Paul Calabresi, MD Lecture: The Impact of a Community Focused Approach

Transcript

• 00:00It's really my honor,
• 00:02to moderate today's,
• 00:05Paul Calabresi Memorial Lectureship,
• 00:08with doctor Robert Winn, the
• 00:09impact of community focused approach.
• 00:13Here today,
• 00:14and for the sixteenth time,
• 00:16we honor doctor Paula Calabresi,
• 00:18who is an internationally recognized
• 00:20authority and pioneer on the
• 00:21clinical pharmacology of anticancer agents,
• 00:23for which she was awarded
• 00:25the Oscar B. Hunter Memorial
• 00:26Award in therapeutics in the
• 00:28American Society for Clinical Pharmacology
• 00:29and Therapeutics in nineteen ninety
• 00:31two.
• 00:32A graduate of Yale, both
• 00:33his BS and MD,
• 00:35he served his internship and
• 00:36residency at the Harvard hospitals
• 00:38in Boston. He was on
• 00:39the faculty of Yale until
• 00:41nineteen sixty eight when he
• 00:42went to Brown University as
• 00:44professor of medicine and as
• 00:45physician in chief of Roger
• 00:47Williams Hospital. In nineteen seventy
• 00:49four, doctor Talibrazi became chairman
• 00:50of the Brown University Hospital
• 00:52Department of Medicine.
• 00:53He was a member of
• 00:54the board of overseers of
• 00:55Tufts University.
• 00:56And many other awards,
• 00:58and he, of course, was
• 00:59a member of the National
• 01:00Academy of Medicine.
• 01:02This is very personal for
• 01:03me because I first met,
• 01:04Paul,
• 01:05on the right,
• 01:06in nineteen eighty when I
• 01:08happened to have Peter, who's
• 01:09standing next to me, that
• 01:11is me,
• 01:12at at,
• 01:15as a roommate freshman year
• 01:17a while ago, and that's
• 01:18his parents and my parents.
• 01:20And, Paul, as you'll hear
• 01:22today, is known for mentorship
• 01:23as well as all the
• 01:24other amazing things he's done,
• 01:26you know, five f u,
• 01:28treatments for cancer, but also
• 01:29as a mentor and as
• 01:30a sponsor and as a
• 01:31leader, and we celebrate that
• 01:33today with with today's speaker.
• 01:35You can see over the
• 01:36years, we've had quite a
• 01:37few notable,
• 01:40lectures,
• 01:41and, we usually make this,
• 01:42professorship where people come and
• 01:44spend time, and many of
• 01:45you have spent time with,
• 01:47today's,
• 01:49awardee,
• 01:50doctor Robert Wynne. So it's
• 01:52really my pleasure to introduce
• 01:53Robert,
• 01:54who's currently, the director at
• 01:56Littmann Scherer Oncology at the
• 01:58VCU
• 01:59Massey Comprehensive Cancer Center
• 02:01in, Richmond, Virginia. He's professor
• 02:03of pulmonary diseases and critical
• 02:05care medicine at the same
• 02:06institution.
• 02:08As the current director of
• 02:09VCU Massey,
• 02:10Robert oversees a cancer center
• 02:12designated by the NCI that
• 02:13provides advanced cancer care, conducts
• 02:16ground groundbreaking
• 02:17research, discovering new therapies, offers
• 02:19high quality education and training,
• 02:21and engages with the community
• 02:22to make advancements in cancer
• 02:24treatment and prevention,
• 02:26equally available to all.
• 02:28He's leading the nation in
• 02:29establishing a twenty first century
• 02:31model of equity for cancer
• 02:33science
• 02:34and care in which the
• 02:35community is informing and partnering
• 02:37with Massey on its research
• 02:39to best address the cancer
• 02:40burden and disparities of those
• 02:42that,
• 02:44with,
• 02:44a global and a both
• 02:46a national and a global
• 02:47focus.
• 02:48As a physician scientist, he
• 02:49works in basic and translational
• 02:51work research
• 02:52focused on novel in vitro
• 02:53and in vivo models to
• 02:54study the translational aspects of,
• 02:56signaling pathways in lung cancer.
• 02:59This is how I first
• 02:59met him. One has also
• 03:01brought the importance of the
• 03:02concept of zDNA.
• 03:03If you don't know about
• 03:04it, I bet you will
• 03:05in about an hour, where
• 03:06one ZIP code or neighborhood
• 03:07of association
• 03:08will impact the biological outcomes
• 03:11and the care that you
• 03:12get for your cancer. He's
• 03:13really, as I say, focused
• 03:14on health equity.
• 03:16Yesterday, we met with, Robert.
• 03:18Each of these,
• 03:19physicians in the room are
• 03:21part of what we call
• 03:22the WIN program, and he's
• 03:23got a program now. Each
• 03:25of these, some of them
• 03:26were oncologists,
• 03:27some are endocrinologists,
• 03:28dermatologists, cardiologists,
• 03:30they're receiving forty percent salary
• 03:31support through a grant that
• 03:33Robert established, and they're getting
• 03:34mentorship in clinical trials and
• 03:36doing clinical trials in diverse,
• 03:39areas. So it was really
• 03:40an honor to, and and
• 03:41really no brainer to invite
• 03:42Robert this year, because this
• 03:44is what it's all about,
• 03:45and this is what Paul
• 03:46Calabresi was all about. So
• 03:47in the presence of the
• 03:48Calabresi family in the front
• 03:49row, and, I'm gonna invite
• 03:51Eric to come up with
• 03:51me, and we're gonna present
• 03:53Robert with, the two thousand
• 03:55twenty six Paul Calabresi award.
• 04:13Okay.
• 04:23We're good.
• 04:29Now with that, I hope
• 04:29I don't let you down.
• 04:32First of all, Eric and
• 04:34Roy,
• 04:35I just wanna say a
• 04:36big thank you for,
• 04:37just the invitation here.
• 04:40Means a lot,
• 04:41for the committee.
• 04:42I will say that when
• 04:43we talk about some of
• 04:44the programs so that you
• 04:45have some luminaries in this
• 04:46room, Pat LaRusso. I mean,
• 04:48you have so many people
• 04:49in this room that have
• 04:50been really important,
• 04:51at various points of my
• 04:53life.
• 04:53So what I thought I
• 04:55would start by doing is
• 04:58that
• 04:59and,
• 05:00with the permission
• 05:02of,
• 05:04mister Calabresi,
• 05:05Rito, last night. He said
• 05:06something that actually touched me,
• 05:08that actually changed the focus
• 05:10of this talk
• 05:11so much so that I
• 05:12had to actually
• 05:14reframe what I was gonna
• 05:15talk to you about today.
• 05:17So I don't know that
• 05:18I'll do it justice,
• 05:20but let's start this off
• 05:21by sort of saying,
• 05:23by bringing the right energy
• 05:24and the spirit to the
• 05:25room that I learned something
• 05:26last night from him.
• 05:29He said the following,
• 05:30that to make real change,
• 05:32and if I'm paraphrasing poorly,
• 05:34you can actually let me
• 05:35know,
• 05:37that excellence,
• 05:39decency, humanity, and love are
• 05:40required.
• 05:43He also said that excellence
• 05:44alone,
• 05:45while certainly foundational, is necessary
• 05:47but not sufficient to make
• 05:49the kind of change
• 05:50that is needed.
• 05:53And if I'm right, he
• 05:54also said that decency,
• 05:56humanity, and love, while absolutely
• 05:58critical
• 05:59in and of itself, sometimes
• 06:00falls short.
• 06:02It's the connection of both
• 06:04the excellence
• 06:05and all of these other
• 06:06factors. And I might add
• 06:07just one more, community focus
• 06:10that allows us to do
• 06:12and tackle big problems and
• 06:13make big change.
• 06:15I wanted to start that
• 06:16because with that spirit,
• 06:18it really
• 06:19reframed
• 06:20my focus of this talk
• 06:21today
• 06:22in a way that I'll
• 06:23show you in a second.
• 06:24So So these are my
• 06:25disclosures. I won't be talking
• 06:26about anything. You you you
• 06:28can bet on it, but
• 06:29I have to show this
• 06:30anyways.
• 06:32I wish I had something
• 06:33to really talk about, but,
• 06:34you know, with some of
• 06:34those, but, you know, I
• 06:36refuse cash, so it's all
• 06:37good and nobody talks about.
• 06:40So I had to reframe
• 06:41this and think about this
• 06:42talk about
• 06:45what doctor Calabresi
• 06:47really who was an inspiration
• 06:48for a lot of us
• 06:49and a North Star for
• 06:50many of us as we
• 06:51were coming up. But there's
• 06:52one thing to read about
• 06:53them. It's another thing to
• 06:54start talking to people and
• 06:55getting to know them.
• 06:57Until last night, as I
• 06:58was going back to my
• 06:59room and thinking about this
• 07:01talk and the message today,
• 07:03it came out that excellence
• 07:05in humanity
• 07:06are not competing with one
• 07:08another they are aligned with.
• 07:09I had to give a
• 07:10talk at Notre Dame once,
• 07:11and I sort of said,
• 07:12you do know that science
• 07:13and religion are not at
• 07:14war with one another
• 07:16unless it's bad science or
• 07:18bad religion.
• 07:20In the same sort of
• 07:21vein,
• 07:22excellence in humanity, the science
• 07:24that we drive is not
• 07:27at all
• 07:28at war with this concept
• 07:30of humanity and making sure
• 07:32that as we are driving
• 07:34science, we are also going
• 07:35with the purpose that it
• 07:36impacts
• 07:39somebody. Now we say that,
• 07:40but how do you do
• 07:41it?
• 07:42So one of the other
• 07:43things I actually have to
• 07:44say that I have been
• 07:45stoked and I'm gonna talk
• 07:47that, Paul and some other
• 07:48people know that this is
• 07:49a really important thing to
• 07:50me and has become an
• 07:51important thing. So,
• 07:53I
• 07:54I got this from doctor,
• 07:56from Paul Goldberg because I
• 07:57I could not find a
• 07:58copy.
• 07:59But I'm actually gonna get,
• 08:00hopefully, this reprinted for most
• 08:02of you here. I don't
• 08:03usually use props, but this
• 08:05prop,
• 08:07you should get to know,
• 08:09particularly you folks at Yale.
• 08:11This prop is called the
• 08:12cancer at the crossroads report.
• 08:14It was done by doctor
• 08:16Calabresi who chaired this,
• 08:19who looked at where we
• 08:20were in the context of
• 08:22cancer
• 08:23from a research and perspective
• 08:25of also care.
• 08:27And I'm not gonna go
• 08:28into details because at some
• 08:30point, I'm gonna actually have
• 08:31a call to action that
• 08:32on today, I am declaring
• 08:34that we should pick up
• 08:35the mantle of where he
• 08:36left it off and have
• 08:38another
• 08:39crossroads section
• 08:40that's been inspired by doctor
• 08:42Calabresi in the context of
• 08:44figuring out the discussions we
• 08:45need to have as we
• 08:46move forward.
• 08:47Now most of you probably
• 08:49know that,
• 08:50some of these things look
• 08:51familiar.
• 08:53The issue about resources for
• 08:54research,
• 08:55the issues around quality of
• 08:56care and how occasionally some
• 08:58of the health care reforms
• 08:59can get in the way
• 09:00of that.
• 09:01I know many of you
• 09:02probably know that when you
• 09:03have the national cancer program,
• 09:04it suffers from an absence
• 09:06of national coordination of cancer
• 09:07fighting efforts, public private involuntary
• 09:10sectors. That, I think, sounds
• 09:11probably familiar.
• 09:14That many people in this
• 09:15country, especially the poor
• 09:17and the elderly
• 09:18and the uninsured
• 09:20still receive some care,
• 09:22but clearly not the care
• 09:24that is needed.
• 09:27By the way, this report
• 09:28was in nineteen ninety four.
• 09:30It's that whole thing deja
• 09:32vu all over again.
• 09:35I'm gonna make a pitch
• 09:36to you that while many
• 09:37of these things, the failure
• 09:38to support translational research, which
• 09:40hinders
• 09:41this is a little bit
• 09:42like, I think, Marcus Aurelius,
• 09:44and I'm blinking his favorite
• 09:45poet, but I think it
• 09:46was Heracles or something, who
• 09:48said when a person visits
• 09:50a river,
• 09:51the person is not the
• 09:52same nor the river.
• 09:53What I'm gonna say to
• 09:54you is that the crossroads
• 09:56while similar
• 09:57that we are facing,
• 10:00similar but different, so are
• 10:02we.
• 10:03We also have different tools,
• 10:04and we'll get to that
• 10:05in a second.
• 10:08Let's
• 10:09when I say we need
• 10:10to talk about cancer, we
• 10:11need to start talking about
• 10:12cancer because actually in the
• 10:13communities, we send out two
• 10:15messages and they're all confusing.
• 10:17And sometimes even confusing for
• 10:18us.
• 10:20We talk about c, the
• 10:21big cancer, but, yo, we
• 10:23should be celebrating the fact
• 10:24that thirty four percent fewer
• 10:25people are dying from cancer
• 10:27in United States.
• 10:29Another way of sort of
• 10:30saying that is thirty four
• 10:31percent more people are showing
• 10:32up to birthday parties or
• 10:33showing up to graduations.
• 10:35And so we
• 10:36want community to be partnered
• 10:38with us, but we're so
• 10:40focused sometimes on the progress
• 10:42that we're not focused in
• 10:43allowing people to celebrate with
• 10:45us the successes.
• 10:47Come on. We need to
• 10:48be complete in the story.
• 10:51It would be and for
• 10:53some of y'all, y'all young
• 10:54enough that y'all might have
• 10:55to look it up on
• 10:56YouTube, but there's some called
• 10:57the dream team, the first
• 10:58dream team.
• 11:00I know. You I'm just
• 11:01saying.
• 11:03Or in the nineteen eighties
• 11:04for the hockey fans, the
• 11:05miracle to team on the
• 11:06miracle on ice. What would
• 11:09have happened
• 11:12if at the last second,
• 11:15the US is down and
• 11:16all of a sudden, either
• 11:17basketball or hockey,
• 11:19you shoot. And with one
• 11:21second left, we make it.
• 11:23The US wins, and all
• 11:24of the players just walked
• 11:25off the court.
• 11:28You'd be confused.
• 11:32We do that in science.
• 11:35We don't really bring along
• 11:37folks enough so that people
• 11:39from Dinwiddie, which is in
• 11:40Virginia, all the way to
• 11:42high impact urban areas understand
• 11:44that we still have a
• 11:45lot to go, but we've
• 11:46made some progress. And so
• 11:47I would sort of say,
• 11:49would you keep giving someone
• 11:50money if they kept telling
• 11:51you, nope. Is it getting
• 11:52better? No. It's getting better.
• 11:53No. Not getting better. Nope.
• 11:54Not getting better.
• 11:57At some point, we are
• 11:58gonna have to be better
• 11:59at communicating
• 12:01the challenges ahead, but also
• 12:03sharing in the success.
• 12:05It's important because when we
• 12:07frame the conversation,
• 12:08we ought to know that
• 12:10we have made some progress
• 12:11even in the context of
• 12:12disparities.
• 12:13The difference between black, white
• 12:15deaths was thirty three percent
• 12:16and ninety sets down to
• 12:17eleven.
• 12:18Is it one? Is it
• 12:20zero percent? No. What this
• 12:22says is that we don't
• 12:23take our foot off the
• 12:24pedal, but you have to
• 12:26actually sort of say that
• 12:27when people from the community
• 12:29actually understand that there is
• 12:30hope
• 12:33and how do we bring
• 12:34that hope to those communities,
• 12:35it makes a little bit
• 12:36of our jobs easier, but
• 12:38so the people in communities.
• 12:39Because, again, we can't just
• 12:41be in our laboratories and
• 12:42be on our computers and
• 12:43now doing the AI stuff
• 12:45and being our little sort
• 12:46of bubble without communicating
• 12:50that those philanthropic dollars that
• 12:52they give
• 12:54when they watch a show
• 12:55and they wanna donate or
• 12:58pay their taxpayer dollars or
• 13:00actually going to something that's
• 13:01making a difference.
• 13:03Now I will wanna tell
• 13:04you that
• 13:06there has been progress
• 13:09at all,
• 13:10racist and ethnicities,
• 13:12and
• 13:13there has been some progress
• 13:17smaller in rural communities.
• 13:20So the issue isn't progress.
• 13:21The issue is can we
• 13:22do better?
• 13:24I submit to you that
• 13:25we are gonna have to
• 13:26because despite this progress, we
• 13:28still have disparities between communities,
• 13:30between races,
• 13:32between people who are living
• 13:34in rural areas.
• 13:39We actually have
• 13:41things that we need to
• 13:42do.
• 13:44I pointed this out because
• 13:45I'm actually gonna get to
• 13:47the point, which is
• 13:49we are fascinated by the
• 13:51DNA aspects of our biology.
• 13:53Oh my god. By the
• 13:55way, if love and science
• 13:56is wrong, I don't wanna
• 13:57be right.
• 13:59But I do have to
• 14:00tell you when we start
• 14:02looking at and this is
• 14:03just a map of life
• 14:03expectancy.
• 14:04So what you see is
• 14:05that there is a pattern.
• 14:07Red
• 14:08means shorter life expectancy,
• 14:10so that's to your left.
• 14:11And to your right, the
• 14:12blue is
• 14:14worse outcomes from cancer,
• 14:16by looking at deaths.
• 14:19Here's a scenario for you.
• 14:21When we talk about disparities
• 14:22research, we usually talk about
• 14:23African Americans. We talk about
• 14:25prostate cancer, all of a
• 14:25sudden. The very first thing
• 14:26we go to is there
• 14:27must be a mutation. There
• 14:28must be a genetic there
• 14:29must be this SNP. Right?
• 14:31But hold up.
• 14:35Why don't we talk about
• 14:36the genetic aspects
• 14:38when you actually have a
• 14:40white woman from Boston
• 14:42with the same stage breast
• 14:44cancer compared to the same
• 14:46age white woman from Shreveport,
• 14:48Louisiana.
• 14:49But tell you what, in
• 14:50Shreveport, Louisiana, there's three times
• 14:51worse outcomes from cancer.
• 14:53Same stage, same breast cancer.
• 14:55We don't usually say, oh
• 14:57my god. What's going on
• 14:58here in Beattyville, Kentucky?
• 14:59There must be some genetic
• 15:01abnormalities there.
• 15:03What's going on with these
• 15:04women in Shreveport?
• 15:06We don't say that.
• 15:08Now I'm not the one
• 15:10to tell you that there
• 15:11isn't something very important
• 15:13in drivers and mutations and
• 15:15all these things, but I
• 15:16am here to sort of
• 15:17say to you
• 15:19that your ZIP code and
• 15:20neighborhood of association
• 15:21where you live matters.
• 15:23How do you explain that
• 15:25a seventy year old white
• 15:25male with the same stage
• 15:27lung cancer
• 15:28has a three times better
• 15:30outcome if they live in
• 15:31Salt Lake
• 15:32City, Utah than if they
• 15:34live in Beattyville, Kentucky.
• 15:36Anybody from Kentucky here?
• 15:38Okay.
• 15:39It's a nice place y'all
• 15:40need to visit.
• 15:44I wanna make the point
• 15:45that we have to expand
• 15:47our way of thinking about
• 15:49science.
• 15:50And over the last decades
• 15:52or so, we've gotten a
• 15:53way of doing this. Now
• 15:54since it's a grand round,
• 15:55I figured let's come with
• 15:56a case. It's a different
• 15:57kind of case, guys, but
• 15:59stick with me for a
• 16:00little bit.
• 16:01Two brothers,
• 16:03and they are cute.
• 16:06That guy looks like my
• 16:07little brother. He would always
• 16:08bite me and stuff like
• 16:09that. I'm like, dude, what
• 16:10are you doing?
• 16:12Control yourself.
• 16:15Raised
• 16:15together in the same city.
• 16:17So just thinking about this.
• 16:19In the same home,
• 16:21under the same circumstances,
• 16:23and they subsequently
• 16:24grow up as all kids
• 16:25do, and they move away.
• 16:30One,
• 16:30and we're gonna use Illinois
• 16:32because I was always told
• 16:34never go to a city
• 16:35or a town and then
• 16:36talk about that town. Just
• 16:38talk about other towns.
• 16:40My great father said, if
• 16:41you're gonna talk about someone,
• 16:42always talk about somebody else.
• 16:43Don't be talk about somebody
• 16:44else's house? Don't talk. So
• 16:45we're gonna talk about we're
• 16:47gonna talk about Illinois. One
• 16:48moves to the Gold Coast.
• 16:50The Gold Coast would be,
• 16:52to make this even easier
• 16:53where there are shops. There's
• 16:54all these wonderful things. Let
• 16:56me make this even easier.
• 16:57Oprah Winfrey, when she goes
• 16:58back to Chicago, she's heading
• 16:59back to the Gold Coast.
• 17:01Many of you know it's
• 17:02a wonderful,
• 17:03amazing place.
• 17:05One of the brothers happens
• 17:06to just move there.
• 17:09In his,
• 17:10you know, early twenties, he
• 17:11finds a job. The other
• 17:12one moves to Moline.
• 17:14Moline is not the Gold
• 17:16Coast.
• 17:17High poverty,
• 17:19high crime,
• 17:22low access to really good
• 17:24foods.
• 17:25This would be the same
• 17:26situation, by the way, in
• 17:28I'm using Moline because I'm
• 17:30laughing a little bit for
• 17:30those from Illinois because a
• 17:32Moline, whether you're on the
• 17:33south side of Chicago or
• 17:35you're in rural areas like
• 17:36a Moline,
• 17:38it's the same situation.
• 17:40So, like, two brothers.
• 17:43The question that I have
• 17:44for this audience, and we'll
• 17:45get to dealing with this
• 17:47with some of the data
• 17:48that I think I have,
• 17:50to point at that I
• 17:51think the conclusions will be
• 17:52maybe different.
• 17:54They both develop lung cancer.
• 17:57Will both the treatments be
• 17:58the same? Will they work
• 17:59the same for both brothers?
• 18:01They're clearly brothers.
• 18:05What does
• 18:08their environment, I e, what
• 18:09they eat, how does it
• 18:10change the microbiome, and therefore,
• 18:12how would it actually impact
• 18:13the treatment if at all?
• 18:15And lastly,
• 18:17how does the role of
• 18:18stress, everyday stress,
• 18:20play into
• 18:23impacting someone's outcome?
• 18:26I wanna bring to you
• 18:27this concept of how the
• 18:28ZNA,
• 18:30those who know ZIP code
• 18:31neighborhood of association,
• 18:33and the intersectionality
• 18:35of that with the DNA
• 18:36is really how we talk
• 18:38about outcomes or how I
• 18:39think about outcomes.
• 18:41Today, I'm not gonna get
• 18:42into the whole concept of
• 18:43transdisciplinary
• 18:44research and why I think
• 18:45Convergent science should grow and
• 18:47we should grow as
• 18:49thinking about tackling problems. Instead
• 18:51of just our silos, we
• 18:52should be breaking down the
• 18:53silos and working in a
• 18:54different way. That's another talk
• 18:56for another day.
• 18:58But I am gonna say,
• 19:00think about this slide just
• 19:01for one second. If you
• 19:01could take a look at
• 19:02this. This is going back
• 19:03to Chicago now. We're staying
• 19:05in Illinois for a while.
• 19:07You can see to
• 19:09your right, the life expectancy
• 19:11in what we call the
• 19:11loop that's near the Gold
• 19:13Coast is eighty five.
• 19:15You go four miles
• 19:16literally
• 19:17just west, the life expectancy
• 19:20drops to sixty nine. That's
• 19:21in a place called Garfield
• 19:22Park. And not shown here,
• 19:24this is work done by
• 19:25Steve Wolf from VCU,
• 19:27not shown here is if
• 19:28you go eight miles south,
• 19:30eight miles south,
• 19:31the life expectancy drops by
• 19:33thirty.
• 19:35Now
• 19:35I see somebody in the
• 19:36audience, and they go, come
• 19:37on, doctor Wei. You know
• 19:39what's up. Isn't there such
• 19:41thing as gun violence? Y'all
• 19:42watch too much TV, by
• 19:43the way. But let's
• 19:45take into account the issue
• 19:46around violence.
• 19:47It turns out when they
• 19:48went back
• 19:49and factored out for that
• 19:50that the violence and the
• 19:53difference in life expectancy was
• 19:55negligible.
• 19:58So
• 20:01what gives?
• 20:04I have an idea
• 20:06that where you live matters.
• 20:09It is not to say
• 20:10that snips, mutations, driver genes,
• 20:13and all the rest of
• 20:13that don't play a role,
• 20:15but I think the concept
• 20:16is if you look at
• 20:17it from a social molecular
• 20:19perspective,
• 20:21that which is going outside
• 20:22is impacting the person.
• 20:24And I think being better
• 20:26able to understand that interplay
• 20:29will come up with hopefully
• 20:30better interventions, not all medicines,
• 20:32by the way. Doctor Broder,
• 20:34nineteen eighty nine, actually was
• 20:36one who talked about poverty
• 20:37as a carcinogen.
• 20:39We have from Dick Warnege,
• 20:40who's
• 20:41one of my,
• 20:43one of my mentors, just
• 20:44a giant in the field
• 20:45of of looking at the
• 20:46social sciences, actually came up
• 20:48with this concept of the
• 20:49upstream drivers of health. And
• 20:51most of us know through
• 20:52COVID that we started paying
• 20:54attention to those upstream drivers.
• 20:56You know, us in traditional
• 20:57academic centers, we know we
• 20:58focus more on the fundamental
• 21:00research and the downstream factors,
• 21:02but it's quite apparent
• 21:04that those downstream factors
• 21:06are actually also influenced by
• 21:08what happens upstream.
• 21:10So for me,
• 21:11it has been understanding that
• 21:13communities,
• 21:15or African American communities don't
• 21:16just get more cancer just
• 21:18because they're biologically more you
• 21:20know,
• 21:21that that their biology. It's
• 21:22their skin that's not entirely
• 21:24true.
• 21:25But it is true at
• 21:26things like particulate matter two
• 21:28point five that disproportionately in
• 21:29areas of poor places and
• 21:31people of color.
• 21:33So I stopped at my
• 21:35cancer center
• 21:36having people say, well, this
• 21:38is African American. They're just
• 21:39more predisposed.
• 21:40Predisposed why?
• 21:42Is it based on the
• 21:43DNA or their ZNA? Another
• 21:44way of looking at it
• 21:45is the intersectionality
• 21:46between the genome and the
• 21:47xenome. And I know the
• 21:48xenome's a made up word,
• 21:49but just hang with me
• 21:50for
• 21:52for the concept.
• 21:55So what does that mean?
• 21:57My first thing when I
• 21:58came to Massey is I
• 21:59said the bench to bedside
• 22:01model is great and has
• 22:02gotten us this far, but
• 22:03we were gonna flip the
• 22:04script and go to a
• 22:05people to pipette model.
• 22:07And any people to pipette
• 22:09model,
• 22:09it was looking at the
• 22:11omics that were missing in
• 22:12the community.
• 22:13And having that data help
• 22:15us refine our scientific questions
• 22:18and refine even some of
• 22:19our approaches.
• 22:21So how do we do
• 22:21that? I'm gonna show you
• 22:22that in a minute. I'm
• 22:23gonna show you the outcome.
• 22:26And, again,
• 22:27the the phrase community omics
• 22:29was phrase, coined by, doctor
• 22:31Catherine Toces, but I really
• 22:32liked it because it was
• 22:34the missing omics.
• 22:35And what I loved about
• 22:36this, it gave me now
• 22:38a way to talk to
• 22:39my scientist colleagues who would
• 22:40always say, I'm a basic
• 22:42scientist. I don't know what
• 22:42I can do in the
• 22:43community. I would say, right.
• 22:44So you got the missing
• 22:45omic problem.
• 22:47Never say, what's the missing
• 22:48omic? I go, that's the
• 22:49issue. Right?
• 22:50So thinking about catchment area
• 22:52is not just a descriptor
• 22:54or thinking about community,
• 22:55and engagement is not just
• 22:57an activity,
• 22:58but a science of outreach
• 23:00and engagement, we've been able
• 23:01to frame
• 23:02the missing data within communities
• 23:04and bring that back to
• 23:05help drive our science.
• 23:07It's been fun to watch,
• 23:09and I'll give you an
• 23:09example of what happens at
• 23:11the end.
• 23:12So what happens if we
• 23:14talk about precision medicine, but
• 23:15we talk about the same
• 23:17precision in the time in
• 23:18the context of communities.
• 23:20Now
• 23:22in the in the neighborhoods
• 23:23in Chicago, it was great
• 23:24because when I talked about
• 23:25ZIP codes, because that's how
• 23:26I started. Let's talk about
• 23:27ZIP codes. And, one of
• 23:28the older women actually came
• 23:29to me and says, doc,
• 23:30can I tell you something?
• 23:31Because she was looking a
• 23:32little bit uncomfortable. She said,
• 23:33doc, can I tell you
• 23:34something? I said, yeah. She
• 23:35goes, the only people that
• 23:36understand that ZIP code stuff
• 23:37is you and and the
• 23:38mailman.
• 23:39What she meant was that
• 23:40the academics and the mailman
• 23:41are the only people who
• 23:42use that. I was like,
• 23:43what?
• 23:44So we had this concept.
• 23:46What happens if I were
• 23:47in in addition to using
• 23:49ZIP codes? Because it turns
• 23:50out, for example, Chicago,
• 23:53several million people, fifty different
• 23:55wards.
• 23:56Imagine that they're shared ZIP
• 23:57codes.
• 23:59I started thinking about practical,
• 24:02moving from academic excellence to
• 24:04academic relevance
• 24:06and thinking about not only
• 24:07just the papers and the
• 24:09grants, but the impact in
• 24:10the community
• 24:11that we needed a different
• 24:12model and I needed a
• 24:13different language.
• 24:15So
• 24:16Texas
• 24:17is the football
• 24:18as politics is to Chicago.
• 24:21So I got an idea.
• 24:23What would happen
• 24:24if I took the fifty
• 24:25wards and just broke everything
• 24:27down in a voting district?
• 24:29Now you may say,
• 24:32uh-huh. What why would that
• 24:33matter? It turned out it
• 24:35mattered greatly
• 24:36because not only was I
• 24:37able to describe the things
• 24:39that they were we're gonna
• 24:39take the twentieth Ward. This
• 24:41is Inglewood for those who
• 24:42are counting Inglewood area. This
• 24:44is the area where you
• 24:44had that thirty percent reduction
• 24:46in life expectancy.
• 24:47So when I was able
• 24:48to sort of say and
• 24:49by the way, it allowed
• 24:50me and the legislators and
• 24:52the politicians and and the
• 24:53mappers to all get together
• 24:56every couple years and says,
• 24:58what are the voting maps?
• 25:00Because at the end of
• 25:01the day, people say, well,
• 25:02we don't know in there.
• 25:03And, you know, this is
• 25:04all this gerrymandering. But somebody's
• 25:06whatever squiggly line has those
• 25:08things and actually is responsible
• 25:10for that area.
• 25:11We've learned how to do
• 25:13that. As a result of
• 25:14that, we were able to
• 25:15take
• 25:16in the twentieth word at
• 25:17the time in the alderman
• 25:18and and,
• 25:19this slide was the best
• 25:20slide. I still keep it
• 25:21in there because it was
• 25:22an moment when all of
• 25:24a sudden, I just simply
• 25:25took the information back to
• 25:27my alderman in the twentieth
• 25:28ward and said he goes,
• 25:30he goes, doc, can I
• 25:30ask you something? I said,
• 25:31yeah. He goes, what's the
• 25:32red? He goes, the red,
• 25:33good or bad? I said,
• 25:35the red is bad.
• 25:37That's a lot of bad.
• 25:40Think about this. Life expectancy
• 25:41thirty years. I want you
• 25:42to look at the prostate
• 25:43cancer one in mortalities.
• 25:45What we were able then
• 25:46to to do during the
• 25:48period about whether we should
• 25:49screen, not screen, we were
• 25:50able to go into that
• 25:51community
• 25:52and be able to say
• 25:54that you have three times
• 25:56worse outcomes,
• 25:58death from prostate cancer than
• 25:59they do in United States
• 26:00and the rest,
• 26:02of the state of Illinois.
• 26:04It changed the conversations not
• 26:06only with the alderman, but
• 26:07it changed the conversations with
• 26:09the folks within that health
• 26:10system.
• 26:12Had I just done ZIP
• 26:12codes, I'm not quite sure
• 26:14we'd have gotten to this
• 26:15because, actually, what then happened
• 26:16was I would eight was
• 26:18able to go to each
• 26:19legislator
• 26:20and say, this is a
• 26:21snapshot of what you have.
• 26:23What can we do?
• 26:25It was probably the the
• 26:27most wonderful thing ever. And
• 26:29in fact, I initially thought
• 26:30that people were gonna be
• 26:31so pissed because they wanted
• 26:33good numbers,
• 26:35But no one said, well,
• 26:36can you make that red
• 26:38black?
• 26:39It's Chicago y'all. Come on.
• 26:42Didn't happen.
• 26:44You know, I kept saying
• 26:45to people, if you want
• 26:47people to care, you have
• 26:48to connect.
• 26:49And sometimes we give a
• 26:51lot of data,
• 26:53and facts
• 26:54will tell, but it's the
• 26:55stories that sell and connect.
• 26:58And as communicators, we have
• 27:00to get much more sophisticated
• 27:02as we are facing doctor
• 27:04TikTok, doctor Google, and many
• 27:05other things that they are
• 27:06doing something better than we're
• 27:08doing in science. They're learning
• 27:09how to connect with people.
• 27:12I've oftentimes said that if
• 27:13you had a person with
• 27:14lung cancer and you show
• 27:15them
• 27:16their CAT scan as they
• 27:17used to and you said
• 27:18this spot is yours, all
• 27:19of a sudden, there's a
• 27:20connectiveness.
• 27:22This is the same sort
• 27:23of model in a communication
• 27:25sort of style of just
• 27:26working with our legislators, our
• 27:28hospitals, our community groups, and
• 27:31showing them data that they
• 27:32can connect to.
• 27:34As a result of that,
• 27:36we've actually grown now, and
• 27:38we are even much more
• 27:39sophisticated. We provide much data.
• 27:41This is done by our
• 27:41CADA catchment area data, analysis
• 27:44group, that's run by doctor
• 27:45Toces and several other people.
• 27:48It's gotten much more sophisticated
• 27:49about what we can tell
• 27:50you about not only your
• 27:52district, but your state senator,
• 27:55your federal senator, and your
• 27:57congressperson.
• 27:58We can make maps now
• 28:00almost for everybody based on
• 28:02political districts.
• 28:05It's been fun,
• 28:08and a little bit frustrating.
• 28:10So let's just get to
• 28:13this. We've set up the
• 28:14stage for why community matters.
• 28:16I told you all the
• 28:17stuff about the missing omics
• 28:18in the community and doesn't
• 28:19matter, because really I could
• 28:21just do my science, but
• 28:22I can't do the science
• 28:23without the community.
• 28:25But I recognize that doing
• 28:26the science without the community
• 28:27is good,
• 28:29but it's better when it's
• 28:30connected to the community.
• 28:33And so there's people to
• 28:34pipette, otherwise known as a
• 28:36community bench model. I'm gonna
• 28:37give you a concrete example
• 28:39of how the thinking around
• 28:41this allowed me to actually
• 28:42get a discovery and an
• 28:43moment that I hope that,
• 28:45from this day forward, we'll
• 28:47actually,
• 28:48now my new residence will
• 28:49be Fox and Yale, that
• 28:50I think we have some
• 28:51opportunities of working together with
• 28:52your basic science and with
• 28:54some of these ideas. I
• 28:55think we're
• 28:56almost onto something different.
• 28:59So here's an idea, and
• 29:01I can't do this without,
• 29:03my colleagues, doctor Kim and
• 29:04doctor,
• 29:05Erdogan,
• 29:06from both from University of
• 29:08Illinois system. So I wanna
• 29:10start this. So let's think
• 29:11about this idea.
• 29:14Let's say we
• 29:16are going to look at
• 29:17the concept of stress and
• 29:19what it does in certain
• 29:20neighborhoods. But this time around,
• 29:22I'm not going to look
• 29:23at the traditional things in
• 29:24which you study, black versus
• 29:26white.
• 29:27There are fifty wards
• 29:29within
• 29:30Chicago,
• 29:31and the idea
• 29:33was to say, why don't
• 29:34we look at just the
• 29:35African Americans with lung cancer,
• 29:37particularly males within those fifty
• 29:39wards? Period. Just compare. Place,
• 29:41space, what's the impact?
• 29:44And so we use something
• 29:46that you're gonna see in
• 29:47this that, I know I'm
• 29:49gonna get some some some
• 29:50eyes rolling and some side
• 29:51eyes, but hold on with
• 29:52me.
• 29:53It turns out that the
• 29:54best data was not in
• 29:55the the the my school
• 29:56of public health. The best
• 29:58data was not in my
• 29:59public health programs.
• 30:01The best data please don't
• 30:02don't start throwing things at
• 30:04me. Turns out that the
• 30:05people that were collecting the
• 30:06best data on communities,
• 30:08I'm I'm sorry to say,
• 30:10but it's true.
• 30:12My brother would call them
• 30:13the five o. I could
• 30:14joke with that because he's
• 30:15a police.
• 30:16So I went to the
• 30:17Chicago Police Department.
• 30:20The database
• 30:24that they had collected
• 30:27over a period of fifty
• 30:28years was incredible.
• 30:31Incredible.
• 30:34You wanna talk about people
• 30:35who know the neighborhoods because
• 30:37they're having to watch neighborhoods
• 30:38almost all the time. And
• 30:39so you would say, why
• 30:40would you work with the
• 30:41c you know, Chicago PD?
• 30:43It's the PD.
• 30:44It turns out because they
• 30:45were also interested in interventions
• 30:48and keeping people well and
• 30:49healthy.
• 30:51So we made
• 30:53this partnership with this Chicago
• 30:55Police Department databases
• 30:57and a couple of my
• 30:58researchers,
• 31:00doctor Kim,
• 31:02and and doctor Erdogan to
• 31:03say, let's use that database
• 31:05and what could we tell.
• 31:06Well, here's the first thing,
• 31:08which was probably not that
• 31:09big of a surprise. This
• 31:10is a dumb moment. This
• 31:11is just looking at
• 31:13in places that actually have
• 31:15more we're gonna call it
• 31:16neighborhood it's called the neighborhood
• 31:17violence index. That's how the
• 31:19people in CDP use it.
• 31:21Chicago Police Department, neighborhood violence
• 31:22index. So you have high
• 31:24scores in neighborhood violence index,
• 31:26low scores. Now I know
• 31:27there's the ADI. There's a
• 31:28whole other sort of but
• 31:29we just said, look. We're
• 31:30just gonna use this one
• 31:31score. They use it. Can
• 31:33we can is it any
• 31:34valuable? It may not be.
• 31:36But it turns out the
• 31:37the dumb moment was it
• 31:38turns out that African American
• 31:40men
• 31:41from really relatively well-to-do areas
• 31:44actually had less likely,
• 31:47or better outcomes in the
• 31:49context of their lung cancers.
• 31:52Less probability that they would
• 31:53have it, but better outcomes.
• 31:55African American men from really
• 31:57rough areas like the Inglewood,
• 31:58we're gonna go back to
• 31:59the twentieth ward, had,
• 32:01poor outcomes.
• 32:03So we did something crazy
• 32:04cool. This is why you
• 32:05need the community.
• 32:06We got all all fifty
• 32:10all fifty wards. We had
• 32:12neighborhood barbershops
• 32:14where these African men were
• 32:16able to go, and then
• 32:17we expanded beauty beauty cost.
• 32:18But we did barbershops work
• 32:20because it we thought it
• 32:21was the easiest.
• 32:22All fifty. The African American
• 32:24barbershops within all fifty. You
• 32:25know what we were able
• 32:26to do? We're able to
• 32:27collect hair samples,
• 32:29pull them together, and we
• 32:30know what it did. We
• 32:31looked at the cortisol.
• 32:33I know. Right?
• 32:36It was a dumb moment.
• 32:38African Americans that came for
• 32:39wealthier places that actually less
• 32:41violent, the neighborhood put it
• 32:43this way. The neighborhood violence
• 32:44score neighborhood violence index was
• 32:46lower.
• 32:47Actually, it had lower cortisol.
• 32:49You might say,
• 32:51I would have known that
• 32:52without this data. My I
• 32:53love my grandmother who's ninety
• 32:55nine, by the way. I
• 32:55gotta tell you this story.
• 32:56I I gave her my
• 32:57first paper on disparities and
• 32:59some other things like that,
• 33:00and, she's now ninety nine.
• 33:01She's about ninety
• 33:03she's ninety four at the
• 33:04time. Ninety no. Ninety two
• 33:06at the time. And I
• 33:07gave her this paper that
• 33:07I was really happy about,
• 33:09and she said, come with
• 33:10me. She she got up,
• 33:11and she went out the
• 33:12window. She go, well, this
• 33:13paper's good, but I coulda
• 33:14told you that by looking
• 33:15outside.
• 33:17It was my best moment.
• 33:19I was like, okay.
• 33:21I got it.
• 33:23But here's what I want
• 33:24you to pay attention to.
• 33:27We then actually started thinking
• 33:29about, let's go deeper. So
• 33:31if we have a neighborhood
• 33:32violence index, let's start looking
• 33:34beyond just the cortisol. What
• 33:35could we do?
• 33:37So we had people,
• 33:38who were in the high
• 33:40neighborhood violence index score or
• 33:41the low neighborhood violence index
• 33:43score.
• 33:45The violence, by the way,
• 33:47is counted by homicides, and
• 33:48there are a couple other
• 33:49factors in it. We made
• 33:50it try to make it
• 33:51as simple as we could.
• 33:53I just want you to
• 33:53pay attention for this slide
• 33:55for just a second. Just
• 33:56a second.
• 34:00The red bar up top
• 34:02or the bar up top
• 34:03says, if it's to the
• 34:04right,
• 34:05there is a lower
• 34:08neighborhood violence score, the green.
• 34:10If it's to the your
• 34:12left,
• 34:13that's the red. That's a
• 34:14higher neighborhood violence index score.
• 34:17Check this out.
• 34:19What you see is that
• 34:20it's not just cortisol high
• 34:21or low. There's difference in
• 34:23signaling.
• 34:26Cell repair, DNA repair,
• 34:28cell cycle, many other things.
• 34:31It's the first moment. In
• 34:33fact, I didn't think we
• 34:34were gonna get anything
• 34:35from this data, but I
• 34:37did it anyways because it
• 34:38sounded like it was fun
• 34:39and was it was a
• 34:40pretty
• 34:41designed well, relatively
• 34:42well designed program. It was
• 34:44a shot. I didn't think
• 34:45I was gonna see any
• 34:46difference, but we saw clear
• 34:47differences.
• 34:50Second,
• 34:52we were able to show
• 34:54interesting things with the neighborhood
• 34:56violence index scores that there
• 34:57were also other,
• 34:59altered gene expressions like the
• 35:00glucocorticoid
• 35:01signaling and all the rest
• 35:02of that stuff that were
• 35:03off, metabolisms.
• 35:04I mean, all the rest
• 35:05of these other things were
• 35:06really off between, again, comparing
• 35:08African Americans
• 35:10matched.
• 35:11We had tumor tissue, and
• 35:12we actually had,
• 35:14spewed them and some other
• 35:15things that we did, and
• 35:16we we compared them. But
• 35:17but look, this is the
• 35:18tumor tissue
• 35:20matched, just different areas.
• 35:25It turns out
• 35:28that if you're coming from
• 35:29a high neighborhood violence score
• 35:31and you're African American versus
• 35:32a low neighborhood violence index,
• 35:35the singlings were really impressive
• 35:38about the differences.
• 35:41I wanna get to the
• 35:42point
• 35:43really quick
• 35:44because I think it's important.
• 35:46This is just a long
• 35:47tumor TMA.
• 35:49And, again, the top is,
• 35:52what would be called high
• 35:53neighborhood violence index. The bottom
• 35:56is low neighborhood violence index.
• 35:57You can see some differences
• 35:58in p d one signaling.
• 36:00I don't know why the
• 36:00CDH signaling didn't come out
• 36:02so well, but the GCR,
• 36:03you can see that stuff.
• 36:04But let's get to the
• 36:05point.
• 36:11What if I told you
• 36:13that where you lived
• 36:15mattered? And going back to
• 36:16the original sides of those
• 36:18two brothers,
• 36:19what if I told you
• 36:21that I think we were
• 36:22on to figuring out the
• 36:24hypothesis was, would those things
• 36:26influence whether someone had hot
• 36:28tumors or cold tumors? And
• 36:30it turns out that many
• 36:31of the people we were
• 36:32seeing from the non, and
• 36:33from the high neighborhood violence
• 36:34index were having
• 36:36less success with their therapies.
• 36:39So this idea just came
• 36:40out. I mean, literally, it
• 36:41was like, well, could they
• 36:42what's happening? Could they be
• 36:43having just cold tumors? Or
• 36:44someone came up with one
• 36:45of the postdocs and they're
• 36:46like, yeah. Let's check.
• 36:48So hold on here. So
• 36:50as you know, cold tumors,
• 36:51not always responsive.
• 36:54You see typically an absence
• 36:55of CD eight, low inflammatory
• 36:58signatures, etcetera. Right? So think
• 37:00about this. We're not comparing
• 37:01black versus white. We're comparing
• 37:03essentially where you live.
• 37:06Group of African Americans.
• 37:09This is also applicable for
• 37:10me because even though I'm
• 37:11talking about African Americans, this
• 37:13may explain
• 37:14why people in Beattyville, Kentucky
• 37:16versus Salt Lake City, Utah
• 37:18also have different outcomes. So
• 37:19it's not just a black
• 37:20thing.
• 37:22We're just using this group.
• 37:24Okay.
• 37:26I I I love this
• 37:28slide. I got some better
• 37:29ones coming.
• 37:31That
• 37:32top slide to your left
• 37:35is the place where they
• 37:36have really high neighborhood violence
• 37:38index, and we took, a
• 37:39number of samples. We have
• 37:40a probably a total now
• 37:41about two hundred and fifty
• 37:42total all total. But I'm
• 37:43just using this as an
• 37:44example.
• 37:46This is a patient who
• 37:47was not very responsive to
• 37:49therapy at all.
• 37:52And in fact, we matched
• 37:54them to somebody, you know,
• 37:55again, neighborhood,
• 37:58same stage tumors, etcetera, etcetera,
• 38:01just different
• 38:02ZIP code, if you would.
• 38:06It was interesting
• 38:07that in general, the people
• 38:09who came from these stressed
• 38:10places
• 38:10had much more,
• 38:13frequency of cold tumors.
• 38:16I know.
• 38:19High c d eight,
• 38:21I mean, high m two,
• 38:22which is circle, which is
• 38:23circle. They tried to put
• 38:24a circle around it for
• 38:25you guys.
• 38:26Low c d eight.
• 38:29People from the low neighborhood
• 38:30violence index, African American men,
• 38:33had essentially the opposite.
• 38:37People keep telling me and
• 38:38why I really fought this
• 38:40and I really paid some
• 38:41attention to this because
• 38:43I kept hearing since the
• 38:44time I was a medical
• 38:45student
• 38:46at Michigan that the reason
• 38:48why I got more cancers
• 38:49was simply because I was
• 38:50black.
• 38:52I'm just more predisposed to
• 38:53it. It's just my biology.
• 38:55It turns out that some
• 38:57of that is true.
• 39:00But they my angel says
• 39:01when you know better, you
• 39:02do better.
• 39:03We also now have evidence
• 39:04that sort of says that
• 39:05beyond that package that I
• 39:07come in,
• 39:09that which happens in the
• 39:10genome is also important.
• 39:14This issue of
• 39:16whether African Americans just aren't,
• 39:19you know, are so different
• 39:21that they just don't respond
• 39:22to standard therapy without looking
• 39:23in the context of what's
• 39:24happening in the z and
• 39:25a space, I think is
• 39:27old timey.
• 39:29I go back to this
• 39:30question.
• 39:32Both those brothers, they develop
• 39:33lung cancer. One lives in
• 39:35Englewood. The other lives in,
• 39:37the Gold Coast
• 39:39for a long period of
• 39:41time.
• 39:42Will they actually have
• 39:44the same response to the
• 39:46same therapy for their lung
• 39:47cancers if it's
• 39:48is all things being the
• 39:49same?
• 39:50The answer is,
• 39:53if you would have answered
• 39:53me in the nineties, I
• 39:54would have said, of course.
• 39:56If you ask me now
• 39:57in
• 39:58twenty twenty six, I say,
• 39:59I'm not sure.
• 40:02The new PSA,
• 40:04place space and I'll add
• 40:05Ancestry there,
• 40:07I think is really important.
• 40:08And by the way, when
• 40:09I say Ancestry,
• 40:10everyone does have an ancestry.
• 40:13I went once in ancestry.
• 40:14Someone said, well, you know,
• 40:15that's an African American thing.
• 40:16As I'm like, are you
• 40:17kidding
• 40:18me?
• 40:18I was just in London.
• 40:20I swear to god.
• 40:22So
• 40:23But this new issue
• 40:25of bringing the social molecular
• 40:27aspects together
• 40:29in this science, I think,
• 40:30is really exciting.
• 40:33I'm gonna switch just with
• 40:35a couple minutes that I
• 40:36have right now, and I
• 40:37know I you know, people
• 40:39say this guy always talks
• 40:40about community engagement no matter
• 40:41what. I do
• 40:43and will continue.
• 40:45You can't convince me that
• 40:46a modern day academic medical
• 40:48center that's trying to do
• 40:49impact if you only focus
• 40:51on just the science
• 40:53and you don't actually have
• 40:54the approach to bridge that
• 40:55with a very muscular
• 40:57outreach and engagement program to
• 40:59get it into communities, you're
• 41:01doing some good, but not
• 41:02as much good as you
• 41:03could.
• 41:03So for me, I value
• 41:05and, actually,
• 41:07both with my resources too.
• 41:09One of the things that's
• 41:09unique about Massey and hopefully
• 41:11will be at Fox Chase
• 41:12is that the basic science
• 41:13is being elevated to no
• 41:14end, but so are investments
• 41:16in outreach and engagement and
• 41:17the science thereof.
• 41:21By the way, engagement is
• 41:22an approach.
• 41:24But to make this happen,
• 41:26you have to have the
• 41:26compact with your community.
• 41:29I stole this, by the
• 41:30way, from, you know, Russo
• 41:31and John Locke.
• 41:34It may be, may not
• 41:35be all the point, but
• 41:36I hope you get the
• 41:37sentiment. You know, where they
• 41:38we used to talk about
• 41:39people surrender some of their
• 41:40natural rights in exchange for
• 41:42common good. I'm gonna say
• 41:44that as academics, we need
• 41:45to,
• 41:46maybe as researchers,
• 41:48surrender some of our natural
• 41:50control
• 41:53in exchange
• 41:54for common
• 41:55truce with the community.
• 41:57I actually think
• 41:59that if it's done well,
• 42:01we actually all benefit because
• 42:03the missing omics within the
• 42:04community gets filled in,
• 42:06and our questions that we
• 42:07get to ask gets more
• 42:09refined.
• 42:10I'll give you one quick
• 42:11example of this compact.
• 42:12By the way, a compact,
• 42:13I love it, is a
• 42:14someone is a green light.
• 42:15My you know,
• 42:16you know, why do we
• 42:17all stop at green lights?
• 42:19You could go through anything.
• 42:20Right?
• 42:21Why do you why do
• 42:23you go through, you know,
• 42:23you go through green, you
• 42:24stop at red. Why do
• 42:26you do that? You don't
• 42:27have to do that. You
• 42:28don't really have to do
• 42:29anything.
• 42:31But we agree as a
• 42:32compact for the common good
• 42:33that we would. I think
• 42:35that there's something
• 42:36similar to that, that ethos
• 42:38that we need to bring
• 42:39back into working with communities.
• 42:41I'm gonna give you just
• 42:42a quick example. I'm done
• 42:43in two minutes.
• 42:44This is the coolest example
• 42:46ever.
• 42:47Literally,
• 42:48this map,
• 42:49we have eleven tribes,
• 42:51tribal nations within the Commonwealth
• 42:53of Virginia.
• 42:55One of those tribes said
• 42:56the chief chief Atkins says,
• 42:59doctor Wynne, I have been
• 43:01seeing you out.
• 43:02Sometimes on Sundays, I'll go
• 43:04to some of the churches.
• 43:05I'll wind up in some
• 43:06mosques. I also wind up
• 43:07in temple. I I I
• 43:09actually sort of say that
• 43:10I need I need
• 43:12to be out there with
• 43:13the folk.
• 43:15So they had heard that
• 43:16this cancer crazy cancer center
• 43:18director was out there working
• 43:19with people. So they literally
• 43:20came to the office, made
• 43:22an appointment, which I thought
• 43:23was the best. Like, I
• 43:24got an appointment with who?
• 43:26They said chief Atkins, the
• 43:27the the tribal chief of
• 43:29the Chickahominy. I was like,
• 43:30okay. Cool.
• 43:32He literally steps in my
• 43:33office, and he throws this
• 43:35piece of paper
• 43:36on the desk
• 43:37with Suzanne Brown. He says,
• 43:39tell me why am I
• 43:40losing all these people? Well,
• 43:41I'm like, well, hold hold
• 43:42on. I don't even know
• 43:43you that well, but
• 43:45can we have a conversation?
• 43:48It turns out what they
• 43:49there was a landfill nearby,
• 43:50and they were concerned that
• 43:52they had, this was just
• 43:54a part of it, that
• 43:54they had a excessive number
• 43:56of cancer deaths. And you
• 43:58can see that they went
• 43:59through. They put the name.
• 44:00They, you know, put what
• 44:01they had and what they
• 44:02died from and all this
• 44:03stuff. It's really simple.
• 44:05They can got the churches
• 44:07together within what's called Charles
• 44:09County, and they said, well,
• 44:10we're gonna do so they
• 44:11had these maps, and we
• 44:11said, okay.
• 44:12Why don't we do something
• 44:13better? So this is what
• 44:15I was telling someone yesterday
• 44:16that this started off called
• 44:17the truth project. This is
• 44:19Doctor. Tocis. This started
• 44:21off as a grant,
• 44:23but I stopped doing just
• 44:24grants. I made a ten
• 44:26year commitment to I don't
• 44:28sign off of anything as
• 44:29a cancer center director unless
• 44:31the people who are saying
• 44:32beyond the grant, what's the
• 44:34ten year plan?
• 44:37Just to go through quickly,
• 44:38we were able to test
• 44:39the waters. We were able
• 44:40to do all these other
• 44:41things. But what wound up
• 44:43happening is beautiful. We build
• 44:45not just trust, but we
• 44:46became more trustworthy.
• 44:48And in that process, we
• 44:50became
• 44:51trusted by the other tribes,
• 44:53tribal nations.
• 44:54And now we actually have
• 44:56left them with a conference
• 44:57that is an annual first
• 44:59and only annual conference
• 45:01around cancer in tribal communities
• 45:03within the US every year.
• 45:06We've also not only just
• 45:08did papers, which is great,
• 45:10but we've also now allowed
• 45:11them,
• 45:12and enabled them in some
• 45:13ways to really kind of
• 45:15amp it up.
• 45:16Last two slides.
• 45:18Some of you may
• 45:20remember I've shown this slide
• 45:21maybe few years ago, but
• 45:22I'm bringing it back because
• 45:23it's important to me.
• 45:25Ralph Abernathy
• 45:26and doctor Payne. And I
• 45:28don't know if you all
• 45:29know the story, but right
• 45:30before they were gonna put
• 45:31the first man on the
• 45:32moon,
• 45:34there was a
• 45:36I mean I mean, doctor
• 45:37Abernathy, which is down with
• 45:38MLK and all the rest
• 45:39of those guys, Shuttleworth,
• 45:41actually had a protest.
• 45:43And it got so loud
• 45:44that
• 45:45NASA said, go quiet those
• 45:47guys out. Go go find
• 45:48out what do they want.
• 45:49This picture is a very
• 45:50famous picture for me and
• 45:52actually is orient much of
• 45:53what I do.
• 45:55Doctor Payne comes out and
• 45:56he says, listen.
• 45:57We are about to put
• 45:58the first man on the
• 46:00moon.
• 46:02It is a technological, and
• 46:04we have everybody else, you
• 46:06know, watching us, especially the
• 46:07communist. And they're gonna you
• 46:08and he said, ho ho.
• 46:09Stop.
• 46:10He goes, believe me. Reverend
• 46:12Avance, he said, I am
• 46:13actually proud to be an
• 46:14American, and we're gonna do
• 46:15that. It's a technological dominance
• 46:17of America. It also shows
• 46:19what we're made of and
• 46:19what we can do. He
• 46:21goes, but what I'm worried
• 46:22about is that
• 46:23four miles from here,
• 46:26we have some of the
• 46:26worst poverty. He goes, all
• 46:28I wanna ask you is
• 46:29if we can put somebody
• 46:29on the moon
• 46:32to solve that problem, why
• 46:33can't we go four or
• 46:34five miles down from where
• 46:35we're about to launch this
• 46:37thing and take care of
• 46:37those communities? That's a problem
• 46:39too.
• 46:40So I'll end with this.
• 46:43Brings me full circle.
• 46:45We are at a crossroads.
• 46:50And now more than ever,
• 46:52we need to
• 46:53think not about now, but
• 46:55about our future.
• 46:58And I know sometimes people
• 46:59say, god, Rob, you're just
• 47:00the most optimistic guy I
• 47:02know. What's wrong with you?
• 47:04It's not optimism.
• 47:06It's to understand that science
• 47:07continues to march forward
• 47:09no matter.
• 47:11We've had times
• 47:14that have been incredibly tough.
• 47:17My grandmother reminds me that
• 47:18Jim Crow wasn't that far
• 47:19away,
• 47:22and yet the science continue
• 47:24to move.
• 47:27I'm gonna actually send out
• 47:28a call to action. I've
• 47:29been so inspired
• 47:31by Paul and by this
• 47:33meeting and by the spirit
• 47:34of doctor Calabresi that says
• 47:35we should be rethinking about
• 47:37this next crossroads
• 47:40and what we should be
• 47:41doing about it.
• 47:43And so I think I
• 47:44will,
• 47:45say on this day, I'm
• 47:47calling us all out.
• 47:49I'd like to restart the
• 47:51conversation,
• 47:55figure out how to organize
• 47:56and how to get with
• 47:57people and people from the
• 47:59community, by the way,
• 48:01to help us come up
• 48:02with another, not just report,
• 48:04but in a I'm gonna
• 48:04call it an action plan
• 48:07of what we're gonna do
• 48:08in the years to come.
• 48:09So with that, I know
• 48:10I probably overstayed my welcome,
• 48:13but I do wanna say,
• 48:14to the Calabresi family, to
• 48:15Eric and Roy and everybody
• 48:17in this room, doggone it,
• 48:18thank you so much for
• 48:20allowing me to be with
• 48:21you. Appreciate it.
• 48:30Thanks thanks, Rob, for an
• 48:32excellent lecture. I just wanna
• 48:33remind some of the trainees
• 48:34or anyone who wants to
• 48:35come at Michela Dine in,
• 48:36we'll have what's called brewing
• 48:37connections right next door where,
• 48:40people can spend more time
• 48:41with Robert. And now as
• 48:42is the tradition of the
• 48:43Calabresi lecture, judge Giulio Calabresi
• 48:46will ask the first question.
• 48:49I actually have two questions,
• 48:51and
• 48:52they're one technical
• 48:54and one much broader.
• 48:56The technical question is, has
• 48:58the same kind of study
• 49:00been done with other kinds
• 49:02of diseases?
• 49:03Heart diseases,
• 49:05strokes,
• 49:07renal diseases,
• 49:09do they react in the
• 49:10same geographical
• 49:12way more or less?
• 49:14And the second question is,
• 49:16given that we have to
• 49:18do something
• 49:19as a community,
• 49:21do you think it is
• 49:22best to focus locally?
• 49:25You mentioned senators, people like
• 49:27that,
• 49:28or to focus nationally?
• 49:30You know, that's a question
• 49:32to me as a lawyer
• 49:33and so on. Where do
• 49:35you think we can
• 49:37do the pressure
• 49:38that will help you all
• 49:39to do this? This has
• 49:41been wonderful,
• 49:42and I, you know, I
• 49:44wanna do something.
• 49:48Thank you so much.
• 49:49To your first question, I
• 49:51you know, this concept is
• 49:52starting to take some roots.
• 49:54There has been a really
• 49:56amazing group in, both Maryland.
• 49:59There's been a group in
• 50:00Philadelphia and around the country
• 50:01that are starting to understand
• 50:03that where you live probably
• 50:04does matter.
• 50:06I have this funny thing.
• 50:07We won't talk about it
• 50:08now because I don't know
• 50:08if it's gonna work, but
• 50:10I I I you know,
• 50:11there was, as a pulmonologist,
• 50:12as a lung guy, I
• 50:13had this thing called the
• 50:14Fick equation.
• 50:15So I was working with
• 50:16machine learning and AI about
• 50:18creating what's called a social
• 50:20fic equation, about how, you
• 50:21know, turbulence and other things
• 50:23like that, how if you
• 50:24have drug x, how does
• 50:25it get to community y?
• 50:26Anyways, I think it's a
• 50:27failure for the first round,
• 50:29but we'll keep working on
• 50:30that. To your second point,
• 50:32I actually think one team,
• 50:34one fight.
• 50:36It's local efforts with national
• 50:38impact.
• 50:39And I've been going around
• 50:41sort of saying to everybody
• 50:42that we are fighting the
• 50:43wrong thing.
• 50:45One team, one fight, and
• 50:47then this fight, it's to
• 50:48fight cancer, but other broad
• 50:49diseases. So there is a
• 50:51alignment
• 50:52of local efforts, which have
• 50:53gotten much better. This is
• 50:54why I'll wind up in
• 50:55a, a at the,
• 50:58Tappahannock,
• 50:59you know, on a Sunday
• 51:00in a church with four,
• 51:01five hundred people, three hundred
• 51:03people, or a church with
• 51:04twenty people, but aligning that
• 51:05with the legislators and aligning
• 51:07that both locally and nationally
• 51:09because it's about talking to
• 51:10one another. I know that
• 51:11sounds strange because we have
• 51:13our cell phone, and we
• 51:14just all we need to
• 51:14do is social media. But
• 51:16it turns out that when
• 51:16you talk to one another
• 51:17and you align efforts, you
• 51:19can get bigger things. So
• 51:20that's the kinda underpinning thing
• 51:22of trying to get this
• 51:23information out in this approach.
• 51:27I wanted to just mention
• 51:28something about my dad, which
• 51:30I had a chance to
• 51:31share with you last night,
• 51:32but not with the audience,
• 51:34which is
• 51:35that, one of the things
• 51:36he was proudest of in
• 51:38life is that having gone
• 51:39to Yale College, Yale Medical
• 51:41School,
• 51:42and having worked at Yale
• 51:44New Haven Hospital and the
• 51:45cancer center here for
• 51:47eight years,
• 51:48he went to Providence, Rhode
• 51:49Island to cofound with Pierre
• 51:51Galletti, the Brown University Medical
• 51:54School.
• 51:55And he said,
• 51:57one of the reasons he
• 51:58was particularly proud of that
• 52:00is because the people of
• 52:01Rhode Island, Eastern Connecticut, and
• 52:04Cape Cod
• 52:05were getting lower quality medical
• 52:07care than people in Boston
• 52:08and people in New Haven
• 52:10and people in New York.
• 52:11And you needed more university
• 52:14hospitals with interns and residents
• 52:16to do that. Yes. One
• 52:18thing that occurs to me
• 52:19is that in my lifetime,
• 52:20the population of the country
• 52:22has doubled.
• 52:23But the only new medical
• 52:25school I know of that's
• 52:26been founded is Brown. I
• 52:27assume there may be others.
• 52:28I just don't know.
• 52:31I wonder if we don't
• 52:32need twice as many doctors
• 52:33now
• 52:34as we needed,
• 52:36as as as we actually
• 52:37have.
• 52:38That if we had twice
• 52:40as many doctors and twice
• 52:41as many medical schools, they
• 52:43could farm out all of
• 52:45they all over the country
• 52:46and reach some of the
• 52:47African American communities and other
• 52:49underserved communities you're talking about.
• 52:51Yep. You know what? I
• 52:53I I'm gonna volunteer you
• 52:54to come with me when
• 52:55I talk to some people
• 52:56on the hill.
• 52:57It's I'll do it.
• 53:00But I do think that
• 53:01I also think that the
• 53:03workforce,
• 53:04we're starting to think about
• 53:05it a little bit differently,
• 53:06particularly in rural areas. It
• 53:07turns out we we kept
• 53:08talking about nurse practitioners and
• 53:10PAs.
• 53:11The best ever story I
• 53:12ever had was I was
• 53:13talking to someone, and I
• 53:15was in Frontier Country. So
• 53:16we were doing some cool
• 53:17things in Frontier Country.
• 53:18And a a nurse came
• 53:20to me, and she said,
• 53:21doc,
• 53:22she goes, if you think
• 53:23doctors don't wanna go there,
• 53:24why do you all of
• 53:25a sudden think that a
• 53:26PA or NP wants to
• 53:27go there? And I was
• 53:28like, you got a point.
• 53:31So what I started thinking
• 53:32about is thinking about it
• 53:33much more globally and the
• 53:34workforces that we need. And
• 53:35and and as we're thinking
• 53:37about twenty first century things,
• 53:38it's funny. Almost every other
• 53:40industry is thinking about themselves
• 53:42differently, but we still are
• 53:44stuck in the twentieth century.
• 53:45So it's how do we
• 53:46push things? How do we
• 53:47use by the way, it's
• 53:48not just technology. I believe
• 53:50in high-tech,
• 53:52but what we think about
• 53:53high-tech needs an infrastructure of
• 53:55high touch.
• 53:57And while we're driving AI
• 53:58and wearables and all these
• 54:00other things, the reality is
• 54:01if you've never been to
• 54:02a Brunswick,
• 54:03Virginia where your cell phone
• 54:05stops working I was literally
• 54:07in Brunswick, and my cell
• 54:08phone stopped working. And I
• 54:09was like, I know I
• 54:10paid my bills, so I
• 54:11asked what and the guy
• 54:12said, no. No. No. We
• 54:13don't have broadband out here.
• 54:15So,
• 54:16again, high-tech is wonderful,
• 54:19but it has impact only
• 54:21when there's an infrastructure of
• 54:23high touch to allow it
• 54:24to work. So I am
• 54:25so with you about thinking
• 54:26about general workforces
• 54:28of how we can actually
• 54:29expand,
• 54:30in the twenty first century
• 54:31to make impact.
• 54:32Thank you. Thank you. By
• 54:33the way, that happens to
• 54:34your phone when you walk
• 54:35down the hall here too.
• 54:36Yeah. Anne?
• 54:38Great talk. Really inspiring. Thank
• 54:40you.
• 54:41You mentioned just two two
• 54:42questions. One, you mentioned rural
• 54:44communities, and I wondered if
• 54:46you could share a little
• 54:47bit more about because that's
• 54:48really important. And then secondly,
• 54:51and you are also touched
• 54:52on it, but thinking about
• 54:54possible interventions,
• 54:56telehealth
• 54:57or AI, you know, what
• 54:58are things that
• 55:00where where we could mitigate
• 55:01some of these DNA factors?
• 55:03Yeah. You know,
• 55:05this is just to get
• 55:06way out there.
• 55:07But rural,
• 55:08I am actually
• 55:10really
• 55:11it's a passion for me
• 55:13because people think rural is
• 55:15just
• 55:16almost homogeneous.
• 55:18You think of a rural
• 55:19community almost like watching Green
• 55:20Acres. And for those who
• 55:22are young, that sounds like,
• 55:23what the hell is Green
• 55:23Acres? You look it up
• 55:24on YouTube.
• 55:27It's very different. What you
• 55:29have in the west, what
• 55:30I have in the south,
• 55:31particularly along that I ninety
• 55:32five corridor, where you think
• 55:34about South Carolina,
• 55:36Virginia, North Carolina.
• 55:38It's a very different mixture
• 55:40of rurality.
• 55:42And yet or when you
• 55:43go way to,
• 55:45the northeast.
• 55:46But we treat it almost
• 55:47the same.
• 55:48So, with the National Cancer
• 55:50Policy Form and well, I'm
• 55:51gonna I'm gonna knock you
• 55:52out right. So we've been
• 55:54talking a lot about bringing
• 55:55more attention to
• 55:57not only world communities, but
• 55:58the differences in them, which
• 56:00also may actually,
• 56:02influence
• 56:03the approaches
• 56:04because they're not all the
• 56:06same.
• 56:07To your last point, I
• 56:08am super excited that we
• 56:10have not really pushed the
• 56:12envelope yet of what we
• 56:13are possibly able to do
• 56:14within rural communities
• 56:16by the using of technology,
• 56:18but by the focus on
• 56:19the infrastructure
• 56:21that is required.
• 56:23Having just a telemonitor
• 56:25without a broadband or having
• 56:26a wearable
• 56:27that kinda works, but but
• 56:29actually having I know this
• 56:30is gonna sound crazy, but
• 56:32having a centrally located place
• 56:34where people can actually go
• 56:36in and maybe get their
• 56:37blood drawn and all the
• 56:38rest of that stuff, it
• 56:39sounds futuristic.
• 56:40But I'm literally thinking about
• 56:41not how people get to
• 56:42us, but how do we
• 56:43take care out to them.
• 56:44But, again, a lot of
• 56:45that is built on structure
• 56:46and infrastructure
• 56:48to be able to use
• 56:48the technologies. And so far,
• 56:50most of the conversations have
• 56:51been about the tech, but
• 56:52not the infrastructure of touch.
• 56:55Great. I think we're at
• 56:56tonight.
• 56:57I'm sorry. I can probably
• 56:58talk too much. No. That's
• 56:59great. I think that's a
• 57:00good idea. I think I'll
• 57:00move to a rural community.
• 57:02So, actually, I wanna thank
• 57:03Rob. He's actually moving to
• 57:04Fox Chase when in the
• 57:06summer? July one. He'll be
• 57:07the director there right up
• 57:08the train from us.
• 57:10Thank you all very much.
• 57:11If you want more questions,
• 57:12everyone's welcome to the brewing
• 57:13connections. We have coffee. We
• 57:15have muffins and things, and
• 57:17we're gonna talk about anything
• 57:18you want. It's an open
• 57:19discussion. Robert, thank you Calabresi
• 57:21family. It's this is a
• 57:23wonderful tradition. We'll continue it
• 57:24on. Thank you all for
• 57:25coming today. Likewise.