June 12, 2025 • 40 mins
Recently Leslie's friend was diagnosed with cancer at the very young age of 30, which is becoming all too common a trend in the US. This week, Leslie talks to Alicia Zhou about the evolving nature of cancer treatment, funding cuts under the current administration, and how you can be proactive in preventing cancer. They also talk about ways to fiix heathcare, non-Mangione style. Alicia also talks about her fan fiction!
Hosted by Leslie Dobson. Produced by Liam Billingham. Executive producers are Paul Anderson and Scott McCarthy for Workhouse Media. The views expressed in this podcast episode are solely those of the guest speaker and do not reflect the views of the host or the production company.
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:13):
Welcome to another episode of intentionally disturbing. This is a
really personal episode for me. My friend last year was
diagnosed with cancer and she's only thirty at stage four
colon cancer, and through my efforts to help her through
her treatment, I met doctor Alicia Joe, who is the
youngest CEO of the Cancer Research Institute and one of
(00:35):
the most brilliant people I've ever met. I asked Alicia
to join me on this chat so that we could
bring this information to you, the same information she's helped
me understand to guide my friend through her treatment. And
my friend is no longer on palliative care. She is
back in active treatment, moving towards surgery, and actually living
(00:57):
her life now. So I'm very excited for you to
meet doctor Joe.
Speaker 2 (01:01):
Okay, you're here. Thank you for doing this.
Speaker 3 (01:08):
Yeah, thank you so much for having me.
Speaker 1 (01:09):
I want to introduce the world to you. So, doctor
Alicia Joe. So we met because I was lucky enough
to attend your talk with how many people?
Speaker 2 (01:21):
Fifteen people?
Speaker 3 (01:22):
Yeah, something like that. Yeah, it was a really fun
night a couple of weeks ago. Really trying to share
what we're doing at the Cancer Research Institute and share
some knowledge about cancer prevention, diagnosis, and treatment.
Speaker 1 (01:34):
I thought it was great, and I adore Jennifer Segerstrom
who put it together, and I think she's.
Speaker 2 (01:41):
A hoot as well. So it was a good group.
Speaker 1 (01:43):
But I you taught me in that time things I
had never things I just did not know about cancer.
Speaker 3 (01:52):
Oh, I appreciate that. I think it's the thing about
cancer also, is that what we know about it has
become more and more. There's so many news studies coming out.
There's so many new treatments, new diagnostics, and I think
that's actually quite hard for most folks to keep up with.
So I try to distill it in such a way
that hopefully, you know, you can take away a few tidbits.
Speaker 2 (02:11):
And that's what happened for me.
Speaker 3 (02:14):
I appreciate that, you know.
Speaker 1 (02:15):
I've known about radiation, I've known about chemotherapy. I have
not really understood immunotherapy. Yeah, So I think where I
would love to start is my friend is thirty and
she has stage four colon cancer, and you were wonderful
enough to speak with her. I'm wondering if you can
(02:39):
share what you shared with her.
Speaker 3 (02:42):
Yeah, I'm happy to talk about that. So cancer is
a very individual journey for each patient, and I think
it really kind of depends when you're speaking to a
patient where they are in their treatment and then where
they are in their journey in terms of what resources
they're looking for. So in this particular case, this is
a young woman at the age of thirty who was
(03:03):
diagnosed with stage four colorectal cancer, which of course is
a very scary diagnosis, and so at this point, I
think there's managing multiple different lines of treatment. And so
with colorectal cancer, we typically do look to use all
four pillars of treatment to try to go after this cancer.
So we use surgery, we use chemotherapy, we use radiation,
(03:27):
and we use immunotherapy, and they all have slightly different mechanisms,
but ultimately the goal, of course, is to eliminate and
eradicate the cancer. And so I wanted to make sure
that she understood what options were available to her, and
especially for some patients, especially stage four patients, oftentimes clinical
trials are an option. So I wanted to understand if
(03:47):
she had already explored those options. Then there's actually a
whole other side of this, which is that when a
patient is undergoing treatment, especially if they're going undergoing multiple
lines of treatment, they actually have to manage the complex
of working with their doctor and their healthcare system to
ensure that it gets paid for. And sometimes we don't
talk about this, but it can be one of the
(04:08):
sort of biggest burdens for cancer patients. So it's also
understanding that, you know, it's not just the chemotoxicity, it's
the financial toxicity. And so those are some of the things.
Speaker 2 (04:18):
That we talked about. Can you say more about that?
Speaker 1 (04:23):
And we don't necessarily have to get political, but how
has this current administration changed the access to care for
cancer patients?
Speaker 3 (04:35):
Yeah, it's a really great question, and I'm glad you
asked it. So I think there are a couple of
things that have been happening. So in the past several
of months, we have seen that there are proposed budget
cuts to the NIH as well as the National Science
Foundation NIH's National.
Speaker 2 (04:53):
Institutes of Health.
Speaker 3 (04:55):
These are some pretty big, long standing institutions that have
really supported science and meta and within the United States
when it comes to access to care. A couple of
things we've noticed, So the NIH itself is responsible for
sponsoring and actually even conducting several large clinical trials in
all different disease areas. We have seen that the NIH
(05:18):
sponsored trials right now are kind of in this pause state.
They haven't been canceled, but they are kind of in
this indefinite pause state. And I think the question for
cancer patients, especially folks who are stage four and are
looking at a pretty scary prognosis, you know, time is
(05:38):
something that has a lot of value, and having to
wait several months can make a real difference in terms
of the outcomes. So unfortunately, we are seeing some patients
sort of stuck in this sort of waiting loop to
see if these trials are going to start up again.
Speaker 1 (05:56):
How long do you think the waiting loop will continue,
I guess, or be extended.
Speaker 3 (06:02):
I don't really know. I would say that especially for
the NAH sponsored trials, the ones that it's actually conducted
by the NIH, it's really uncertain because of course, there
have been a lot of staffing changes at the NH.
There are a lot of clinical trials that are sponsored
by private institutions or by public universities. These are drug
(06:23):
company sponsored trials or ones that are being conducted multi
center trials that are being conducted at academic cancer centers.
Many of those are still ongoing, and so generally I
would say if you are in a waiting line for
an NAH trial, it's probably worthwhile also to explore what
your other options are. Oftentimes there are other clinical trials
(06:43):
that might be available to you. I think the hardship here, though,
of course, is that depending on what the trial is
that you're trying to get into, they might be recruiting
in a specific geography, and so they might not be
recruiting in your area. It might mean you need to travel.
So it becomes quite difficult and quite a burden for
patients to be able to find a trial that is
(07:05):
in their area that is recruiting for patients like them
that they feel like they would like to be a
part of. Actually, one of the things we do at
the Cancer Research Institute is we have a Clinical Trial Finder,
and what we try to do is help you navigate
this so you know, based off of your disease, we
look at you know, some of the biomarkers, stage of disease,
(07:26):
history of treatment, and we try to help you find
a trial that is in your area. We do have
some patients that say that they're open to travel, but
obviously that can be quite a burden for some patients.
Speaker 1 (07:38):
Right, Okay, so this is amazing. So so what do
people do?
Speaker 2 (07:43):
Tell me?
Speaker 1 (07:43):
Like, Okay, I just found out I have stage four cancer. Yeah,
I'm listening to this podcast. What's the website? Tell me
walk me through all these steps. Yeah, well I have
let's say I have an IQ of ninety five and
a third Greed reading level.
Speaker 3 (07:56):
I mean, I think the conversation actually starts first with
your on colleges, of course, and I think this is
where we do need to have our trust in our
medical team. My first advice that I always give patients
is that make sure you find an oncologist that you
feel like you trust and it is a relationship. It's
going to be a long term relationship and one that
is very important to you, the patient, And so make
(08:18):
sure that you have a good rapport with that doctor
that you feel like they really understand where you're coming from. Obviously,
they are going to try to optimize for your treatment,
but you need to also be clear about the things
that you want as you are undergoing treatment. What are
you optimizing for? Are you optimizing for the quality of
your life? Are you wanting to know what types of
side effects? What's more important to you, if we're talking
(08:41):
about sort of stage four and potentially getting into experimental therapies,
what's your priority in terms of how you feel versus
you know, getting onto the most innovative or promising trial.
So I think these are things that you do need
to talk to your doctor about. And then as a resource,
the Cancer Research Institute, our website is cancer research dot org.
(09:04):
We do have a clinical trial finder and matcher and
will help you find a clinical trial that will be
recruiting for patients like you. We specialize in immunotherapy trials.
So immunotherapy is a type of cancer therapy that actually
activates your immune system to go and target and eliminate
the cancer. And so there are many different types of
(09:26):
immunotherapy and we can help match you to one of
those trials, but I would start with talking to your oncologists.
Speaker 2 (09:33):
So am I correct?
Speaker 1 (09:34):
And if I rephrase this, chemotherapy kills cancer, but immunotherapy
teaches the cancer to kill itself.
Speaker 3 (09:43):
Yeah, that's very close. So chemotherapy actually is really interesting.
Chemotherapy we use molecular mechanisms to actually try to go
after cells that are dividing very quickly, so tumor cells,
cancer cells, are in this category. These are cells that
dividing very quickly, and so what we do is we
chemically sort of poison these proliferative mechanisms. We're trying to
(10:07):
go after cells that divide very quickly, and we're trying
to kill off those cells. In that way, chemotherapy does
target those cancer cells. Chemotherapy does also, for that reason,
have side effects for other fast dividing cells in your body.
That includes, for example, your hair follicles, so that's another
place where you have a lot of division happening. Your
hair is always growing. And then also your gasterinetestinal tract
(10:27):
so sort of GI system, the lining of your intestines.
That's also a place where those cells turn over very quickly.
In fact, every week or so, you have new cells
in your GI tract. So oftentimes with chemotherapy you end
up with side effects like your hair falling out or
experiencing that sort of nausea or those GI symptoms. And
(10:47):
that's actually why those side effects are associated with chemotherapy.
Immunotherapy is different. Instead of treating the cancer cells or
trying to go after the cancer cells, immunotherapy is actually
trying to treat your immune system. The underlying idea here
is that your immune system is billions of cells in
your body that are primed to go after and eliminate
(11:08):
when you have a bacterial infection or a viral infection.
So when you get the common cold, when you get
the flu, your immune system is activated, and we know
that you feel really bad for a little while, but
usually within a week or so, you're feeling a lot better.
So how do we get this system, the immune system
to actually recognize cancer as a sort of foreign entity
(11:29):
that needs to be eliminated. And so that's actually what
immune therapy is trying to do, is actually trying to
activate your immune system to recognize the cancer and go
after that cancer.
Speaker 2 (11:39):
How do you do it?
Speaker 1 (11:41):
Yeah, Tisha, I know this is like really getting in
the weeds, but this is your bread and butter.
Speaker 3 (11:47):
Yeah. So it's actually pretty fascinating because, as you can imagine,
your immune system has a lot of different functions. From
the moment that you're born, your immune systems has started
to work, and we always talk about sort of building
up an immunity over the course of your lifetime. So
every time you encounter new viruses, new bacteria, each time
you see something like that your immune system actually starts
(12:10):
to learn and recognize those foreign pathogens. So that's why,
actually if you have a newborn, you have to get
a lot of vaccinations because you're teaching the immune system
right away. But also you'll notice that your kid gets
sick a lot, and in fact, your kid gets sick
a lot between the ages of like one and let's
call it four. Your kid is like constantly with a
(12:30):
sniffley nose. And that's because your kid's immune system is
actually learning that whole time about all of these different viruses.
And the more that your immune system learns, the next
time that same virus or bacteria comes back, you actually
have pre programmed immune cells that now recognize that and
will go after it and oftentimes will eliminate it before
you even feel any symptoms. That's also why as kids
(12:51):
grow older, they don't get sick as much. But there's
sort of this sort of fine line between your immune
system recognizing things that are four and then making sure
that your immune system doesn't attack your normal cells because
as you can imagine, if that happens, that's what autoimmune
disease is. And then also in your immune system is
actually going after your own cells and that's not a
(13:11):
good thing. So what that means is that your immune
system actually has this interesting balance where it gets turned
on when it sees something that it thinks is a
foreign attacking agent, and then it's actually silenced to ensure
it doesn't go after your own cells. Now, cancer cells
are really interesting because all cancer cells start out as
normal cells. And in fact, what we all sort of
(13:33):
agree on at this point is that all cancer actually
starts as one cell that sort of accumulates a ton
of mutations and then eventually gets out of control and
grows into a tumor. So at the beginning, your immune
system doesn't recognize that cell because that cell was a
normal cell. But at some point that cell becomes so
different from normal it starts to look incredibly different that
(13:57):
your immune system should be able to see it. What
we found is that what we actually have to do
for immune therapy is we actually have to block this
kind of what's called a checkpoint. It's actually these proteins
that keep your immune system kind of in check. We
actually have to block that checkpoint in order for the
immune system to recognize the tumor. And that was sort
(14:18):
of the groundbreaking revelation that we realized in the field
in about twenty years ago, fifteen years ago, and there
was all of this theory that if we could block
this checkpoint and it's kind of unblind the immune system,
that the immune system would naturally be able to see
the cancer and then go and eliminate it. And that's
actually worked. So in some cancers like melanoma, which is
(14:40):
an aggressive form of skin cancer, we've seen dramatic changes
and outcomes for patients. It used to be a fifteen
percent likelihood of survival for a stage four melanoma's cancer patients.
These days that is getting up too close to sixty
percent if it was stage four diagnosis. There we're actually
talking cures, not simply just living with your decease.
Speaker 2 (14:59):
Oh wow wow.
Speaker 1 (15:01):
Yeah, We're going to take a quick break and we'll
be right back.
Speaker 2 (15:08):
So that brings me to another question.
Speaker 1 (15:10):
I have you know, since this is intentionally disturbing podcast.
Speaker 2 (15:13):
Sure, the statistics.
Speaker 1 (15:16):
That you shared when we met, they were disturbing to me.
It seems like younger people are getting cancer. Yeah, and
I was wondering if you could speak a bit to that.
Speaker 3 (15:30):
Yeah. So there have been these studies that are ongoing
throughout multiple decades looking at the incidents of many of
the common cancer types, and so every year we kind
of look back at the last year that we have
data for and ask ourselves what are some changes and trends.
So one of the things that we've been looking at
is cancer incidents, and so what's really disturbing is in
(15:53):
the last year, and really over the last several years,
we've seen this trend. We're seeing more and more patients
under the age of fifty who are getting cancer, and
that's relatively young. Most cancer effects individuals over the age
of fifty. In fact, most cancers affect people over the
age of sixty. But we're seeing this sort of disturbing
(16:13):
increase in incidents of breast cancer, colorectal cancer, pancreatic cancer,
and patients that are under the age of fifty, and
that's really confusing and we're not really sure what's going on.
There are a couple of different things that we know.
Certainly for breast cancer, for example, we know that we
are getting better at earlier detection, So as you can imagine,
(16:33):
if patients are getting screened at an earlier age, you
are going to find more cancer in a younger age
than if you weren't screening at all, so you know,
you don't find things that you're not looking for. So
part of the increased incidence can be explained by just
folks being more proactive in their screening, which is great
because we know about breast cancer, for example, is if
you can diagnose breast cancer at early stage stage one,
(16:54):
overall survival in twenty twenty five is ninety nine percent.
So that's actually a really racististic. So that's part of it.
But we also think there are other factors that are
probably keying into causing earlier onset of cancer, and so
there's a lot of studies that are ongoing looking at
behavioral modifications, lifestyle, and environment. Some folks are wondering whether
(17:16):
or not there are things like process foods or microplastics
that might have something to do with increased younger colorectal cancer.
And then certainly we know some things we know for
sure are unfortunately do increase your riskic corectal cancer, and
that includes red meat, process meats, alcohol, So these things
we know we have to sort of reduce our consumption
(17:38):
of alcohol everything in moderation.
Speaker 1 (17:43):
I know when you went over that statistic when we
met and we were all drinking wine.
Speaker 2 (17:47):
I know, I am guilty.
Speaker 1 (17:51):
Yeah, well I was drinking wine and then whiskey.
Speaker 2 (17:54):
But is there a healthier version or there just solve I.
Speaker 3 (18:00):
Think it's about everything in moderation, right, So it's about
I mean, I think one of the actually one of
the studies that is being conducted, so we don't know
yet what the outcomes are going to be, is whether
or not binge drinking actually might increase the incidence of
coloxal cancer. So the idea here is is it doesn't
matter whether you're having sort of one or two drinks
several nights a week versus on one night having you know,
(18:22):
ten drinks or more. We certainly know that there are
all sorts of bad side effects of binge drinking for
other reasons, but does it also increase your risk of
coloroestal cancer. There's actually studies looking into that.
Speaker 1 (18:35):
One random question I just thought of, sure because this
just came to my mind. I had a colostomy for
a while. Okay, not cancer related, but is there a
relationship between scar tissue and cancer or trauma to tissue?
Speaker 3 (18:51):
Yeah, this is an interesting question. So I would say
what we do know is that cancer is typically cause
when you see sort of damage to cells that occurs
over time. So the best example of this is smoking
in lung cancer, where we know that nicotine in tar
that's in cigarettes is actively causing mutations in the cells
(19:13):
in your lungs. Therefore you end up with a very
high likelihood of delping lung cancer. Similarly, UV radiation and
skin cancer, we know that there's that direct link where
the UV radiation from the sun damages the DNA and
that your skin in your skin cells, and that increases
your likelihood having skin cancer. So that we know is true.
(19:33):
So whenever we see things that damage your cells and
your DNA, it increases the likelihood that you accumulate mutations
that could one day result in cancer. The question then
is about sort of scarring and whether or not that
is related. It's unclear. So I'll give you a couple
of things that we do know. So interestingly, for a
gastric cancer, recently it's been shown actually that some aultcers
(19:56):
are actually related to having gastric cancer, and it's the
ones that are really to a bacterial infection with a
bacteria called H. Pylori And that's relatively new for us
to realize that one that H pylori causes ulcers, and
then that that is actually related to gastric cancer, so
we know, for example, there there's a bit of a link.
Here's an interesting sort of flip side of this story,
(20:19):
which is that in breast cancer, what we know is
and this is a correlation first before we realize why.
There's actually this interesting correlation between how many children a
woman has had in breastfeed and then their likelihood of
developing breast cancer. And what we found is that women
who have had zero children have us higher risk of
breast cancer slightly than women who have had at least
(20:41):
one child. But then at some point, I think if
you have more than four, that risk goes up again.
And the question is why is that. It turns out
the reason is because when you undergo pregnancy and then
subsequent breastfeeding, the entire memory tissue of your breasts have
to be completely sort of reorganized. As you can imagine,
you have to restructure the breast tissue in order to
(21:02):
be able to create milk, and that process of doing
that actually helps you kind of reset your breast tissue.
So that's why actually having at least one child actually
lowers your risk of breast cancer compared to not having
children at all. So it's kind of interesting the different
things that.
Speaker 2 (21:18):
Are related with cancer risk. That's amazing.
Speaker 1 (21:20):
So even if you if your boobs fill up with milk,
but you can't breastfeed because there's no latching or you
don't believe in it, it still could reduce your risk for.
Speaker 3 (21:30):
Cancer exactly because what's happening is biologically that that tissue
gets reorganized in order to create milk. And whether or
not you actually breastfeed or not, that's a biological process
that happens regardless.
Speaker 2 (21:42):
You are fabulous.
Speaker 3 (21:44):
I have a lot of random, random like tidbits of information.
I'm glad that this is this is fun.
Speaker 1 (21:51):
You're like, okay, this is your life obviously, right. I mean,
you have to devote your life to be able to
be so brilliant and and you've succeeded, and you're you're young,
and you are in charge of a massive company.
Speaker 2 (22:05):
You have so much influence.
Speaker 1 (22:06):
I mean, people who have cancer go to get it treated,
and your pictures on the wall.
Speaker 2 (22:13):
I'll have your friends send a picture of your picture
on the wall.
Speaker 3 (22:17):
It's you know, it's really interesting. I think I never
got into this and to be on the picture on
anybody's wall, actually, it's really interesting sort of my motivation
for why I got into this field. Yeah, honestly, I
just I've always done biology super fascinating, and I think
it was just from a pure curiosity standpoint. The moment
(22:41):
I learned about biology, I just felt like, how is
how does that? Everybody must love this topic because isn't
this just us studying the reason why we all exist?
Isn't this the study of life? And isn't that fascinating?
And so I just have always enjoyed understanding sort of
the why behind how do you human's work, how do
(23:01):
sells function? How we related to other organisms in this earth?
And then I got turned on to cancer research. Actually
when I was in high school. So I was just
really interested in biology. I thought that the actual work
was interesting. I wanted to hold a pipette, I wanted to,
you know, look up peer into a Petri dish, and
(23:21):
so I was encouraged by my high school biology teacher
to try to work in a research lab when I
was in high school. So, when I was a junior
in high school, I was at the University of Chicago
Laboratory Schools, which is a high school associated with the
University of Chicago. And so I went over to the
Universe of Chicago and I kind of just cold outreached
(23:42):
one of their investigators, and his name was Jeffrey Green.
It turns out he was the director of their cancer center,
but I didn't know who he was, and I asked
if he was interested in if I could, as a
high school student, work in his lab, and he took
such a big leap of faith in sort of letting
me do that, because I'm not sure that I would
let like a fifteen sixteen year old person into my
(24:04):
lab and touch all the equipment. But he was so
kind and he sort of took me under his wing
and he let me train in his lab. And I
think it was that sort of leap of faith and
that sort of paying it forward that really made it
so that I had an exposure to this field so
early in life, and I just completely fell in love
(24:25):
with it and I've been working on it ever since.
Speaker 1 (24:28):
So what training do you have, Like, I mean, you
have eight million letters after your name's.
Speaker 2 (24:34):
Fit for the sure the layman. You know, how did
you become who you are in your career.
Speaker 3 (24:42):
So I have a bachelor's in biology from MIT, and
then I have a PhD in Biological my medical sciences
from Harvard, and then I have a postdoctoral work at
UCSF afterwards. And in all of those three institutions, I
was pursuing cancer research. So actually, as an undergrad at MIT,
(25:03):
I had the privilege of working in an amazing cancer
research lab of a researcher called Bob Weinberg, who actually
is kind of credited as the grandfather of cancer research.
And I didn't know that when I started working for him,
but I had the privilege of working for four years
in his lab as an undergraduate technician, and I learned
so so much about cancer research, and I really feel
(25:24):
like that's where my career really took off. But yeah,
that's my background.
Speaker 1 (25:29):
It's absolutely incredible. It's incredible. Okay, I have to ask,
what is the most disturbing moment in your life that
you've experienced, work or personal or.
Speaker 2 (25:43):
Yeah, part of you.
Speaker 3 (25:45):
This is a hard one to answer because I feel
like I guess I've lived the pretty privileged in sheltered
life in some way. But I would say, you know,
one thing that I found that was kind of a
rude awakening for me that was disturbing to was I
went into academic science because I really was following the
curiosity and I just loved that journey of discovery. And
(26:09):
then I realized that because of the way that academic
science is funded and because of how competitive it is,
it does create these incentives that I think sometimes creates
disturbing behavior. So I remember when I was when I
was training, I would see, you know, postdoctoral fellows. These
are folks that are going to go on to start
(26:30):
their own labs and sort of do their own independent research.
I would see this behavior where their mentor their advisor
who was their postdoc advisor. As soon as that that
person became an independent investigator, they would immediately become competitors.
And I thought that was really unfair because it's, you know,
you spend all this time trying to claw your way
(26:51):
to independence. You're doing your own studies, you're looking for
your own funding, but ultimately then for your data that
you generated with your own two hands, for that to
be used against you because now your advisor is using
your own, your own data to compete against you. That
that that felt really icky, and so you know, it
(27:12):
kind of turned me on too. Understanding this so sort
of like funding problem in academic research and how do
we incentivize collaboration rather than competition. But yeah, that was
a that was a bit of a rude awakening. It's cutthroat,
very cut throat, I mean, more so than I would
have ever anticipated. And yeah, I guess that was sort
(27:33):
of when that my naive, romantic bubble about science got
a little bit popped.
Speaker 1 (27:39):
I had a similar experience when I had a super
We were doing research on schizophrenia and I had a supervisor.
We were videotaping interviews in order to gain data to
run about schizophrenia and behaviors, and the supervisor told me
I don't think you should be on this project anymore.
And I asked why and he said, because I don't
(28:00):
think there's anything good about you. WHOA And I was like,
I was young, right, And then he went on and
he took all of my data from my interviews, you know,
a qualitative analysis of behavioral structures and published it.
Speaker 3 (28:17):
Yeah. Yeah, I mean it's really unfortunately the incentives for
you know, how you get promoted or how you get
funding are all tied to your ability to publish and
be able to be a certain author order being the
first author of the last author, and yeah, it creates
really bad behavior. Yeah.
Speaker 1 (28:38):
I mean that's why I married a psychologist and so
then we published together. So we're either first or second
on everything. Yeah.
Speaker 3 (28:44):
Yeah, nice, which actually I think no, But I think
that's the thing we're all kind of learning. I mean,
after I left academic research, I was in I was
in a company called Color Health for almost ten years.
I was their chief science officer, and it was the
startup company that was trying to help patients get access
to genetic testing that would tell them about their likelihood
(29:06):
of developing cancer. And it was all about making products.
It was all about bringing a product to market. And
one of the things I quickly saw as soon as
I started at Color was that it was so collaborative
compared to what I had experienced in academic medicine. And
I realized that you can get things done just as
if effectively, when you work together then if you're just
(29:28):
sort of in it for yourself. And I do actually
think I'm seeing academic medicine and academic science moving in
that direction. And I think the reason is actually because
one I think that we as people are realizing the
importance of collaboration. I think the Internet has a lot
to do that. I think you can now ask an
expert anywhere in the world for a little bit of advice,
and it's so much more accessible than it used to be.
(29:50):
But I think the other thing is that we've the
complexity of the problems that we're trying to solve have
become massive. You know, these days, we're having to solve
a biological problem in parallel with a huge computational problem
because oftentimes we're looking at large data sets and it's
actually really important to have different people on the team
who have different expertise. So I'm actually feeling like academic
(30:10):
science is becoming more collaborative, which I'm very excited to see.
Speaker 2 (30:13):
And that's something I fight for so much.
Speaker 1 (30:15):
You know, we should be lifting each other up because
the gain would be synergistic, it would be so much greater.
Speaker 3 (30:22):
Yep, yep, exactly.
Speaker 2 (30:24):
Yeah, that's I mean.
Speaker 1 (30:25):
You coming on the podcast and talking is our collaboration.
And this message is people are going to hear things
and learn things that they had no idea about exactly,
and then you speak so eloquently and people want to
listen to you as well.
Speaker 3 (30:39):
I hope so. I hope we haven't put anybody to sleep.
Speaker 2 (30:43):
I think so, but they probably wouldn't tell us. We're
going to take a quick break and we'll be right back. Okay,
so we're going to do our lightning round of questions.
Speaker 3 (30:55):
Let's do it.
Speaker 2 (30:56):
Okay.
Speaker 1 (30:57):
If you could commit a crime and get away with
what would it be?
Speaker 3 (31:02):
Yeah, this is I was thinking about this. So if
I could get away with this crime, I think that
the way that healthcare and payment for health care today
is sort of done in the United States is a crime.
I think that there are patients who have a lot
of health care debt and aren't able to get access
(31:24):
to the treatments that they need, and are getting sort
of hounded by collection agencies, and they're making decisions about
the quality of the care they're getting based off of
how much money or how much they can afford. So
if I could sort of like like Zoro in the Night,
like go and erase all the records of people who
have health care debt and just like slate all that,
(31:47):
I would do that.
Speaker 1 (31:48):
Oh my gosh, I would be like Zarro's sidekick. I mean,
I've personally given Ellie fifty grand for her treatment because
she is struggling so much. So I'm okay, let's we'll
get our black masks on and.
Speaker 3 (32:04):
Go exactly exactly well, big hat, black masks. Nobody will
know what's coming.
Speaker 1 (32:10):
Doesn't need to be Luigi Mangioni, so we can figure
it out a different way.
Speaker 3 (32:14):
Yes, yes, yes, exactly.
Speaker 1 (32:16):
Okay, next question, and this, I know this is the
oddest question, but if you had to die by death penalty,
how would you want to go firing squad, injection, electrocution
or maybe you you personally have different fun ideas.
Speaker 3 (32:31):
I mean, so I'm going to take a really sort
of scientific, nerdy approach. I would I would pick lethal
injection in the reason and ideally administered under proper clinical protocols.
Speaker 2 (32:43):
A clinical trial of your death.
Speaker 1 (32:45):
Okay.
Speaker 3 (32:46):
What I'm optimizing here for is sort of the being
able to go in in in peace, right, And I
think there's a little more sedation involved with lethal injection
than the other two. So yeah, yeah, I INTERFAI have to.
Speaker 1 (33:03):
I interviewed a CIA agent, and of course he wanted
to go by firing squad. I mean that, of course,
it's our trade, right, Yeah, yeah, I would want to
be manipulated and probably into my own suicide, I think
because I'm a secologist, Yeah, yeah, I can see that. Okay,
(33:25):
this is a big question for you. If you could
change a law, what would it be.
Speaker 3 (33:30):
I mean, this is very much related to the previous
my previous answer, but I do have a really strong
point of view in this. I think that the way
that healthcare is paid for in the United States, and
the really opaque way in which payers private insurance carriers
are able to sort of obvious skate how much it
costs in order to maximize profits is very detrimental to
(33:55):
the patient and it creates very misalignedacent of structures, and
so it's hard to say whether there's one wrong player.
I think that everybody kind of conforms to this very
weird incentive structure that exists, but I think it does
start at the regulatory part of the policy part of
the world. So if I could change a lot, it
would very much be about how we cover basic essential
(34:18):
healthcare for every single person that needs it. And that's
not just on the treatment side. I actually think that's
also on the prevention side, because at the end of
the day, we can do a better job of preventing
some of these very expensive diseases to treat, like late
stage cancer. We would save money as society, but we
(34:40):
actually do need to make available some of these life
saving technologies. And I just think that right now, the
public policy and the sort of private insurance reimbursement as
well as medicaid and medicare reimbursement for all the new technology,
it's just not keeping up. Like we're inventing technology at
a much faster rate than the policy is keeping up,
(35:01):
and we end up in this situation where if you
have the means to pay for it yourself, maybe you
get access to it, but not everybody else can. So
this is the place where I would definitely focus.
Speaker 2 (35:11):
I love that.
Speaker 1 (35:12):
Yeah, like the gallery test or the what is the
tube that people are going in prenew novo. Yeah yeah, yeah, yeah,
to just the very wealthy people are able to access
incredible preventative treatments right now.
Speaker 2 (35:28):
Yeah, Okay, final question, Okay, can you tell me a secret?
Speaker 3 (35:34):
Yeah, this is gonna be slightly embarrassing. So we've we've
we've talked about how amazing and my career has been
as a scientist, but actually when I was when I
was like when I was in high school, I really
dreamed of becoming a novelist. Like I really really enjoyed
reading science fiction and fantasy, and I would just I
(35:55):
was such a bookworm. I go to the library. So
I really like I I had like a like a
journal where you write down your dreams or whatever, and
I wrote, like, I I want to write. I want
to publish a book one day, not like a nonfiction book,
like a like a novel. And of course I'm not
a novelist, but in order to sort of uh scratch
(36:16):
that itch, I do like for my own self. I
don't publish, but uh, I write fan fiction to like
escape from reality. And I have this my own little
collection of like terribly written fan fiction just to like
continue that that that dream.
Speaker 2 (36:31):
Like a handwritten or you type. Oh, I tried it.
Speaker 3 (36:34):
I actually so I started in high school. I started
writing my own fan fiction. I thought it was so great.
I think I wrote my first when I was like thirteen,
and it was a Star Wars fan fiction, and I like,
I was so proud of it. I made cover art
for it using Photoshop and I printed it out. It
was like one hundred pages, but it was like double
space because because it wasn't good. But but I just
(36:55):
I don't know. I've always you know, maybe one day
I will, I will try to write an actual story.
Speaker 2 (37:01):
I think you should. You know. I have a master's.
Speaker 1 (37:03):
One random master's I have is in dream analysis. For
dream analysis. I can help you edit it.
Speaker 3 (37:09):
Yeah, yeah, I mean that would be so much fun.
That would if I could, you know, I would be
it would be such a different alternate reality if I
were a novelist's instead up a scientist. But but yeah,
I really I really enjoyed in that.
Speaker 2 (37:23):
I love that. I did not expect that, and I love.
Speaker 3 (37:27):
This is actually a very very little known fact. So
I'm not sure why I just told.
Speaker 1 (37:31):
Everybody that it's O case seven million people.
Speaker 3 (37:37):
I'm gonna get a lot of questions from people who
know me really well because they did not know this
about me.
Speaker 1 (37:44):
Well, can you leave us with a tip, a tip
for people who may not have cancer, maybe a tip
for prevention that we can take on.
Speaker 3 (37:53):
Yeah, I think it's about being proactive about your health.
I think that's sometimes we kind of think that we
are a passenger on this journey that is life, and
whatever happens going to happen right, and then what tends
to happen is that we get really scared of knowing
what's around the corner. And so what happens is you'll
see people putting off prevention. They just think like, oh,
you know, I don't need to go to my doctor,
(38:14):
or you know, I can do that next month, or
I can do that next year, and then all of
a sudden, it just kind of falls off of your radar.
Speaker 2 (38:21):
And speaking to all of the men out there exactly.
Speaker 3 (38:24):
And in fact, one of the things that studies have
shown is that even though the incidence of cancer is
hirering women, the mortality for cancer is higher in men.
And one of the reasons this is true is because
men tend to be diagnosed at a later stage. They
tend to be less proactive about their screening, and what
ends up happening is that they end up with later
stage cancer diagnoses. They wait until something hurts, they wait
(38:47):
until something's symptomatic, and by the time something is symptomatic,
it means it's progressed enough that something is off in
your system. The whole point of prevention is that you
find things before they become symtomatic, and so it is
really important to do that. It's the same reason why
you know you you take your car in for an
oil change, it's so that you don't break down the
(39:07):
middle of the freeway. We have to do that for
our bodies too, And so this is the tip that
I would give to everyone.
Speaker 2 (39:14):
I think that's great.
Speaker 1 (39:15):
So to summarize, men, take your hand and fondle your
balls right now, or or ask your doctor to do it.
Speaker 2 (39:28):
Women, grab your boobies.
Speaker 3 (39:29):
Sorry, yeah, yep, yep, yep.
Speaker 1 (39:31):
Well, I really appreciate you taking the time to come
on and educate us because your brain is incredible and
what you know so few people are even aware of
at a shallow level, and you just offered us so
much depth in a short period of time.
Speaker 3 (39:49):
It's thank you. Yeah, it was so much fun, and
this is such a great conversation. So thanks for having me.
Speaker 1 (39:55):
Thank you for listening to another episode of Intentionally Disturbing.
I hope you enjoyed it, and I hope you actually
learned things you didn't know. And I hope right now
your hand is either.
Speaker 2 (40:04):
On your testicles or your tits. See you next time.
Welcome to another episode of intentionally disturbing. This is a
really personal episode for me. My friend last year was
diagnosed with cancer and she's only thirty at stage four
colon cancer, and through my efforts to help her through
her treatment, I met doctor Alicia Joe, who is the
youngest CEO of the Cancer Research Institute and one of
(00:35):
the most brilliant people I've ever met. I asked Alicia
to join me on this chat so that we could
bring this information to you, the same information she's helped
me understand to guide my friend through her treatment. And
my friend is no longer on palliative care. She is
back in active treatment, moving towards surgery, and actually living
(00:57):
her life now. So I'm very excited for you to
meet doctor Joe.
Speaker 2 (01:01):
Okay, you're here. Thank you for doing this.
Speaker 3 (01:08):
Yeah, thank you so much for having me.
Speaker 1 (01:09):
I want to introduce the world to you. So, doctor
Alicia Joe. So we met because I was lucky enough
to attend your talk with how many people?
Speaker 2 (01:21):
Fifteen people?
Speaker 3 (01:22):
Yeah, something like that. Yeah, it was a really fun
night a couple of weeks ago. Really trying to share
what we're doing at the Cancer Research Institute and share
some knowledge about cancer prevention, diagnosis, and treatment.
Speaker 1 (01:34):
I thought it was great, and I adore Jennifer Segerstrom
who put it together, and I think she's.
Speaker 2 (01:41):
A hoot as well. So it was a good group.
Speaker 1 (01:43):
But I you taught me in that time things I
had never things I just did not know about cancer.
Speaker 3 (01:52):
Oh, I appreciate that. I think it's the thing about
cancer also, is that what we know about it has
become more and more. There's so many news studies coming out.
There's so many new treatments, new diagnostics, and I think
that's actually quite hard for most folks to keep up with.
So I try to distill it in such a way
that hopefully, you know, you can take away a few tidbits.
Speaker 2 (02:11):
And that's what happened for me.
Speaker 3 (02:14):
I appreciate that, you know.
Speaker 1 (02:15):
I've known about radiation, I've known about chemotherapy. I have
not really understood immunotherapy. Yeah, So I think where I
would love to start is my friend is thirty and
she has stage four colon cancer, and you were wonderful
enough to speak with her. I'm wondering if you can
(02:39):
share what you shared with her.
Speaker 3 (02:42):
Yeah, I'm happy to talk about that. So cancer is
a very individual journey for each patient, and I think
it really kind of depends when you're speaking to a
patient where they are in their treatment and then where
they are in their journey in terms of what resources
they're looking for. So in this particular case, this is
a young woman at the age of thirty who was
(03:03):
diagnosed with stage four colorectal cancer, which of course is
a very scary diagnosis, and so at this point, I
think there's managing multiple different lines of treatment. And so
with colorectal cancer, we typically do look to use all
four pillars of treatment to try to go after this cancer.
So we use surgery, we use chemotherapy, we use radiation,
(03:27):
and we use immunotherapy, and they all have slightly different mechanisms,
but ultimately the goal, of course, is to eliminate and
eradicate the cancer. And so I wanted to make sure
that she understood what options were available to her, and
especially for some patients, especially stage four patients, oftentimes clinical
trials are an option. So I wanted to understand if
(03:47):
she had already explored those options. Then there's actually a
whole other side of this, which is that when a
patient is undergoing treatment, especially if they're going undergoing multiple
lines of treatment, they actually have to manage the complex
of working with their doctor and their healthcare system to
ensure that it gets paid for. And sometimes we don't
talk about this, but it can be one of the
(04:08):
sort of biggest burdens for cancer patients. So it's also
understanding that, you know, it's not just the chemotoxicity, it's
the financial toxicity. And so those are some of the things.
Speaker 2 (04:18):
That we talked about. Can you say more about that?
Speaker 1 (04:23):
And we don't necessarily have to get political, but how
has this current administration changed the access to care for
cancer patients?
Speaker 3 (04:35):
Yeah, it's a really great question, and I'm glad you
asked it. So I think there are a couple of
things that have been happening. So in the past several
of months, we have seen that there are proposed budget
cuts to the NIH as well as the National Science
Foundation NIH's National.
Speaker 2 (04:53):
Institutes of Health.
Speaker 3 (04:55):
These are some pretty big, long standing institutions that have
really supported science and meta and within the United States
when it comes to access to care. A couple of
things we've noticed, So the NIH itself is responsible for
sponsoring and actually even conducting several large clinical trials in
all different disease areas. We have seen that the NIH
(05:18):
sponsored trials right now are kind of in this pause state.
They haven't been canceled, but they are kind of in
this indefinite pause state. And I think the question for
cancer patients, especially folks who are stage four and are
looking at a pretty scary prognosis, you know, time is
(05:38):
something that has a lot of value, and having to
wait several months can make a real difference in terms
of the outcomes. So unfortunately, we are seeing some patients
sort of stuck in this sort of waiting loop to
see if these trials are going to start up again.
Speaker 1 (05:56):
How long do you think the waiting loop will continue,
I guess, or be extended.
Speaker 3 (06:02):
I don't really know. I would say that especially for
the NAH sponsored trials, the ones that it's actually conducted
by the NIH, it's really uncertain because of course, there
have been a lot of staffing changes at the NH.
There are a lot of clinical trials that are sponsored
by private institutions or by public universities. These are drug
(06:23):
company sponsored trials or ones that are being conducted multi
center trials that are being conducted at academic cancer centers.
Many of those are still ongoing, and so generally I
would say if you are in a waiting line for
an NAH trial, it's probably worthwhile also to explore what
your other options are. Oftentimes there are other clinical trials
(06:43):
that might be available to you. I think the hardship here, though,
of course, is that depending on what the trial is
that you're trying to get into, they might be recruiting
in a specific geography, and so they might not be
recruiting in your area. It might mean you need to travel.
So it becomes quite difficult and quite a burden for
patients to be able to find a trial that is
(07:05):
in their area that is recruiting for patients like them
that they feel like they would like to be a
part of. Actually, one of the things we do at
the Cancer Research Institute is we have a Clinical Trial Finder,
and what we try to do is help you navigate
this so you know, based off of your disease, we
look at you know, some of the biomarkers, stage of disease,
(07:26):
history of treatment, and we try to help you find
a trial that is in your area. We do have
some patients that say that they're open to travel, but
obviously that can be quite a burden for some patients.
Speaker 1 (07:38):
Right, Okay, so this is amazing. So so what do
people do?
Speaker 2 (07:43):
Tell me?
Speaker 1 (07:43):
Like, Okay, I just found out I have stage four cancer. Yeah,
I'm listening to this podcast. What's the website? Tell me
walk me through all these steps. Yeah, well I have
let's say I have an IQ of ninety five and
a third Greed reading level.
Speaker 3 (07:56):
I mean, I think the conversation actually starts first with
your on colleges, of course, and I think this is
where we do need to have our trust in our
medical team. My first advice that I always give patients
is that make sure you find an oncologist that you
feel like you trust and it is a relationship. It's
going to be a long term relationship and one that
is very important to you, the patient, And so make
(08:18):
sure that you have a good rapport with that doctor
that you feel like they really understand where you're coming from. Obviously,
they are going to try to optimize for your treatment,
but you need to also be clear about the things
that you want as you are undergoing treatment. What are
you optimizing for? Are you optimizing for the quality of
your life? Are you wanting to know what types of
side effects? What's more important to you, if we're talking
(08:41):
about sort of stage four and potentially getting into experimental therapies,
what's your priority in terms of how you feel versus
you know, getting onto the most innovative or promising trial.
So I think these are things that you do need
to talk to your doctor about. And then as a resource,
the Cancer Research Institute, our website is cancer research dot org.
(09:04):
We do have a clinical trial finder and matcher and
will help you find a clinical trial that will be
recruiting for patients like you. We specialize in immunotherapy trials.
So immunotherapy is a type of cancer therapy that actually
activates your immune system to go and target and eliminate
the cancer. And so there are many different types of
(09:26):
immunotherapy and we can help match you to one of
those trials, but I would start with talking to your oncologists.
Speaker 2 (09:33):
So am I correct?
Speaker 1 (09:34):
And if I rephrase this, chemotherapy kills cancer, but immunotherapy
teaches the cancer to kill itself.
Speaker 3 (09:43):
Yeah, that's very close. So chemotherapy actually is really interesting.
Chemotherapy we use molecular mechanisms to actually try to go
after cells that are dividing very quickly, so tumor cells,
cancer cells, are in this category. These are cells that
dividing very quickly, and so what we do is we
chemically sort of poison these proliferative mechanisms. We're trying to
(10:07):
go after cells that divide very quickly, and we're trying
to kill off those cells. In that way, chemotherapy does
target those cancer cells. Chemotherapy does also, for that reason,
have side effects for other fast dividing cells in your body.
That includes, for example, your hair follicles, so that's another
place where you have a lot of division happening. Your
hair is always growing. And then also your gasterinetestinal tract
(10:27):
so sort of GI system, the lining of your intestines.
That's also a place where those cells turn over very quickly.
In fact, every week or so, you have new cells
in your GI tract. So oftentimes with chemotherapy you end
up with side effects like your hair falling out or
experiencing that sort of nausea or those GI symptoms. And
(10:47):
that's actually why those side effects are associated with chemotherapy.
Immunotherapy is different. Instead of treating the cancer cells or
trying to go after the cancer cells, immunotherapy is actually
trying to treat your immune system. The underlying idea here
is that your immune system is billions of cells in
your body that are primed to go after and eliminate
(11:08):
when you have a bacterial infection or a viral infection.
So when you get the common cold, when you get
the flu, your immune system is activated, and we know
that you feel really bad for a little while, but
usually within a week or so, you're feeling a lot better.
So how do we get this system, the immune system
to actually recognize cancer as a sort of foreign entity
(11:29):
that needs to be eliminated. And so that's actually what
immune therapy is trying to do, is actually trying to
activate your immune system to recognize the cancer and go
after that cancer.
Speaker 2 (11:39):
How do you do it?
Speaker 1 (11:41):
Yeah, Tisha, I know this is like really getting in
the weeds, but this is your bread and butter.
Speaker 3 (11:47):
Yeah. So it's actually pretty fascinating because, as you can imagine,
your immune system has a lot of different functions. From
the moment that you're born, your immune systems has started
to work, and we always talk about sort of building
up an immunity over the course of your lifetime. So
every time you encounter new viruses, new bacteria, each time
you see something like that your immune system actually starts
(12:10):
to learn and recognize those foreign pathogens. So that's why,
actually if you have a newborn, you have to get
a lot of vaccinations because you're teaching the immune system
right away. But also you'll notice that your kid gets
sick a lot, and in fact, your kid gets sick
a lot between the ages of like one and let's
call it four. Your kid is like constantly with a
(12:30):
sniffley nose. And that's because your kid's immune system is
actually learning that whole time about all of these different viruses.
And the more that your immune system learns, the next
time that same virus or bacteria comes back, you actually
have pre programmed immune cells that now recognize that and
will go after it and oftentimes will eliminate it before
you even feel any symptoms. That's also why as kids
(12:51):
grow older, they don't get sick as much. But there's
sort of this sort of fine line between your immune
system recognizing things that are four and then making sure
that your immune system doesn't attack your normal cells because
as you can imagine, if that happens, that's what autoimmune
disease is. And then also in your immune system is
actually going after your own cells and that's not a
(13:11):
good thing. So what that means is that your immune
system actually has this interesting balance where it gets turned
on when it sees something that it thinks is a
foreign attacking agent, and then it's actually silenced to ensure
it doesn't go after your own cells. Now, cancer cells
are really interesting because all cancer cells start out as
normal cells. And in fact, what we all sort of
(13:33):
agree on at this point is that all cancer actually
starts as one cell that sort of accumulates a ton
of mutations and then eventually gets out of control and
grows into a tumor. So at the beginning, your immune
system doesn't recognize that cell because that cell was a
normal cell. But at some point that cell becomes so
different from normal it starts to look incredibly different that
(13:57):
your immune system should be able to see it. What
we found is that what we actually have to do
for immune therapy is we actually have to block this
kind of what's called a checkpoint. It's actually these proteins
that keep your immune system kind of in check. We
actually have to block that checkpoint in order for the
immune system to recognize the tumor. And that was sort
(14:18):
of the groundbreaking revelation that we realized in the field
in about twenty years ago, fifteen years ago, and there
was all of this theory that if we could block
this checkpoint and it's kind of unblind the immune system,
that the immune system would naturally be able to see
the cancer and then go and eliminate it. And that's
actually worked. So in some cancers like melanoma, which is
(14:40):
an aggressive form of skin cancer, we've seen dramatic changes
and outcomes for patients. It used to be a fifteen
percent likelihood of survival for a stage four melanoma's cancer patients.
These days that is getting up too close to sixty
percent if it was stage four diagnosis. There we're actually
talking cures, not simply just living with your decease.
Speaker 2 (14:59):
Oh wow wow.
Speaker 1 (15:01):
Yeah, We're going to take a quick break and we'll
be right back.
Speaker 2 (15:08):
So that brings me to another question.
Speaker 1 (15:10):
I have you know, since this is intentionally disturbing podcast.
Speaker 2 (15:13):
Sure, the statistics.
Speaker 1 (15:16):
That you shared when we met, they were disturbing to me.
It seems like younger people are getting cancer. Yeah, and
I was wondering if you could speak a bit to that.
Speaker 3 (15:30):
Yeah. So there have been these studies that are ongoing
throughout multiple decades looking at the incidents of many of
the common cancer types, and so every year we kind
of look back at the last year that we have
data for and ask ourselves what are some changes and trends.
So one of the things that we've been looking at
is cancer incidents, and so what's really disturbing is in
(15:53):
the last year, and really over the last several years,
we've seen this trend. We're seeing more and more patients
under the age of fifty who are getting cancer, and
that's relatively young. Most cancer effects individuals over the age
of fifty. In fact, most cancers affect people over the
age of sixty. But we're seeing this sort of disturbing
(16:13):
increase in incidents of breast cancer, colorectal cancer, pancreatic cancer,
and patients that are under the age of fifty, and
that's really confusing and we're not really sure what's going on.
There are a couple of different things that we know.
Certainly for breast cancer, for example, we know that we
are getting better at earlier detection, So as you can imagine,
(16:33):
if patients are getting screened at an earlier age, you
are going to find more cancer in a younger age
than if you weren't screening at all, so you know,
you don't find things that you're not looking for. So
part of the increased incidence can be explained by just
folks being more proactive in their screening, which is great
because we know about breast cancer, for example, is if
you can diagnose breast cancer at early stage stage one,
(16:54):
overall survival in twenty twenty five is ninety nine percent.
So that's actually a really racististic. So that's part of it.
But we also think there are other factors that are
probably keying into causing earlier onset of cancer, and so
there's a lot of studies that are ongoing looking at
behavioral modifications, lifestyle, and environment. Some folks are wondering whether
(17:16):
or not there are things like process foods or microplastics
that might have something to do with increased younger colorectal cancer.
And then certainly we know some things we know for
sure are unfortunately do increase your riskic corectal cancer, and
that includes red meat, process meats, alcohol, So these things
we know we have to sort of reduce our consumption
(17:38):
of alcohol everything in moderation.
Speaker 1 (17:43):
I know when you went over that statistic when we
met and we were all drinking wine.
Speaker 2 (17:47):
I know, I am guilty.
Speaker 1 (17:51):
Yeah, well I was drinking wine and then whiskey.
Speaker 2 (17:54):
But is there a healthier version or there just solve I.
Speaker 3 (18:00):
Think it's about everything in moderation, right, So it's about
I mean, I think one of the actually one of
the studies that is being conducted, so we don't know
yet what the outcomes are going to be, is whether
or not binge drinking actually might increase the incidence of
coloxal cancer. So the idea here is is it doesn't
matter whether you're having sort of one or two drinks
several nights a week versus on one night having you know,
(18:22):
ten drinks or more. We certainly know that there are
all sorts of bad side effects of binge drinking for
other reasons, but does it also increase your risk of
coloroestal cancer. There's actually studies looking into that.
Speaker 1 (18:35):
One random question I just thought of, sure because this
just came to my mind. I had a colostomy for
a while. Okay, not cancer related, but is there a
relationship between scar tissue and cancer or trauma to tissue?
Speaker 3 (18:51):
Yeah, this is an interesting question. So I would say
what we do know is that cancer is typically cause
when you see sort of damage to cells that occurs
over time. So the best example of this is smoking
in lung cancer, where we know that nicotine in tar
that's in cigarettes is actively causing mutations in the cells
(19:13):
in your lungs. Therefore you end up with a very
high likelihood of delping lung cancer. Similarly, UV radiation and
skin cancer, we know that there's that direct link where
the UV radiation from the sun damages the DNA and
that your skin in your skin cells, and that increases
your likelihood having skin cancer. So that we know is true.
(19:33):
So whenever we see things that damage your cells and
your DNA, it increases the likelihood that you accumulate mutations
that could one day result in cancer. The question then
is about sort of scarring and whether or not that
is related. It's unclear. So I'll give you a couple
of things that we do know. So interestingly, for a
gastric cancer, recently it's been shown actually that some aultcers
(19:56):
are actually related to having gastric cancer, and it's the
ones that are really to a bacterial infection with a
bacteria called H. Pylori And that's relatively new for us
to realize that one that H pylori causes ulcers, and
then that that is actually related to gastric cancer, so
we know, for example, there there's a bit of a link.
Here's an interesting sort of flip side of this story,
(20:19):
which is that in breast cancer, what we know is
and this is a correlation first before we realize why.
There's actually this interesting correlation between how many children a
woman has had in breastfeed and then their likelihood of
developing breast cancer. And what we found is that women
who have had zero children have us higher risk of
breast cancer slightly than women who have had at least
(20:41):
one child. But then at some point, I think if
you have more than four, that risk goes up again.
And the question is why is that. It turns out
the reason is because when you undergo pregnancy and then
subsequent breastfeeding, the entire memory tissue of your breasts have
to be completely sort of reorganized. As you can imagine,
you have to restructure the breast tissue in order to
(21:02):
be able to create milk, and that process of doing
that actually helps you kind of reset your breast tissue.
So that's why actually having at least one child actually
lowers your risk of breast cancer compared to not having
children at all. So it's kind of interesting the different
things that.
Speaker 2 (21:18):
Are related with cancer risk. That's amazing.
Speaker 1 (21:20):
So even if you if your boobs fill up with milk,
but you can't breastfeed because there's no latching or you
don't believe in it, it still could reduce your risk for.
Speaker 3 (21:30):
Cancer exactly because what's happening is biologically that that tissue
gets reorganized in order to create milk. And whether or
not you actually breastfeed or not, that's a biological process
that happens regardless.
Speaker 2 (21:42):
You are fabulous.
Speaker 3 (21:44):
I have a lot of random, random like tidbits of information.
I'm glad that this is this is fun.
Speaker 1 (21:51):
You're like, okay, this is your life obviously, right. I mean,
you have to devote your life to be able to
be so brilliant and and you've succeeded, and you're you're young,
and you are in charge of a massive company.
Speaker 2 (22:05):
You have so much influence.
Speaker 1 (22:06):
I mean, people who have cancer go to get it treated,
and your pictures on the wall.
Speaker 2 (22:13):
I'll have your friends send a picture of your picture
on the wall.
Speaker 3 (22:17):
It's you know, it's really interesting. I think I never
got into this and to be on the picture on
anybody's wall, actually, it's really interesting sort of my motivation
for why I got into this field. Yeah, honestly, I
just I've always done biology super fascinating, and I think
it was just from a pure curiosity standpoint. The moment
(22:41):
I learned about biology, I just felt like, how is
how does that? Everybody must love this topic because isn't
this just us studying the reason why we all exist?
Isn't this the study of life? And isn't that fascinating?
And so I just have always enjoyed understanding sort of
the why behind how do you human's work, how do
(23:01):
sells function? How we related to other organisms in this earth?
And then I got turned on to cancer research. Actually
when I was in high school. So I was just
really interested in biology. I thought that the actual work
was interesting. I wanted to hold a pipette, I wanted to,
you know, look up peer into a Petri dish, and
(23:21):
so I was encouraged by my high school biology teacher
to try to work in a research lab when I
was in high school. So, when I was a junior
in high school, I was at the University of Chicago
Laboratory Schools, which is a high school associated with the
University of Chicago. And so I went over to the
Universe of Chicago and I kind of just cold outreached
(23:42):
one of their investigators, and his name was Jeffrey Green.
It turns out he was the director of their cancer center,
but I didn't know who he was, and I asked
if he was interested in if I could, as a
high school student, work in his lab, and he took
such a big leap of faith in sort of letting
me do that, because I'm not sure that I would
let like a fifteen sixteen year old person into my
(24:04):
lab and touch all the equipment. But he was so
kind and he sort of took me under his wing
and he let me train in his lab. And I
think it was that sort of leap of faith and
that sort of paying it forward that really made it
so that I had an exposure to this field so
early in life, and I just completely fell in love
(24:25):
with it and I've been working on it ever since.
Speaker 1 (24:28):
So what training do you have, Like, I mean, you
have eight million letters after your name's.
Speaker 2 (24:34):
Fit for the sure the layman. You know, how did
you become who you are in your career.
Speaker 3 (24:42):
So I have a bachelor's in biology from MIT, and
then I have a PhD in Biological my medical sciences
from Harvard, and then I have a postdoctoral work at
UCSF afterwards. And in all of those three institutions, I
was pursuing cancer research. So actually, as an undergrad at MIT,
(25:03):
I had the privilege of working in an amazing cancer
research lab of a researcher called Bob Weinberg, who actually
is kind of credited as the grandfather of cancer research.
And I didn't know that when I started working for him,
but I had the privilege of working for four years
in his lab as an undergraduate technician, and I learned
so so much about cancer research, and I really feel
(25:24):
like that's where my career really took off. But yeah,
that's my background.
Speaker 1 (25:29):
It's absolutely incredible. It's incredible. Okay, I have to ask,
what is the most disturbing moment in your life that
you've experienced, work or personal or.
Speaker 2 (25:43):
Yeah, part of you.
Speaker 3 (25:45):
This is a hard one to answer because I feel
like I guess I've lived the pretty privileged in sheltered
life in some way. But I would say, you know,
one thing that I found that was kind of a
rude awakening for me that was disturbing to was I
went into academic science because I really was following the
curiosity and I just loved that journey of discovery. And
(26:09):
then I realized that because of the way that academic
science is funded and because of how competitive it is,
it does create these incentives that I think sometimes creates
disturbing behavior. So I remember when I was when I
was training, I would see, you know, postdoctoral fellows. These
are folks that are going to go on to start
(26:30):
their own labs and sort of do their own independent research.
I would see this behavior where their mentor their advisor
who was their postdoc advisor. As soon as that that
person became an independent investigator, they would immediately become competitors.
And I thought that was really unfair because it's, you know,
you spend all this time trying to claw your way
(26:51):
to independence. You're doing your own studies, you're looking for
your own funding, but ultimately then for your data that
you generated with your own two hands, for that to
be used against you because now your advisor is using
your own, your own data to compete against you. That
that that felt really icky, and so you know, it
(27:12):
kind of turned me on too. Understanding this so sort
of like funding problem in academic research and how do
we incentivize collaboration rather than competition. But yeah, that was
a that was a bit of a rude awakening. It's cutthroat,
very cut throat, I mean, more so than I would
have ever anticipated. And yeah, I guess that was sort
(27:33):
of when that my naive, romantic bubble about science got
a little bit popped.
Speaker 1 (27:39):
I had a similar experience when I had a super
We were doing research on schizophrenia and I had a supervisor.
We were videotaping interviews in order to gain data to
run about schizophrenia and behaviors, and the supervisor told me
I don't think you should be on this project anymore.
And I asked why and he said, because I don't
(28:00):
think there's anything good about you. WHOA And I was like,
I was young, right, And then he went on and
he took all of my data from my interviews, you know,
a qualitative analysis of behavioral structures and published it.
Speaker 3 (28:17):
Yeah. Yeah, I mean it's really unfortunately the incentives for
you know, how you get promoted or how you get
funding are all tied to your ability to publish and
be able to be a certain author order being the
first author of the last author, and yeah, it creates
really bad behavior. Yeah.
Speaker 1 (28:38):
I mean that's why I married a psychologist and so
then we published together. So we're either first or second
on everything. Yeah.
Speaker 3 (28:44):
Yeah, nice, which actually I think no, But I think
that's the thing we're all kind of learning. I mean,
after I left academic research, I was in I was
in a company called Color Health for almost ten years.
I was their chief science officer, and it was the
startup company that was trying to help patients get access
to genetic testing that would tell them about their likelihood
(29:06):
of developing cancer. And it was all about making products.
It was all about bringing a product to market. And
one of the things I quickly saw as soon as
I started at Color was that it was so collaborative
compared to what I had experienced in academic medicine. And
I realized that you can get things done just as
if effectively, when you work together then if you're just
(29:28):
sort of in it for yourself. And I do actually
think I'm seeing academic medicine and academic science moving in
that direction. And I think the reason is actually because
one I think that we as people are realizing the
importance of collaboration. I think the Internet has a lot
to do that. I think you can now ask an
expert anywhere in the world for a little bit of advice,
and it's so much more accessible than it used to be.
(29:50):
But I think the other thing is that we've the
complexity of the problems that we're trying to solve have
become massive. You know, these days, we're having to solve
a biological problem in parallel with a huge computational problem
because oftentimes we're looking at large data sets and it's
actually really important to have different people on the team
who have different expertise. So I'm actually feeling like academic
(30:10):
science is becoming more collaborative, which I'm very excited to see.
Speaker 2 (30:13):
And that's something I fight for so much.
Speaker 1 (30:15):
You know, we should be lifting each other up because
the gain would be synergistic, it would be so much greater.
Speaker 3 (30:22):
Yep, yep, exactly.
Speaker 2 (30:24):
Yeah, that's I mean.
Speaker 1 (30:25):
You coming on the podcast and talking is our collaboration.
And this message is people are going to hear things
and learn things that they had no idea about exactly,
and then you speak so eloquently and people want to
listen to you as well.
Speaker 3 (30:39):
I hope so. I hope we haven't put anybody to sleep.
Speaker 2 (30:43):
I think so, but they probably wouldn't tell us. We're
going to take a quick break and we'll be right back. Okay,
so we're going to do our lightning round of questions.
Speaker 3 (30:55):
Let's do it.
Speaker 2 (30:56):
Okay.
Speaker 1 (30:57):
If you could commit a crime and get away with
what would it be?
Speaker 3 (31:02):
Yeah, this is I was thinking about this. So if
I could get away with this crime, I think that
the way that healthcare and payment for health care today
is sort of done in the United States is a crime.
I think that there are patients who have a lot
of health care debt and aren't able to get access
(31:24):
to the treatments that they need, and are getting sort
of hounded by collection agencies, and they're making decisions about
the quality of the care they're getting based off of
how much money or how much they can afford. So
if I could sort of like like Zoro in the Night,
like go and erase all the records of people who
have health care debt and just like slate all that,
(31:47):
I would do that.
Speaker 1 (31:48):
Oh my gosh, I would be like Zarro's sidekick. I mean,
I've personally given Ellie fifty grand for her treatment because
she is struggling so much. So I'm okay, let's we'll
get our black masks on and.
Speaker 3 (32:04):
Go exactly exactly well, big hat, black masks. Nobody will
know what's coming.
Speaker 1 (32:10):
Doesn't need to be Luigi Mangioni, so we can figure
it out a different way.
Speaker 3 (32:14):
Yes, yes, yes, exactly.
Speaker 1 (32:16):
Okay, next question, and this, I know this is the
oddest question, but if you had to die by death penalty,
how would you want to go firing squad, injection, electrocution
or maybe you you personally have different fun ideas.
Speaker 3 (32:31):
I mean, so I'm going to take a really sort
of scientific, nerdy approach. I would I would pick lethal
injection in the reason and ideally administered under proper clinical protocols.
Speaker 2 (32:43):
A clinical trial of your death.
Speaker 1 (32:45):
Okay.
Speaker 3 (32:46):
What I'm optimizing here for is sort of the being
able to go in in in peace, right, And I
think there's a little more sedation involved with lethal injection
than the other two. So yeah, yeah, I INTERFAI have to.
Speaker 1 (33:03):
I interviewed a CIA agent, and of course he wanted
to go by firing squad. I mean that, of course,
it's our trade, right, Yeah, yeah, I would want to
be manipulated and probably into my own suicide, I think
because I'm a secologist, Yeah, yeah, I can see that. Okay,
(33:25):
this is a big question for you. If you could
change a law, what would it be.
Speaker 3 (33:30):
I mean, this is very much related to the previous
my previous answer, but I do have a really strong
point of view in this. I think that the way
that healthcare is paid for in the United States, and
the really opaque way in which payers private insurance carriers
are able to sort of obvious skate how much it
costs in order to maximize profits is very detrimental to
(33:55):
the patient and it creates very misalignedacent of structures, and
so it's hard to say whether there's one wrong player.
I think that everybody kind of conforms to this very
weird incentive structure that exists, but I think it does
start at the regulatory part of the policy part of
the world. So if I could change a lot, it
would very much be about how we cover basic essential
(34:18):
healthcare for every single person that needs it. And that's
not just on the treatment side. I actually think that's
also on the prevention side, because at the end of
the day, we can do a better job of preventing
some of these very expensive diseases to treat, like late
stage cancer. We would save money as society, but we
(34:40):
actually do need to make available some of these life
saving technologies. And I just think that right now, the
public policy and the sort of private insurance reimbursement as
well as medicaid and medicare reimbursement for all the new technology,
it's just not keeping up. Like we're inventing technology at
a much faster rate than the policy is keeping up,
(35:01):
and we end up in this situation where if you
have the means to pay for it yourself, maybe you
get access to it, but not everybody else can. So
this is the place where I would definitely focus.
Speaker 2 (35:11):
I love that.
Speaker 1 (35:12):
Yeah, like the gallery test or the what is the
tube that people are going in prenew novo. Yeah yeah, yeah, yeah,
to just the very wealthy people are able to access
incredible preventative treatments right now.
Speaker 2 (35:28):
Yeah, Okay, final question, Okay, can you tell me a secret?
Speaker 3 (35:34):
Yeah, this is gonna be slightly embarrassing. So we've we've
we've talked about how amazing and my career has been
as a scientist, but actually when I was when I
was like when I was in high school, I really
dreamed of becoming a novelist. Like I really really enjoyed
reading science fiction and fantasy, and I would just I
(35:55):
was such a bookworm. I go to the library. So
I really like I I had like a like a
journal where you write down your dreams or whatever, and
I wrote, like, I I want to write. I want
to publish a book one day, not like a nonfiction book,
like a like a novel. And of course I'm not
a novelist, but in order to sort of uh scratch
(36:16):
that itch, I do like for my own self. I
don't publish, but uh, I write fan fiction to like
escape from reality. And I have this my own little
collection of like terribly written fan fiction just to like
continue that that that dream.
Speaker 2 (36:31):
Like a handwritten or you type. Oh, I tried it.
Speaker 3 (36:34):
I actually so I started in high school. I started
writing my own fan fiction. I thought it was so great.
I think I wrote my first when I was like thirteen,
and it was a Star Wars fan fiction, and I like,
I was so proud of it. I made cover art
for it using Photoshop and I printed it out. It
was like one hundred pages, but it was like double
space because because it wasn't good. But but I just
(36:55):
I don't know. I've always you know, maybe one day
I will, I will try to write an actual story.
Speaker 2 (37:01):
I think you should. You know. I have a master's.
Speaker 1 (37:03):
One random master's I have is in dream analysis. For
dream analysis. I can help you edit it.
Speaker 3 (37:09):
Yeah, yeah, I mean that would be so much fun.
That would if I could, you know, I would be
it would be such a different alternate reality if I
were a novelist's instead up a scientist. But but yeah,
I really I really enjoyed in that.
Speaker 2 (37:23):
I love that. I did not expect that, and I love.
Speaker 3 (37:27):
This is actually a very very little known fact. So
I'm not sure why I just told.
Speaker 1 (37:31):
Everybody that it's O case seven million people.
Speaker 3 (37:37):
I'm gonna get a lot of questions from people who
know me really well because they did not know this
about me.
Speaker 1 (37:44):
Well, can you leave us with a tip, a tip
for people who may not have cancer, maybe a tip
for prevention that we can take on.
Speaker 3 (37:53):
Yeah, I think it's about being proactive about your health.
I think that's sometimes we kind of think that we
are a passenger on this journey that is life, and
whatever happens going to happen right, and then what tends
to happen is that we get really scared of knowing
what's around the corner. And so what happens is you'll
see people putting off prevention. They just think like, oh,
you know, I don't need to go to my doctor,
(38:14):
or you know, I can do that next month, or
I can do that next year, and then all of
a sudden, it just kind of falls off of your radar.
Speaker 2 (38:21):
And speaking to all of the men out there exactly.
Speaker 3 (38:24):
And in fact, one of the things that studies have
shown is that even though the incidence of cancer is
hirering women, the mortality for cancer is higher in men.
And one of the reasons this is true is because
men tend to be diagnosed at a later stage. They
tend to be less proactive about their screening, and what
ends up happening is that they end up with later
stage cancer diagnoses. They wait until something hurts, they wait
(38:47):
until something's symptomatic, and by the time something is symptomatic,
it means it's progressed enough that something is off in
your system. The whole point of prevention is that you
find things before they become symtomatic, and so it is
really important to do that. It's the same reason why
you know you you take your car in for an
oil change, it's so that you don't break down the
(39:07):
middle of the freeway. We have to do that for
our bodies too, And so this is the tip that
I would give to everyone.
Speaker 2 (39:14):
I think that's great.
Speaker 1 (39:15):
So to summarize, men, take your hand and fondle your
balls right now, or or ask your doctor to do it.
Speaker 2 (39:28):
Women, grab your boobies.
Speaker 3 (39:29):
Sorry, yeah, yep, yep, yep.
Speaker 1 (39:31):
Well, I really appreciate you taking the time to come
on and educate us because your brain is incredible and
what you know so few people are even aware of
at a shallow level, and you just offered us so
much depth in a short period of time.
Speaker 3 (39:49):
It's thank you. Yeah, it was so much fun, and
this is such a great conversation. So thanks for having me.
Speaker 1 (39:55):
Thank you for listening to another episode of Intentionally Disturbing.
I hope you enjoyed it, and I hope you actually
learned things you didn't know. And I hope right now
your hand is either.
Speaker 2 (40:04):
On your testicles or your tits. See you next time.
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