Exclusive Episode: Caring for the Whole Person with Wisdom and Focus

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Otis Brawley is a globally-recognized expert in cancer prevention and control. He has worked to reduce overscreening of medical conditions, which has revolutionized patient treatment by increasing quality of life and reducing health disparities.

Brawley’s research focuses on developing cancer screening strategies and ensuring their effectiveness. He has championed efforts to decrease smoking and implement other lifestyle risk reduction programs, as well as to provide critical support to cancer patients and concentrate cancer control efforts in areas where they could be most effective. Brawley currently leads a broad interdisciplinary research effort on cancer health disparities at the Bloomberg School of Public Health and the Johns Hopkins Kimmel Cancer Center, striving to close racial, economic, and social disparities in the prevention, detection, and treatment of cancer in the United States and worldwide. He also directs community outreach programs for underserved populations throughout Maryland.

Brawley joined Johns Hopkins University as a Bloomberg Distinguished Professor in 2019 from the American Cancer Society and Emory University.

Show Notes

• Otis Brawley, M.D.
• The Sidney Kimmel Comprehensive Cancer Center
• Division of Cancer Prevention
• How We Do Harm: A Doctor Breaks Ranks About Being Sick in America
• National Cancer Plan
• Cancer Intervention and Surveillance Modeling Network (CISNET)
• Cancer Prevention Overview

Ad: NCI Future Fellows Application System

Your Turn: Guest Recommendation

• The slogan “5 A Day—For Better Health”

Episode Transcript

[UPBEAT MUSIC]

OLIVER BOGLER: Hello and welcome to Inside Cancer Careers, a podcast from the National Cancer Institute. I'm your host, Oliver Bogler. I work at the NCI in the Center for Cancer Training. On Inside Cancer Careers, we explore all the different ways that people join the fight against disease and hear their stories. Today, we have a special, we are talking to Dr. Otis Brawley about his wide-ranging career and the many things he has brought to cancer research, cancer prevention, and health disparities research. Listen through to the end of the show to hear him make an interesting recommendation that we can all take to heart, and where I will also invite you to take your turn.

OLIVER: It's an honor to welcome Dr. Otis Brawley to the podcast. Welcome.

OTIS BRAWLEY: Thank you. Thank you for having me.

OLIVER: Dr. Brawley is Bloomberg Distinguished Professor of Oncology and Associate Director of Community Outreach and Engagement at the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins. He leads a broad interdisciplinary research effort on cancer health disparities, working to close racial, economic, and social disparities in the prevention, detection, and treatment of cancer in the United States and worldwide. He is a member of the National Academy of Medicine, and Dr. Brawley also serves on the NCI's Board of Scientific Advisors. Dr. Brawley, we could fill several episodes with conversation about the many interesting things and important things you've done, but given that our focus here is on careers, perhaps I might start by asking you of your assessment of where the future of the cancer research workforce is in 2023.

OTIS: Sure. Thank you for having me. And you can still call me Otis.

OLIVER: Okay, thank you.

OTIS ley: Okay. You know, we're in an amazing time where the science is all coming together, and there are huge opportunities for people who want a career in cancer medicine and cancer science in terms of being able to do things. Now, that being said, I'm very concerned that money is tight, and support for people going into oncologic research, especially the basic and translational oncologic research is very scarce. I worry, and many people -- I was once at the American Cancer Society. I still work with people at the American Cancer Society to advocate for support of young investigators because the opportunities for society are so great. The number of young investigators, the number of graduate students, the number of graduate students in the sciences and the basic sciences as well as medical students going into medical oncology, some amazing people out there, people who understand things that I will never be able to understand. And so, I see huge opportunity, but I'm worried that we need to support the people who can go grab that opportunity.

OLIVER: Yeah. I mean, it strikes me that one of the big changes that we've seen in the last several decades is the growth of sectors adjacent to biomedical research, right? We have the tech sector, we have the biotech sector, the pharmacy sector. So we're competing now for talent in a way that we might not have been for 20, 30 years ago.

OTIS: That's right. That's right. Now, keep in mind, the academics are trying to advance science and create new knowledge, and they create new knowledge for new knowledge's sake. The people in biotech and the people in corporations take knowledge, some of it new, and try to apply it, and especially apply it for profit. I'm not putting that down at all; that's a very legitimate thing. But we need to be careful over the next 10, 20, 30 years, or else we're going to lose the academic component that actually trains people that go into the corporate world as well as the academic component -- That's where a lot of the really new, hard-hitting stuff is developed, the creativity that you can have in academics that's not allowed in corporate America.

OLIVER: So how do we remain competitive in academia?

OTIS: Well, I actually believe that, you know, some of the things that the NCI have done in community outreach and engagement, something I'm very interested in, is really important because, when I say "community," I'm talking about the broader community of the entire United States. I'm not talking about inner-city Baltimore, for example. Not just inner-city Baltimore, but broader. We need to make sure the people, the constituency, the United States taxpayer, understands the importance of science and the importance of what we're doing. Now, there's a lot of people out there who are very pro-cancer research. I want people to be pro-supporting and giving money to cancer research. And how you do that is through good outreach and engagement and explain to them the things that we can do today because of great research and the things that we will be able to do in the future because of great research. In the same token, by the way, I worry sometimes people are so into treatment of cancer at the expense of risk reduction or prevention of cancer. Much of what we've learned over the last 50 years since Richard Nixon signed the National Cancer Act is a lot of molecular biology and understanding of the inner workings inside the cell, how to manipulate the inner workings inside the cell. From that, you get how cancer is caused, carcinogenesis, which is heavily linked to risk reduction or cancer prevention, how you can stop cancer from happening, as well as how you can kill cancer, which is treatment.

OLIVER: So you touched on community outreach and engagement. That's one of your roles at Johns Hopkins. You're the associate director of the Sidney Kimmel Comprehensive Cancer Center, which is an NCI-designated cancer center. This community outreach and engagement role is a relatively new element in the NCI-designated cancer centers. Can you tell us a little bit more about why that role was created and what you do?

OTIS: The role was created, and it was first created about ten years ago. And it has evolved, and I'm actually trying to evolve it even further. It was initially created to increase the number of minorities on clinical trials, to increase understanding in minority and inner-city communities what's going on with cancer. It then changed a little bit more to include cancer centers need to know what's going on in their catchment area. What are the unique problems in their catchment area? For example, certain cancer centers have large numbers of Southeast Asians in their population and have a hepatitis, hepatoma problem. Here in Baltimore, at Hopkins, we have a huge HIV malignancy problem that needs to be addressed, and the cancer center should be addressing those things. In order to address things that are pertinent to the community, you need to know what's going on in the community. That was where the NCI moved at about three to five years ago. I'm trying to move it even further and say that we need to be the people who interact with Congress folks in the state legislatures and do things that NCI and NIH cannot do. We need to be the folks who explain to people throughout the community of our catchment area what science is and the scientific process and how being scientific has gotten us a lot of things. We can also do things -- you know, I'm very high on the fact that the COVID vaccine was developed so quickly because of basic science that was developed through Nixon's war on cancer that started in 1972. You know, very much all the tools that were used to understand this virus and to get an RNA vaccine were developed over the last 20, 30, 40 years it’s just -- thank goodness we had all those tools together and could very quickly come up with an RNA vaccine, test that vaccine, and by George, it worked.

OLIVER: Yeah. I think that's a really good point. It's underappreciated, perhaps, how much fundamental science occurs in the context of trying to deal with the cancer problem, and then that can beneficially move into other areas. Otis, you touched on the outreach element and also diversity. I wonder You've been very frank about your own experiences. I wonder what your assessment is of current efforts to diversify the cancer research workforce. I mean, I think there's -- we all acknowledge there's a long way to go and there's much to be done. Are we making progress?

OTIS: Well, yes, we are making progress. I'm one of the people who's very grateful that a large, large number of people in cancer medicine and cancer science acknowledge that this is a problem, and we need to do better.  There are a substantial number of older white men in oncology who want to do better and who have tried to mentor and brought both women and minorities under their wing to bring them into the system. But we still need to do better. One of the things that I am hellbent on is we need to have better science taught in grade schools, especially inner-city grade schools where minority kids go to school. We need to actually stress STEM in high school. We need to create opportunities for young folks who are in their early teens to go into laboratories and do things. You know, I went into a laboratory when I was 14 years old, and we need to create these opportunities. There's a whole world out there that a large number of folks, especially poor folks in inner-city schools, don't know exists. And if they knew that it existed, they actually might find this kind of fun. And it's interesting.

OLIVER: So a perfect segue. You mentioned you first went into a lab when you were 14. That's pretty amazing. Why? How did you end up going to a lab? What sparked your interest in science?

OTIS: Well, yeah, I was always interested in science. I had my little doctor's kit when I was seven or eight years old. I had a science fair kit and science fair projects. And, you know, for Christmas, I would always get the various laboratory stuff. So I was very interested and very curious and was very fortunate that my father encouraged it, you know. When our washing machine stopped working and he had to buy a new one, he didn't let the people who delivered the new washing machine take the old one away. He kept the old washing machine so I could take it apart and see what was inside, how did it work, you know. And my father encouraged curiosity, and that's how I got the bug. Then I ended up going to a Jesuit high school. It was a combination of my mother and father and the nuns in grade school sent me off to the Jesuit high school. And the Jesuits, of course, are very famous in saying, "We teach people to ask questions, and we teach people not what to think, but how to think." And how you think is by asking questions and by having inherent curiosity. And then the Jesuits sent me off to the University of Chicago, which is a collection of nerds interested in asking questions. And so that's how I was created, and that's how I was cultivated over time.

OLIVER: Interesting. What led you, then, to pursue medicine as well? I mean, did you feel like you wanted to treat patients or --

OTIS: Well, now, that's interesting. When I was in high school, I developed a true interest in policy and politics. You kow, this is the time of Watergate. This is the early 1970s early to mid-1970s, and I got very interested in policy and politics. Many people, at that time, would have guessed that I would have ended up going to law school and not medical school. I was also interested in science. And when I went to the University of Chicago, I did chemistry. And for some time, I thought I'd do chemistry in law school. Sometime I thought I'd do chemistry in graduate school. I was very fortunate to befriend a full professor who happened to be an infectious disease doctor, a herpes specialist, named Elliott Kieff. And Elliott took me into his laboratory, and I actually worked for a summer in his laboratory. And Elliott said, "Why don't you forget about this law school thing or this chemistry? You should go to medical school." And so he started introducing me to his friends, and that's how I ended up at the University of Chicago Pritzker School of Medicine.

OLIVER: And then, pretty quickly, you got interested in lymphoma and oncology, right?

OTIS: Yeah. I keep coming under the influence of people. There was an oncologist there, a guy named John Ultmann. He was one of the original 60 oncologists who founded ASCO. And John and I became very good friends, and John became influential to me for the rest of his life. Indeed, I first met John in the early 1980s, and for the next 20 years, he guided me. I never took a job without first running it by him and getting his view of things. And John very much guided me throughout medical oncology. The importance of mentorship. There were the nuns in grade school; the Jesuit priests; Father Polakowski, who told me to go to the University of Chicago; once I got to Chicago, Elliott Kieff, who told me to go to medical school; and then John Ultmann, who got me into oncology. And he convinced me, by the way, that there was a lot of policy going on in oncology. This was ten years after the National Cancer Act. It was still being developed, and he really explained to me that I could take this interest in science and this interest in policy, and I could meld it all together. Of course, it really bloomed when I spent 12 years at the American Cancer Society as the chief medical and scientific officer because, there, I did policy. I explained policy to people. We were heavily involved in the crafting of the Affordable Care Act. We did epidemiology to show that, if we could get our act together and actually provide adequate care throughout the entire spectrum from prevention through appropriate screening, appropriate diagnosis, and appropriate treatment, of the 600,000 people who die every year in the United States, our estimate is we could prevent 130,000 of those deaths. Twenty-two percent of all deaths in the United States due to cancer are preventable by applying current technologies. No new drugs, no new treatment; just give everybody adequately what we already have, and 22% of the current deaths would go away.

OLIVER: Staggering number. And, you know, given that Dr. Bertagnolli recently developed, you know, a National Cancer Plan, which emphasizes, how do we get to the goals that President Biden has set, very important. So you've brought in two themes that I want to explore a little bit more, that of cancer prevention and then also that of health disparity. So maybe we'll start with the prevention. You also spent some of your time at NCI, I believe.

OTIS: That's right.

OLIVER: At some point, you got fascinated by cancer prevention as a discipline, right?

OTIS: Oh, I had 13 beautiful years at the National Cancer Institute from 1988 to 2001. I trained in medical oncology at the NCI because John Ultmann told me to come there and train, and then I went over to the Division of Cancer Prevention and Control and worked for another mentor, Barry Kramer. That's where I learned the importance of risk reduction, the fact that we could actually save more lives through an effective prevention and risk reduction program than through an effective treatment program. I went to the Division of Cancer Prevention and Control. And then, in the middle 1990s, I was very fortunate. Rick Klausner was director at the time, and he moved me into his office, and I created a suboffice in special populations research where we tried to help develop the field of health disparities. At the time, the Surgeon General, David Satcher, made it something that he really wanted to focus on. Indeed, it was called minority health, or special populations health, and David Satcher, in 1996, said, "Let's call it what it is: disparities in health."

OLIVER: So tell us a little bit more. Maybe not everybody listening is intimately familiar with cancer prevention as a discipline…

OTIS: Mm

OLIVER: Or the discipline of health disparities research.

OTIS: Mm. Well, the clearest cancer prevention discipline ever, of course, is smoking cessation, tobacco control. How do we stop people from smoking? We've learned that giving them very graphic messages in Europe actually keeps people from smoking. We learned that taxing it, raising the minimum age, all of these things decrease the number of people smoking. Health promotion, health education among children at the age of eight and nine years. By the way, the majority of people who smoke start smoking before their 17th birthday. Most common age that people start smoking is 16. The second most common age is 15.

OLIVER: Wow.

OTIS: So getting into these people, getting into their minds before they start smoking, that's all very important. Now, that's easy prevention. Epidemiology over the last 25 to 30 years old us the second-leading cause of cancer in the United States is not obesity, but the combination of obesity, consumption of too many calories, and not enough exercise. Think of it as a three-legged stool. Obesity is the easiest marker to remember, but it's the consumption of too many calories and not enough exercise. Indeed, our success with tobacco control is such that, by the end of this decade, the obesity-energy imbalance combination will be the leading cause of cancer in the United States. Again, another something that we can do to help reduce the number of people getting cancer: risk reduction again. We've had tremendous success with risk reduction through vaccination: hepatitis B; human papillomavirus vaccine and so forth, preventing cervical, probably some head and neck cancers with HPV, as well as preventing some hepatomas, or liver cancers, and some lymphomas with hepatitis B vaccine. The things that we can do to lower risk, pollution. You know, when we smell things like diesel engine exhaust, that's not a good thing. We've learned these things by the way over the last 40-50 years and trying to implement it. Now, poor people tend to live in more polluted environments, heavy metals; they work in jobs that are more likely to expose them to things that cause cancer. And so, risk reduction among poor people is a really, really important thing. These are the cheap ways, by the way, to save lives through reducing the number of people getting cancer. Now, you asked me talk about health disparities; we focus a lot on this, but still not enough. There's a substantial number of Americans, actually large number of Whites than Blacks or any other race, who get less than optimal care once diagnosed. Now, they get less than optimal care once diagnosed because they live in systems where resources are scarce, and this is one of the reasons why one of my themes throughout my career has been if we do screening we have to do smart screening, because there's a lot of screening out there that's being done that's unwise. It's not going to save lives, but it does consume resources and by consuming those resources, it's actually depriving people of getting adequate treatment once diagnosed. So, it's harming the people who are getting the unnecessary or unwise screening and it's harming people who actually have disease by taking resources away such that they don't get adequate treatment for their diagnosed disease.

OLIVER: Sounds to me like you're beginning to touch on a theme in your book which you wrote about 10 years ago I think, with Paul Goldberg "How We Do Harm" where you make the case that there is overtreatment in some parts of our population and under-treatment in other parts, and maybe screening as well. Is that correct?

OTIS: That's absolutely correct. Now, many people think I'm against screening. I'm not against screening at all. I'm against stupid screening.

OLIVER: Okay.

OTIS: And I'm for wise screening and I'm for people being in screening programs. And so, frequently for example, everybody is fixated about breast cancer, or now more recently, everybody's fixated about lung cancer and they forget the rest of the patient exists. You know, we literally have women who get annual mammography, but end up dying of cervical cancer because they don't get cervical cancer screening. Or very recently I was reviewing a case--this woman who was getting lung cancer screening which is something very few people get, but she was religiously getting her lung cancer screening and the lung cancer screening was read by the radiologist as, "Her lungs are clear, but did you know she has stage III breast cancer?"

OLIVER: Wow.

OTIS: She's not getting breast cancer screening; she's only been getting lung cancer screening. We get--we need to think about the whole person and we need to do the screening tests that have been proven beneficial in perspective randomized trials in the populations that will benefit from it.

OLIVER: And do you think adjusting that kind of work would then allow us to bring more people into screens and be more equitable in our distribution of those resources?

OTIS: It absolutely would. It absolutely would. Sometimes we get hung up on certain things like screening and we forget things. For example, in breast cancer screening, lots of discussion about should we be screening women in their 40s? Now, I'm going to say I'm not against screening women in their 40s, but I am against forgetting the fact that there is a substantial number of women in their 50s and 60s where we know it saves lives and they don't get screened, or once screened, they don't get adequate treatment. Let's talk about that as well. You know, literally 40% of women in their 50s and 60s don't get routine regular high-quality mammography and that's, by the way, the average age of a breast cancer death is in the late 60s.

OLIVER: Uh-hmm.

OTIS: We literally talk about should we screen women in their 40s while we let a larger number of women in their 50s and 60s die and not say anything about how we could save their lives, again, I have to end that thought by I'm not against screening women in their 40s. I'm just against focusing only on that and forgetting about women in their 50s and 60s. The other thing I will point out is there's a beautiful CISNET NCI study from about 10 years ago that says, of the 43,000 or so women who die every year from breast cancer, about 10,000 deaths are due to lack of good treatment and about 5000 deaths are due to lack of screening. We talk about screen, screen, screen. More women die because they don't get good treatment after diagnosis and because they don't get early diagnosis. And I'm for, again, I'm not against screening.

OLIVER: Right.

OTIS: We talk about screen, screen, screen. More women die because they don’t get good treatment after diagnosis, than because they don’t get early diagnosis. And, again, I am not against screening. I'm just--let's think about what we can do to best save as many lives as possible.

OLIVER: Sounds to me like you're saying follow the science, right? Follow the evidence and apply the resources you have most wisely at the points where you can have most effect.

OTIS: Follow the science and let's do what we can do to save as many lives, prevent as many deaths as possible.

[UPBEAT MUSIC]

OLIVER: The NCI is the US federal government's principal agency for cancer research and training and conducts a broad range of research in its Intramural Research Program. If you are interested in gaining research experience and training at NCI there is a great first step, you can take. Here with me to tell you about that is Chanelle Case Borden, Associate Director of Training Programs in our Office of Training and Education.

CHANELLE BORDEN: Thanks Oliver! We are talking about a webpage called Future Fellows where you can submit your CV or resume if you are interested in a postdoctoral, doctoral, or postbaccalaureate (both master-level and post-college) fellowship at NCI. We will put the link in the show notes, but you can find the webpage by searching for “future fellows NCI.” At the site, you can tell us about your research interests and also indicate a division or center that you would like to work in.

OLIVER: What happens once an applicant has submitted their material at the site, Chanelle?

CHANELLE: Once you are in the database, any research team leader at NCI can see your application for the next six months. If they have an open position that fits your indicated interests, they will contact you directly to arrange an interview. A question we commonly get is when are positions typically available. Generally, most postbac and postdoc positions are available on a rolling basis, but the fall/winter is generally a time where we see a lot of postbac hiring to begin the following summer. Internally, we are always promoting the use of Future Fellows to our investigators and staff to fill their open positions. So, if you are considering completing training at the NCI, I encourage you to submit your information.

OLIVER: Great, thanks Chanelle. So that’s Future Fellows on the NCI’s cancer.gov website – check it out and submit your info today. You never know where it might lead.

OLIVER: So, to someone listening maybe still making a choice about which, you know, career to go in to which may be part of the cancer research world, what do you think are the most exciting opportunities and challenges that are in the fields that you work in in prevention in health disparities research?

OTIS: That's probably the most unfair question. I--well, I'm really turned on by looking at the numbers; looking at the trends; looking at what treatments work, what treatments don't work; what screening tests work, what screening tests work better; looking at resources. That's what turns me on. There's some folks out there who are really into molecular biology. I encourage them to go into molecular biology. You know, I speak the language, but I'm not a molecular biologist. I know enough about molecular biology to truly appreciate it, and I would encourage people if you are really interested in something, pursue what you're interested in. At Hopkins I was very fortunate that Michael Bloomberg gave me an endowment to come spice things up at Hopkins and mentor young faculty, you know, I'm now of age that I'm doing for young faculty what I hope I'm doing for young faculty what John Ultmann  and Elliott Kieff did for me and Barry Kramer as well. So, what I tell people is, find something that you're really interested in. Now, it's best that you find something that you're really interested in that's really hot or that's better yet going to be hot in 5 to 10 years, and if you're really good, you're going to be the one that makes it hot, okay? Those are the people who end up getting tenured early and get to full professor by the time they're 40 and start winning things like Lasker awards and so forth. You know, there's a fellow named Eddy Reid [assumed spelling] who was, he was I think the first Black Fellow in the medicine branch at the NCI. He got there a few years before I did and he was famous for saying two things that stuck with me, and this is important for young people coming into science. "Focus, focus, focus." And the other thing that he said which is I think is very appropriate for the clinicians or the clinician want-to-be's, "It's the greatest honor one human being can give another is to say, can you help me?" And if you're a physician, you need to remember that every time you meet a patient, what they're really saying is, "Can you help me?" And they're giving you the greatest honor one human can give another.

OLIVER: Thank you. That's amazing advice. You just touched on it, I wanted to ask you, you've combined medicine and science in your entire career. I wonder if you could comment on how seeing patients informs your research. I know you've wrote very movingly in your book; I think the opening scene in "How We Do Harm" is you taking care of an emergency situation with a breast cancer patient. You were Chief Medical Officer I believe, Medical Director of the Georgia Cancer Center at the Grady Memorial Hospital, Atlanta famous public hospital.

OTIS: Yes. I got called down to the emergency room by a wonderful emergency medicine doctor Tammie Quest, somebody who really cares and she was just totally disgusted when she saw me and sort of flipped the clipboard, we didn't have computers back then, Grady I think got computers just in the last few years, and the lady's chief complaint was "My breast fell off can you reattach it?" And this is a woman who had a little bit of education. She might not had been a college graduate, who had watched her breast cancer grow in her breast. She could feel it for over 10 years. She had a fairly large breast. The tumor was close to the chest wall and --there's this phenomenon that we call "auto-mastectomy" where the tumor eroded all of the blood vessels and her breast shriveled up and dropped off and she had a gaping wound on her chest where her breast used to be. And the other part of the story is, she wrapped the shriveled up breast in a moist white terrycloth, put it in a plastic bag and brought it in a paper bag, the kind that you would have your lunch in--brought it to the emergency room, but that was my introduction to people who have a problem, either don't know what to do about that problem or it's a combination of not one to realize they have a problem, as well as, if I just ignore it maybe it will go away. And I took care of that woman for about two years. She had widely metastatic disease, I took care her for about two years, but she taught me a lot. And this is a longwinded way of saying, I still see patients. I still take care of patients, because it keeps me grounded. It keeps me understanding of what is going on out there, what the patient's face, what some of the doctors who are taking care of the patients face in terms of obstacles to provide the good care.

OLIVER: Thank you for sharing that, and you know, I in reading the book, you--maybe I'll put it this way, you don't shy away from being critical of your discipline of medicine and I wonder if you could tell us a little bit about that. I can't believe that's necessarily a comfortable place or a comfortable thing to do, but…

OTIS: Well, no. You know, I was--I was amazed at this myself. You know, grew up in the inner city of Detroit. I've been beat up by gangs. I actually sort of had adjunct membership in a gang for a while for protection purposes. I'm a big guy. I can take a hit. I've had tremendous fortune and I felt an obligation to tell the truth. I was willing to take a big hit for that. Amazingly, my colleagues in medical oncology especially, but medicine broadly embraced me and said thank you. The first thank you, The American Society for Clinical Oncology gave me a special recognition award. The American Medical Association gave me the first of these medals you wear around your neck on a ribbon, you know, they gave me an award and their--they have every year they have a Distinguished Physician Award, C. Everett Koop is one and a few other--all of a sudden little Otis from Detroit [brief laughter]. So, I found out that a lot of people especially doctors, and you know, some of the things I said in the book actually, you know, was critical how some doctors make money, but the professional societies embraced me and said thank you and so I learned to respect people in medicine in a way I never dreamed.

OLIVER: Well, that's very encouraging to hear. I do think it's a phenomenal read. I even--I'm not a physician, but I learned a lot about these things, and you also describe a lot of sort of big systemic issues, right, that that are sort of built in to the system that we have in the United States. I wonder in closing whether you could make any comment; what do you think the future holds? How do we address these big, uh--big issues?

OTIS: Well, you know, we had the Affordable Care Act which I've actually written--I've actually authored papers and studies, that show that people are not dying because of the Affordable Care Act and some of the new disparities of the 21st-century are not Black versus White, they're Mississippi versus Massachusetts, because Massachusetts has more better implemented the Affordable Care Act versus Mississippi. So, as we go forth, I think we need to focus on those sorts of things looking at disparities in general. I'm somewhat optimistic. I'm somewhat--I am truly optimistic that we can get people to focus on worrying about the health of others. The Affordable Care Act was called health care reform. I think we actually need to try to transform health care. We need to think differently about how we approach health care. Part of health care in my world involves going in the second and third grade and teaching kids about the value of vegetables and avoiding fast food. Part of my idea of health care is bringing their parents in the PTA and teaching them the same thing, trying to get beyond this obesity epidemic. You know, in 1970 15% of American adults were obese; today, it's well-over 40%, for Black women it's closer to 70%. We need to get on top of this. And so, my view is we need to try to transform health care. We need to stress a lot of the risk reduction things out there. We need to try to teach and coach people how to stay healthy. And we need to also have good screening programs that are scientifically based, also remember to stress diagnostics and stress appropriate care. We need to think about how people get into the health care system and are guided through the health care system; navigation and those sorts of things that are important.

OLIVER: Well, you give me hope as a cancer survivor and as a person working in cancer for my whole life, and let me just say that I think if there is hope, it's because people like yourselves have this systemic view and this broad view and deep view of the field and what needs to change and you know work in it, advocate for it and teach us about it. So, thank you very much Dr. Brawley for coming on the podcast.

OTIS: Well, thanks for having me. I really appreciate this.

[UPBEAT MUSIC]

OLIVER: So, I'd like to now turn to a segment we call "Your Turn" because it's chance also for our listeners to send in a recommendation about something they'd like to share. If you listening, then you're invited to take your turn. Send us a tip for a book, a video, a podcast, or a talk that you found inspirational or amusing or interesting. You can send those to us at NCIICC@nih.gov, record a voice memo and we might just play it. But now I'd like to invite our guest Dr. Brawley to give his recommendation 

OTIS: Well, I'm not going to give a recommendation of a book or a TV show, my recommendation is that all of us focus on, you know, this was a slogan at that the old NCI had that maybe should be brought back. I hope Monica Bertagnolli is listening to me. It was "5 a Day--for Better Health!"

OLIVER: Okay.

OTIS: And people should try to eat 5 to 9 servings of fruits and vegetables per day for better health. You know, an apple a day is not good enough. It's 5 to 9 servings of fruits and vegetables and then we should all think about how much exercise we do.

OLIVER: Oh, well thank you very much Otis. I can sense that you're taking care of us like we are your patients, so I really appreciate that. I'd like to make a recommendation myself as well, and that is the book that Dr. Brawley wrote with Paul Goldberg, the "How We Do Harm" book. It's 10 years ago, but it speaks to a lot of the themes that we touched on here and it's an exciting and fun read and I can only recommend it. We will put show note--this in the show notes and let me just thank you again Otis for coming on the podcast and sharing your views and your experience.

OTIS: Thank you.

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OLIVER: That’s all we have time for on today’s episode of Inside Cancer Careers! Thank you for joining us and thank you to our guests. We want to hear from you – your stories, your ideas and your feedback are always welcome. And you are invited to take your turn to make a recommendation we can share with our listeners. You can reach us at NCIICC@nih.gov. Inside Cancer Careers is a collaboration between NCI’s Office of Communications and Public Liaison and the Center for Cancer Training. It is produced by Angela Jones and Astrid Masfar and Edited by Janette Goeser. A special thanks to Lakshmi Grama and Sabrina Islam-Rahman. Join us every first and third Thursday of the month when new episodes can be found wherever you listen – subscribe so you won’t miss an episode. I'm your host Oliver Bogler from the National Cancer Institute and I look forward to sharing your stories here on Inside Cancer Careers. If you have questions about cancer or comments about this podcast, email us at NCIinfo@nih.gov or call us at 800-422-6237. And please be sure to mention Inside Cancer Careers in your query. We are a production of the U.S. Department of Health and Human Services, National Institutes of Health, National Cancer Institute. Thanks for listening.