebody who would answer her and say, no, we don't treat it all the same.
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You know, talk to your doctor.
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That not only led her to get treated, she formed a nonprofit now that is educating other patients about this.
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So that obviously makes me very happy.
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And we're going to meet again for the first time since 10 years ago when we're together at the World Cancer Congress because her NGO is a member of the Union for International Cancer Control.
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Beautiful.
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Beautiful.
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Julie, what do you think?
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What's the next frontier in oncology globally?
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Wow.
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I mean, things are really moving fast.
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You know, I trained in an era when we had one or two chemo drugs.
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We didn't even have endocrine therapy for breast cancer, really, at the time, and then watch this whole evolution of oncology as a specialty drugs that worked, you know, all of that.
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Um, with this whole the genomics and the precision oncology and the understanding of what's driving each individual cancer.
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Now we're not just treating lung cancer as lung cancer, right?
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Or even just non-smell as, you know, we are looking at the genomic profile.
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We're learning also at the same time the whole immune system and the immunology and how we can use our own immune system.
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So we've got immunotherapy, we've got the precision diagnostics paired with drugs.
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I mean, but just think about there are dozens of drugs that were approved last year in oncology, in the United States, in precision medicine.
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We can't keep up with that anymore, right?
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How can anyone doctor, even if you're a specialist in lung cancer, keep up with all the mutations?
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You need to look at like at least 12 that right now have different drugs approved.
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And then if you don't have one of those mutations, you've got all that immunotherapy that you could do.
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So I do think what I'm getting at is we're going to need help from AI.
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We are going to need to incorporate artificial intelligence as a partner, not as a substitute, in keeping up with all of this.
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And so it's all intertwined.
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We can't, we're moving so fast right now in new targets, new drugs that are being approved, new regimens that we need help from AI in basically keeping up.
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At ASCO, our systematic literature reviews of the future are going to be every eight weeks.
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AI will be running in the background.
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It'll be looking for publications and drug approvals that happened in the last eight weeks.
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A human panel will look at what AI spits out and says, does our guideline need updating?
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And we'll be able to do it pretty instantaneously.
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Just keep it on the website, not publish it each time.
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And we can actively do it.
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We're going to need to keep up like that because more and more every cancer is individual, if you really look hard enough.
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And so it's a combination of better understanding the cancer, better understanding our own body and our own immune system tied to AI helping us understand the unique profile of the cancer and the patient.
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Julie, what's the best movie recently you watched?
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So a movie I watched on a plane recently.
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I take a lot of long plane rise, as you know, as do you, um, was Project Hail Mary.
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I thought it was very interesting, and it was taking a look at the future and AI, and um it was entertaining, but it was also thought-provoking.
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So uh I would recommend that.
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It's a great movie for a plane.
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Any book you would recommend to read?
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So a book I'm reading right now at the recommendation of one of our board members is The Great American Drug Deal, a book by Peter Kolczynski, uh, which addresses why prescription drug prices, especially for new drugs, uh are so high in the United States.
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Because it was basically in response to Draxon RASIP, the RAS inhibitor that was the ASCO plenary, you know, the RAS inhibitor for pancreatic cancer with a standing ovation and all.
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And then it came out with a price of$40,000 a month.
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So, but in response to this, I'm really trying to understand how we price drugs and what the issue is.
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And this book is very interesting because I'm only about a quarter of the way through it because I started on the plane on the way here.
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But it's basically showing how the American healthcare system's payment system is a big part of the problem for why the drug is so high.
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Because if you you can argue about what price you really want, but let's say you wanted$25,000, and that's what you wanted to price it at, because of our pharmacy benefit manufacturers that get rebates from companies because of discounting that is mandated by the government, the 340B discounting and other things that that industry has to give if you if you qualify, that whole um, you know, inflation reduction, all of these things mean that if you what you really want for your drug is$25,000, which you can argue that's way too high anyway, but you have to price it at$40,000 because of the way our system is so non-transparent and with rebates and discounts and all of this that are mandated.
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And that is only relevant to the US, but it impacts the whole rest of the world then, right?
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Because even if each individual government could negotiate the price of the drug, it's really hard to negotiate way down on what that price is.
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So it is very interesting to me that it's a very complex answer to why are these drugs so high?
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And it's not just because industry wants the money back for having developed the drug and then more money to put into it and you know, all that.
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It is the American healthcare system payment system is contributing to that in a way that the rest of the world doesn't see it and it's not transparent.
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Aaron Powell Thank you very much, Julie.
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One one last question.
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And I think I asked during our f first interview, but I'm gonna ask again who I should interview next.
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I think you should interview Dr.
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Susa Blumenthal, who has been at this conference with us and is amazing and very impressive and has done a lot, worked with four different presidents, and is still working hard and has done amazing things and continues to do so.
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She's a fascinating woman for you to interview.
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Thank you so much, Julie.
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Yeah.
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If you enjoyed this episode, please subscribe to our podcast and leave us a review.
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Don't forget to follow us on social media for more updates and join the conversation using hashtag oncodaily.
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Until next time, stay informed and stay strong in the fight against cancer.
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Thank you for listening.
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Welcome to Onco Daily, your go-to podcast for the latest in oncology news, research breakthroughs, and expert insights.
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Let's dive into today's episode.
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When I s think about global health, you are one of the first people come to my mind.
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Why you think is that?
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We've known each other for a very long time.
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Back when we first met in Armenia, um there weren't that many people doing global oncology, right?
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I mean, really, it was not a career pathway in the US, that's for sure, back when we first met.
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I think we both had global interests.
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We wanted to make cancer more effitable around the world.
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So we bomb it early on over a common cause, and we didn't have as many people working on it at that point in time.
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Do you agree?
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I think so, but also I think because you are one of the people in the field who is so open to help and support, genuinely.
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When I mean in general, in our field, there are many people, and it's kind of it's good to have this cooperation with many.
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But whenever I ask you anything You often even don't let me to finish, and you are already doing that.
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And I think many, many people around the world ex have this experience with you.
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Well, I am currently in a position where I can use my current title to influence a lot of people and to open doors.
00:01:37.439 --> 00:01:43.120
I can really open doors, and that's a privilege that I have, and I recognize it.
00:01:43.439 --> 00:01:49.599
And I need to use that privilege widely because it can really make a difference.
00:01:49.760 --> 00:01:54.079
Some of the introductions that I make, it is amazing to see where they go.
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It is indeed a privilege to have this job and to be in that position where I know so many people and I can connect to people to do better for our patients.
00:02:03.519 --> 00:02:04.319
Thank you.
00:02:04.560 --> 00:02:06.400
Thank you for all what you're doing.
00:02:06.640 --> 00:02:10.240
I want to go back from your early childhood.
00:02:11.120 --> 00:02:14.639
Please can you tell us how everything started?
00:02:14.800 --> 00:02:19.280
About your family, about your childhood, why did you choose medicine?
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Why did you choose oncology?
00:02:23.120 --> 00:02:30.319
I um am the daughter of a Navy test pilot and a nurse, my parents.
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I moved I've lived all around the US, any place you could get an aircraft carrier into.
00:02:35.680 --> 00:02:37.919
So I've looked up and down both coasts.
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And I'm the oldest child and got good grades and was a good student.
00:02:43.199 --> 00:02:48.879
And when people asked me when I was a little girl, what do you want to be when you grow up?
00:02:49.199 --> 00:03:01.120
I, when I was five years old, said, I either want to be a princess or an actress or a teacher, because her teachers are so influential at that age, right?
00:03:01.360 --> 00:03:03.680
And I continued to do well in school.
00:03:03.919 --> 00:03:07.120
Um, and then I got to be doctor or lawyer.
00:03:07.199 --> 00:03:11.199
That's kind of then that that comes up when you're when you're getting good grades.
00:03:11.520 --> 00:03:20.800
And um I was much more interested in the medicine side of things, with my mother being a nurse and and some other relatives that were in medicine.
00:03:20.879 --> 00:03:22.159
So I went that direction.
00:03:22.319 --> 00:03:25.439
But ultimately, I became a teacher, right?
00:03:25.599 --> 00:03:30.080
Uh professor emeritus now um at the University of Washington.
00:03:30.639 --> 00:03:31.840
The most important emeritus.
00:03:32.319 --> 00:03:32.879
Mentors.
00:03:33.199 --> 00:03:34.479
Oh, and mentorship.
00:03:34.639 --> 00:03:34.960
Okay.
00:03:35.039 --> 00:03:35.199
Well.
00:03:35.520 --> 00:03:39.759
And I'm I I mean, honestly, you also mentored me uh in a lot of things.
00:03:40.000 --> 00:03:44.240
But sorry to I would not have thought of that as a formal mentorship.
00:03:44.479 --> 00:03:53.039
But in some ways, you know, the I've I've learned a little bit the acting role because I'm being interviewed all the time.
00:03:53.280 --> 00:04:04.560
And then um, as we've seen time and time again, I get to interact with first ladies and princesses and all so who are very influential in their own way.
00:04:04.800 --> 00:04:11.919
So in a sense, I've achieved some combination uh of all those things I said I wanted when I was five years old.
00:04:12.159 --> 00:04:25.360
This point in my life, I'm I'm moving for the mentorship and the sponsorship and you know, generating those who will follow and lead and do all kinds of amazing things that I can't even imagine at this point in time.
00:04:25.839 --> 00:04:27.199
What keeps you up in the night?
00:04:27.680 --> 00:04:29.759
Inequality, the gaps.
00:04:30.000 --> 00:04:44.319
We know so much about how we can reduce the incidence and detect cancer early and treat cancer when it's formed and make life better, even if living with cancer.
00:04:44.720 --> 00:04:47.600
And most of the world is not accessing that.
00:04:47.920 --> 00:04:50.879
Unfairness, that inequity is very sad.
00:04:51.199 --> 00:04:59.360
We know we have so much available to a certain subset of the world, and most of the world doesn't have access to this.
00:04:59.439 --> 00:05:04.240
I mean, we could save hundreds of thousands of lives tomorrow if we could just implement what we already know.
00:05:04.480 --> 00:05:09.439
And I do recognize that patients who have access to everything are still dying of cancer.
00:05:09.600 --> 00:05:12.240
We need more research, absolutely.
00:05:12.959 --> 00:05:18.720
And we need to continue that because we're not preventing or curing all cancers.
00:05:18.879 --> 00:05:29.519
But it's the inequity, and that's what gives me the passion to do global oncology is to go out and to try to warp with others around the world.
00:05:29.600 --> 00:05:39.600
And how are we going to get access for everyone, no matter where they live, to prevention and early detection and treatment and survivorship and palliative care?
00:05:40.079 --> 00:05:53.680
I mean, if you are the decision maker for everyone and you can like make the change, what are the top things you you would change to make the world a more equal place or with less inequalities, I would say?
00:05:53.920 --> 00:06:04.639
If you have all the resources you think they're available right now, practically how you would make the world a place with less inequalities?
00:06:05.120 --> 00:06:10.399
Big level, and talking broader than just cancer and rather than just health care.
00:06:11.040 --> 00:06:29.920
I strongly believe that if we all traveled a bit more, reached out, met our neighbors in other countries, understood that for 99 plus percent of the world, we want the same base of things for our children and ourselves, right?
00:06:30.160 --> 00:06:35.839
We want health, we want education, we want food and shelter, right?
00:06:36.079 --> 00:06:43.040
I mean, 99 plus percent of the world wants the same thing and are good people.
00:06:43.360 --> 00:07:03.759
So I first I really think it's important that we meet people from other cultures and contexts and countries, et cetera, so that we can work together and not just be, I want it for me, I want it for my own country, I want it for my own family, that we will work together to find a solution.
00:07:04.079 --> 00:07:15.040
I think within cancer, I think even within a lower middle resource country, there are clearly the haves and the have-nots.
00:07:15.279 --> 00:07:23.759
I mean, I go to countries all over the world where the universal health coverage, you know, but it doesn't cover most things.
00:07:23.839 --> 00:07:25.600
And that's what the average patient gets.
00:07:25.759 --> 00:07:34.720
And yet they'll have a state-of-the-art, amazing cancer center in the main city that the wealthy can come to and get it.
00:07:34.879 --> 00:07:39.839
So it's not that you can't give that level of care in these countries.
00:07:40.079 --> 00:07:42.160
It's just that it costs too much.
00:07:42.319 --> 00:07:46.319
So we have to figure out ways of being able to deliver more broadly.
00:07:46.480 --> 00:07:52.639
We've already, if you've got that high-level, you know, state-of-the-art facility in the country, they know how to do it.
00:07:52.800 --> 00:07:55.600
And so we just have to figure out how to be able to spread it.
00:07:55.759 --> 00:07:59.519
Is it capacity building, that we train more people how to do it?
00:07:59.680 --> 00:08:01.279
Some of it's infrastructure, right?
00:08:01.439 --> 00:08:05.360
You need the building, some of it's the equipment, a lot of it's not the equipment.
00:08:05.600 --> 00:08:08.399
And then I think we can maximize the drugs.
00:08:08.560 --> 00:08:10.879
I'm an oncologist or a pediatric oncologist.
00:08:11.600 --> 00:08:20.079
If we could get all the drugs on the WHO's essential medicine list available to everybody, we would make a huge dent.
00:08:20.399 --> 00:08:27.759
And then we can start figuring out how to do the genomic profiling and testing and then getting the drugs that go along with that.
00:08:27.920 --> 00:08:33.120
I mean, we do need to add that piece of it to get the best results.
00:08:33.279 --> 00:08:34.879
And that's where we're going right now.
00:08:35.200 --> 00:08:37.759
But in many places, we don't even have the basics.
00:08:37.840 --> 00:08:43.600
We don't even have the generics and the biosimilars that are on the WHO's essential medicine list.
00:08:44.320 --> 00:08:51.600
And so that would be a goal would be let's get the basics and not let's not shoot too high.
00:08:51.840 --> 00:09:09.679
Let's get an infrastructure down, let's get it working, let's make sure that a patient who comes in with a symptom that could be cancer is referred appropriately, is diagnosed in a timely manner, is not just sent back home or lost to the system because the appointment's three months from now.
00:09:09.840 --> 00:09:15.679
You know, it's not just about the cost of the drugs, it's also about that health system's infrastructure.
00:09:15.840 --> 00:09:26.399
If you lose a patient who comes in with a breast mask because you're told, oh, a 35-year-old woman doesn't get breast cancer, you know, and you just send her out and you don't do any follow-up.
00:09:26.960 --> 00:09:33.200
And then she comes back with a locally advanced breast cancer a year or two later, you you you've done a lot of harm.
00:09:33.360 --> 00:09:49.519
We need the system in place to get referred in the system, get the diagnosis, positive or negative for cancer, you know, move along into surgery, radiation, treat chemo, whatever the treatment would be.
00:09:49.759 --> 00:09:51.759
And we're creating a lot of awareness.
00:09:51.919 --> 00:10:03.039
I've worked, as you know, with a lot of patient advocates around the world who are very inspirational, very vocal, willing to say I've had cancer and, you know, with the stigma in a lot of countries.
00:10:03.200 --> 00:10:04.960
But you can't just generate awareness.
00:10:05.039 --> 00:10:18.320
You have to have a system that if a woman therefore hears and is encouraged and says, I have a little breast slump, you know, that she can get through the system and get it found early before it's it's too late or much less curable.
00:10:20.720 --> 00:10:22.639
Is there one story?
00:10:22.799 --> 00:10:48.480
I mean, I'm sure there are many, but one story which stays you with you always, I mean, from the from your clinical work, I have a lot of stories for my clinical work, and I I love that I still get occasional emails with pictures of the child who's just graduated from college, and when I met the patient, he was just graduating from kindergarten, and you know, I I love all that.
00:10:48.559 --> 00:10:50.080
I just got one of those this week.
00:10:50.320 --> 00:10:54.559
Here's an interesting on a global scale story that I didn't even know about.
00:10:54.639 --> 00:10:59.279
And this gets to, you know, just talking and being open and traveling.
00:10:59.440 --> 00:11:08.000
I was invited exactly 10 years ago to give a talk in Lagos, Nigeria at a second girls' secondary school.
00:11:08.240 --> 00:11:20.639
Um, the first lady of Ando State was someone I knew from breast cancer work, and one of the alumni from the secondary girls' school was um had died of breast cancer.
00:11:20.720 --> 00:11:24.080
So the alumni at the school and the girls, and it was World Cancer Day.
00:11:24.159 --> 00:11:29.840
So I got invited on World Cancer Day to come and give a talk about breast health to the girls.
00:11:30.080 --> 00:11:32.639
Talk to your mother about this, to the alumni.
00:11:32.799 --> 00:11:35.840
They were doing it in honor, their colleague who had died.
00:11:36.000 --> 00:11:50.799
And so I went, it's my first trip to Nigeria, you know, and seriously, a month or two ago, I got an email from somebody who I am about to meet next week at the World Cancer Congress in Hong Kong.
00:11:51.120 --> 00:12:02.639
She told me that she had just been diagnosed with breast cancer and really didn't, was afraid of treatment, didn't want surgery, was burying her head in the sand.
00:12:02.879 --> 00:12:09.279
But she had a friend who kind of dragged her along to hear my talk in at the girls' school.
00:12:09.440 --> 00:12:17.120
And she said, she asked me a question at the end of my talk and said, Do all women with breast cancer need a masteptomy?
00:12:17.679 --> 00:12:22.639
And she said, my reply was, no, it depends.
00:12:22.720 --> 00:12:25.279
It depends on the cancer, it depends on the patient.
00:12:25.440 --> 00:12:27.120
Talk to your talk to your doctor about it.
00:12:27.279 --> 00:12:28.879
No, it's not inevitable.
00:12:29.200 --> 00:12:34.799
And she said that that answer prompted her to get treated.
00:12:35.120 --> 00:12:45.360
And now she has formed an NGO in Nigeria that is doing breast cancer and general cancer awareness and work.
00:12:45.519 --> 00:12:51.440
And she apparently, and I read it, wrote a chapter in a book she published about that whole interaction.
00:12:51.679 --> 00:12:58.159
And that that kind of I didn't even know for 10 years that I had had that impact.
00:12:58.399 --> 00:13:08.320
But look at not only did she get treatment based on just getting access to somebody who would answer her and say, no, we don't treat it all the same.
00:13:08.480 --> 00:13:10.240
You know, talk to your doctor.
00:13:10.559 --> 00:13:17.279
That not only led her to get treated, she formed a nonprofit now that is educating other patients about this.
00:13:17.440 --> 00:13:20.639
So that obviously makes me very happy.
00:13:20.799 --> 00:13:30.639
And we're going to meet again for the first time since 10 years ago when we're together at the World Cancer Congress because her NGO is a member of the Union for International Cancer Control.
00:13:31.679 --> 00:13:32.480
Beautiful.
00:13:32.720 --> 00:13:33.840
Beautiful.
00:13:34.799 --> 00:13:36.320
Julie, what do you think?
00:13:36.399 --> 00:13:39.039
What's the next frontier in oncology globally?
00:13:39.679 --> 00:13:40.159
Wow.
00:13:40.320 --> 00:13:42.720
I mean, things are really moving fast.
00:13:42.799 --> 00:13:48.480
You know, I trained in an era when we had one or two chemo drugs.
00:13:48.639 --> 00:14:01.279
We didn't even have endocrine therapy for breast cancer, really, at the time, and then watch this whole evolution of oncology as a specialty drugs that worked, you know, all of that.
00:14:01.519 --> 00:14:10.799
Um, with this whole the genomics and the precision oncology and the understanding of what's driving each individual cancer.
00:14:10.879 --> 00:14:13.759
Now we're not just treating lung cancer as lung cancer, right?
00:14:13.840 --> 00:14:18.960
Or even just non-smell as, you know, we are looking at the genomic profile.
00:14:19.120 --> 00:14:27.200
We're learning also at the same time the whole immune system and the immunology and how we can use our own immune system.
00:14:27.360 --> 00:14:32.960
So we've got immunotherapy, we've got the precision diagnostics paired with drugs.
00:14:33.200 --> 00:14:42.960
I mean, but just think about there are dozens of drugs that were approved last year in oncology, in the United States, in precision medicine.
00:14:43.120 --> 00:14:45.200
We can't keep up with that anymore, right?
00:14:45.360 --> 00:14:51.120
How can anyone doctor, even if you're a specialist in lung cancer, keep up with all the mutations?
00:14:51.279 --> 00:14:55.279
You need to look at like at least 12 that right now have different drugs approved.
00:14:55.440 --> 00:15:00.000
And then if you don't have one of those mutations, you've got all that immunotherapy that you could do.
00:15:00.240 --> 00:15:04.639
So I do think what I'm getting at is we're going to need help from AI.
00:15:04.799 --> 00:15:13.840
We are going to need to incorporate artificial intelligence as a partner, not as a substitute, in keeping up with all of this.
00:15:14.080 --> 00:15:16.399
And so it's all intertwined.
00:15:16.559 --> 00:15:30.320
We can't, we're moving so fast right now in new targets, new drugs that are being approved, new regimens that we need help from AI in basically keeping up.
00:15:30.960 --> 00:15:37.200
At ASCO, our systematic literature reviews of the future are going to be every eight weeks.
00:15:37.360 --> 00:15:39.039
AI will be running in the background.
00:15:39.200 --> 00:15:43.600
It'll be looking for publications and drug approvals that happened in the last eight weeks.
00:15:43.759 --> 00:15:49.840
A human panel will look at what AI spits out and says, does our guideline need updating?
00:15:50.080 --> 00:15:52.720
And we'll be able to do it pretty instantaneously.
00:15:52.799 --> 00:15:55.360
Just keep it on the website, not publish it each time.
00:15:55.519 --> 00:15:56.799
And we can actively do it.
00:15:56.960 --> 00:16:05.759
We're going to need to keep up like that because more and more every cancer is individual, if you really look hard enough.
00:16:06.000 --> 00:16:18.559
And so it's a combination of better understanding the cancer, better understanding our own body and our own immune system tied to AI helping us understand the unique profile of the cancer and the patient.
00:16:20.159 --> 00:16:23.360
Julie, what's the best movie recently you watched?
00:16:23.759 --> 00:16:25.600
So a movie I watched on a plane recently.
00:16:25.679 --> 00:16:31.440
I take a lot of long plane rise, as you know, as do you, um, was Project Hail Mary.
00:16:31.600 --> 00:16:40.799
I thought it was very interesting, and it was taking a look at the future and AI, and um it was entertaining, but it was also thought-provoking.
00:16:41.120 --> 00:16:42.879
So uh I would recommend that.
00:16:43.039 --> 00:16:44.480
It's a great movie for a plane.
00:16:44.879 --> 00:16:46.399
Any book you would recommend to read?
00:16:46.799 --> 00:17:04.640
So a book I'm reading right now at the recommendation of one of our board members is The Great American Drug Deal, a book by Peter Kolczynski, uh, which addresses why prescription drug prices, especially for new drugs, uh are so high in the United States.
00:17:04.960 --> 00:17:18.079
Because it was basically in response to Draxon RASIP, the RAS inhibitor that was the ASCO plenary, you know, the RAS inhibitor for pancreatic cancer with a standing ovation and all.
00:17:18.160 --> 00:17:21.279
And then it came out with a price of$40,000 a month.
00:17:21.519 --> 00:17:28.319
So, but in response to this, I'm really trying to understand how we price drugs and what the issue is.
00:17:28.559 --> 00:17:37.279
And this book is very interesting because I'm only about a quarter of the way through it because I started on the plane on the way here.
00:17:37.519 --> 00:17:50.160
But it's basically showing how the American healthcare system's payment system is a big part of the problem for why the drug is so high.
00:17:50.400 --> 00:18:35.759
Because if you you can argue about what price you really want, but let's say you wanted$25,000, and that's what you wanted to price it at, because of our pharmacy benefit manufacturers that get rebates from companies because of discounting that is mandated by the government, the 340B discounting and other things that that industry has to give if you if you qualify, that whole um, you know, inflation reduction, all of these things mean that if you what you really want for your drug is$25,000, which you can argue that's way too high anyway, but you have to price it at$40,000 because of the way our system is so non-transparent and with rebates and discounts and all of this that are mandated.
00:18:36.000 --> 00:18:41.200
And that is only relevant to the US, but it impacts the whole rest of the world then, right?
00:18:41.839 --> 00:18:50.799
Because even if each individual government could negotiate the price of the drug, it's really hard to negotiate way down on what that price is.
00:18:51.039 --> 00:18:59.920
So it is very interesting to me that it's a very complex answer to why are these drugs so high?
00:19:00.079 --> 00:19:09.759
And it's not just because industry wants the money back for having developed the drug and then more money to put into it and you know, all that.
00:19:10.079 --> 00:19:18.799
It is the American healthcare system payment system is contributing to that in a way that the rest of the world doesn't see it and it's not transparent.
00:19:18.880 --> 00:19:20.720
Aaron Powell Thank you very much, Julie.
00:19:21.039 --> 00:19:22.640
One one last question.
00:19:22.960 --> 00:19:29.200
And I think I asked during our f first interview, but I'm gonna ask again who I should interview next.
00:19:29.839 --> 00:19:33.279
I think you should interview Dr.
00:19:33.440 --> 00:19:52.559
Susa Blumenthal, who has been at this conference with us and is amazing and very impressive and has done a lot, worked with four different presidents, and is still working hard and has done amazing things and continues to do so.
00:19:52.720 --> 00:19:55.920
She's a fascinating woman for you to interview.
00:19:56.160 --> 00:19:57.279
Thank you so much, Julie.
00:19:57.440 --> 00:19:57.599
Yeah.
00:19:57.839 --> 00:20:01.680
If you enjoyed this episode, please subscribe to our podcast and leave us a review.
00:20:01.839 --> 00:20:07.920
Don't forget to follow us on social media for more updates and join the conversation using hashtag oncodaily.
00:20:08.160 --> 00:20:12.559
Until next time, stay informed and stay strong in the fight against cancer.
00:20:12.799 --> 00:20:14.079
Thank you for listening.
