Main Topic In this episode of Oncology Unscripted, Dr John Marshall examines a White House push for final sign-off on NIH grants and what politicizing science could mean for research and health equity in cancer care. He also looks at merger talks between AstraZeneca and Bristol Myers Squibb and weighs both sides of the discussion surrounding blood tests for cancer screening. MedBuzz In this MedBuzz, Dr John Marshall reflects on a week of Zoom interviews for a new cancer center director, a head pastor, and fellowship candidates, and on how hard it has become to get butts in chairs at in-person medical meetings and where we go from here. Interview In this Candid Conversation, John Marshall, MD, Lucile Adams-Campbell, PhD, and Monica Baskin, PhD, discuss breakthroughs in cancer center leadership, including Dr Baskin becoming the first Black woman to lead a cancer center designated by the National Cancer Institute. They also talk about mentorship, the women who paved the way, and why politics has no place in science.
Main Topic
In this episode of Oncology Unscripted, Dr John Marshall examines a White House push for final sign-off on NIH grants and what politicizing science could mean for research and health equity in cancer care. He also looks at merger talks between AstraZeneca and Bristol Myers Squibb and weighs both sides of the discussion surrounding blood tests for cancer screening.
MedBuzz
In this MedBuzz, Dr John Marshall reflects on a week of Zoom interviews for a new cancer center director, a head pastor, and fellowship candidates, and on how hard it has become to get butts in chairs at in-person medical meetings and where we go from here.
Interview
In this Candid Conversation, John Marshall, MD, Lucile Adams-Campbell, PhD, and Monica Baskin, PhD, discuss breakthroughs in cancer center leadership, including Dr Baskin becoming the first Black woman to lead a cancer center designated by the National Cancer Institute. They also talk about mentorship, the women who paved the way, and why politics has no place in science.
Main Topic: What Do Politics, Mergers, and Blood Tests Mean for Cancer Care?
John Marshall, MD: Good day out there. It might be night where you are, but I hope you're having a nice day. They are harder and harder to come by sometimes. John Marshall, Oncology Unscripted, and thank you so much for being out there and listening in and caring about the topics that we are bringing forward to you on a weekly, every-other-week basis.
It, again, has been a very busy week here in Washington, DC, and it is affecting us a lot in the cancer and global research world. And the biggest thing on my list that's happened in the news, in the business of oncology, in the business of medicine, frankly, is that the current administration, the Trump administration, is wanting to gain final sign-off on the National Institutes of Health, the National Cancer Institute (NCI) grants that they're awarding. So there's the peer reviews. You get a score. We say, "Yes, you're going to fund it." Then the White House or someone down there gets to make the final choice as to whether you actually get your grant or not. Well, needless to say, we're not very happy about this, and several, including Senators Collins and Murray, have put forward pretty strong efforts to try and block this.
Now, let's face it, Congress just left last night, closing early before the midterms so that we don't have to listen to them fight and argue, and maybe the American voting public will forget that there is a Congress. Who knows what will happen? But they all left town last night. The little light over the Capitol went out, and they're all gone.
But this is really worrisome. Not only has the Trump administration cut $177 billion in grants across the state, they're also wanting to control the grants that they are funding. And politicizing this is very, very scary, as I'm sure you agree. But it ultimately worries me about who's going to drive the science. So keep a nose out. If you have an opportunity to write to somebody, your congressman, that you don't like this idea that the White House would have sign-off on science grants that we're funding with our tax dollars, please make sure and write to your Congress.
One of the things that rises immediately to the top is that this administration does not believe that there is any substantial inequity based on race or gender or anything else. It's perfectly fine to say if you're a White man, but those who are not a White man know that there is inequity out there. And we and many other cancer centers around the country spend a lot of time and effort to try and balance health equity so that those who have less support behind them can get the same sort of health outcome that those who have can get. This health access issue for me is so important that I actually reached out to folks who focus on health equity and access, and you should stick around and watch the interview of 2 amazing cancer leaders, the first-ever African American woman to lead an NCI comprehensive cancer center. Stick around and watch the interviews.
Other big news, and this is, how big can a company get? AstraZeneca (AZ) is in discussions with Bristol Myers Squibb (BMS) to have a merger. That would be a big company. AZ, it's an interesting strategy. They have a nice, beautiful campus over in England. They have one here in the DC region as well. But they, since 1999, have acquired, I guess is the right term, 23 different companies over just that window of a quarter century or so. So clearly this merger acquisition process is the way drug development is going. You've got smaller companies that are doing a lot of the innovative science, getting capital investment, then the big companies buy them. I think the small companies are glad that the big companies are buying them, but this is a little different. This is AZ and BMS, so keep a nose out to see if that's going to go forward.
But one of the areas that just came out over the last week that I am most interested in is this idea of blood testing for cancer screening. Obviously, new technology of circulating tumor DNA, minimal residual disease testing, is very exciting, and we can see how this is going to play out as a cancer screening tool. We all get it. And there are a bunch of companies that have done it. The most recent one is through Grail, and their blood test is called Galleri, with an I. And the US Food and Drug Administration (FDA) just gave it a positive nod, and it really sparked a bunch of discussion, pro and con: Is this a good idea or not?
Now, one of the studies that was used to present to the FDA was a big study done in the UK National Health Service, where you can do studies like that, not here in this country. But it involved a bunch of people, 140,000 people. Another study that was done in North America involved 35,000 people, all over the age of 50. And the primary endpoint was that this blood testing, if you picked up the cancer earlier using it, would improve overall survival. But unfortunately, it didn't actually meet the overall endpoint. Now, the counterargument was that it was only a few years. The counterargument was that they were picking up a lot of stage IVs and not stage IIs and IIIs.
But regardless, the overall sentiment was this is where we're going. Some people are saying that, "Well, we know it's not perfect, but something is better than nothing," right? So people who are not getting any screening, this is better than that. The other side of the argument is that, "Wait, if I go and get a blood test and I find out it's negative, aren't I done? I don't need a colonoscopy. I don't need a mammogram," et cetera. And that's really not what these tests are, at the level to be able to say that. So it's falsely reassuring on one side, it could be. On the other side, yes, we know we're going to go that way, and it picks up a bunch of other cancers that we currently don't screen for.
So both sides of the argument are appropriate, but we as clinicians and those who are counseling our community about the incorporation of these blood tests need to know both sides. So yes, something's better than nothing, but realizing the limitations of these blood tests as they stand right now is really important as you go out there and see patients and talk to your friends and colleagues in the doctors' lounge, so that they have the best understanding of what these tests can do and cannot do. Hope this helps. Hope your day and your week ahead is good. John Marshall, Oncology Unscripted.
MedBuzz: What We Lose When We Can't Get Butts in Chairs
John Marshall, MD: John Marshall, Oncology Unscripted. I've had kind of an interesting week. I'm on a bunch of search committees. So I'm on a search committee at work to find my new boss, director of a cancer center. As a result of that, there were 10 Zoom interviews with candidates already just this week. By the way, I did see some patients, too. I'm also on a search committee at my church, where I'm looking for a new head pastor, along with other people at our church, and I had 2 of those interviews. And later today, I'm interviewing 6 residents who are interested in being in our fellowship program.
And guess what? All of those interviews for this week are on Zoom, not live. They're not coming to campus. They're not going to our church to check it out. We're doing it by Zoom. Yep, we can look at each other's websites and all of that stuff, but we're not having lunch together. We're not walking them around the campus to see what it's like.
And for those of you who trained a while ago, honestly, that was one of the most important parts of an interview for me, is actually going to the campus and getting a feeling of the place and how people interact. Having a meal with somebody to know if I like the person across the table from me or not. And yeah, it clearly limited the number of places that I could go interview. And yeah, clearly it costs to go and travel and see those. And yeah, clearly on our side, we had to provide tour guides, et cetera, in order to have that face-to-face interaction. But it was incredibly valuable, and I think in the current structure, it feels kind of lost.
Now, another piece of my week, actually the month that's been going on, is that this is the season of a lot of meetings, right? In-person continuing medical education (CME) or other kinds of meetings. Part of the responsibility, if you're the chair of one of those meetings or just a participant in one of those meetings, is to get people to show up, what I call getting butts in the chairs. And that is a metric of a successful meeting. How many people actually came and showed up and gave their time, not just on the Zoom, where they're also doing emails on the side, but actually showed up to, in fact, communicate and collaborate and connect.
And getting butts in chairs is harder and harder and harder. And I'm really worrying that with the post-pandemic Zoom technology and the efficiency that we have through connecting through computers, just like you're doing right now, is that we're losing something. And I'm pretty sure you out there feel the same way, whether it's grand rounds, whether it's televisits with a patient, whether it's some sort of CME opportunity. How are you getting your information? How are you connecting with other human beings in the field is a challenge ahead.
And so I just encourage us all, if you have an opportunity to go and show up at grand rounds, if you have the opportunity to go and show up at a meeting where you sit down and connect with those around you. If you're looking at a new job, I do know that usually before you say yes, you'll end up going and kicking some tires and knocking on some doors and meeting some people in real life to know that that's the place. But our residents and fellows don't have that same opportunity to go and check that out.
So we should all be very conscious of this and do our best, because in many ways, that's why we went into health care, is to connect to our fellow human beings and to be there side by side, not only on the professional side, but with our patient relationships as well. So just a little food for thought. Put your butt in some chair somewhere next to somebody and go learn something. Share the experience together. Connect outside of the little square on your screen. John Marshall, Oncology Unscripted.
Interview: Breakthroughs in Cancer Center Leadership: A Candid Conversation with Dr Lucile Adams-Campbell and Dr Monica Baskin
John Marshall, MD: Hey, everybody out there in internet land. John Marshall for Oncology Unscripted, coming to you live from the basement of a hotel. The Ohio River is just right over there. I'm in Louisville, Kentucky, an area where I grew up. I went to medical school about 4 or 5 blocks down that way, down Muhammad Ali Boulevard, believe it or not. I am joined today from this basement of a hotel. Very nice basement with very nice art, by the way. With one very close friend and one new friend, because there have been some breakthroughs in the world of hematology/oncology cancer center leadership, and I couldn't not invite both these folks on to share some time with us on Oncology Unscripted.
Now, to set this up, I'm an old White guy from Kentucky. My grandmother actually went to the Medical College of Virginia (MCV). And so the family lore goes, I haven't confirmed this, she was the first female licensed physician in the state of Kentucky. She never practiced, even though she went to medical school and was trained and all of that to do that. Met her husband, my grandfather, in medical school, and he's the one who practiced. But on some level she represented a breakthrough in having women licensed practitioners.
Lucile's joined us for a previous program about the male ceiling that exists out there in science in general. But in today's world, you guys have maybe an even steeper hill, of not only being a woman, but being a Black or African American descent woman, trying to achieve in a world that is still male White dominant. And I wanted to talk a little bit about that.
But I was thinking about, in getting ready for this, those who've come before us, the Joycelyn Elders of the world, the Edith Mitchells of the world, gastrointestinal oncologists who recently passed on. I was just at an exhibit by an artist that maybe you guys have heard of, a woman named Minnie Evans, who was actually a Southern woman who did beautiful art. And she couldn't get her art sold because she was a Black woman, but it's on display across the street from where I am now. So she too had a steep hill.
But let me introduce first my good friend, Dr Lucile Adams-Campbell, who in her own right was the first African American Black woman to receive a PhD in epidemiology in the United States. It says that about you, Lucile, on Wikipedia, by the way. She's a professor now at Georgetown, but when I first met her, she was the head of the cancer center at Howard University, and has become a friend and one who will tell me what I'm supposed to be thinking on a regular basis. So Lucile, thank you, thank you, thank you for agreeing to join us. Please say hello to our gang that's out there.
Lucile Adams-Campbell, PhD: Hello, and thank you for having me, John. This is always an honor to be with you and get a chance to hear what you're thinking so that we can expand on it a little bit.
John Marshall, MD: Well, and it's always a little risky to have you on because you will tell me, as I said, what I need to be hearing, what we all frankly need to be hearing. You shoot straight, and I appreciate that very much.
But a new face for me and a new, hopefully, friend as we go forward is Dr Monica Baskin. And now she is also a new breakthrough person, because she is the first Black African American female to become an NCI-designated cancer center director. And that came across my feed recently, and I thought, "Now, that's not an easy thing to do." And she was nice enough to say, "Yeah, I'll come in and talk about that." So Dr Baskin, thank you, thank you, thank you very much for joining.
Monica Baskin, PhD: Thank you so much. And certainly whenever Dr Adams-Campbell asks me to do something, the answer is usually yes.
John Marshall, MD: It's the wisest thing to do. I also have a Richmond tie. As you know, I just was saying, my grandparents went to medical school there. John Marshall Hotel, not too far from where your institution is. I come from that family, by the way. But also my daughter now is a minister in downtown Richmond. So we have lots of excuses to come and visit your beautiful city.
But I also, every time I'm there, am reminded that it was the capital of the South, and there clearly are still lots of reminders and remnants. And so for me, when I heard about you getting the position there, I thought even more what a really landmark moment that is for you and for us as a medical field and medical world.
So let me start with you, Monica. Give me a little sense of, like, big picture. How tough was it? How steep of a climb was it for you to get where you got today?
Monica Baskin, PhD: That's a tough one. I mean, I think for me, it certainly was not something I had planned. And so Lucile has known me for a little while, so it certainly wasn't something I had on my vision board per se. But I think the hill was not as challenging to climb because of people like Lucile, like many of the other people that you have already described, and others who certainly had the skills and the qualifications; they just were not given the opportunity.
So one of the things that I take away from this breakthrough is that it's certainly an awesome responsibility to be the first. I'm certainly hopeful that the second is right behind me, and not decades away. But I think there certainly were struggles, people that didn't see someone like myself, not only in being African American and female, but also being one of only 2 behavioral scientists that are leading comprehensive cancer centers. I think that's the other piece that I think is unique about my trajectory here.
John Marshall, MD: Monica, you threw out this thing about... you're under the microscope a little bit. I referred earlier to Muhammad Ali, who was not Muhammad Ali when he was born. He was Cassius Clay. He became Muhammad Ali as part of a protest, but he was in a position of being an athlete and all of the different things that he represented, that he could take a stand in our world. We do have to be more careful, or you do have to, on some level, balance those microscope visions, don't you? What's that like?
Monica Baskin, PhD: It puts a lot of pressure on you for sure. I think most people that know me or have known me for any significant amount of time will say that a large part of my career I've been put under pressure, and I usually hold up pretty well. Certainly don't ask my family members and don't ask Lucile, because sometimes I crack, and so I go to people and supports there. But I generally have grown up in an environment to recognize that there are always people that are going to doubt qualifications and not expect you to be in rooms.
And as you bring up the issue of the South, I was born and raised in Atlanta, Georgia, particularly in Southwest Atlanta, and grew up and went to school with the children of many civil rights leaders that are very prominent. And so part of what my upbringing was, was recognizing that excellence was the only way to go. And so everything you do, whether or not it's education or any of those things, it's really important for you to strive for excellence. Also, I think growing up in that background in Atlanta was a strong sense of community and a commitment towards that, and I think that certainly has shaped my career going forward, and I really honor that part. And I know that that upbringing was very unique in terms of having that background.
John Marshall, MD: I think that goes to that mentorship thing, is you saw the model around you on some level and were able to then keep shaping that. And you've been also passing that down, I know, to those behind us.
So Lucile, give us your story about your climb, because you went through the Howard system and then came over to Georgetown, but in a city that has had its issues as well. So I mean, how steep was your climb to get where you got?
Lucile Adams-Campbell, PhD: Well, I'm born and raised in Washington, DC. From Southeast, that little corner that everybody talks about we should stay away from. So...
John Marshall, MD: There are no National Guardsmen over there, by the way, because they're all in, like, Georgetown now. Yeah, exactly.
Lucile Adams-Campbell, PhD: Hill. How steep was my climb? My climb was... I don't know if I considered it steep, because when you're in it, you're not looking at the slope, to be honest. And I was an engineering major for many years, so I'm using that term. We're not looking at the slopes. We're just doing our work and doing everything that we wanted to do to move ahead for our careers. I don't think there was ever a plan or intent, "I'm going to end up here." How would I know I'm the first African American woman to get a PhD in epidemiology? Never on my books, never in my mindset.
But having the ability to work with great people, even when I was doing my internship for my co-op at Drexel University, but at Fox Chase Cancer Center when Baruch Blumberg won the Nobel Prize, and I told him I made him famous because we were in the newspaper all over. I think I was the only Black person at Fox Chase that wasn't a dishwasher at that time. And that type of influence is really important in encouraging me to go on and keep doing things.
And I had a strong science background anyhow. In my high school, we majored. I majored in engineering in high school. So I was on that trajectory, and with my parents both being well educated, that was a big push. And my father is from Atlanta, Georgia, was from Georgia, so... and went to school with many of the civil rights people as well. So we had that community tie anyhow.
But as I joined Howard from the New England Research Institute, previously University of Pittsburgh, I joined Howard skeptical. I didn't know if I can keep my career going, and I called the National Institutes of Health and said, "I'm thinking about going to Howard because people are trying to get me to come there, but I've never been to a historically Black college or university (HBCU). I've never trained at an HBCU." I was really curious, and they said, "Well, you're funded at Pitt, you're funded at New England. I think it'll be great for you to come here."
And I went there actually in cardiovascular disease epidemiology. I changed my focus but not the areas I studied. I always studied obesity, nutrition, energy expenditure. I continued to do that, but I flipped it to cancer. Then I got asked after a few years, "Would you be the interim director of the cancer center?" And I said yes, and from then on, I kept moving up. But it was not planned. I think some people have a goal, "I want to be president of the United States." That was not my goal. My goal was just to be successful and do what I had to do. But I learned in school, at University of Pittsburgh in particular, that I had to work twice as hard...
John Marshall, MD: Dr Sara Fagerlie, who partners with me on this, putting this together for everybody, interviewed Edith Mitchell a while ago on a program that she set up called Lighting the Fire: Improving Racial Parity in Oncology Through Meaningful Digital Small Group Mentoring Experiences. So here was Edith basically recognizing, Dr Mitchell recognizing, that she needed to set up structure for others to be mentored as well. Dr Baskin, would you say that that's sort of part of the job too, is to make sure you're doing that?
Monica Baskin, PhD: Yeah, absolutely. So as I was describing, I mean, certainly my upbringing, just on a personal level, I saw a lot of people that looked like me in a lot of different leadership roles, whether or not they were presidents of universities or banks or chief executive officers, entrepreneurs. I saw that, and that was really important. So whether or not I had the direct mentorship, it definitely made it possible for me to think about higher-level leadership roles. And because I have directly benefited from tremendous leaders who have mentored me from all walks of life, I definitely make it a point to try to do the same thing for others.
And so I was recently asked, in terms of my career, what was one of the things that I was most proud of? And I think for me, it's seeing my mentees continue to grow and excel, from one who had gotten not only one R01, but got 2 R01s in a single year, and then others that are getting promoted. So that's really important, because I do want them to see that there is a pathway that is there that may not be what others see you as, but I want that. And I think both professionally... and I also have 2 young adult daughters, and I want them to see as well that the opportunities are wide open for whatever they want to do.
John Marshall, MD: Well, and I also thank you for that. I was also thinking that both of you have taken your positions and your leadership positions and your knowledge and said, "Okay, how do I not just help those within the field, but help the people around you?" Your chosen science is health care access, health care parity, and you've spent your careers driving in that way. And actually, I would argue you have contributed to the fact that there is now dedicated resource to these issues, right? I think about the Affordable Care Act and the recognition that that needed to happen, and you guys are air and ground support for those kinds of initiatives so more people can have access to health care in the United States. And correct me if I'm wrong, but I credit you with that. Well, so maybe just let it be and take the credit.
But what I'm thinking about is the current environment, like every day's Washington Post telling us about how we, as NCI cancer centers, our money's being cut. The most recent is that there's a push. The White House is asking that they give the final sign-off on grant awards, essentially controlling what gets funded and what does not. And maybe, Lucile, I'll start with you, because we're sort of boots on the ground here in Washington. What's your take on all of that and what the potential impact could be?
Lucile Adams-Campbell, PhD: You know, if you look at the statistics that are out there now talking about where the US ranks in terms of science and math and reading compared to other countries, I think we're headed in this negative direction, and it will get worse, because we need to let the people who are trained with the expertise make the decisions on those topics. It can't be an administrative signing or personal signing and agreeing or cutting monies because you don't like this person. We have to really focus on the science. And I think that we miss that when we get involved from government, from the White House, and I think that's going to be a big problem. So our science will be going backwards.
John Marshall, MD: But you're talking about science globally. I'm actually talking about your specific kind of science and how that's no longer valued by a lot of people who are in power.
Lucile Adams-Campbell, PhD: You know, it's really interesting. I'm going to go back in time a little bit. I've been doing health disparities and minority health research before it was ever popular, when there was no funding for it. Then when there was funding for health disparities, who got most of the money? Not the minorities, not the Blacks, not people of color. It was the White male. So we always are fighting a battle trying to really stay on par with other people. But these things we've been doing for a long time without the recognition, without the funding, and now when funding comes available, we're last in line.
The way we see things, and the way I see things nowadays, it's almost trying to erase who we are, but we will not be erased. You can erase us in one sense administratively and all of that, but who's running from whom? We're not running. I think everybody else is running a little bit scared. And I think being educated, Black educated women, I think it's the biggest threat in this city and nationally. People don't want to hear about that. So that's just my own perspective about it, but it's really bad.
John Marshall, MD: Yeah. Thank you for sharing, or sorry that you have to share that, but thank you for sharing it. Dr Baskin, it's hard enough being a cancer center director, an NCI cancer center director, in any time, good times. But more, it seems to me it's a difficult job in front of you. So as you're thinking about the new position, do you have a sense of what the future looks like for us as NCI centers and you in particular, servicing a really important part of our country as well?
Monica Baskin, PhD: Yeah. So certainly, as I mentioned, it was not my plan. And certainly if it was my plan, this was the worst time for me to actually take this on. So definitely, this wasn't planned out. But I do think that folks like Lucile and I and others, as I've been getting inspiration from many people from across the country and beyond, I do think that we're in these roles at this time for a specific reason. I think it's because we can draw upon other experiences, not only our own, but ancestral, historical parts of what people have been able to do, and resilience, and still, in spite of lots of obstacles put in front of them, be able to have great achievements. So I do again accept my time here, and I certainly plan to focus on getting back to what is really important.
So the question you're raising about what's happening out of DC and the potential impacts for NCI-designated cancer centers or other kind of research, I think is really important. And I think that politics has no place in science, and we've got to go back to the science. What we've certainly seen, evident over the last 3, 4 years, is that the public's having an erosion of trust around science, and adding politics to that is not going to help. So I definitely feel like we've got to actually have processes that are in place that ensure that individuals who have the competency to evaluate scientific grants are the ones that are doing that, and certainly looking at what the priorities are for our entire country. I think that's really critical.
And specific to cancer centers, I think there is certainly some misinformation, disinformation about the work that, I will say, that I do, and that's really led from our cancer center, and even what I know of Dr Adams-Campbell in Georgetown. We are not picking a specific population and saying this is, we want to do work only for this population. What we are saying is, here is the population that we're responsible for. Every NCI-designated cancer center has to identify a catchment area, and what we're saying is that everybody within that catchment area deserves high-quality care as well as the translation of our discoveries there. So that's what we're doing. We are making sure that everybody can benefit from that. So that's what it is. It's not all the other narrative that's out there.
John Marshall, MD: I love that. It's not about an individual, it's about the community. And what we've lost, in many ways, from the voices on the other end of Pennsylvania Avenue from us, is that loss of sense of community and that we're all in this together. And this is just an awesome way to close us out. So thank you very much.
Now you out there know why I'm lucky enough to have the job I'm having right now, is interviewing 2 of the most amazing beams of light that are glowing on us all, and we need to listen very carefully to what they're saying and what they're doing, and support their work, because they have all of us in mind, and we will be better together.
So let me again thank my good friend and colleague, Dr Lucile Adams-Campbell, and my new friend and colleague, Dr Monica Baskin from MCV, the newest NCI-designated cancer center director and the first ever in her female African American Black category. So again, congratulations to you both, and I wish you all the success in the world, because when you succeed, we all do. Thanks for joining us on Oncology Unscripted.
Monica Baskin, PhD: Thank you, John.
Lucile Adams-Campbell, PhD: Thank you.
This transcript was generated by AI and lightly edited.