"A New Deal for Cancer"

Transcript

• 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.