1 00:00:03,520 --> 00:00:05,840 Speaker 1: One of everyone's greatest fears that he or she might 2 00:00:05,840 --> 00:00:08,200 Speaker 1: be diagnosed at some point in their life with cancer. 3 00:00:08,560 --> 00:00:11,160 Speaker 1: I recently had a chance of talk to doctor Selwyn Vickers, 4 00:00:11,360 --> 00:00:14,040 Speaker 1: who runs a Royal song Kettering Cancer Center, one of 5 00:00:14,040 --> 00:00:16,160 Speaker 1: the leading cancer centers in the United States, and I 6 00:00:16,160 --> 00:00:18,000 Speaker 1: had a chance to talk with him about the progress 7 00:00:18,040 --> 00:00:22,240 Speaker 1: being made in treating cancer. So today we are about 8 00:00:22,720 --> 00:00:25,880 Speaker 1: I guess, more than fifty years after President Nixon declared 9 00:00:25,960 --> 00:00:29,360 Speaker 1: war on cancer? Have we really made that much progress 10 00:00:29,400 --> 00:00:31,639 Speaker 1: in the fifty years or so since he first declared 11 00:00:31,720 --> 00:00:32,479 Speaker 1: war on cancer? 12 00:00:32,920 --> 00:00:35,120 Speaker 2: Yeah, I think we have the. 13 00:00:36,720 --> 00:00:41,120 Speaker 3: Ability for someone who has a diagnosis of cancer broadly 14 00:00:41,360 --> 00:00:45,360 Speaker 3: thinking about having a chance for cure has significantly improved. 15 00:00:45,680 --> 00:00:49,240 Speaker 3: We've gone from all cancer diagnoses probably around the time 16 00:00:49,280 --> 00:00:52,560 Speaker 3: of that announcement that was around thirty to forty percent 17 00:00:52,680 --> 00:00:56,240 Speaker 3: chance of cure that we're approaching sixty eight to seventy 18 00:00:56,280 --> 00:01:00,000 Speaker 3: percent of patients across the board who get the diagnosis 19 00:01:00,080 --> 00:01:02,960 Speaker 3: of cancer have a chance at five years to being 20 00:01:03,000 --> 00:01:04,160 Speaker 3: told they don't have a tumor. 21 00:01:04,440 --> 00:01:06,920 Speaker 1: So what is the best way to avoid getting cancer? 22 00:01:06,920 --> 00:01:08,959 Speaker 1: I guess that's the question everybody asked, Well, what is 23 00:01:09,000 --> 00:01:09,760 Speaker 1: the answer to that? 24 00:01:10,040 --> 00:01:13,360 Speaker 3: Yeah, I think the best way to avoid it is 25 00:01:13,480 --> 00:01:19,720 Speaker 3: obviously healthy lifestyles, avoid smoking, certainly limit red meat to 26 00:01:19,760 --> 00:01:22,200 Speaker 3: the amount that you eat. Now, all of these statements 27 00:01:22,240 --> 00:01:24,399 Speaker 3: are no guarantee you won't get cancer, but we do 28 00:01:24,560 --> 00:01:26,839 Speaker 3: know to some degree that they probably have a role 29 00:01:27,280 --> 00:01:31,720 Speaker 3: in accelerating or increasing risk. In general, there is no 30 00:01:31,959 --> 00:01:34,399 Speaker 3: actual way to prevent it. There are certainly things we 31 00:01:34,520 --> 00:01:37,320 Speaker 3: do can screen early, and if we catch cancers early, 32 00:01:37,720 --> 00:01:39,960 Speaker 3: we have a really good chance of curing them. 33 00:01:40,040 --> 00:01:44,800 Speaker 1: What extent is environmental factors, What extent is it behavioral factors, 34 00:01:44,800 --> 00:01:47,360 Speaker 1: And what extent is the genetic factors that causes cancer? 35 00:01:47,800 --> 00:01:52,000 Speaker 3: Yeah, so it's a combination. There's a small percentage of 36 00:01:52,080 --> 00:01:55,880 Speaker 3: inherited genes that put you at risk. The most common 37 00:01:56,200 --> 00:01:58,880 Speaker 3: is BRCA one and two for women with breast cancer, 38 00:01:58,960 --> 00:02:01,720 Speaker 3: increasing risk of a varian cancer as well, and one 39 00:02:01,760 --> 00:02:04,440 Speaker 3: or two others those we know and we can detect. 40 00:02:04,720 --> 00:02:07,600 Speaker 3: There's certain other select genes that are passed on that 41 00:02:07,720 --> 00:02:09,280 Speaker 3: significantly increase. 42 00:02:08,919 --> 00:02:10,400 Speaker 2: Your risk, but that's a small number. 43 00:02:10,960 --> 00:02:15,200 Speaker 3: The other genetic aspect are genetic mutations that occur over 44 00:02:15,320 --> 00:02:19,320 Speaker 3: time because of the environment and age. Those somatic mutations 45 00:02:19,320 --> 00:02:22,600 Speaker 3: sometimes caused by viruses, caused by cells that are not 46 00:02:22,680 --> 00:02:28,120 Speaker 3: correcting themselves certainly have a role and actually producing malignant 47 00:02:28,200 --> 00:02:31,480 Speaker 3: cells that grow on control. And then I think there 48 00:02:31,480 --> 00:02:35,160 Speaker 3: are certainly environmental exposures, and we are learning more. We 49 00:02:35,240 --> 00:02:39,120 Speaker 3: know that there are classically ones from multiple chemicals that 50 00:02:39,200 --> 00:02:41,960 Speaker 3: do it, but it's the broad combination. But I would 51 00:02:41,960 --> 00:02:44,480 Speaker 3: say the biggest contributor is our aging. That has a 52 00:02:44,480 --> 00:02:45,359 Speaker 3: big factor in it. 53 00:02:45,560 --> 00:02:48,280 Speaker 1: So what is the most common cancer that humans get? 54 00:02:48,360 --> 00:02:54,720 Speaker 1: Is that lung cancer, breast cancer, pancreatic cancer, brain cancer. 55 00:02:54,760 --> 00:02:55,640 Speaker 1: What is the most common? 56 00:02:55,720 --> 00:02:59,359 Speaker 3: So the most common cancers in America are breast and prostate. 57 00:03:00,520 --> 00:03:04,400 Speaker 3: Three hundred thousand cases of breast, somewhere around two hundred 58 00:03:04,400 --> 00:03:09,760 Speaker 3: and eighty thousand cases of prostate. Lung is arguably one 59 00:03:09,760 --> 00:03:12,040 Speaker 3: of the most if not the number one killer. 60 00:03:12,200 --> 00:03:13,280 Speaker 2: It's about one hundred and. 61 00:03:13,160 --> 00:03:16,440 Speaker 3: Fifty thousand cases, but it is the most lethal large 62 00:03:16,520 --> 00:03:21,280 Speaker 3: number pancre's cancer. The incidence has increased. When I began 63 00:03:21,440 --> 00:03:24,400 Speaker 3: my practice, there was about thirty thousand cases a year 64 00:03:24,760 --> 00:03:25,360 Speaker 3: on average. 65 00:03:25,400 --> 00:03:27,200 Speaker 2: Now there are over sixty. 66 00:03:26,760 --> 00:03:30,040 Speaker 3: Five thousand new cases of pancredit cancer a year, and 67 00:03:30,160 --> 00:03:33,000 Speaker 3: so it's approaching a level where it's going to be 68 00:03:33,360 --> 00:03:38,320 Speaker 3: the second killer, comeless common killer of patients with cancer, 69 00:03:38,400 --> 00:03:41,440 Speaker 3: even though it doesn't have the numbers. Like breast cancer, 70 00:03:41,760 --> 00:03:44,880 Speaker 3: we can cure well over ninety percent of breast cancers 71 00:03:45,040 --> 00:03:48,120 Speaker 3: and well over ninety five percent of prostate cancers are cured. 72 00:03:48,360 --> 00:03:52,160 Speaker 1: And now with prospective prostate cancer there's a PSA which 73 00:03:52,200 --> 00:03:54,680 Speaker 1: is a kind of a blood marker. But we don't 74 00:03:54,680 --> 00:03:57,880 Speaker 1: have those kind of things for brain cancer or or 75 00:03:57,920 --> 00:03:59,880 Speaker 1: for pancreatic cancer, right we don't have a market. 76 00:04:00,360 --> 00:04:01,800 Speaker 2: We don't. 77 00:04:02,040 --> 00:04:05,560 Speaker 3: They are clearly tests that are being evolved based on 78 00:04:06,200 --> 00:04:10,280 Speaker 3: being able to detect circulating tumor, DNA and other markers, 79 00:04:10,680 --> 00:04:13,720 Speaker 3: and our ability to have broader ability to manage the 80 00:04:13,800 --> 00:04:18,400 Speaker 3: data through competition oncology that are giving us gradual insight 81 00:04:18,680 --> 00:04:22,039 Speaker 3: for early detection. It's not as specific as we want 82 00:04:22,080 --> 00:04:24,680 Speaker 3: and it's not completely as accurate. So sometimes if I 83 00:04:24,720 --> 00:04:27,360 Speaker 3: get a positive test, I really don't know which tumor 84 00:04:27,400 --> 00:04:31,160 Speaker 3: to look for. Sometimes it does give directions, but that's evolving. 85 00:04:31,560 --> 00:04:32,320 Speaker 2: But you're right. 86 00:04:32,520 --> 00:04:36,320 Speaker 3: We have PSA, we have mammograms, we have colonoscopy, we 87 00:04:36,400 --> 00:04:39,880 Speaker 3: have cervical screening for certain cancers, and we have CT 88 00:04:40,040 --> 00:04:44,560 Speaker 3: scans for lung but we don't have broad availability of 89 00:04:44,600 --> 00:04:47,800 Speaker 3: screening for the large number of cancers that are still killers. 90 00:04:47,839 --> 00:04:50,240 Speaker 1: Now, the type of cancers that are killers are ones 91 00:04:50,279 --> 00:04:53,799 Speaker 1: where you don't know about them until maybe stage four globlastoma, 92 00:04:53,920 --> 00:04:58,159 Speaker 1: brain cancers, that type, pancreatic cancers, another type, maybe liver cancer. 93 00:04:58,240 --> 00:04:58,640 Speaker 2: That's right. 94 00:04:59,200 --> 00:05:01,640 Speaker 1: How do you know if you have one of those 95 00:05:01,720 --> 00:05:03,520 Speaker 1: kind of cancers? What is the best way to go 96 00:05:03,600 --> 00:05:05,520 Speaker 1: in for an annual cancer checkup or. 97 00:05:05,520 --> 00:05:05,919 Speaker 2: What do you do? 98 00:05:06,440 --> 00:05:10,719 Speaker 3: Yeah, so it's hard, and that's a question that's perplexed me. 99 00:05:11,160 --> 00:05:12,919 Speaker 2: I would love to say, go out and get a 100 00:05:12,960 --> 00:05:15,479 Speaker 2: cat scan for everybody. We can't do that. We don't 101 00:05:15,480 --> 00:05:17,560 Speaker 2: have enough cat scanners to screen. 102 00:05:18,400 --> 00:05:22,040 Speaker 3: We need a better ability to enrich who's truly at risk. 103 00:05:22,160 --> 00:05:25,880 Speaker 3: And recent studies now with AI have been able to 104 00:05:25,960 --> 00:05:30,039 Speaker 3: begin to predict who in the population by virtue of 105 00:05:30,080 --> 00:05:32,880 Speaker 3: a number of things that they pulled together their medical history, 106 00:05:32,960 --> 00:05:37,120 Speaker 3: some blood tests, who's at risk for a pank ratic cancer. 107 00:05:37,520 --> 00:05:39,960 Speaker 3: We do know now if you're a smoker, and if 108 00:05:39,960 --> 00:05:42,680 Speaker 3: you're a certain age or exposed to smoke, you should 109 00:05:42,680 --> 00:05:44,960 Speaker 3: in you over fifty, you clearly should get a low 110 00:05:45,000 --> 00:05:48,080 Speaker 3: dough CT scan, which is proven to have a significant 111 00:05:48,080 --> 00:05:52,400 Speaker 3: difference in outcome and detect early cancers, and yet only 112 00:05:52,440 --> 00:05:55,440 Speaker 3: about six to eight percent of the eligible candidates take 113 00:05:55,480 --> 00:05:59,440 Speaker 3: advantage of that CAT scan. So one, I think it's 114 00:05:59,480 --> 00:06:02,560 Speaker 3: coming day that AI programs looking at our broad array 115 00:06:02,600 --> 00:06:06,479 Speaker 3: of data can enrich the population who we know maybe 116 00:06:06,520 --> 00:06:10,560 Speaker 3: at risk, and then once doing that, probably getting a 117 00:06:10,680 --> 00:06:13,360 Speaker 3: scan MRI, a CT scan is going to be the 118 00:06:13,400 --> 00:06:15,760 Speaker 3: tool which we can't do for everybody, but we can 119 00:06:15,800 --> 00:06:17,039 Speaker 3: do for a select population. 120 00:06:17,120 --> 00:06:21,000 Speaker 1: Now, pancreatic cancer, that's a disease that Ruth Bader Ginsburg 121 00:06:21,080 --> 00:06:24,280 Speaker 1: died from and increasingly many people have it. You don't 122 00:06:24,320 --> 00:06:27,080 Speaker 1: typically know you have until stage four. You are a 123 00:06:27,120 --> 00:06:30,440 Speaker 1: pancredic cancer surgeon. Why didn't you decide to specialize in 124 00:06:30,480 --> 00:06:31,400 Speaker 1: that area? 125 00:06:32,200 --> 00:06:34,520 Speaker 2: You know? One a couple of things. 126 00:06:34,600 --> 00:06:38,320 Speaker 3: Number One, at the time that I trained at Johns Hopkins, 127 00:06:38,640 --> 00:06:43,440 Speaker 3: we were the leading center for treating patients or pancreatic cancer. 128 00:06:43,800 --> 00:06:47,440 Speaker 3: And as you talked about, at that time, the leading 129 00:06:47,480 --> 00:06:51,240 Speaker 3: opportunity to make a difference in somebody's life was surgery. 130 00:06:51,600 --> 00:06:55,040 Speaker 3: So Number one, I felt, I felt I had great 131 00:06:55,120 --> 00:06:58,640 Speaker 3: training and had capacity to make a difference by virtue 132 00:06:58,680 --> 00:07:00,680 Speaker 3: of that skill set. So it was the environment, the 133 00:07:00,760 --> 00:07:04,800 Speaker 3: leaders there who encouraged us to look at difficult problems 134 00:07:05,080 --> 00:07:07,200 Speaker 3: and make a difference. So one it was a skill 135 00:07:07,240 --> 00:07:09,960 Speaker 3: set of training. Two I was at a center where 136 00:07:10,040 --> 00:07:12,920 Speaker 3: we focused on it, and three it was a problem 137 00:07:12,960 --> 00:07:15,320 Speaker 3: that really needed the attention to make a difference. 138 00:07:15,800 --> 00:07:17,520 Speaker 2: I soon learned as a surgeon. 139 00:07:17,640 --> 00:07:21,480 Speaker 3: After I did my first hundred patients for pancredic cancer, 140 00:07:21,600 --> 00:07:24,920 Speaker 3: successfully operating on them, I could count on one hand 141 00:07:24,960 --> 00:07:27,320 Speaker 3: how many were alive at five years, and so I 142 00:07:27,360 --> 00:07:30,520 Speaker 3: knew that was a bigger problem than just my surgical 143 00:07:30,520 --> 00:07:31,440 Speaker 3: skills could resolve. 144 00:07:31,560 --> 00:07:34,840 Speaker 1: Okay, so I'm always worried about pancredic cancer too. What's 145 00:07:34,880 --> 00:07:37,679 Speaker 1: the best sign that I might be having pan credic cancer? 146 00:07:38,600 --> 00:07:42,680 Speaker 3: You know, the signs of cancer are often due to 147 00:07:42,760 --> 00:07:45,560 Speaker 3: something simple. But if you were to think about the 148 00:07:45,600 --> 00:07:49,880 Speaker 3: things that you might worry about, particularly as you get older. 149 00:07:50,240 --> 00:07:53,320 Speaker 3: We don't naturally just lose weight when we get older. 150 00:07:53,640 --> 00:07:55,360 Speaker 3: So one notice that. 151 00:07:55,480 --> 00:07:58,400 Speaker 2: Yes, a sudden Yes, a sudden weight loss. 152 00:07:58,560 --> 00:08:00,680 Speaker 3: So you want to ask the quest question, why am 153 00:08:00,720 --> 00:08:02,720 Speaker 3: I dropping weight even though I've been trying for the 154 00:08:02,800 --> 00:08:07,240 Speaker 3: last five years and nothing's happened. New onset diabetes that 155 00:08:07,400 --> 00:08:10,600 Speaker 3: for some reason now I don't have a history of it. 156 00:08:10,680 --> 00:08:14,840 Speaker 3: I'm over sixty five and I'm developing diabetes that and 157 00:08:14,880 --> 00:08:19,120 Speaker 3: then subtly, although not early on, it's the case where 158 00:08:19,240 --> 00:08:24,240 Speaker 3: either somehow my urine turns dark or I begin to 159 00:08:24,320 --> 00:08:26,960 Speaker 3: have some shades of change and my eyes or my 160 00:08:27,080 --> 00:08:30,320 Speaker 3: thumbnails that begin to look a bit of a yellow 161 00:08:30,480 --> 00:08:31,440 Speaker 3: what we call jarndice. 162 00:08:31,520 --> 00:08:34,760 Speaker 1: Now you've said weight loss is a sign sometimes something 163 00:08:34,800 --> 00:08:37,880 Speaker 1: isn't good, but I know it's not directly in your area. 164 00:08:37,920 --> 00:08:41,320 Speaker 1: But ozempic, which is now a very popular drug to 165 00:08:41,360 --> 00:08:44,640 Speaker 1: produce weight, some people say that it might cause some 166 00:08:44,720 --> 00:08:48,280 Speaker 1: type of tumors. Are you an advocate of ozempic for 167 00:08:48,360 --> 00:08:49,720 Speaker 1: everybody or for some people? 168 00:08:49,960 --> 00:08:50,240 Speaker 2: Yeah. 169 00:08:50,320 --> 00:08:54,760 Speaker 3: I think as the new golp one inhibitors, which are 170 00:08:55,240 --> 00:08:59,760 Speaker 3: these drugs that really affect how we feel about being full, 171 00:09:00,640 --> 00:09:03,679 Speaker 3: become further advanced, I think it's going to be an 172 00:09:03,760 --> 00:09:08,400 Speaker 3: overall sea change for American health care, including cancer, because 173 00:09:08,440 --> 00:09:12,760 Speaker 3: we know obesity over time has a significant impact increasing 174 00:09:12,840 --> 00:09:16,319 Speaker 3: cancer rate and risk. I don't have a strong opinion 175 00:09:16,320 --> 00:09:19,239 Speaker 3: about at this stage whether an ozembic or a manjuro 176 00:09:19,320 --> 00:09:22,480 Speaker 3: would cause a cancer, but I think the global impact 177 00:09:22,520 --> 00:09:26,200 Speaker 3: is one to actually reduce our overall health burden, including cancer. 178 00:09:26,400 --> 00:09:28,559 Speaker 1: Talk about your background. Where were you born? 179 00:09:29,080 --> 00:09:31,640 Speaker 3: So? I was born in Demopolis, Alabama. It's in the 180 00:09:31,720 --> 00:09:35,560 Speaker 3: small town in the black belt of Alabama, a rural 181 00:09:35,679 --> 00:09:39,679 Speaker 3: farming area where my parents were educators. 182 00:09:39,960 --> 00:09:43,320 Speaker 1: Now, your parents were extremely well educated for blacks in 183 00:09:43,400 --> 00:09:45,520 Speaker 1: the South at that time. How did they get so 184 00:09:45,600 --> 00:09:46,320 Speaker 1: well educated? 185 00:09:46,840 --> 00:09:51,080 Speaker 3: Yeah, So on my father's side, it was really a 186 00:09:51,120 --> 00:09:55,240 Speaker 3: parents who themselves had limited education. My grandfather with a 187 00:09:55,320 --> 00:09:57,760 Speaker 3: fourth grade education, who didn't learn how to write and 188 00:09:57,800 --> 00:10:01,360 Speaker 3: read until he was in his forties, who really felt 189 00:10:01,400 --> 00:10:02,760 Speaker 3: his children needed. 190 00:10:02,520 --> 00:10:03,560 Speaker 2: A college education. 191 00:10:04,200 --> 00:10:08,080 Speaker 3: And on my mother's side, her mother in the nineteen 192 00:10:08,200 --> 00:10:11,960 Speaker 3: twenties at the travel two hundred miles to an academy 193 00:10:12,040 --> 00:10:15,000 Speaker 3: to start it by Presbyterians in the southern part of 194 00:10:15,000 --> 00:10:18,400 Speaker 3: Alabama to get her high school degree, and then went 195 00:10:18,480 --> 00:10:22,640 Speaker 3: to summers to get her bachelor's degree. So they had 196 00:10:23,160 --> 00:10:27,920 Speaker 3: foundations of understanding the value of education and the ability, 197 00:10:27,960 --> 00:10:30,760 Speaker 3: particularly for a Nigro in the South, to have a 198 00:10:30,880 --> 00:10:33,200 Speaker 3: chance to advance their lives and careers. 199 00:10:33,240 --> 00:10:36,440 Speaker 1: When you grew up in a segregated environment, isume So 200 00:10:36,720 --> 00:10:39,080 Speaker 1: you were the only child of your parents. Yes, so 201 00:10:39,160 --> 00:10:41,040 Speaker 1: did they say we're putting all our hope in you, 202 00:10:41,160 --> 00:10:43,280 Speaker 1: and we want you to be a pancreatic cancer surgeon. 203 00:10:43,760 --> 00:10:45,920 Speaker 2: No, they had no clue what I might be. 204 00:10:46,559 --> 00:10:49,240 Speaker 3: I think they simply wanted me to do the best 205 00:10:49,280 --> 00:10:53,120 Speaker 3: I could in anything I took my interest in. Clearly, 206 00:10:53,360 --> 00:10:58,360 Speaker 3: achievement in high school and undergrad was really sort of 207 00:10:58,400 --> 00:11:01,040 Speaker 3: the first thing that they looked for and expected of me, 208 00:11:02,240 --> 00:11:05,440 Speaker 3: and I tried to do that because I realized the 209 00:11:05,559 --> 00:11:10,040 Speaker 3: legacy of both grandparents and even great grandparents who studied 210 00:11:10,040 --> 00:11:13,760 Speaker 3: with book A. T. Washington, that I had a significant responsibility. 211 00:11:13,920 --> 00:11:15,720 Speaker 1: So were you a superstar in high school? 212 00:11:16,440 --> 00:11:19,120 Speaker 2: You know, I was a good student. I would say this. 213 00:11:20,120 --> 00:11:21,920 Speaker 2: I grew up in a town called Huntsville. 214 00:11:22,920 --> 00:11:26,640 Speaker 3: It really offered the best education that I could get 215 00:11:26,679 --> 00:11:29,679 Speaker 3: in Alabama at the time. But when I arrived at 216 00:11:29,720 --> 00:11:33,440 Speaker 3: Johns Hopkins, I was probably behind ninety five percent of 217 00:11:33,440 --> 00:11:34,240 Speaker 3: my classmates. 218 00:11:34,240 --> 00:11:36,080 Speaker 1: And what I've been exposed, you must have done okay 219 00:11:36,120 --> 00:11:38,120 Speaker 1: at Johns Hopkins undergrad because you got on the Johns 220 00:11:38,120 --> 00:11:39,200 Speaker 1: Hopkins medical school. 221 00:11:39,400 --> 00:11:41,400 Speaker 2: Yeah, I had to catch up. It took me about 222 00:11:41,400 --> 00:11:42,600 Speaker 2: a year to catch up. 223 00:11:42,640 --> 00:11:46,559 Speaker 3: And you know, there were classes my classmates had who 224 00:11:46,600 --> 00:11:49,480 Speaker 3: went to prep schools I was taking for the first time. 225 00:11:49,640 --> 00:11:52,080 Speaker 3: I hadn't had calculus when I arrived, and they'd all 226 00:11:52,120 --> 00:11:54,840 Speaker 3: had calculus, and so the level loved thing of the 227 00:11:54,840 --> 00:11:57,400 Speaker 3: playing ground took me about a year for that to occur. 228 00:11:57,559 --> 00:11:58,600 Speaker 2: Once the playing. 229 00:11:58,280 --> 00:12:01,400 Speaker 3: Ground became level, I found that I compete just as 230 00:12:01,480 --> 00:12:02,120 Speaker 3: well as they could. 231 00:12:02,200 --> 00:12:04,440 Speaker 1: When you went to Johns Hopkins Medical School, which is 232 00:12:04,480 --> 00:12:06,600 Speaker 1: one of the most famous medical schools in the country, 233 00:12:06,840 --> 00:12:09,600 Speaker 1: up in the world, was it very integrated at the time, 234 00:12:09,640 --> 00:12:10,560 Speaker 1: were mostly white. 235 00:12:10,679 --> 00:12:13,880 Speaker 3: So there was a surgeon there who was from Alabama, 236 00:12:13,960 --> 00:12:17,320 Speaker 3: a guy named Levi Watkins, who became a mentor and friend, 237 00:12:17,960 --> 00:12:23,760 Speaker 3: and he grew up in Alabama where my grandmother and 238 00:12:23,840 --> 00:12:26,960 Speaker 3: my mother went to the college where his father was president, 239 00:12:27,320 --> 00:12:32,000 Speaker 3: and Levi went to Tennessee State, Vanderbilt and then Johns Hopkins. 240 00:12:32,320 --> 00:12:36,440 Speaker 3: Stayed on faculty, but challenged Johns Hopkins that it clearly 241 00:12:36,720 --> 00:12:39,560 Speaker 3: needed to be more diverse. So he wrote all the 242 00:12:39,600 --> 00:12:43,000 Speaker 3: African American medical applicants in the country and encouraged them 243 00:12:43,000 --> 00:12:46,079 Speaker 3: to apply to Johns Hopkins, and he provided a platform 244 00:12:46,200 --> 00:12:48,800 Speaker 3: for people like me to have an interest in going there. 245 00:12:49,040 --> 00:12:50,360 Speaker 1: After you graduated, what did you do? 246 00:12:50,880 --> 00:12:54,120 Speaker 3: So after I graduated, I made the transition to realize 247 00:12:54,160 --> 00:12:57,040 Speaker 3: I wanted to be a surgeon, looked around the country, 248 00:12:57,040 --> 00:13:00,160 Speaker 3: and decided to stay in Baltimore because I thought Hopkins 249 00:13:00,040 --> 00:13:02,360 Speaker 3: had the best surgical training of that time. 250 00:13:02,440 --> 00:13:04,440 Speaker 1: But ultimately you went back to Alabama. 251 00:13:05,040 --> 00:13:07,720 Speaker 3: That was a hard decision. I had an offer to 252 00:13:07,760 --> 00:13:11,440 Speaker 3: stay on faculty at Hopkins. I'd been there for in 253 00:13:11,480 --> 00:13:15,559 Speaker 3: Baltimore for sixteen years, and briefly accepted a job to stay, 254 00:13:15,600 --> 00:13:19,760 Speaker 3: but then change my mind to go to Alabama, in 255 00:13:19,880 --> 00:13:22,920 Speaker 3: part because I felt I wanted to go back home 256 00:13:22,960 --> 00:13:24,480 Speaker 3: into a new environment. 257 00:13:24,800 --> 00:13:27,640 Speaker 1: Now as a great surgeon, sometimes you might say I 258 00:13:27,640 --> 00:13:30,880 Speaker 1: don't need to go be into administrative parts of hospitals. 259 00:13:31,000 --> 00:13:32,920 Speaker 1: I just want to be a doctor, just do surgery. 260 00:13:33,040 --> 00:13:35,000 Speaker 1: What prompted you to want to get out of just 261 00:13:35,040 --> 00:13:38,240 Speaker 1: doing surgery to be an administrator and a hospital leader. 262 00:13:38,720 --> 00:13:42,920 Speaker 3: Yeah, I think it was again watching others who did 263 00:13:42,920 --> 00:13:43,400 Speaker 3: it well. 264 00:13:43,720 --> 00:13:45,440 Speaker 2: I had a. 265 00:13:44,800 --> 00:13:48,680 Speaker 3: Dean who recruited me from Birmingham, Alabama, to Minneapolis, Minnesota, 266 00:13:49,040 --> 00:13:51,079 Speaker 3: which is a big jump to convince me to move 267 00:13:51,120 --> 00:13:56,640 Speaker 3: my family, but she did several things that showed me 268 00:13:56,720 --> 00:13:59,480 Speaker 3: the power of a leader at a significant level to 269 00:13:59,480 --> 00:13:59,959 Speaker 3: affect the. 270 00:14:00,040 --> 00:14:01,319 Speaker 2: Career of other leaders. 271 00:14:02,040 --> 00:14:05,520 Speaker 3: And after I'd helped build a growing Department of Surgery 272 00:14:05,520 --> 00:14:08,360 Speaker 3: at the University of Minnesota. I thought I could serve 273 00:14:08,440 --> 00:14:13,000 Speaker 3: in that role. In particular, I realized over time that 274 00:14:13,080 --> 00:14:16,440 Speaker 3: my training as a surgeon brought a set of credible 275 00:14:16,520 --> 00:14:20,920 Speaker 3: things to the table. One, if surgeons have a measure 276 00:14:20,920 --> 00:14:24,280 Speaker 3: of emotional intelligence, not much of our training reinforces that. 277 00:14:24,600 --> 00:14:28,760 Speaker 3: It reinforces skill, not necessarily emotional intelligence. But if a 278 00:14:28,800 --> 00:14:32,360 Speaker 3: surgeon has some self awareness and emotional intelligence, what they 279 00:14:32,360 --> 00:14:35,760 Speaker 3: bring to the table of leadership are three fundamental things. 280 00:14:36,160 --> 00:14:41,200 Speaker 3: Number One, they do everything in teams, their operations. Their 281 00:14:41,280 --> 00:14:46,000 Speaker 3: patience they see is all team focused. Number Two, they 282 00:14:46,160 --> 00:14:51,040 Speaker 3: value process, but they hold themselves very much accountable to execution. 283 00:14:51,480 --> 00:14:54,600 Speaker 3: They understand that it's good to explore a patient, but 284 00:14:54,720 --> 00:14:57,040 Speaker 3: what really matters is did you take the tumor out? 285 00:14:57,560 --> 00:15:02,240 Speaker 3: And then number three, they make difficult decisions on incomplete information. 286 00:15:02,840 --> 00:15:05,920 Speaker 3: Those things I realized that I could bring to the 287 00:15:05,960 --> 00:15:08,880 Speaker 3: table as a leader if I had a sort of 288 00:15:08,880 --> 00:15:11,400 Speaker 3: a passion for working with people and had some sense 289 00:15:11,440 --> 00:15:12,200 Speaker 3: of self awareness. 290 00:15:12,200 --> 00:15:14,440 Speaker 1: So he rose up in Minnesota. Why did you go 291 00:15:14,560 --> 00:15:16,800 Speaker 1: back to Alabama? Which had racial issues? 292 00:15:17,400 --> 00:15:18,920 Speaker 2: UAB is a unique place. 293 00:15:19,280 --> 00:15:24,480 Speaker 3: It's a bit of an oasis of academic excellence, broad diversity. 294 00:15:24,840 --> 00:15:28,200 Speaker 3: It's the most diverse Carnegie Tier one research university in 295 00:15:28,200 --> 00:15:32,120 Speaker 3: the country. It's done more transplants in African American than 296 00:15:32,160 --> 00:15:33,920 Speaker 3: any hospital in the world. 297 00:15:34,120 --> 00:15:34,800 Speaker 2: So I felt the. 298 00:15:34,760 --> 00:15:41,040 Speaker 3: Compelling opportunity to continually drive the mission of that institution 299 00:15:41,280 --> 00:15:45,120 Speaker 3: in spite of the landscape socially and politically that I 300 00:15:45,160 --> 00:15:47,760 Speaker 3: thought it could have a significant impact on that part 301 00:15:47,800 --> 00:15:48,520 Speaker 3: of the world. 302 00:15:48,600 --> 00:15:51,240 Speaker 1: And how long did you run? UAB So I was 303 00:15:51,240 --> 00:15:53,480 Speaker 1: there for nine and a half years, almost ten years. 304 00:15:53,560 --> 00:15:56,760 Speaker 1: So when Memorial Sloan Kettering approached you, did you say, Look, 305 00:15:57,120 --> 00:15:59,800 Speaker 1: I'm a great surgeon. I got what I want right here. 306 00:16:00,280 --> 00:16:02,080 Speaker 1: This is my native state. I don't need to leave. 307 00:16:02,640 --> 00:16:06,600 Speaker 3: Were you intrigued, No, it was more of the former, 308 00:16:06,720 --> 00:16:09,200 Speaker 3: Like you said, it was I have a good place, 309 00:16:09,640 --> 00:16:12,680 Speaker 3: have a good job, I've built a level of trust 310 00:16:12,680 --> 00:16:18,000 Speaker 3: in the community, i have a compelling mission, and I 311 00:16:18,040 --> 00:16:20,000 Speaker 3: think I need to really think. 312 00:16:19,920 --> 00:16:21,640 Speaker 2: Very hard about leaving it. 313 00:16:21,800 --> 00:16:24,360 Speaker 3: And I would say there are very few places that 314 00:16:24,520 --> 00:16:28,440 Speaker 3: would intrigue you to consider it leaving, and Memorrison Cattering 315 00:16:28,520 --> 00:16:29,160 Speaker 3: is one of them. 316 00:16:29,240 --> 00:16:32,240 Speaker 1: So as you rose from a small town only child 317 00:16:32,360 --> 00:16:35,280 Speaker 1: in Alabama to where you are now, you must have 318 00:16:35,360 --> 00:16:37,280 Speaker 1: encountered a fair amount of racial prejudice. 319 00:16:37,480 --> 00:16:39,040 Speaker 2: Yeah, I had my share of it. 320 00:16:39,600 --> 00:16:45,320 Speaker 3: I learned early on from one of my mentors at 321 00:16:45,360 --> 00:16:48,440 Speaker 3: john Hopkins. He was one of the faculty there, and 322 00:16:48,480 --> 00:16:53,320 Speaker 3: he reminded me that people will often have difficulties with you, 323 00:16:54,360 --> 00:16:58,920 Speaker 3: but don't make their problem your problem. And so one 324 00:16:59,000 --> 00:17:03,080 Speaker 3: of my early experiences of taking care of a patient 325 00:17:04,040 --> 00:17:07,119 Speaker 3: who had a liver cancer or in this case of 326 00:17:07,160 --> 00:17:11,920 Speaker 3: bioduct cancer, they struggled that there was a black surgeon 327 00:17:12,320 --> 00:17:15,399 Speaker 3: saying that they needed half of their liver out. I 328 00:17:15,480 --> 00:17:19,720 Speaker 3: respected that because it was unusual. Even my grandmother had 329 00:17:19,760 --> 00:17:22,359 Speaker 3: not ever seen a black doctor, so that was a 330 00:17:22,400 --> 00:17:25,880 Speaker 3: foreign thing to her. So I respected the understanding that 331 00:17:25,920 --> 00:17:29,080 Speaker 3: what they were going through was not the norm. They 332 00:17:29,160 --> 00:17:31,960 Speaker 3: called back to Johns Hopkins to see if I actually trained, 333 00:17:33,000 --> 00:17:35,040 Speaker 3: and I said, do what you need to do to 334 00:17:35,040 --> 00:17:36,639 Speaker 3: be comfortable with this situation. 335 00:17:36,920 --> 00:17:39,239 Speaker 1: So when you join Memorial Sloan Kettering, what you want 336 00:17:39,280 --> 00:17:42,000 Speaker 1: to do is expand the coverage of moreel Sloan Kettering 337 00:17:42,040 --> 00:17:44,520 Speaker 1: and make sure more people were able to get the services. 338 00:17:44,640 --> 00:17:46,600 Speaker 1: What progress have you made so far in that. 339 00:17:46,560 --> 00:17:48,959 Speaker 3: I have wanted Memorial Sloan Kettering and be a cancer 340 00:17:49,000 --> 00:17:52,159 Speaker 3: center to the world, both culturally, ethnically. 341 00:17:51,640 --> 00:17:52,600 Speaker 2: And geographically. 342 00:17:53,000 --> 00:17:55,320 Speaker 3: And there have been great efforts that have occurred, some 343 00:17:55,359 --> 00:17:58,080 Speaker 3: of them before I got here. One of the efforts 344 00:17:58,080 --> 00:18:01,439 Speaker 3: by our legislative team was to get our state to 345 00:18:01,960 --> 00:18:07,119 Speaker 3: really drive manage Medicaid, manage care in New York, to 346 00:18:07,240 --> 00:18:11,680 Speaker 3: actually negotiate with Morrisloan Kettering so patients with Medicaid broadly 347 00:18:11,840 --> 00:18:15,600 Speaker 3: could access us. We've had that law enacted and patients 348 00:18:15,640 --> 00:18:18,720 Speaker 3: now broadly are able to come to us. Our Medicaid 349 00:18:18,840 --> 00:18:22,399 Speaker 3: service of patients is up by sixty three percent. So 350 00:18:22,520 --> 00:18:25,679 Speaker 3: Number One, we now are getting a broader access to patients. 351 00:18:25,800 --> 00:18:29,960 Speaker 3: Number two, we're partnering with hospitals across New York City, 352 00:18:30,480 --> 00:18:35,240 Speaker 3: Jamaica Queen's Hospital near JFK, which has a tremendously diverse population. 353 00:18:35,480 --> 00:18:39,120 Speaker 3: The most diverse county in America is Queen's. We're partnering 354 00:18:39,160 --> 00:18:42,000 Speaker 3: with them to develop a cancer program. We also work 355 00:18:42,040 --> 00:18:45,280 Speaker 3: with New York Hospital Health and Services also for clinical 356 00:18:45,280 --> 00:18:48,359 Speaker 3: trials and patients access at our RAF Lauren Cancer Center. 357 00:18:48,840 --> 00:18:52,199 Speaker 3: And we've developed a broad strategy around health equity that 358 00:18:52,280 --> 00:18:55,080 Speaker 3: I think will further impact our city and our region 359 00:18:55,119 --> 00:18:58,080 Speaker 3: for making sure everyone has access to the best cancer 360 00:18:58,119 --> 00:18:58,800 Speaker 3: care in the world. 361 00:18:58,880 --> 00:19:01,440 Speaker 1: So, as the head of the Slung Cattering Cancer Center, 362 00:19:01,480 --> 00:19:04,240 Speaker 1: your biggest problem is getting enough money to do the 363 00:19:04,280 --> 00:19:06,679 Speaker 1: research and give the patients the care they want. So 364 00:19:06,720 --> 00:19:09,640 Speaker 1: you're always raising money or that's not your biggest problem. 365 00:19:10,000 --> 00:19:11,879 Speaker 3: You know, it's not my biggest problem, but it is 366 00:19:11,920 --> 00:19:14,920 Speaker 3: a problem. There is no doubt the cost and healthcare 367 00:19:14,960 --> 00:19:17,760 Speaker 3: is significant, not only for our patients, but for the 368 00:19:17,800 --> 00:19:19,120 Speaker 3: science and for the drugs. 369 00:19:19,480 --> 00:19:21,440 Speaker 2: So it is a significant. 370 00:19:20,800 --> 00:19:23,399 Speaker 3: Part of what I do is putting resources on the 371 00:19:23,440 --> 00:19:27,800 Speaker 3: table so that our scientists, our clinical trialists, and our 372 00:19:27,840 --> 00:19:31,040 Speaker 3: physicians are able to do their job and make discoveries. 373 00:19:31,080 --> 00:19:33,800 Speaker 1: So I'm Memorial Sloan Cattering. What it does is it 374 00:19:33,840 --> 00:19:38,280 Speaker 1: does research and then also does patient care. Yes, and 375 00:19:38,320 --> 00:19:40,520 Speaker 1: there's an advantage, you would say, to patient care because 376 00:19:40,560 --> 00:19:42,360 Speaker 1: you have people doing the cutting edge research. 377 00:19:42,720 --> 00:19:47,200 Speaker 3: Yes, cutting edge research that's connected to doctors who are 378 00:19:47,280 --> 00:19:50,720 Speaker 3: looking to answer questions as well as take care of people. 379 00:19:50,760 --> 00:19:53,600 Speaker 1: You also have students at Moral Sloan Cattering. You have 380 00:19:53,640 --> 00:19:56,359 Speaker 1: a graduate school for students, is that right. 381 00:19:56,240 --> 00:19:58,520 Speaker 3: Yeah, So the Gersonal School is really one of the 382 00:19:58,560 --> 00:20:02,760 Speaker 3: outstanding biomedical grad programs in the country. That our students 383 00:20:02,760 --> 00:20:05,679 Speaker 3: are focused in our labs largely on basic science and 384 00:20:05,720 --> 00:20:10,320 Speaker 3: cancer research. We also have almost two thousand fellows and 385 00:20:10,440 --> 00:20:14,040 Speaker 3: residents who rotate the Memorial Hospital, so we have a 386 00:20:14,160 --> 00:20:17,840 Speaker 3: robust educational program, although we don't have a distinct medical school, 387 00:20:18,200 --> 00:20:22,679 Speaker 3: great graduate school, great training programs, nearly one hundred different 388 00:20:22,680 --> 00:20:23,800 Speaker 3: fellowships at Memorial. 389 00:20:23,840 --> 00:20:27,000 Speaker 1: Suppose somebody says they have a cancer that's i'd say, 390 00:20:27,119 --> 00:20:29,160 Speaker 1: not a very good kind of cancer, not that any 391 00:20:29,200 --> 00:20:31,399 Speaker 1: good cancer, not that any cancer is good. But suppose 392 00:20:31,440 --> 00:20:36,160 Speaker 1: you have somebody's very serious stage four gleoblastoma. The advantage 393 00:20:36,160 --> 00:20:38,399 Speaker 1: of coming here is you can really make a difference 394 00:20:38,440 --> 00:20:39,720 Speaker 1: at stage four for somebody. 395 00:20:40,400 --> 00:20:43,560 Speaker 3: Yeah, so the advantage of coming here broadly. So Number one, 396 00:20:43,720 --> 00:20:46,840 Speaker 3: the outcomes are different even at stage one. For coming 397 00:20:46,840 --> 00:20:50,560 Speaker 3: to a Memorial at a stage four, we certainly have 398 00:20:50,680 --> 00:20:54,560 Speaker 3: the better chance of often prolonging life and having a 399 00:20:54,680 --> 00:20:58,680 Speaker 3: chance to getting access to the most novel therapeutics, with 400 00:20:58,880 --> 00:21:01,200 Speaker 3: no guarantee that we're willing to cure you, but we're 401 00:21:01,240 --> 00:21:03,679 Speaker 3: going to give you every chance there is in the 402 00:21:03,760 --> 00:21:06,359 Speaker 3: space of cancer to make a difference in your tumor. 403 00:21:06,440 --> 00:21:09,239 Speaker 1: So, how does somebody become a patient somebody walks off 404 00:21:09,280 --> 00:21:11,040 Speaker 1: the street and says, I think I don't feel well, 405 00:21:11,119 --> 00:21:13,439 Speaker 1: maybe I got a cancer. How do people get to 406 00:21:13,440 --> 00:21:14,200 Speaker 1: be a patient here? 407 00:21:14,480 --> 00:21:19,400 Speaker 3: So number one, you can refer yourself and call and 408 00:21:19,440 --> 00:21:22,840 Speaker 3: we will help make that diagnosis a Number two, your 409 00:21:22,880 --> 00:21:25,960 Speaker 3: physician who you've seen as a primary care doctor can 410 00:21:26,000 --> 00:21:26,680 Speaker 3: refer you here. 411 00:21:26,760 --> 00:21:27,200 Speaker 2: Either way. 412 00:21:27,240 --> 00:21:29,720 Speaker 1: I suppose somebody says, I don't have any health insurance. 413 00:21:29,760 --> 00:21:30,240 Speaker 1: What do you do? 414 00:21:30,880 --> 00:21:33,440 Speaker 3: We have services to take care of people who don't 415 00:21:33,440 --> 00:21:34,720 Speaker 3: have financial ability. 416 00:21:34,960 --> 00:21:37,560 Speaker 1: So when you are doing pancratic cancer surgery, you're not 417 00:21:37,600 --> 00:21:38,639 Speaker 1: doing surgery now, are you. 418 00:21:38,760 --> 00:21:40,160 Speaker 2: I still do some ser surgery. 419 00:21:40,240 --> 00:21:42,280 Speaker 3: Yeah, they let me come in the operating room by 420 00:21:42,280 --> 00:21:44,440 Speaker 3: permission special occasion. 421 00:21:44,640 --> 00:21:47,080 Speaker 1: But if you're only doing it occasionally, can you still 422 00:21:47,119 --> 00:21:49,120 Speaker 1: do surgery and really be up to speed on everything? 423 00:21:49,280 --> 00:21:49,520 Speaker 2: Yeah? 424 00:21:49,560 --> 00:21:51,639 Speaker 3: So I do it regular enough to know that what 425 00:21:51,720 --> 00:21:53,919 Speaker 3: I do that the outcomes are not affected. So I 426 00:21:54,000 --> 00:21:56,760 Speaker 3: have to As a low volume surgeon, you have to 427 00:21:56,840 --> 00:22:00,680 Speaker 3: watch closely, and I typically operate with my other surgeons 428 00:22:00,760 --> 00:22:03,280 Speaker 3: so that I have other senior surgeons who are part 429 00:22:03,280 --> 00:22:04,240 Speaker 3: of the picture as well. 430 00:22:04,280 --> 00:22:05,880 Speaker 1: What does it take to be a great surgeon? 431 00:22:06,320 --> 00:22:07,840 Speaker 2: It may sound trite. 432 00:22:08,359 --> 00:22:13,760 Speaker 3: Perseverance, resilience in practical terms, being able to take a 433 00:22:13,800 --> 00:22:17,240 Speaker 3: blow and not having it become a permanent deformity, and grit, 434 00:22:17,720 --> 00:22:23,399 Speaker 3: the ability to really turn lemons into lemonade, and to 435 00:22:23,960 --> 00:22:29,720 Speaker 3: not both let discouragement or disappointment from the prior patient 436 00:22:29,920 --> 00:22:32,280 Speaker 3: prevent you from taking care of the next patient. 437 00:22:32,359 --> 00:22:35,399 Speaker 1: You see, you're relatively young by my standard, so this 438 00:22:35,560 --> 00:22:37,520 Speaker 1: is something you expect to do for another decade or 439 00:22:37,560 --> 00:22:38,440 Speaker 1: so something like that. 440 00:22:38,840 --> 00:22:40,920 Speaker 3: Yeah, I would say that would be the goal. There 441 00:22:40,920 --> 00:22:43,520 Speaker 3: are some things that I want to see accomplished that memorial. 442 00:22:43,720 --> 00:22:47,440 Speaker 3: It's a place of phenomenal people and talent more than ever, 443 00:22:47,480 --> 00:22:50,240 Speaker 3: as we talked about people getting older and the incidents 444 00:22:50,320 --> 00:22:54,040 Speaker 3: of cancer really growing, I think we have a special 445 00:22:54,119 --> 00:22:57,080 Speaker 3: role for the society, not only in New York and America, 446 00:22:57,119 --> 00:22:59,520 Speaker 3: in the world than the role that we play around 447 00:22:59,560 --> 00:23:01,679 Speaker 3: discovery and what I think is in golden age of 448 00:23:01,720 --> 00:23:02,520 Speaker 3: cancer treatment. 449 00:23:02,920 --> 00:23:05,320 Speaker 1: Did your parents live to see your success? You're obviously 450 00:23:05,359 --> 00:23:08,639 Speaker 1: an extremely successful person. Did your parents live to see this? 451 00:23:09,760 --> 00:23:12,320 Speaker 2: You know? My mother did to a degree. 452 00:23:12,440 --> 00:23:15,639 Speaker 3: She saw a large part of success as it relates 453 00:23:15,680 --> 00:23:18,160 Speaker 3: to both my family. She lived to see my four 454 00:23:18,240 --> 00:23:22,000 Speaker 3: kids born, which was immnt since I was an only child. 455 00:23:22,080 --> 00:23:25,719 Speaker 3: I think she certainly desired a larger family, and she 456 00:23:25,760 --> 00:23:29,240 Speaker 3: saw some of my success as an academic surgeon, particularly 457 00:23:29,240 --> 00:23:32,600 Speaker 3: for people in her purview who I treated and operated on. 458 00:23:33,040 --> 00:23:36,000 Speaker 3: I just saw a man two or three weeks ago 459 00:23:36,080 --> 00:23:39,440 Speaker 3: with my father who I did a pancredic cancer procedure 460 00:23:39,440 --> 00:23:42,040 Speaker 3: on twenty two years ago, who's still alive. So my 461 00:23:42,160 --> 00:23:46,160 Speaker 3: father has seen that as well, and clearly, who's ninety two, 462 00:23:46,680 --> 00:23:50,480 Speaker 3: has seen much of my success throughout my journey as 463 00:23:50,520 --> 00:23:52,119 Speaker 3: an academic surgeon and leader. 464 00:23:53,160 --> 00:23:55,679 Speaker 1: Thanks for listening to hear more of my interviews. You 465 00:23:55,720 --> 00:23:59,840 Speaker 1: can subscribe and download my podcast on Spotify, Apple, or 466 00:24:00,000 --> 00:24:00,640 Speaker 1: however you listen. 467 00:24:08,920 --> 00:24:08,960 Speaker 3: H