MedBuzz: Dr John Marshall reflects on a turbulent moment in medicine where trust is in flux. When the sources of trusted information change, who do clinicians and patients believe? A candid look at science, skepticism, and the shifting ground of cancer care. Main Topic: In this episode of Oncology Unscripted, Dr John Marshall explores the global race to reshape cancer care through molecular innovation. From ctDNA-based screening to the expanding use of minimal residual disease (MRD) surveillance, liquid biopsy technologies are pushing precision medicine upstream toward earlier detection and individualized care. Candid Conversations: From government shutdowns and funding instability to the rise of public misinformation, there is mounting pressure in cancer research and care. In this Candid Conversations, Dr John Marshall speaks with Dr Eric Winer about systemic and cultural shifts affecting patients, institutions, and the future of oncology.
MEDBUZZ [0:00:05]
When the Sources of Trusted Information Change—Who Do We Believe?
John Marshall, MD:
Happy whatever day it is today when you're watching this. John Marshall for Oncology Unscripted. A little bit of a rainy day here in Washington, DC. It's been a little bit of a weird time here in Washington, DC—even weirder than it normally has been.
Let's start with a little of the business of our world today—the business of oncology. You may have seen that we have a new National Cancer Institute director: Dr Anthony. Professor of medicine, he's kind of a basic science guy, but he's also a medical oncologist from Dana-Farber. Would you take that job if it was offered to you? I knew some of the candidates who were in line for it—or the finalists—and you'd really have to want that job to take it right now, because of all the unsettledness at the NIH in general, et cetera. So, I'm grateful that this very smart person has said yes to the job. Now, what he does—one of his areas of expertise—is programmed cell death, which is sort of a subtle way of getting a cancer cell to kill itself, right? So maybe, just maybe, he'll use some of that expertise to help in the shifting of government. A little programmed cell death around here might go a long way. So, fingers crossed that he succeeds in maintaining and growing the research that we are doing in cancer, much of which is sponsored through the National Cancer Institute. So, fingers crossed.
But as soon as he gets the job, what happens? Well, we shut down the government.
We've done this before. It is weird in Washington when the government shuts down. Whether it's patients who now don't have a job for the moment and who risk not having health insurance to receive their ongoing cancer care—in my case—or care in general out there.We're clearly seeing an impact on patients. We're clearly seeing an impact on government operations. I'm supposed to fly to Florida to get measles, maybe, this coming weekend, and I'm not sure we will do it because—who knows if there'll be air traffic controllers available? Would you go to work if you weren't getting paid?
I had a recent call with an NCI colleague who is going to work, who is seeing patients, and is trying to manage things—but is uncertain about whether they will be paid.
I also happened to come across recently somebody in the medical center who works up in McLean. If you know what offices are in McLean, I'll let you figure that out—sort of secret spy stuff. Normally, they're incredibly busy, but because there aren't any other government activities going on, they're kind of sitting there saying, "Well, we can't do what we normally do because we're dependent on the rest of the government to do what we do." So even those who are going to work are kind of stalled.
So, there's a whole lot going on. The one positive—and it's not really a positive to make up for the negatives—is that the traffic's a lot lighter here in Washington. But still, not enough to make up for it.
Now, I do want to talk a bit about another big topic that’s come forward. You know that RFK Jr. fired 17 members of the Advisory Committee on Immunization Practices. This is the group that gathers to make recommendations around vaccines and immunizations in general. He fired a lot of them. He put some replacements in—many of whom have been featured in other articles—I won’t drill down into the weeds on some of this, but many of them are more than just anti-vaxxers. They’re suggesting that we’ve mismanaged this as a medical community, and that we’ve not been telling the true scientific story.
The new people who’ve been put in place haven’t made any formal recommendations yet. But the most recent one that came out is that there’s even some debate about whether newborns should be given hepatitis vaccines. And that data is very, very tight about how many lives are saved because of vaccines—as they all have been shown. But we’ve forgotten data, and we’re going to have to relearn the lesson going forward.
Do you read the front page of the paper or don’t you? In my family, it’s split. My wife only reads the sports section. I read the front section—or at least read the headlines.
In the Washington Post editorial page was an article written by the last six Surgeon Generals—right and left—appointed by different presidents over time. And this was a very thoughtful piece that basically summarized that RFK Jr.—he’s perfectly entitled to have his own opinions about things—but he’s not entitled (this was their conclusion) to put other people’s health at risk.
And they collaboratively, collectively, emphatically said that that is what is going on with this new ACIP committee—with RFK Jr. at the helm. That we are putting a lot of people at risk, and it’s what’s making us all very, very anxious in the medical community today.
Now, I want to talk in closing on this about a book that I am reading. Don’t worry, it’s not too boring.
And the stuff I’ve been seeing during Jeopardy—I always measure the pulse of America by what ads run during Jeopardy every night.
Now, the book I’m reading is brilliant.
It’s called Empire of Pain. It’s written by a guy named Patrick Radden Keefe, and it’s the story of the Sacklers, Purdue Pharma, and OxyContin. I’m sure you may have seen the movie about this. It’s brilliantly written, and it starts with the first advertising that was ever done for drugs.
This was Librium and Valium—done by Pfizer at the time. And the Sacklers kind of invented this strategy where they were figuring out how to tell a story of a new medicine—in this case, anti-anxiety, kind of anti-depression medicines, Librium and Valium.
These were for patients who weren’t psychotic—so they didn’t need to be admitted for their psychiatric anxiety and problems—but there were a lot of people out there who could use a little something to help take the edge off. So, they created a market. They had drugs that would solve this problem for people. And Librium and Valium became the biggest-selling drugs at their time. This was through peer-to-peer teaching. So, start thinking about your own role in this as you listen. Physicians who were trained to teach other physicians about the new medicine. Direct-to-consumer, certainly. The Sacklers owned a medical journal where they advertised in it and could write editorials about their medicine. They also had consultants that worked for it.
Now, as I’ve been reading this, I’ve been thinking: I play all of these roles. I’m a consultant of pharmaceutical companies. I do peer-to-peer education. I do clinical trials. I write papers for journals. I do video podcasts, for God’s sake.
And so, I’m out communicating my bias, my opinions to others—to influence their practice on some level. Not my goal, but it’s certainly a downstream product of influencing their practice.
So, this family had figured out a way to take advantage—and coach and train us all—how to use medicines. And this was in the very, very early part of my career. But then what they figured out was how to take pain medicine, believe that the pain medicine would help, make it longer-acting, get a good price for it, sell it, convince us all that we needed to be on it, and increase the utilization of long-acting pain medicines. So, when I was just a fellow and a new faculty member, we were all coached that there is no high enough dose. That all patients need to be on it. That it’s normal to be on these drugs. And in point of fact, it is the right thing for people to be doing. Only now do we recognize that this was really an over-push for these people.
I’m just reading the section of the book now where people were abusing it. That they became addicted to it. And it was not really for cancer pain or other things—they were just hooked to the drug. And it took a long time for that to get broken.
So early in my career, I was pushing huge doses of this medicine. You were, too.
And now there’s nobody I’m giving much more than about 10, 20, 30 BID of long-acting pain medicine. So, we learned our lesson about how we were kind of lied to in this setting.
More recently, we have a new point-counterpoint with the government. I’m seeing it from Pfizer. I’m seeing ads today during Jeopardy and other shows like that, where Pfizer is basically reminding us all—as an audience—that vaccines can help.
The government is telling us, RFK Jr. is telling us, that vaccines are bad. That we shouldn’t be taking them. That they cause all sorts of trouble in patients, and we shouldn’t be messing with it.
But then I’ve got Pfizer doing a very clean ad over here that says, “Don’t forget vaccines.”
Let’s look a little bit at the science that’s being referred to. The science back when we were giving long-acting pain medicines, and now when we are making new recommendations by our government.
So, back then, they actually didn’t even get formal FDA approval for MS Contin, because morphine was already approved. They just got it. They just started shipping it out. They just started making it and shipping it out.
They then got approval for OxyContin—but the guy who approved it at the FDA, believe it or not, a couple of years later, starts to go and work for them outside the FDA. So, there’s a lot of question about whether that was legitimately covered.
But the idea was that OxyContin would be less addictive—but they never really showed that, even though they marketed that.
So, the cleaner processes that we’re used to for drug approval were not put in place. And then the claims that could be made about how well these pain medicines worked—anybody could say anything. There wasn’t a lot of supervision around that until it kind of came back to bite them and haunt them.
We are, in today’s world, hearing the government, RFK Jr.’s gang, and other people talking about immunotherapy, vaccines, et cetera—saying things that have no real foundation in science. They are based on just speculation, or something somebody put on Twitter one day. And it becomes our job, in the medical community, to judge what is the correct thing to be doing.
And I think right now, you’re seeing insurance companies and pharmaceutical companies and the medical teams really sticking with the more clean science, and applying therapies based on what they know—and sort of ignoring what they’re hearing in the public media, et cetera, based on what the government is saying.
So, this has put us in a new and awkward position, where we are on the side of business in this case, and not on the side of government.
If you haven’t read this book, Empire of Pain, I would recommend that you do—particularly if you are an older person who’s lived through some of this. But I also want you to recognize that there’s a lot of pressure—mixed pressure—out there on just providing today’s standard of care.
And so, the next time you see that Pfizer ad, remember that you’re probably now on that side of the coin—advocating for ongoing immunotherapy for our patients in the form of vaccines to prevent, but also in managing and preventing other cancers from occurring through the use of immunotherapy.
Complex times. Lots going on in the news today. Lots that’s affecting our world and the treatments that we are offering. Lots to incorporate in your recommendations.
I hope this has been helpful in summarizing that, and it’s useful for you tomorrow in your practice.
John Marshall for Oncology Unscripted.
Main Topic [0:13:12] The Molecular Space Race: Will It Bring Earlier Detection and Better Treatment?
John Marshall for Oncology Unscripted. An amazing amount of science is going on right now in the cancer world—on the molecular side of things—and I like to think of it kind of like a molecular space race. Because the technology that’s out there—of being able to measure what’s going on in a tumor, what’s going on in the blood, finding different genetic characteristics, and being able to act on those—has never grown quite as fast as what we are seeing now. Just like we were racing to get to the moon or racing to orbit around the Earth, we are now seeing companies and different groups from all over the world developing and improving technologies to try and read the tea leaves of whatever’s going on in the blood, whatever’s going on in a tumor—in what I think of as a molecular space race. And I wanted to feature a paper about this that I thought was quite interesting and will set us up for the beginnings of what will be, really, a few-month-long discussion around precision medicine—to try and understand better how it’s going to help us evolve and become more efficient in the practice of not just cancer care, but healthcare in general.
Now, the paper I want to talk about is in this journal called The Journal of Clinical Oncology. Yeah, I still do get a paper version. And this one is from China. Now, I want to start by saying that I’m a little surprised this paper made it into JCO, because it is a molecular analysis done totally in China.
But where I wanted to start from was that the funding for this work came from a bunch of philanthropic and government-supported stuff in China. A big, long list of different resources—including the healthcare system where it was started out of.
And I keep thinking about here in the United States—where we’ve been leading in investment, where we’ve been leading in discovery—we are now finding it more and more difficult to access the kind of support that came to make this science possible. So, when we think about our individual U.S.-based impact on outcomes and research and progress—without that funding—we’re going to clearly keep falling behind.
And the two papers I want to talk about—this one in China and the other one out of the European Union group—show that all of this novel, positive work is coming from other sources, other investment. Just food for thought.
But anyway, this group took patients with the attempt to try and find a blood-based test to detect early, early-stage pancreas cancer. Because, as you know, it is very, very difficult to cure pancreas cancer if it shows up clinically. I won’t go into the weeds on this paper—it’s in JCO—but they basically took some learning sets and some training sets, et cetera, and developed a panel—a blood-based panel. And they were able to show, with very high precision, that they could distinguish who had small-volume pancreatic cancer and who didn’t. They even had a cyst sub-study subgroup in there to look at—and things like that. And I think it’s worthy of being presented in JCO, because if you think about what we’ve been doing with our blood-based testing, is people who already have cancer—who then get blood-based or tissue-based genetic testing to decide what we’re going to do to treat them or how to follow them: looking for minimal residual disease or what targeted agent might be available for that individual patient. But this is the other end of where I think this kind of technology is going to go—and that is screening. Healthy population. Blood-based testing. See if you’ve got cancer or not—and intervene. And I’m very, very interested in seeing over the next 5, 10-plus years how this kind of technology shifts from just coaching us to be more efficient in the treatment of existing disease—existing cancer—and more shifting towards early detection and prevention strategies.
So, I think there’s nothing hotter than this blood-based testing that’s going on now, which is why we’ve decided to spend a few months on it. And this paper sets the stage.
The other paper I want to contrast that with also just came out in the Annals of Oncology. So yeah, good group, good journal—but not quite JCO, right? So, a little bit off the beaten path. But to me, maybe the most important paper of the week.
And this was the group from the PRODIGE 13 adjuvant colon cancer study, where after the intervention was done, patients were randomized into four groups of follow-up. Now, I don’t know what you do. NCCN says I’m supposed to do it maybe once a year. I do it a little more often than that, if I can get away with it—although that sometimes means I’ve got to do a peer-to-peer to get a scan or other things. I’ve incorporated, more recently, doing MRD testing. But the standard right now is a CEA every now and then, and a scan every now and then, and a colonoscopy every now and then.
Well, the study actually randomized patients into more intensive follow-up versus less. Now, remember why we do this in colon cancer. The primary reason is that we feel like if we can find a met before the patient feels it, that we could remove it—and maybe cure the patient, right? And so, unexpectedly, this study basically said the opposite. It didn’t matter how intensive your follow-up was. You had the same overall survival. Well-done study. Prospectively looked at.
So, then I’m thinking, oh my gosh—if it doesn’t really matter, like should we do what the breast cancer doctors do? They don’t even do follow-up scans at all, right? They do an occasional LFT and a physical exam, and that’s it. Should we begin shifting to something like that?
Know that we are dialing up in the other direction—because we’re increasingly doing MRD testing, where we’ll have an even more sensitive measure than CEA or scan to determine if somebody’s got residual or persistent cancer.
And I am hopeful that what we will show is that by identifying patients at the molecularly positive level—like an MRD test—we can intervene.
And in fact, I’m helping to lead a study across our country to test new agents in that space. That if we intervene with those new therapies, we will, in fact, cure more people through that earlier intervention than by waiting to see what grows out there in the patient’s liver or lungs, et cetera.
Recently, I have a patient—a colon cancer patient, a young man—who had an MRD-positive blood test. And his scan—regular conventional CT scan—was negative.So, I ordered a PET. Now, you could argue maybe I shouldn’t have. But he had two in a row—blood tests, positive; CT, negative. I ordered a PET. Guess what? The insurance company said, “No, you can’t order that.” So, I ended up doing a peer-to-peer review.
Don’t you love peer-to-peer reviews? How many of you initially say, “Are you actually an oncologist?” when you talk? I wasn’t—I was polite to the doc on the other end. I told her the story. She plugged in the data that now the patient was MRD positive, and she read out the approval code to let me go ahead and get the PET scan. So, clearly, MRD testing is having an influence on decision-making and insurance coverage. But it’ll become our challenge to demonstrate that knowing MRD testing is important enough that it will influence survival—unlike that Annals of Oncology paper that showed that CTs and CEAs maybe not so much.
I think this paper puts us at a higher bar for challenge—to make sure that following patients closely makes sense, and that this MRD testing better work for us. Or else, we’ll just be pulling back in general after patients are initially treated.
So, I hope you find this next series of discussions about MRD testing, et cetera, interesting and useful to you. And I hope you find these two papers a bit challenging—one that takes us to a screening test for pancreatic cancer, the other that takes us to: should we be doing anything after we follow patients, outside of these newer tests that are coming?
So, more to come. I hope it’ll be useful to you, and I hope you’ll tune in next time for Oncology Unscripted.
Crisis, Misinformation, and the Future of Cancer Care: A Candid Conversation with Dr Eric Winer
John Marshall, MD:
Hey, everybody out there—John Marshall for Oncology Unscripted.
And I am a lucky guy to be able to talk with such an amazing contributor to our world of cancer: Dr Eric Winer. And I’m going to embarrass him for a minute. Not only are we Dukies—by the way, go Devils—but we all know he has, as everyone on this call knows, really led so much of the innovation and progress in solid tumors—specifically breast cancer. Transformed things up at Harvard first, now back to his home base of Yale, where he oversees an incredible group of people and a program. And I am just—first—honored that he said yes when I asked him for a quick interview on the world today. So, Dr Winer—Eric—thank you for joining us.
Eric Winer, MD:
Oh, pleasure to be here—and I was honored to be asked.
John Marshall, MD:
You are so cool. Thanks a lot.
I mean, what I wanted to talk with you about is the impact—the acute impact—that we are having in general around cancer research and around cancer care, since this academic versus executive branch battle that’s been going on around grant funding, around cancer care, but now more acutely with the government shutdown, we have NCI trials. You know, patients are losing insurance and this sort of thing. And I know what it feels like here in Washington, but I thought—you, having a pretty broad vision around things in the country and maybe on a global scale—might have some reflections on this.
So, maybe just wax poetic a second about what the last several months have been like, and how the last month has made that even more.
Eric Winer, MD:
Sure. So, the last several months have not been easy, for sure. In truth, there are not that many grants that have not been refunded at our center at Yale. There are some—and there are people who lost some funding—and we’ve done our best to backfill whenever possible.
I think there’s a lot of anxiety. There’s a lot of anxiety, particularly among young people—young people trying to make careers in the lab, trying to make careers in clinical research—and that’s been pretty tough on everyone. And at Yale, we are one of those institutions—which I guess I should say we’re lucky to have such a large endowment—but we are one of the 8% endowment earnings tax institutions. So that is hundreds of millions of dollars a year to the university that we will be losing. And so, there have been many conversations about how it is that we’re going to manage to keep doing everything that we want to do. This is not just at the School of Medicine or in the cancer center—this is the university at large.
With, you know, with that kind of hit, I think the last few weeks have even been harder. Today there was, of course, supposed to be a Cancer Director’s meeting at the NCI. And the reason we are in our offices all day is because that was cancelled because of the shutdown.
John Marshall, MD:
Tell me the impact of that.
I mean, you guys get a lot done. I know when Lou Weiner goes up to those meetings, he comes back with a lot of fresh ideas, new collaborations, progress.
Tell me what a missed meeting—I mean, somebody said, “Well, we meet too often anyway.” What’s your take on that?
Eric Winer, MD:
Well, I think missing a meeting—you know, one meeting—isn’t such a big deal. I mean, in truth, was I perfectly happy to stay at home in Connecticut rather than go to Washington today? Sure. On the other hand, I think these meetings serve a real purpose.
It allows us to talk to one another. It allows us to hear what’s going on at the NCI, and how the Cancer Center Support Grants potentially are going to change. It’s a way of collaborating. So, I think it’s serious, and it’s concerning.
I guess my biggest worry with the government shutdown is all the people who aren’t getting paychecks. All the people diagnosed with cancer, who are living with cancer, who are struggling to find food to put on the table. You know, there were multiple stories this week—just watching the various news outlets—about government employees going to food banks. And some of those people have cancer. And it’s very hard.
I think that all the anxiety that we feel in academia at the moment—particularly related to medical research—I think now, suddenly, the whole country is feeling, with the government shutdown. And it’s hard to be under multiple stressors at the same time.
John Marshall, MD:
With cancer being one of them—particularly, think about our patients.
So, my wife accuses me of a lot of hyperbole—and she’s probably right—but I think we’re about one in three, one in five of my patients here in Washington, where one of the couple has either lost their job, is on furlough, or it’s questionable. And they’re often the one the insurance is with, right? And so, we’re trying to make plans for next scans or next cycles. And hospitals are on their heels a bit too about: will these be maintained? Will people keep up their premiums?
And so, I’m assuming you all are feeling it there in Connecticut as well, right?
Eric Winer, MD:
I mean, we don’t have as many government employees—federal government employees—as you do in DC. But, you know, I think it’s this pervasive sense of angst that so many people have that just makes it so much harder.
You know, my patients come in—and I see patients one day a week and totally enjoy it—but I have to say that the anxiety level is up for everybody. And I think that’s hard.
And it’s very hard when you’re going through difficult treatment and a difficult diagnosis, and you may be facing a diagnosis that is going to shorten your life expectancy—and to deal with everything else is pretty tough.
John Marshall, MD:
You’ve had a career in drug development, and I know you have a very good sense of global cancer research and global cancer care. There was just another colon cancer study that popped positive—using an IO plus an oral VEGF—that beat regorafenib by a nose. And I think about very expensive therapies—trial done all around the world—for a U.S. market, primarily.
And I sometimes wonder if our patients understand—or our federal government understands—just what a privilege it is to practice medicine here. Because we do have access to all the innovations. We’re the first to have access to them. We can provide them for our patients. Yes, it costs a lot of money—but it is a privilege. And we’re sort of the leading point on breakthroughs and applying those breakthroughs to our patients.
Do you think... you know, the administration before the Biden administration wanted this to happen. Certainly, RFK Jr. wants this to happen—some sort of leveling out of the playing field, of both the investment and the cost of cancer care.
Are you starting to see some of that?
Eric Winer, MD:
I don’t know that I’ve seen a lot of it.
I will—just to sort of shift a little bit—what I worry about is that the access that many people have to new treatments and drugs is not remotely distributed fairly or evenly in our country. And not all insurance is the same. Lots of people don’t have insurance. As there are threats to Obamacare and cutbacks in Medicaid and reductions in subsidies. You know, what the average family is going to pay in some states—where they've received subsidies—for their healthcare is huge. I mean, I think I read that a family of four living in Maine, when they lose their subsidy—a family of four making $130,000—is going to have to pay another $28,000 a year. They can’t do that.
That’s going to mean that people go without healthcare. And that’s going to lead to even greater inequities in the delivery of cancer care than we already know exist. You live in Washington, where the mortality for Black women with breast cancer is dramatically higher than for White women. And we know—if you look across the whole country—that if you’re a 20-year-old Black woman, a Black American woman, that you face twice the chance of dying from breast cancer as a 20-year-old White American woman before the age of 50. So, this is huge.
I will be the first to say: I believe in universal coverage. I think healthcare is a right, not a privilege. And it kills me that we’re getting further and further from that.
John Marshall, MD:
Further away. I couldn’t agree more about that.
And we spend—think how much we invest in our institutions, ourselves, and just the infrastructure and staff—to manage the complexity that you just described. And if we had a simpler system, we would reduce the cost of delivery just by that.
Eric Winer, MD:
Well, and it’s not even just about the dollars.
As treatments get more complicated, and they require more in the way of family involvement—if we have people who are struggling to get by, how are they going to have family members who can help them get through their cancer treatment?
You know, it’s interesting. We have a very large organization in New Haven called Sisters’ Journey, which is essentially a group of largely Black or African American women with breast cancer. And they are very effective advocates. They raise money. They try to help one another. And in talking to them, they realize that the care that many of their members have received over the years is just not the same—for a whole range of reasons—as the care that more affluent, and typically White, people receive.
John Marshall, MD:
Let me take you back and sort of—as we wrap up—to something you brought up at the beginning, and that’s younger people. You know, we are in the gray-hair part of our careers, but we’re still, you know, we’re out there doing our thing. But we’re OK. We’ll be OK individually.
But when you start thinking about somebody who’s 30, 40—early career—whether it’s medical or research or both. I think about my kids, who are in their early thirties. You know, what they’re going to have to deal with going forward about building careers—and the importance of that foundational science that really they provide us as we move the bar in research.
Maybe just share any further reflections you have. How vulnerable are these folks? Is it really angst that they should be worried about, or is it just angst because it’s unstable?
Eric Winer, MD:
Well, look. In the U.S. alone, we still have almost 2 million people diagnosed with cancer every year, and over 600,000 people who die from cancer. We need a lot of research still. We need research, and we need people who deliver the care. It’s just absolutely critical.
And you and I aren’t going to be those people with the breakthrough ideas. You need young people. And when a person who is 30 or 35 or 40—who’s finishing a PhD or an MD or an MD/PhD—looks at the likelihood that they’re going to get funded on their next R01, you know, with a chance of 4%. And maybe, if they’re a new investigator, it’ll be 7%. It’s hard to maintain enthusiasm. And yet, we desperately need those people to keep going into cancer research, or else we’re truly going to have a brain drain. Maybe not tomorrow. Maybe not next year. But in five years—we will.
And so, the damage that’s potentially done through these cuts in funding—and it’s not as if funding was so very generous ever—but at least there was a hope that people would get funded. But with the kinds of pay lines that exist at the moment, if I were a young person, it would be hard to maintain enthusiasm. And I’d be thinking about doing other things. I hope they don’t, but I fear they will.
John Marshall, MD:
Let me go one last place—and this is really what sometimes hurts me the most or makes me the most upset—and that’s the misinformation that’s being put out.
You know, as a GI oncologist, to see the word leucovorin on the front page of The Washington Post was shocking to me. Because, you know, we were going to cure a different problem with folic acid—fancy folic acid. And you see so much of it.
And so many of our patients are clearly reading this, because they’re coming into clinic and asking about it. So, I feel that I’m spending a much greater amount of my time just resetting reality—of what we know as science today and medicine today.
What’s your thoughts on that? Do you have any reaction to that?
Eric Winer, MD:
Well, I think, of course, misinformation is incredibly dangerous. And it’s hard for people who aren’t medical professionals to keep track of all the medical facts. I mean, medicine is complicated. But if at times people are hearing things that are just blatantly incorrect—and particularly when those comments come from people who they may respect—then it’s really challenging. I think we have to do our best to educate society about what we know and what we don’t know, and what steps people can take to improve their health and their family’s health. And when there are false statements made—it’s hugely damaging.
John Marshall, MD:
Thank you. Thank you for that feedback and thank you for your time.
I know it is Breast Cancer Awareness Month. You may or may not know that I’m sort of grumpy about that as a GI oncologist. So, if you want one of our stickers, here’s a “Love Your Butt” sticker—for, you know, the colon cancer people that are out there.
But let me again thank you so much, Dr Winer, for giving us your time and your knowledge and your experiences as we all navigate these challenging times.
We really, really appreciate your time.
Eric Winer, MD:
You bet. Take care.
John Marshall, MD:
John Marshall for Oncology Unscripted.
Thank you all very much.
[38:13]
This transcript has been lightly edited for clarity.
MEDBUZZ [0:00:05]
When the Sources of Trusted Information Change—Who Do We Believe?
John Marshall, MD:
Happy whatever day it is today when you're watching this. John Marshall for Oncology Unscripted. A little bit of a rainy day here in Washington, DC. It's been a little bit of a weird time here in Washington, DC—even weirder than it normally has been.
Let's start with a little of the business of our world today—the business of oncology. You may have seen that we have a new National Cancer Institute director: Dr Anthony. Professor of medicine, he's kind of a basic science guy, but he's also a medical oncologist from Dana-Farber. Would you take that job if it was offered to you? I knew some of the candidates who were in line for it—or the finalists—and you'd really have to want that job to take it right now, because of all the unsettledness at the NIH in general, et cetera. So, I'm grateful that this very smart person has said yes to the job. Now, what he does—one of his areas of expertise—is programmed cell death, which is sort of a subtle way of getting a cancer cell to kill itself, right? So maybe, just maybe, he'll use some of that expertise to help in the shifting of government. A little programmed cell death around here might go a long way. So, fingers crossed that he succeeds in maintaining and growing the research that we are doing in cancer, much of which is sponsored through the National Cancer Institute. So, fingers crossed.
But as soon as he gets the job, what happens? Well, we shut down the government.
We've done this before. It is weird in Washington when the government shuts down. Whether it's patients who now don't have a job for the moment and who risk not having health insurance to receive their ongoing cancer care—in my case—or care in general out there.We're clearly seeing an impact on patients. We're clearly seeing an impact on government operations. I'm supposed to fly to Florida to get measles, maybe, this coming weekend, and I'm not sure we will do it because—who knows if there'll be air traffic controllers available? Would you go to work if you weren't getting paid?
I had a recent call with an NCI colleague who is going to work, who is seeing patients, and is trying to manage things—but is uncertain about whether they will be paid.
I also happened to come across recently somebody in the medical center who works up in McLean. If you know what offices are in McLean, I'll let you figure that out—sort of secret spy stuff. Normally, they're incredibly busy, but because there aren't any other government activities going on, they're kind of sitting there saying, "Well, we can't do what we normally do because we're dependent on the rest of the government to do what we do." So even those who are going to work are kind of stalled.
So, there's a whole lot going on. The one positive—and it's not really a positive to make up for the negatives—is that the traffic's a lot lighter here in Washington. But still, not enough to make up for it.
Now, I do want to talk a bit about another big topic that’s come forward. You know that RFK Jr. fired 17 members of the Advisory Committee on Immunization Practices. This is the group that gathers to make recommendations around vaccines and immunizations in general. He fired a lot of them. He put some replacements in—many of whom have been featured in other articles—I won’t drill down into the weeds on some of this, but many of them are more than just anti-vaxxers. They’re suggesting that we’ve mismanaged this as a medical community, and that we’ve not been telling the true scientific story.
The new people who’ve been put in place haven’t made any formal recommendations yet. But the most recent one that came out is that there’s even some debate about whether newborns should be given hepatitis vaccines. And that data is very, very tight about how many lives are saved because of vaccines—as they all have been shown. But we’ve forgotten data, and we’re going to have to relearn the lesson going forward.
Do you read the front page of the paper or don’t you? In my family, it’s split. My wife only reads the sports section. I read the front section—or at least read the headlines.
In the Washington Post editorial page was an article written by the last six Surgeon Generals—right and left—appointed by different presidents over time. And this was a very thoughtful piece that basically summarized that RFK Jr.—he’s perfectly entitled to have his own opinions about things—but he’s not entitled (this was their conclusion) to put other people’s health at risk.
And they collaboratively, collectively, emphatically said that that is what is going on with this new ACIP committee—with RFK Jr. at the helm. That we are putting a lot of people at risk, and it’s what’s making us all very, very anxious in the medical community today.
Now, I want to talk in closing on this about a book that I am reading. Don’t worry, it’s not too boring.
And the stuff I’ve been seeing during Jeopardy—I always measure the pulse of America by what ads run during Jeopardy every night.
Now, the book I’m reading is brilliant.
It’s called Empire of Pain. It’s written by a guy named Patrick Radden Keefe, and it’s the story of the Sacklers, Purdue Pharma, and OxyContin. I’m sure you may have seen the movie about this. It’s brilliantly written, and it starts with the first advertising that was ever done for drugs.
This was Librium and Valium—done by Pfizer at the time. And the Sacklers kind of invented this strategy where they were figuring out how to tell a story of a new medicine—in this case, anti-anxiety, kind of anti-depression medicines, Librium and Valium.
These were for patients who weren’t psychotic—so they didn’t need to be admitted for their psychiatric anxiety and problems—but there were a lot of people out there who could use a little something to help take the edge off. So, they created a market. They had drugs that would solve this problem for people. And Librium and Valium became the biggest-selling drugs at their time. This was through peer-to-peer teaching. So, start thinking about your own role in this as you listen. Physicians who were trained to teach other physicians about the new medicine. Direct-to-consumer, certainly. The Sacklers owned a medical journal where they advertised in it and could write editorials about their medicine. They also had consultants that worked for it.
Now, as I’ve been reading this, I’ve been thinking: I play all of these roles. I’m a consultant of pharmaceutical companies. I do peer-to-peer education. I do clinical trials. I write papers for journals. I do video podcasts, for God’s sake.
And so, I’m out communicating my bias, my opinions to others—to influence their practice on some level. Not my goal, but it’s certainly a downstream product of influencing their practice.
So, this family had figured out a way to take advantage—and coach and train us all—how to use medicines. And this was in the very, very early part of my career. But then what they figured out was how to take pain medicine, believe that the pain medicine would help, make it longer-acting, get a good price for it, sell it, convince us all that we needed to be on it, and increase the utilization of long-acting pain medicines. So, when I was just a fellow and a new faculty member, we were all coached that there is no high enough dose. That all patients need to be on it. That it’s normal to be on these drugs. And in point of fact, it is the right thing for people to be doing. Only now do we recognize that this was really an over-push for these people.
I’m just reading the section of the book now where people were abusing it. That they became addicted to it. And it was not really for cancer pain or other things—they were just hooked to the drug. And it took a long time for that to get broken.
So early in my career, I was pushing huge doses of this medicine. You were, too.
And now there’s nobody I’m giving much more than about 10, 20, 30 BID of long-acting pain medicine. So, we learned our lesson about how we were kind of lied to in this setting.
More recently, we have a new point-counterpoint with the government. I’m seeing it from Pfizer. I’m seeing ads today during Jeopardy and other shows like that, where Pfizer is basically reminding us all—as an audience—that vaccines can help.
The government is telling us, RFK Jr. is telling us, that vaccines are bad. That we shouldn’t be taking them. That they cause all sorts of trouble in patients, and we shouldn’t be messing with it.
But then I’ve got Pfizer doing a very clean ad over here that says, “Don’t forget vaccines.”
Let’s look a little bit at the science that’s being referred to. The science back when we were giving long-acting pain medicines, and now when we are making new recommendations by our government.
So, back then, they actually didn’t even get formal FDA approval for MS Contin, because morphine was already approved. They just got it. They just started shipping it out. They just started making it and shipping it out.
They then got approval for OxyContin—but the guy who approved it at the FDA, believe it or not, a couple of years later, starts to go and work for them outside the FDA. So, there’s a lot of question about whether that was legitimately covered.
But the idea was that OxyContin would be less addictive—but they never really showed that, even though they marketed that.
So, the cleaner processes that we’re used to for drug approval were not put in place. And then the claims that could be made about how well these pain medicines worked—anybody could say anything. There wasn’t a lot of supervision around that until it kind of came back to bite them and haunt them.
We are, in today’s world, hearing the government, RFK Jr.’s gang, and other people talking about immunotherapy, vaccines, et cetera—saying things that have no real foundation in science. They are based on just speculation, or something somebody put on Twitter one day. And it becomes our job, in the medical community, to judge what is the correct thing to be doing.
And I think right now, you’re seeing insurance companies and pharmaceutical companies and the medical teams really sticking with the more clean science, and applying therapies based on what they know—and sort of ignoring what they’re hearing in the public media, et cetera, based on what the government is saying.
So, this has put us in a new and awkward position, where we are on the side of business in this case, and not on the side of government.
If you haven’t read this book, Empire of Pain, I would recommend that you do—particularly if you are an older person who’s lived through some of this. But I also want you to recognize that there’s a lot of pressure—mixed pressure—out there on just providing today’s standard of care.
And so, the next time you see that Pfizer ad, remember that you’re probably now on that side of the coin—advocating for ongoing immunotherapy for our patients in the form of vaccines to prevent, but also in managing and preventing other cancers from occurring through the use of immunotherapy.
Complex times. Lots going on in the news today. Lots that’s affecting our world and the treatments that we are offering. Lots to incorporate in your recommendations.
I hope this has been helpful in summarizing that, and it’s useful for you tomorrow in your practice.
John Marshall for Oncology Unscripted.
Main Topic [0:13:12] The Molecular Space Race: Will It Bring Earlier Detection and Better Treatment?
John Marshall for Oncology Unscripted. An amazing amount of science is going on right now in the cancer world—on the molecular side of things—and I like to think of it kind of like a molecular space race. Because the technology that’s out there—of being able to measure what’s going on in a tumor, what’s going on in the blood, finding different genetic characteristics, and being able to act on those—has never grown quite as fast as what we are seeing now. Just like we were racing to get to the moon or racing to orbit around the Earth, we are now seeing companies and different groups from all over the world developing and improving technologies to try and read the tea leaves of whatever’s going on in the blood, whatever’s going on in a tumor—in what I think of as a molecular space race. And I wanted to feature a paper about this that I thought was quite interesting and will set us up for the beginnings of what will be, really, a few-month-long discussion around precision medicine—to try and understand better how it’s going to help us evolve and become more efficient in the practice of not just cancer care, but healthcare in general.
Now, the paper I want to talk about is in this journal called The Journal of Clinical Oncology. Yeah, I still do get a paper version. And this one is from China. Now, I want to start by saying that I’m a little surprised this paper made it into JCO, because it is a molecular analysis done totally in China.
But where I wanted to start from was that the funding for this work came from a bunch of philanthropic and government-supported stuff in China. A big, long list of different resources—including the healthcare system where it was started out of.
And I keep thinking about here in the United States—where we’ve been leading in investment, where we’ve been leading in discovery—we are now finding it more and more difficult to access the kind of support that came to make this science possible. So, when we think about our individual U.S.-based impact on outcomes and research and progress—without that funding—we’re going to clearly keep falling behind.
And the two papers I want to talk about—this one in China and the other one out of the European Union group—show that all of this novel, positive work is coming from other sources, other investment. Just food for thought.
But anyway, this group took patients with the attempt to try and find a blood-based test to detect early, early-stage pancreas cancer. Because, as you know, it is very, very difficult to cure pancreas cancer if it shows up clinically. I won’t go into the weeds on this paper—it’s in JCO—but they basically took some learning sets and some training sets, et cetera, and developed a panel—a blood-based panel. And they were able to show, with very high precision, that they could distinguish who had small-volume pancreatic cancer and who didn’t. They even had a cyst sub-study subgroup in there to look at—and things like that. And I think it’s worthy of being presented in JCO, because if you think about what we’ve been doing with our blood-based testing, is people who already have cancer—who then get blood-based or tissue-based genetic testing to decide what we’re going to do to treat them or how to follow them: looking for minimal residual disease or what targeted agent might be available for that individual patient. But this is the other end of where I think this kind of technology is going to go—and that is screening. Healthy population. Blood-based testing. See if you’ve got cancer or not—and intervene. And I’m very, very interested in seeing over the next 5, 10-plus years how this kind of technology shifts from just coaching us to be more efficient in the treatment of existing disease—existing cancer—and more shifting towards early detection and prevention strategies.
So, I think there’s nothing hotter than this blood-based testing that’s going on now, which is why we’ve decided to spend a few months on it. And this paper sets the stage.
The other paper I want to contrast that with also just came out in the Annals of Oncology. So yeah, good group, good journal—but not quite JCO, right? So, a little bit off the beaten path. But to me, maybe the most important paper of the week.
And this was the group from the PRODIGE 13 adjuvant colon cancer study, where after the intervention was done, patients were randomized into four groups of follow-up. Now, I don’t know what you do. NCCN says I’m supposed to do it maybe once a year. I do it a little more often than that, if I can get away with it—although that sometimes means I’ve got to do a peer-to-peer to get a scan or other things. I’ve incorporated, more recently, doing MRD testing. But the standard right now is a CEA every now and then, and a scan every now and then, and a colonoscopy every now and then.
Well, the study actually randomized patients into more intensive follow-up versus less. Now, remember why we do this in colon cancer. The primary reason is that we feel like if we can find a met before the patient feels it, that we could remove it—and maybe cure the patient, right? And so, unexpectedly, this study basically said the opposite. It didn’t matter how intensive your follow-up was. You had the same overall survival. Well-done study. Prospectively looked at.
So, then I’m thinking, oh my gosh—if it doesn’t really matter, like should we do what the breast cancer doctors do? They don’t even do follow-up scans at all, right? They do an occasional LFT and a physical exam, and that’s it. Should we begin shifting to something like that?
Know that we are dialing up in the other direction—because we’re increasingly doing MRD testing, where we’ll have an even more sensitive measure than CEA or scan to determine if somebody’s got residual or persistent cancer.
And I am hopeful that what we will show is that by identifying patients at the molecularly positive level—like an MRD test—we can intervene.
And in fact, I’m helping to lead a study across our country to test new agents in that space. That if we intervene with those new therapies, we will, in fact, cure more people through that earlier intervention than by waiting to see what grows out there in the patient’s liver or lungs, et cetera.
Recently, I have a patient—a colon cancer patient, a young man—who had an MRD-positive blood test. And his scan—regular conventional CT scan—was negative.So, I ordered a PET. Now, you could argue maybe I shouldn’t have. But he had two in a row—blood tests, positive; CT, negative. I ordered a PET. Guess what? The insurance company said, “No, you can’t order that.” So, I ended up doing a peer-to-peer review.
Don’t you love peer-to-peer reviews? How many of you initially say, “Are you actually an oncologist?” when you talk? I wasn’t—I was polite to the doc on the other end. I told her the story. She plugged in the data that now the patient was MRD positive, and she read out the approval code to let me go ahead and get the PET scan. So, clearly, MRD testing is having an influence on decision-making and insurance coverage. But it’ll become our challenge to demonstrate that knowing MRD testing is important enough that it will influence survival—unlike that Annals of Oncology paper that showed that CTs and CEAs maybe not so much.
I think this paper puts us at a higher bar for challenge—to make sure that following patients closely makes sense, and that this MRD testing better work for us. Or else, we’ll just be pulling back in general after patients are initially treated.
So, I hope you find this next series of discussions about MRD testing, et cetera, interesting and useful to you. And I hope you find these two papers a bit challenging—one that takes us to a screening test for pancreatic cancer, the other that takes us to: should we be doing anything after we follow patients, outside of these newer tests that are coming?
So, more to come. I hope it’ll be useful to you, and I hope you’ll tune in next time for Oncology Unscripted.
Crisis, Misinformation, and the Future of Cancer Care: A Candid Conversation with Dr Eric Winer
John Marshall, MD:
Hey, everybody out there—John Marshall for Oncology Unscripted.
And I am a lucky guy to be able to talk with such an amazing contributor to our world of cancer: Dr Eric Winer. And I’m going to embarrass him for a minute. Not only are we Dukies—by the way, go Devils—but we all know he has, as everyone on this call knows, really led so much of the innovation and progress in solid tumors—specifically breast cancer. Transformed things up at Harvard first, now back to his home base of Yale, where he oversees an incredible group of people and a program. And I am just—first—honored that he said yes when I asked him for a quick interview on the world today. So, Dr Winer—Eric—thank you for joining us.
Eric Winer, MD:
Oh, pleasure to be here—and I was honored to be asked.
John Marshall, MD:
You are so cool. Thanks a lot.
I mean, what I wanted to talk with you about is the impact—the acute impact—that we are having in general around cancer research and around cancer care, since this academic versus executive branch battle that’s been going on around grant funding, around cancer care, but now more acutely with the government shutdown, we have NCI trials. You know, patients are losing insurance and this sort of thing. And I know what it feels like here in Washington, but I thought—you, having a pretty broad vision around things in the country and maybe on a global scale—might have some reflections on this.
So, maybe just wax poetic a second about what the last several months have been like, and how the last month has made that even more.
Eric Winer, MD:
Sure. So, the last several months have not been easy, for sure. In truth, there are not that many grants that have not been refunded at our center at Yale. There are some—and there are people who lost some funding—and we’ve done our best to backfill whenever possible.
I think there’s a lot of anxiety. There’s a lot of anxiety, particularly among young people—young people trying to make careers in the lab, trying to make careers in clinical research—and that’s been pretty tough on everyone. And at Yale, we are one of those institutions—which I guess I should say we’re lucky to have such a large endowment—but we are one of the 8% endowment earnings tax institutions. So that is hundreds of millions of dollars a year to the university that we will be losing. And so, there have been many conversations about how it is that we’re going to manage to keep doing everything that we want to do. This is not just at the School of Medicine or in the cancer center—this is the university at large.
With, you know, with that kind of hit, I think the last few weeks have even been harder. Today there was, of course, supposed to be a Cancer Director’s meeting at the NCI. And the reason we are in our offices all day is because that was cancelled because of the shutdown.
John Marshall, MD:
Tell me the impact of that.
I mean, you guys get a lot done. I know when Lou Weiner goes up to those meetings, he comes back with a lot of fresh ideas, new collaborations, progress.
Tell me what a missed meeting—I mean, somebody said, “Well, we meet too often anyway.” What’s your take on that?
Eric Winer, MD:
Well, I think missing a meeting—you know, one meeting—isn’t such a big deal. I mean, in truth, was I perfectly happy to stay at home in Connecticut rather than go to Washington today? Sure. On the other hand, I think these meetings serve a real purpose.
It allows us to talk to one another. It allows us to hear what’s going on at the NCI, and how the Cancer Center Support Grants potentially are going to change. It’s a way of collaborating. So, I think it’s serious, and it’s concerning.
I guess my biggest worry with the government shutdown is all the people who aren’t getting paychecks. All the people diagnosed with cancer, who are living with cancer, who are struggling to find food to put on the table. You know, there were multiple stories this week—just watching the various news outlets—about government employees going to food banks. And some of those people have cancer. And it’s very hard.
I think that all the anxiety that we feel in academia at the moment—particularly related to medical research—I think now, suddenly, the whole country is feeling, with the government shutdown. And it’s hard to be under multiple stressors at the same time.
John Marshall, MD:
With cancer being one of them—particularly, think about our patients.
So, my wife accuses me of a lot of hyperbole—and she’s probably right—but I think we’re about one in three, one in five of my patients here in Washington, where one of the couple has either lost their job, is on furlough, or it’s questionable. And they’re often the one the insurance is with, right? And so, we’re trying to make plans for next scans or next cycles. And hospitals are on their heels a bit too about: will these be maintained? Will people keep up their premiums?
And so, I’m assuming you all are feeling it there in Connecticut as well, right?
Eric Winer, MD:
I mean, we don’t have as many government employees—federal government employees—as you do in DC. But, you know, I think it’s this pervasive sense of angst that so many people have that just makes it so much harder.
You know, my patients come in—and I see patients one day a week and totally enjoy it—but I have to say that the anxiety level is up for everybody. And I think that’s hard.
And it’s very hard when you’re going through difficult treatment and a difficult diagnosis, and you may be facing a diagnosis that is going to shorten your life expectancy—and to deal with everything else is pretty tough.
John Marshall, MD:
You’ve had a career in drug development, and I know you have a very good sense of global cancer research and global cancer care. There was just another colon cancer study that popped positive—using an IO plus an oral VEGF—that beat regorafenib by a nose. And I think about very expensive therapies—trial done all around the world—for a U.S. market, primarily.
And I sometimes wonder if our patients understand—or our federal government understands—just what a privilege it is to practice medicine here. Because we do have access to all the innovations. We’re the first to have access to them. We can provide them for our patients. Yes, it costs a lot of money—but it is a privilege. And we’re sort of the leading point on breakthroughs and applying those breakthroughs to our patients.
Do you think... you know, the administration before the Biden administration wanted this to happen. Certainly, RFK Jr. wants this to happen—some sort of leveling out of the playing field, of both the investment and the cost of cancer care.
Are you starting to see some of that?
Eric Winer, MD:
I don’t know that I’ve seen a lot of it.
I will—just to sort of shift a little bit—what I worry about is that the access that many people have to new treatments and drugs is not remotely distributed fairly or evenly in our country. And not all insurance is the same. Lots of people don’t have insurance. As there are threats to Obamacare and cutbacks in Medicaid and reductions in subsidies. You know, what the average family is going to pay in some states—where they've received subsidies—for their healthcare is huge. I mean, I think I read that a family of four living in Maine, when they lose their subsidy—a family of four making $130,000—is going to have to pay another $28,000 a year. They can’t do that.
That’s going to mean that people go without healthcare. And that’s going to lead to even greater inequities in the delivery of cancer care than we already know exist. You live in Washington, where the mortality for Black women with breast cancer is dramatically higher than for White women. And we know—if you look across the whole country—that if you’re a 20-year-old Black woman, a Black American woman, that you face twice the chance of dying from breast cancer as a 20-year-old White American woman before the age of 50. So, this is huge.
I will be the first to say: I believe in universal coverage. I think healthcare is a right, not a privilege. And it kills me that we’re getting further and further from that.
John Marshall, MD:
Further away. I couldn’t agree more about that.
And we spend—think how much we invest in our institutions, ourselves, and just the infrastructure and staff—to manage the complexity that you just described. And if we had a simpler system, we would reduce the cost of delivery just by that.
Eric Winer, MD:
Well, and it’s not even just about the dollars.
As treatments get more complicated, and they require more in the way of family involvement—if we have people who are struggling to get by, how are they going to have family members who can help them get through their cancer treatment?
You know, it’s interesting. We have a very large organization in New Haven called Sisters’ Journey, which is essentially a group of largely Black or African American women with breast cancer. And they are very effective advocates. They raise money. They try to help one another. And in talking to them, they realize that the care that many of their members have received over the years is just not the same—for a whole range of reasons—as the care that more affluent, and typically White, people receive.
John Marshall, MD:
Let me take you back and sort of—as we wrap up—to something you brought up at the beginning, and that’s younger people. You know, we are in the gray-hair part of our careers, but we’re still, you know, we’re out there doing our thing. But we’re OK. We’ll be OK individually.
But when you start thinking about somebody who’s 30, 40—early career—whether it’s medical or research or both. I think about my kids, who are in their early thirties. You know, what they’re going to have to deal with going forward about building careers—and the importance of that foundational science that really they provide us as we move the bar in research.
Maybe just share any further reflections you have. How vulnerable are these folks? Is it really angst that they should be worried about, or is it just angst because it’s unstable?
Eric Winer, MD:
Well, look. In the U.S. alone, we still have almost 2 million people diagnosed with cancer every year, and over 600,000 people who die from cancer. We need a lot of research still. We need research, and we need people who deliver the care. It’s just absolutely critical.
And you and I aren’t going to be those people with the breakthrough ideas. You need young people. And when a person who is 30 or 35 or 40—who’s finishing a PhD or an MD or an MD/PhD—looks at the likelihood that they’re going to get funded on their next R01, you know, with a chance of 4%. And maybe, if they’re a new investigator, it’ll be 7%. It’s hard to maintain enthusiasm. And yet, we desperately need those people to keep going into cancer research, or else we’re truly going to have a brain drain. Maybe not tomorrow. Maybe not next year. But in five years—we will.
And so, the damage that’s potentially done through these cuts in funding—and it’s not as if funding was so very generous ever—but at least there was a hope that people would get funded. But with the kinds of pay lines that exist at the moment, if I were a young person, it would be hard to maintain enthusiasm. And I’d be thinking about doing other things. I hope they don’t, but I fear they will.
John Marshall, MD:
Let me go one last place—and this is really what sometimes hurts me the most or makes me the most upset—and that’s the misinformation that’s being put out.
You know, as a GI oncologist, to see the word leucovorin on the front page of The Washington Post was shocking to me. Because, you know, we were going to cure a different problem with folic acid—fancy folic acid. And you see so much of it.
And so many of our patients are clearly reading this, because they’re coming into clinic and asking about it. So, I feel that I’m spending a much greater amount of my time just resetting reality—of what we know as science today and medicine today.
What’s your thoughts on that? Do you have any reaction to that?
Eric Winer, MD:
Well, I think, of course, misinformation is incredibly dangerous. And it’s hard for people who aren’t medical professionals to keep track of all the medical facts. I mean, medicine is complicated. But if at times people are hearing things that are just blatantly incorrect—and particularly when those comments come from people who they may respect—then it’s really challenging. I think we have to do our best to educate society about what we know and what we don’t know, and what steps people can take to improve their health and their family’s health. And when there are false statements made—it’s hugely damaging.
John Marshall, MD:
Thank you. Thank you for that feedback and thank you for your time.
I know it is Breast Cancer Awareness Month. You may or may not know that I’m sort of grumpy about that as a GI oncologist. So, if you want one of our stickers, here’s a “Love Your Butt” sticker—for, you know, the colon cancer people that are out there.
But let me again thank you so much, Dr Winer, for giving us your time and your knowledge and your experiences as we all navigate these challenging times.
We really, really appreciate your time.
Eric Winer, MD:
You bet. Take care.
John Marshall, MD:
John Marshall for Oncology Unscripted.
Thank you all very much.
[38:13]
This transcript has been lightly edited for clarity.